Whether triggered by a relationship on the rocks, a pink slip at work, financial hardship or some other stressful event, a case of the blues is akin to a passing storm which is short-lived and leaves behind blue skies. Experiencing sadness and grief is part of the human experience. When those emotions linger for a unreasonable period of time and interfere with daily functioning, and the individual is unable to ‘snap out of it’ but rather finds himself or herself emotionally-stuck, the mood disorder known as depression is manifesting itself.
More than 18 million Americans who are 18 years or older, or 9.5% of the U.S. adult population, suffer from depressive disorders including bipolar disorder, (previously known as manic depression), dysthymic disorder, and major depressive disorder each year. Nearly 6.7% of American adults are diagnosed with major depressive disorder in a given year. One out of every eight adolescents and one in 33 children has clinical depression. Depression is forecast to become the second most important cause of death (after heart disease) by 2020. Numerous illnesses have been linked to depression, including back pain, certain forms of cancer, diabetes, coronary heart disease, eye disease, and osteoporosis. According to the National Institute of Mental Health, depressed individuals run four times the risk of developing a heart attack than those lacking a history of depression. The illness is also considered the third most important issue in the workplace, trailing just behind stress and family crises. Almost $12 billion in annual lost work days are attributed to depression. In fact, it accounts for more absenteeism than any other illness, and it costs employers $70 billion in lost productivity, medical expenses, and other costs.
Left untreated, clinical depression can last months and even years, and it may become increasingly difficult to combat successfully. It can also raise individuals’ suicide risk; two-thirds of suicides in the U.S. are caused by depression. The good news is that this condition is highly treatable. Long-term recovery and relapse prevention hinge upon tackling both the chemical imbalance and symptoms as well as the underlying causes. By seeking help for depression, individuals may liberate themselves from physical and emotional pain and re-create stable interpersonal relationships. The suitable depression treatment method(s) depends on the type of depression that the client has and the severity of his or her symptoms. A combination of anti-depressants and psychotherapy is typically administered to depressed patients. Medication, which is usually prescribed at depression’s peak, assists in balancing the brain chemistry aspect of the illness. As the patient learns and implements the skills acquired in psychotherapy, the medication is gradually tapered off and discontinued. Individuals who experience relapse may need to follow an anti-depressant treatment for a long duration. Therapy, on the other hand, helps patients understand and modify the self-defeating social, cognitive, and behavioral patterns that play a pivotal role in their depressed mood.
Elevating the amount of serotonin in a client’s brain does not always result in mood improvement. Some anti-depressants address both serotonin and other neurotransmission systems such as norepinephrine and dopamine. Oftentimes, both anti-depressants and mood stabilizers are used to treat depression. The former frees the patient from a depressive episode by improving mood. The latter functions to regulate mood by reducing the intensity of the depressive lows and (if present) the manic highs.
The following types of anti-depressants, known as Selective Serotonin Reuptake Inhibitors (SSRIs) are typically prescribed for the treatment of major depression:
- Fluoxetine (Prozac)
- Buproprion (Wellbutrin)
- Sertaline (Zoloft)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
Psychotherapy or “talk therapy” is extremely effective in treating patients with depression by assisting them to 1) discuss their experiences, 2) identify and understand the thinking processes that give rise to the depression symptoms, 3) uncover the influence of past experiences on the current state of their distress, and 4) develop coping and adaptive skills so that they may reduce the likelihood of recurrent episodes of depression. Two psychotherapies that have proven to be successful in treating depression are interpersonal therapy and cognitive behavioral therapy (CBT). In cognitive therapy, clients are taught to spot and correct illogical and unfounded thinking patterns. Through cognitive behavioral therapy, negative behaviors and thoughts are reduced and replaced with healthier ones. Therapists trained in CBT may also recommend breathing exercises, visual imagery, exercise, social activities, and relaxation techniques to diminish depression symptoms. Patients are often assigned homework during the therapy (i.e. keeping track of their moods, behaviors, and thoughts). Another psychotherapeutic method that is of relatively short duration (usually 12-16 sessions) and is used in treating depression is interpersonal therapy. It is helpful for clients who are having difficulty coping with life transitions and/or have underwent recent relationship conflicts.
For severely depressed individuals who exhibit signs of psychotic or self-destructive behavior, inpatient hospitalization is at times necessary. Monitoring serves to ensure that patients are safe and that treatments are making headway. In cases where medications alone are insufficient to relieve the symptoms, depression help comes in the form of medical therapies, the most common being as follows:
1. Electroconvulsive Therapy (ECT)
Dubbed “shock therapy”, electroconvulsive therapy is one of the most controversial psychiatric therapies currently in practice. In ECT an electric current is introduced through a client’s brain to provoke a seizure. It has been demonstrated to be effective in 60-70% of treatment resistant cases of depression when schizoaffective disorder or personality disorders are not present. Despite this efficacy ECT is not a first-line treatment because it carries significant risk of memory loss. Usually the memory loss only effects the time period of a few months before and/or after the treatment, but there have been cases of long term or permanent memory impairment. Newer techniques, such as unilateral electrode placement and brief-pulse current (rather than the older sine-wave current) result in side effects less often and with lessened severity. This type of therapy is usually employed on nursing mothers, or pregnant women, patients with acute episodes that need immediate intervention due to psychosis or risk of suicide, catatonics, and on patients whose depression has resisted other forms of treatment. ECT does offer quick relief from depression that is otherwise unresponsive to treatment.
Light therapy, which exposes clients to intense light, has proven to be beneficial for individuals diagnosed with seasonal affective disorder. The light sources used for this are specially designed light bulbs called “full spectrum lighting.” That means that the white light contains every color in the visible spectrum. If you hold a prism up to most lightbulbs you will not see the full rainbow that the sun produces, but rather streaks of specific colors. It has been found that bright partial spectrum lighting, as produced from most light bulbs, does not trigger the same “Time to be awake and active” neurochemical response that occurs on a bright sunny day. Phototherapy allows individuals to experience the increased energy and positivity associated with being outside on a sunny day without the increased risk of skin damage, aging, and skin cancer because the light sources used do not put out the same amounts of harmful ultraviolet lighting that the sun creates.
Another form of depression therapy involves stimulating the vagus nerve through surgical placement of an electrical pulse generator in the chest. This treatment method helps depressed patients who have not improved with other therapies.
Depression support is also available through support groups, psychodynamic therapy, group therapy, as well as couples and family therapy. In psychodynamic therapy, patients become cognizant of the impact of unconscious factors, relationships, and life events on their mental health state and of how they contribute to depression. Depression support groups abound both online and offline. Prospective members may avail themselves of a multitude of forums, chat rooms, and support groups focused on helping individuals battle depression. There are also depression treatment centers and other treatment centers that deal specifically with depression and other mental health disorders.