Clinical depression

Clinical depression is a health condition of depression with mental and physical components reaching criteria generally accepted by clinicians.

Treatment

Treatment of depression varies broadly, and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically employed in conjunction with one another: medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT), may be used where chemical treatment fails.

Related Topics:
Medication - Psychotherapy - Electroconvulsive therapy

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Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements.

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The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

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While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people's symptoms continue unabated.

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In emergency situations with suicidal persons, psychiatric hospitalization is used simply to keep suicidal people safe until they cease to be dangers to themselves. Another treatment program is partial hospitalization, in which the patient sleeps at home but spends the day, either five or seven days a week, in a psychiatric hospital setting in intense treatment. This treatment usually involves group therapy, individual therapy, psychopharmacology, and academics (in child and adolescent programs).

Related Topics:
Psychiatric hospitalization - Partial hospitalization - Group therapy - Individual therapy - Psychopharmacology

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Medication

Medication which relieves the symptoms of depression has been available for several decades. These drugs are listed in order of historical development. Typical first line therapy for depression is the use of an SSRI type drug, such as sertraline (Zoloft).

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Monoamine oxidase inhibitors (MAOIs) may be used if other antidepressant medications are ineffective. Because there are undesirable interactions between this class of medication and certain foods and drugs, it is important that the user be aware of which ones to avoid. A new MAOI has recently been introduced. Moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase A (RIMA), follows a very specific chemical pathway and does not require a special diet.

Related Topics:
Monoamine oxidase inhibitor - Moclobemide - Reversible inhibitor of monoamine oxidase A

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Tricyclic antidepressants are the oldest, and include such medications as amitriptyline and desipramine. They are used less commonly now, due to side-effects which may include increased heart rate, drowsiness, dry mouth, and memory impairment. Most importantly, they have a high potential to be lethal in moderate overdose. The reason why tricyclic antidepressants are still used is their high potency, especially in severe cases of clinical depression.

Related Topics:
Tricyclic antidepressant - Amitriptyline - Desipramine - Heart - Memory

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Selective serotonin reuptake inhibitors (SSRIs) comprise the current standard family of antidepressants. It is thought that one cause of depression is that an inadequate amount of serotonin, a chemical which the brain uses to transmit signals between nerve cells, is produced. These drugs work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil),escitalopram (Lexapro), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, though such effects as drowsiness, dry mouth, and decreased ability to function sexually may occur.

Related Topics:
Selective serotonin reuptake inhibitor - Serotonin - Fluoxetine - Paroxetine - Escitalopram - Sertraline

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Selective norepinephrine reuptake inhibitors (NARIs) such as reboxetine (Edronax) act via noradrenaline. SNRIs are thought to have a positive effect on concentration and motivation in particular.

Related Topics:
Selective norepinephrine reuptake inhibitor - Reboxetine - Noradrenaline

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Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of anti-depressant which work both on noradrenaline and on serotonin. They typically have similar side-effects to the SSRIs although there may be a withdrawal syndrome on discontinuation which may require a tapering of the dose.

Related Topics:
Serotonin-norepinephrine reuptake inhibitor - Venlafaxine - Duloxetine

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Dietary suppliments

S-adenosyl methionine (SAM-e) is a derivative of the amino acid methionine that is found throughout the human body, where it acts as a methyl donor and participates in other biochemical reactions. It is available as a prescription antidepressant in Europe, and an over-the-counter dietary supplement in the United States. Clinical trials have shown SAM-e to be as effective as standard antidepressant medication, with many fewer side effects.{{ref|oldref_2}},{{ref|oldref_3}} Its mode of action is unknown.

Related Topics:
S-adenosyl methionine - Methionine

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Omega-3 fatty acids (found naturally in oily fish, flax seeds, hemp seeds, walnuts, canola oil etc.) have also been found to be effective while used as a dietary supplement.

Related Topics:
Omega-3 fatty acids - Oily fish - Flax seeds - Hemp seeds - Walnuts - Canola oil

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Augmentor drugs

Some antidepressants have been found to work more effectively in some patients when used in combination with another drug. Such "augmentor" drugs include tryptophan (Tryptan) and buspirone (Buspar).

Related Topics:
Tryptophan - Buspirone

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Tranquillizers and sedatives, typically the benzodiazepines, may be prescribed to ease anxiety and promote sleep. Because of their high potential for fostering dependence, these medications are intended only for short-term or occasional use. Medications are often employed not for their primary function, but to exploit what are normally side effects. Quetiapine fumarate (Seroquel) is designed primarily to treat schizophrenia and bipolar disorder, but a frequently-reported side-effect is somnolence. Hence, this non-addictive drug can be used in place of an addictive anti-anxiety agent such as clonazepam (Klonopin, Rivotril).

Related Topics:
Tranquillizer - Sedative - Benzodiazepine - Side effect - Quetiapine - Schizophrenia - Somnolence - Clonazepam

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Antipsychotics such as risperidone (Risperdal) and olanzapine (Zyprexa), and Quetiapine (Seroquel) are prescribed as mood stabilizers and are also effective in treating anxiety. Antipsychotics (typical or atypical) may be also prescribed in an attempt to augment an antidepressant, to make antidepressant blood concentration higher, or to relieve psychotic or paranoid symptoms often accompanying clinical depression. However, they may have serious side effects, particularly at high doses, which may include blurred vision, muscle spasms, restlessness, tardive dyskinesia, and weight gain.

Related Topics:
Antipsychotic - Risperidone - Olanzapine - Quetiapine - Mood - Anxiety - Antipsychotics - Antidepressant - Psychotic - Paranoid - Vision - Muscle - Tardive dyskinesia

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Lithium remains the standard treatment for bipolar disorder, but may also be effective for people with depression, particularly in preventing relapse. Lithium's potential side effects include thirst, tremors, light-headedness, and nausea or diarrhea. Some of the anticonvulsants such as carbamazepine (Tegretol), sodium valproate (Epilim), and lamotrigine (Lamictal) are also used as mood stabilisers, particularly in bipolar disorder.

Related Topics:
Lithium - Bipolar disorder - Thirst - Tremor - Nausea - Diarrhea - Anticonvulsants - Carbamazepine - Sodium valproate - Lamotrigine

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Failure to take medication, or failure to take it as prescribed, is one of the major causes of relapse. Should one feel a change or discontinuation of medication is necessary, it is critical that this be done in consultation with a doctor.

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Psychotherapy

In psychotherapy, or counselling, one receives assistance in understanding and resolving problems which may be contributing to depression. This may be done individually or with a group, and is conducted by health professionals such as psychiatrists, psychologists, social workers, or psychiatric nurses. It is important to enquire about both the therapist's training and approach; a very close bond often forms between practitioner and client, and it is important that the client feel understood by the clinician.

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Counsellors can help a person make changes in thinking patterns, deal with relationship issues, detect and deal with relapses, and understand the factors that contribute to depression.

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There are many therapeutic approaches, but all are aimed at improving an individual's personal and interpersonal functioning. Cognitive therapy, also known as Cognitive Behavior Therapy, focuses on how people think about themselves and their relationships to the world. It works to counteract negative thought patterns and enhance self-esteem. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him to communicate more effectively and reduce stress. Behavioral therapy is based on the assumption that behaviors are learned. This type of therapy attempts to teach individuals new and healthier types of behaviors. Supportive therapy encourages people to discuss their problems and provides them with emotional support. The focus is on sharing information, ideas, and strategies for coping with daily life. Family systems therapy helps people live together more harmoniously and undo patterns of destructive behavior.

Related Topics:
Cognitive therapy - Interpersonal skills - Behavioral therapy - Supportive therapy - Family systems therapy

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Transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) is currently under study as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. In this therapy, a powerful magnetic field is used to stimulate the left prefrontal cortex, an area of the brain which typically shows abnormal activity in depressed individuals.

Related Topics:
Repetitive transcranial magnetic stimulation - Cortex

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rTMS has been proposed as an alternative to ECT that would have fewer side effects. No sedation is required, and the only reported side effects are a slight headache in some patients, and facial muscle contraction during treatment. However clear evidence that it is an effective treatment is still awaited.{{ref|oldref_6}}

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Recent work in Poland has suggested that weak, variable magnetic fields may offer relief from depression in those that have been unresponsive to medication. However, some of the existing work has been questioned with claims that the effect is not as significant once environmental conditions are controlled for.

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Electroconvulsive therapy

Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs short bursts of a carefully controlled current of electricity (this is fixed at 0.9 ampere in one typical machine) to induce an artificial epileptic seizure while the patient is under general anesthesia.

Related Topics:
Electroconvulsive therapy - Shock therapy - Electricity - Epileptic seizure

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ECT has acquired a fearsome reputation from its use as a tool of repression in the former USSR, and its fictional depiction in films such as One Flew Over the Cuckoo's Nest, but when applied appropriately it is still a useful treatment where other means of treatment have failed, or where the use of drugs is unacceptable, such as in pregnancy. In a typical regimen of treatment, a patient receives three treatments per week over three or four weeks. Repeat sessions may be required. Short-term memory and long-term memory loss, lowering of intellectual ability, personality reconfiguration and headache may result from this treatment.

Related Topics:
Repression - USSR - One Flew Over the Cuckoo's Nest - Pregnancy - Short-term memory

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Other methods of treatment

Light Therapy

Bright light (both sunlight and artificial light) is shown to be effective in seasonal (winter) depression, and sometimes may be effective in other types of depression, especially atypical depression or depression with "seasonal phenotype" (overeating, oversleeping, weight gain, apathy). It is wise to recommend to any depressive patient to take as much sunlight as possible by walking at daytime, even if the patient suffers from depression which does not have seasonal pattern or "seasonal symptoms".

Related Topics:
Light - Sunlight - Seasonal (winter) depression - Phenotype - Apathy

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Important note: an antidepressant effect is caused by visible light stimulation of retina, not by ultra-violet, so it is not necessary (and may be even dangerous in some cases) to sunburn. It is enough just to walk at daytime or to take light therapy in a light cabin with a special powerful lamp.

Related Topics:
Visible light - Retina - Ultra-violet - Sunburn

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Exercise

It is widely believed that physical activity and exercise helps depressive patients and promotes quicker and better relief from depression. It is also thought to help antidepressants and psychotherapy to work better and faster. It can be difficult to find the motivation to exercise if the depression is severe, but sufferers should be encouraged to take part in some form of regularly-scheduled physical activity if possible. A workout need not be strenous; many find walking, for example, to be of great help. Exercise produces higher levels of chemicals in the brain, notably dopamine, serotonin, and norepinephrine. In general this leads to improvements in mood, which is effective in countering depression.

Related Topics:
Exercise - Walking - Dopamine - Serotonin - Norepinephrine

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Note that prior to beginning an exercise regime, it is wise to consult a doctor. He or she can establish whether a person possesses any health problems that could rule out some types of exercise.

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Enemas and Colon Hydrotherapy

Severe clinical depression is often accompanied by constipation. Tricyclic antidepressants themselves also tend to produce constipation as a side effect. Laxatives reduce the absorption of an antidepressant in the small intestine, thereby reducing its bioavailability and clinical efficacy. Warm water enemas, on the other hand, do not interfere with antidepressant absorption, and may have a slight antidepressive effect by increasing serotonin production in thick bowel wall and temporarily raising serotonin level in the bloodstream.

Related Topics:
Constipation - Tricyclic antidepressants - Absorption - Small intestine - Bioavailability - Enemas - Thick bowel - Serotonin

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Meditation

Meditation is increasingly seen as a useful treatment for depression. The current professional opinion of meditation is that it represents at least a complementary method of treating depression. Since the late 1990's, much research has been carried out to determine how meditation affects the brain (for more information see the main article on meditation). While the effects on the mind are somewhat complex, they are often quite positive, encouraging a calm, reflective and rational state of mind which can be of great help against depression. It's notable that while many religions actively encourage/use meditative practice, it is not necessary to be a member of any faith to partake in meditation.

Related Topics:
Meditation - Reflective - Rational - Religion

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Old Methods

Insulin shock treatment is an old and currently mostly abandoned treatment of severe depressions, psychoses, catatonic states and other mental disorders. It consists of induction of hypoglycemic coma by intravenous infusion of insulin. The treatment is potentially unsafe and can be lethal in some cases (about 1% of patients undergoing insulin coma), even with proper monitoring. That was the main reason why it was abandoned from current medical practice. In contrast, ECT is considered to be very safe.

Related Topics:
Psychoses - Catatonic states - Mental disorders - Hypoglycemic coma - Intravenous infusion - Insulin - Insulin coma - ECT

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Nevertheless, insulin shock therapy is still officially used in Russia and some other countries, and can be administered to a very treatment-resistant patient under his written consent in many Western countries.

Related Topics:
Russia - Western countries

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Atropinic shock therapy, also known as atropinic coma therapy, is an old and currently rarely-used method. It consists of induction of atropinic coma by rapid intravenous infusion of atropine.

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The atropinic shock treatment is considered relatively safe but the problem with its administration is that it requires prolonged coma (4-5 hours), careful monitoring and preparation, and it has many unpleasant side effects, like blurred vision due to atropine. Thus it is rarely used now. But it can be used under written consent in Western countries in some very treatment-resistant cases, and is still officially used in Russia and some other countries.

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