Treatment Options for Depression

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Major depressive disorder, commonly known as depression, is a serious mental illness affecting more than 14 million Americans; it is one of the leading causes of disability in America. Early diagnosis and treatment can reduce the suffering and severity of symptoms of major depressive disorder. Depression severity is categorized into mild, moderate, and severe cases. Depending on the severity of your depression, the treatment options may vary.

To be diagnosed with depression, patients must experience at least 14 days of feeling low or apathetic. The diagnosis also relies on patients reporting at least four additional symptoms, including sleep changes (sleeping too much or not enough), increased or decreased appetite, feelings of worthlessness, difficulty focusing or concentrating, and crying spells. Some people experience suicidal thoughts or thoughts of death. In some cases, depressive symptoms are so severe that simple daily tasks such as getting dressed, cooking, or even getting out of bed seem extremely difficult.

Mild cases of depression that are not causing issues with functioning may be treated with therapy. Daily exercise and a healthy diet are also important in treating mild depression. We now realize that there is an association between diet and mood stability. Some scientists hypothesize that depression may be caused by an inflammatory response in the body. Theoretically, certain foods may be more likely to enhance this inflammatory response. There is anecdotal evidence that low glycemic index diets rich in omega-3 fatty acids and omega-6 fatty acids, such as the “Mediterranean diet” are protective against symptoms of depression.

Those suffering from moderate cases of depression who may have some minor difficulty with functioning respond best to a combination of medications and therapy. Antidepressants are the gold standard treatment for moderate depression. There are several classes of medications to choose from, with selective serotonin reuptake inhibitors (SSRIs) being the most common class. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another popular class of medications that target norepinephrine in addition to serotonin. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older classes of medications that are useful; however, they are used less frequently due to side effects. One alternative to medications is called Transcranial Magnetic Stimulation (TMS).  This noninvasive procedure includes the direct stimulation of nerve cells in the dorsal lateral prefrontal cortex, the primary area of the brain where depression lies. It is noted to be effective for most cases of depression and is a great option for people who are sensitive to medication side effects or who want to avoid taking medications. This procedure lasts approximately 5-6 weeks. In some cases, a low dose of medication may need to be continued. There are also cases in which a “booster” follow-up treatment is required if depressive symptoms return.

In severe cases of depression, there is significant difficulty in functioning. Patients with severe depression may not be able to attend work or school. Daily activities of living are a chore to people with severe depression. Because depression affects the area of the brain that helps with focus, learning, and organization, many people with severe depression are disabled by their disease. Antidepressants are absolutely necessary to treat these symptoms. In some cases, two or more medications may be required to fully treat symptoms. Mood stabilizers such as aripiprazole (Abilify) can be helpful for treatment-resistant depression when added to an antidepressant. Severe cases of depression may require hospitalization for intensive treatment and rehabilitation. If someone is not eating or drinking and having profound difficulty responding to medication, electroconvulsive therapy (ECT) may be recommended. This treatment is highly effective for severe depression. A healthy diet and routine exercise will also be necessary to manage a depressive illness. Therapy is useful once the symptoms are no longer causing difficulty with functioning.

Do not delay your treatment for depression. Once you start treatment, do not discontinue it once you are feeling better without the direction of your doctor. Stopping treatment runs the risk of symptoms returning.

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