Help for Clinical Depression

Diagnosing Depression

Finding the best approach begins with an accurate diagnosis. “It’s important to look not only at subjective symptoms, but also at your medical history, social and family history and current medications,” Dr. Khan says. “Together, these assessments help paint the picture of what is happening and can guide what type of treatment is most appropriate.”

Scale matters, too. “A good evaluation can tell if your depression is mild, moderate or severe, as well as first time or recurrent,” he adds. “Those are also important considerations when looking at treatment options.”

Changing Habits and Talk Therapy

If your depression is mild, you may find relief through lifestyle changes, such as dietary adjustments and increased exercise. In particular, research shows that increasing your intake of omega-3 fatty acids, found in cold-water fish and supplements, may help relieve symptoms.

Traditional talk therapy can help, too, says Dr. Khan. “Psychotherapy works very well for some people and provides you with coping skills that can be used lifelong.”

Dr. Khan notes that two types of therapy show particularly good results: cognitive behavioral therapy and interpersonal therapy. Both are short-term interventions and involve specific, practical tasks, such as learning coping and stress reduction mechanisms.

Talk therapy combined with antidepressant medications often work better than medications alone, he adds.

Antidepressants

Available since the 1980s, prescription antidepressants offer a world of help. Keep in mind that any medication for depression generally takes four to six weeks to show effects. You may experience relief with the first one you take, or you may need to try different options.

Antidepressants include two widely used types: selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Both types affect the activity of neurotransmitter chemicals, the substances that help transmit messages from one brain neuron to another. These drugs prevent brain neurons from reabsorbing the neurotransmitters after they have delivered a message, which somehow decreases depression symptoms (scientists aren’t entirely sure how it works).

Common SSRIs, which affect serotonin levels, are Prozac, Celexa, Luvox, Zoloft, Lexapro and Paxil. SNRIs work on both serotonin and norepinephrine; common brands are Effexor XR, Cymbalta, Pristiq and Fetzima.

Another class of reuptake inhibitor, a norepinephrine and dopamine reuptake inhibitor (NDRI), such as Wellbutrin, affects both norepinephrine and dopamine.

Although often very effective, these medications may cause troublesome side effects, including changes in sex drive and weight gain. Even more worrisome, some people report thoughts of suicide while taking antidepressants. If you start taking one of these drugs, you’ll be closely monitored for the duration of treatment.

Dr. Khan recommends that first-time users stay on a medication for at least a year, weathering all seasons and life-event anniversaries, to get a good assessment of effectiveness and side effects. “If you then want to cut back or discontinue the medication, do it gradually and under medical supervision,” he says.

If you’ve had two or more bouts of serious depression in your life, Dr. Khan recommends staying on medication, always measuring any side effects against the benefits of reducing depression’s impact.

Antidepressants in Youth and Seniors

Doctors rarely describe antidepressants to young children, says Dr. Khan. For adolescents and young adults under 25, antidepressants carry strong warnings of potential increases in suicidal thoughts, particularly during the first few weeks of use. Adolescents and young adults who take these meds must be closely monitored.

If you’re a senior citizen, your doctor must take into account that your older body may not process medications as efficiently as it once did. Plus, if you’re taking several other meds, you and your doctor need to be sure they won’t negatively interact with antidepressants.

New Treatment Options

Especially if antidepressants haven’t helped you, consider modern electroconvulsive therapy. While under general anesthesia, your brain will receive carefully calibrated electric currents, which cause small seizures and seems to shift brain chemistry.

Other new options (not available at all facilities) include:

• Transcranial Magnetic Stimulation – Externally applied, painless magnetic pulses are used to “reset” functioning of the mood-regulating areas of the brain.
• Deep Brain Stimulation –  Surgically implanted electrodes in the brain deliver ongoing electrical pulses, blocking the signals that cause depressive symptoms.
• Vagus Nerve Stimulation –  A pacemaker-like device, surgically implanted in the chest, sends mild electrical pulses to the brain by way of the neck’s vagus nerve. The pulses alter neurotransmitters in the brain.
• Ketamine Infusion Therapy –  Researchers discovered that ketamine, an anesthetic, can quickly relieve severe depression in some people who haven’t responded to other treatments. Slowly delivered by intravenous line, ketamine infusion must be repeated regularly because effects last only a few days.