Treatment of Depression
Psychotherapy alone may be effective for those with
personality disorder based depression and sometimes for mild clinical
depression. If the depression is severe, however, treatment with medication is often necessary in
addition to psychotherapy or counseling. Many
persons are reluctant to take medications because they have not fully accepted the medical nature of their illness, they may be fearful of side-effects, and they may have concern about the stigma attached to taking psychiatric medications.
If the depression is really distressing and/or impairing one's ability to function, then one needs to set a priority on getting better in spite of their hesitancies,
just as if you have appendicitis you need surgery in spite of the
risks.
It is interesting to find many persons who need medication
use or have used tobacco, alcohol, speed, marijuana, or other
substances proven to be dangerous are reluctant to take antidepressants.
It is often useful to counsel persons that if the never try
they will never know if a medication can help them (in lieu of
the depression ruining their lives), and by definition no one
should ever take medication that does not work or that is not
easily tolerable to take. Side effects are usually managable if they do occur. If one does take medication, it is also
important to take enough. While too little will not work well,
many persons only want to accept they are “mildly ill” so that
only “mild doses” are needed.
Even when a person takes a medication, they often want to
stop when they are better. This is a complex situation that needs
careful discussion. Often persons are better because they
are on the medication; not that they are better so they can stop
the medication. Also, effects of medications on one’s nervous
system may last many weeks or months so that concluding one does
not need medication because they are still well 2 months after
stopping may not be a valid conclusion. Sometimes persons fear
that they will become dependent on the medication. In this case
it is sometimes helpful to explain to them that if they stop the
medication they will go back to their natural self that is
depressed, and that in this case “natural” may not necessarily
mean “healthy”. Just as if someone with diabetes stops their
insulin, or someone with hypertension stops their
antihypertensive meds, they will return to their natural and
unhealthy state; it is not because they took the medication that
they are ill. It is true that if one stops an antidepressant it
should be stopped slowly to avoid any recurrence of depression
and/or abstinence symptoms of stopping a medication the body has
been used to (this is the same for many medications that treat
the heart and other medical medicines), but there will be no drug
seeking or addiction like a narcotic.
There are also persons who may be able to stop their
medication without having a recurrence of depression. The more
depression is intrinsic or endogenous (i.e., part of themselves),
however, the less likely one can stop without getting the
depression back again. Endogenous depression would be suggested
by 1. chronic history or multiple recurrences especially when
stopping medications in the past, 2. family history (genetic
loading), and 3. no serious discrete event to trigger the
depression. The fewer of these factors one has the more chance
one has to only need one course (at least 6 months) of
antidepressant medication.
As a final note, persons with depression have been found to have an
increased risk of mortality from certain illnesses. One example is that
hardening of the arteries progresses faster in persons with depression
which leads to an increased risk for high blood pressure and
diseases of the heart, and an increased risk for stroke, etc. This is another reason
to take the treatment of depression as a serious matter.
A full and detailed description of all the treatments of
depression is beyond the scope of this site. Please refer to this
link on depression treatment, as well as other sources.
Go to depression top page.
Summary of Depression Links:
Depression｜
Personality Disorder｜
Psychodynamic Psychotherapy｜
Core Issue-Defense｜
Cognitive Therapy ｜
Anxiety｜
Unipolar Depression｜
Dysthymia｜
Rationalization｜
Denial｜
Mania ｜
Pub Med｜
Hypothalamic-Pituitary-Adrenal Axis｜
Cytokines｜
Neurotrophic Factors｜
Serotonin Transporter Allele｜
Molecular Biology Studies｜
Recurrent Brief Depression｜
Circadian Rhythms｜
Projection｜
Atypical Depression｜
bipolar disorder (Manic Depression)｜
Mixed State｜
Diagnostic and Statistical Manual of Mental Disorders-IV｜
Bipolar II｜
Cyclothymia｜
Hypomania｜
Medication-Induced Mania｜
Post-Partum Depression ｜
Seasonal Depression｜
Premenstrual Dysphoric Disorder｜
Antidepressants ｜
Depression Treatment
