Myth vs. Fact: Not always a straight path when treating depression

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There are days when each of us is irritable. There are days when many of us would rather not go to work or school. There are occasions when sleep may be hard to come by. What happens when an "off day" turns into an "off week," and an off week turns into two or more weeks? What happens when it's difficult to find pleasure in all of those things that once made you feel good? What happens when you begin to eat everything in sight even though you're not hungry, or forget about eating because you have no interest and pounds slide away along with your energy?

A diagnosis of major depression is based on criteria from the Diagnostic Statistical Manual-5. A diagnosis is made after a person has suffered for at least two weeks with minimally 5 out of the 9 symptoms listed in the manual. In depression's more severe forms, people have thoughts of ending their lives.

The Centers for Disease Control and Prevention (CDC) indicates 7.6 percent of Americans between 2009 and 2012, over the age of 12 years old, suffered from moderate or severe depression. The CDC also reports that just over one-third (35.3 percent) of persons with severe depressive symptoms reported having seen a mental health professional in the past year. Depression also co-occurs with other illnesses and conditions making them harder to treat. Given that major depression is a treatable illness, with most people responding to treatment, one wonders why so few people seek help.

What is help for major depression? There are a good number of medications and some psychotherapies that have been shown to be of benefit. A combination of medication and psychotherapy is thought to be most useful for treatment.

Several different medications are used to alleviate depression. There are varying classes of antidepressants and mood stabilizers, and sometimes combinations of medication are needed. Mood stabilizers help when depression is caused by bipolar disorder. Unfortunately, there is no absolute way of knowing what medication will work, and sometimes it's a matter of trial and error to figure out what is most effective. Unlike aspirin, which relieves a headache in less than an hour, antidepressants can take up to 2-3 weeks before one notices any difference, and up to 4 to 6 weeks before becoming fully effective. Sometimes knowing what a family member has found helpful can be valuable information, increasing the likelihood of a person responding to a particular medication.

The psychotherapies known to help in treating depression are less in number, but also provide an element of choice with varying levels of effectiveness depending on its severity. Professional literature identifies Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) as two treatments studied and found to be helpful. CBT is a collaborative therapy whereby thinking and behavioral patterns are identified and modified in an effort to decrease feelings of depression. Some assumptions are not accurate and contribute to feeling poorly such as the interpretation of what another person says or their tone of voice. Sometimes assumptions lead to misinterpretations of events and result in negative self-talk such as," I'm not good enough, smart enough, pretty enough, etc. " CBT also encourages evaluation of what behaviors may be contributing to depression, in an effort to lessen them and increase behaviors helping one to feel better. Ultimately CBT is an exercise in strengthening areas of one's life held hostage by depression.

IPT focuses on relationship and communication patterns and styles. Certain means and patterns of communicating are more likely to contribute to depression. IPT also concentrates on exploring situations adding to or increasing symptoms.

Medication can be used in conjunction with therapy. There is some disagreement over whether or not medication is needed for mild or moderate depression, which might benefit from therapy alone. It is generally thought that both medication and therapy combined are of benefit for recurrent or severe depression.

Depression is an illness; it is neither something one can "snap out of" nor shameful. With proper treatment depression can be a pause in your life and not the end. When symptoms exist, talking with you're a primary care doctor is an important beginning toward the road to recovery.

Carolyn Sacco, RN has worked as a nurse in psychiatry since 1985, in inpatient hospital, outpatient clinic, and home settings. Jeffrey Geller, MD. MPH is professor of psychiatry at the University of Massachusetts Medical School. He also treats in- and outpatients.


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