Treatments for Depression

Now that you have an understanding of depression Opens in new window, it’s time to explore treatments for this disorder. This literature will look at traditional interventions, alternative therapies, current trends, and future technologies for treating depression.

It’s important to emphasize that the most crucial aspect regarding any of these approaches is to be an active participant. Learn about psychotherapy. Read up on medicines. Become knowledgeable about holistic treatments and current trends. Be your own advocate.

TRADITIONAL TREATMENTS

Traditional treatments are so termed because they are the go-to techniques that have been used to treat depression. These traditional methods fall into two major categories: psychological and medical.

PSYCHOLOGICAL TREATMENTS

Psychotherapy is the treatment of emotional conflicts through the use of talking and communicating with a trained professional. Also known as “talk therapy,” psychotherapy is practiced by psychologists, psychiatrists, social workers, and psychiatric nurse practitioners.

There are many different schools of psychotherapy, each one working from a unique model of mind and behavior. Though the schools differ in approach and technique, they all share the same goal: to reduce depressive symptoms.

As far as evidence-based research goes, all traditional talk therapies can be effective in reducing mild-to-moderate depressive symptoms.

Psychotherapy is not counseling—and it’s important to make this distinction. Counseling is a short-interval, problem-solving process that targets a specific situation.

The counselor offers advice and suggestions. Psychotherapy is a longer-term treatment that focuses on gaining insight into chronic behavioral and emotional problems. The types of psychotherapy are described below.

1. Behavioral Therapy

Behavioral therapy (BT) is a psychotherapy that focuses solely on your behaviors. Typically, you meet with a therapist once a week to look at what kinds of behaviors reinforce your depressive symptoms.

• Are you focusing on the negative aspects in life instead of the positive ones?
• Are you stuck in a loop of negative social reinforcement from other people?

• Do they respond to you with great concern when things are bad, and gloss over the happier moments?
• Do you lack a set of skills to combat fatigue?

Behavior therapy helps sharpen your observational skills, teaches you about the power of consequences, and shows you that well-being can come from changing your actions.

2. Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) expanded the theory of behaviorism by looking at thoughts as well as actions.

Cognitive-behavioral therapy stresses that specific thinking patterns cause depression.

• Does sadness leave you thinking that there’s no way out?
• Are your thoughts an endless stream of self-critical statements?
• Do you think in all-or-nothing terms?

In this therapy, you meet once a week with a therapist to begin identifying the belief systems you use on a daily basis. The goal in this type of psychotherapy is to correct unrealistic beliefs and distorted thoughts by replacing them with more realistic attitudes. Essentially, changing how you think will change the way you feel.

3. Psychoanalysis

Psychoanalysis is a deep-exploration therapy whose beginnings originated with Sigmund Freud. It is the most intensive of all psychotherapies, requiring a passion and commitment to attending sessions four to five times a week.

In this treatment, you and your analyst will peel away depressive symptoms to find their subconscious and conscious origins. Psychoanalysis is a long process, so it’s not a first-line choice for acute depression intervention. It’s also not generally a choice for children.

Psychoanalysis can be a meaningful experience for adults who have stabilized their depression and want to work on understanding the subtleties and intricacies of their life.

4. Psychoanalytic Psychotherapy

Psychoanalytic psychotherapy is a less intensive form of psychoanalysis. Though it retains the vibrancy and depth of psychoanalysis, psychoanalytic psychotherapy is shorter in its duration.

In this treatment, you and your analyst meet two to three times a week to explore inner thoughts, personal struggles, and how you deal with crucial aspects of your life.

Through interpretation and the studying of your defense mechanisms Opens in new window, you and your analyst will bring meaning to past and recurring events that keep you stuck.

The reduction of depressive symptoms comes not only from learning about your personality, unresolved conflicts, and desires, but also from the changes you make in how you live your life as a result of your self-discovery. Unlike psychoanalysis, psychoanalytic psychotherapy is a viable treatment for children and teens.

5. Psychodynamic Therapy

Psychodynamic therapy, also known as “insight-oriented therapy,” is the least intensive of the psychoanalytic therapies. Psychodynamic therapy focuses on motivation, meaning, and the understanding of relationships in one’s life.

The immediate goals of psychodynamic psychotherapy are to label feelings and learn new behaviors by creating corrective emotional experiences. In this treatment, a therapist meets with you once a week to work on these issues.

The goal here is not only to reduce depressive symptoms but also to understand the underlying issues that might be contributing to your illness.

6. Psychotherapy Integration

Psychotherapy integration is not restricted to following a single school of theory and/or practice when treating mental illness. The school of psychotherapy integration believes that all type of psychotherapy share curative factors.

Some of the approaches include:

• technical eclecticism (in which one uses techniques from many different psychotherapy schools but is not concerned with following any particular theory) and
• assimilative integration (in which a therapist relies on one major school of psychology, but borrows from others).

Most therapists who practice within a psychotherapy integration framework are willing to be flexible in their training to find what works best for their patients.

For me, opined the author, one of the great things about training as a psychology was the opportunity to explore different schools of theory and practice. I’ve had the good fortune to experience each one of these traditional therapies. I began my psychological schooling in a behavioral and social learning theory undergraduate program. I completed cognitive and psychoanalytic training in post-doctoral training. I strongly believe that each of these psychotherapies offers tremendous benefits for dealing with depression.

My practice style comes from the field of psychotherapy integration. I’m a trained psychoanalyst and operate from that theoretical framework but borrow from the fields of behavior and cognitive therapy when I work with children and adults. Personally speaking, continues the author, I use many techniques from the varying schools. Of course, some days are better than others. When a bad day knocks me down, I’m not down for the count. I tap into my insight, change my negative thinking to more positive thoughts, and behave in ways that reinforce feeling good. I do this hoping to get back on my feet—and if I don’t readily bounce back, I keep at it.

MEDICAL TREATMENTS

Pharmacotherapy, the oldest of the traditional therapies for mental illness, has been practiced for thousands of years. Pharmacotherapy treats emotional illness through the use of medication. Long ago, plants and flowers were sourced for their medicinal purposes. Nowadays, scientists in the medical field of psychopharmacology create bioactive compounds. Sometimes referred to as drug therapy, pharmacotherapy changes the neurochemistry in your brain and body to prevent and treat illness.

In this treatment, you meet for a consultation with a trained medical professional who specializes in the management of psychiatric and psychological disorders.

Professionals that perform pharmacotherapy include psychiatrists, certified nurse practitioners, and psychiatric nurse practitioner can prescribe medication, I champion the belief that you should seek highly specialized professionals who work in the field of mental illness.

Pharmacotherapy is one of the most rapidly developing fields in modern science. Adding medication to your treatment regime requires confidence in the professional with whom you are working. So, having someone who knows the latest research, trends, and side effects is critical.

The pharmacotherapy process involves a thorough medical history, one that will take up your entire first consultation.

While you’re there, the specialist will match your symptoms with relevant medications and begin you on a small dose. At first, you will have scheduled appointments within weeks of starting our medication.

As time progresses, dosage my remain the same or increase based on your reported symptoms. If side effects are intolerable, a change in medication may be necessary. However, once you are stabilized on your medication, you won’t need to be seen as often.

Since depression can have co-occcurring disorders, it’s important for your pharmacotherapy consult to cover all bases.

ALTERNATIVE TREATMENTS

1. Light Therapy

Light therapy is an alternative treatment for the relief of depression with a seasonal onset. Sometimes called winter blues, seasonal disorder (SAD) occurs when a person is exposed to shortened daylight hours.

There appears to be a biological reason for SAD, involving production of the hormone melatonin from the pineal gland (a small brain structure that functions as the body’s timekeeper).

The retinas of the eyes register light when exposed to sunshine, sending impulses to the pineal gland. In turn, the pineal gland produces melatonin, which regulates our circadian rhythm and body clock.

During the darker days and nights, the retinas register less light and overproduce melatonin. These higher hormone levels increase depressive symptoms. Depression with seasonal onset affects women more than it does men, and children can experience SAD as well.

Exposure to periods of direct sunlight can combat the surge of melatonin and reduce depressive symptoms, but for individuals who don’t have the ability to find abundant sunshine, light therapy is a good option.

Light boxes are available for purchase with and without a prescription. Research says the success of light therapy depends on finding a bulb that provides a balanced spectrum of light equivalent to being outdoors. Also necessary is to have exposure to this light between twenty and thirty minutes a day.

2. Omega-3

Omega-3 is a critical fatty acid responsible for helping nerve cell membranes function well. Research has found that omega-3 works in conjunction with the neurotransmitter serotonin, helping to regulate its distribution in the brain. Several studies indicated that supplemental omega-3 may be helpful in the management of depression. Of interest were findings using omega-3 as a supportive treatment, not as a singular intervention, which yielded the most significant decrease in depression. Omega-3 can be found in foods like salmon, nuts, eggs, and olive oil, just to name a few. Dietary supplements can also be used, but be mindful of the recommended dosages for optimal benefits.

Low folate and vitamin B12 deficiency have been linked to depression. Studies show that depressed patients often have low levels of red-cell folate, serum folate, and vitamin B12.

• Folate can be found in leafy green vegetables and certain dried beans like black-eyed peas and lentils, as well as in fruits like oranges and bananas.
• Vitamin B12 can be found in seafood like snapper, shrimp, and scallops, and in fermented vegetables like miso and tofu.

Just like omega-3, folate and vitamin B12 dietary supplements can be useful.

3. St. Johns Wort

St. Johns wort (SJW) is a yellow flower commonly known as Tipton’s weed. The botanical extract from this plant has been used as an herbal antidepressant for over two thousand years.

Studies on St. John’s wort, sometimes referred to in research as Hypereicum perforatum,” show it to be more effective than a placebo” and, in several studies, more effective than common antidepressant medications in treating minor depression.

It’s important to note that research on St. John’s wort for treating major depression, cyclothymia, or any of the bipolar disorders is limited.

St. John’s wort impacts the neurotransmitter systems of serotonin, dopamine, and gamma-aminobutyric acid (GABA). Side effects are generally well tolerated and include gastrointestinal distress, allergy Opens in new window to the sun (photosensitivity), and fatigue.

With mild depression, St. John’s wort should be used as a singular treatment, because there are risks when combining SJW with traditional antidepressants. SJW can be purchased in grocery stores, drugstores, and health-food stores. While SJW doesn’t require a prescription, be mindful to follow dosage directions to gain the full benefit.

CURRENT TRENDS

Traditional therapies continue to be the go-to treatments for depression, but several new techniques are taking center stage. As with anything you choose to undertake, be an educated consumer by learning all you can about these treatments. Become familiar with their risks and benefits, pros and cons, short-term versus long-term benefits, and cost and accessibility, so you can make an informed decision.

Psychotherapy Trends

1. Behavioral Activation (BA)

Behavioral activation (BA) therapy proposes that the act of avoidance leads to depression. This offshoot of behavior therapy attempts to make you aware of the inactivity and patterns of avoidance in your life, so that you can modify your behavior.

BA teaches activation strategies—behaviors that get you involved and engaged with others. You and your therapist will monitor your progress with charts and rating scales during this ten-to-twelve-week therapy.

2. Mindfulness-Based Cognitive Therapy

Mindfulness-based cognitive therapy (MBCT) is a treatment only for individuals who have become free from depressive symptoms. The aim of MBCT is to teach you about thoughts, feelings, and bodily sensations by using cognitive therapy and meditation practices.

The purpose of this approach is to help you detect and respond to the warning signs of relapse. This treatment is presented in class format for eight weeks by licensed professionals trained in MBCT.

3. Therapeutic Lifestyle Change

Therapeutic lifestyle change (TLC) is a fourteen-week holistic program that focuses on six essential areas including aerobic exercise, light therapy, adequate sleep, learning of anti-rumination strategies, omega-3 fatty acid supplements, and enhanced social support. At the time of this write-up, this program is in its research stage at the University of Kansas under the direction of Dr. Stephen Ilardi.

Medical Trends (Nonsurgical)

1. Repetitive Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a treatment in which a coil-like tool is positioned around your head to apply short, undetectable magnetic pulses to excite target-specific areas in the brain.

Studies report minimal side effects, such as headache, tingling, and light-headedness. These side effects were reported to decline quickly, however. Repetitive transcranial magnetic stimulation is performed while you’re awake, often in a doctor’s office. Some individuals report discomfort with the clicking sounds the magnetic coil makes, so earplugs can help.

The treatment takes about forty minutes, and daily treatments are recommended for a month. There is no down time, so you can drive home the same day and carry on with your daily routine.

Although you will come back from time to time for additional treatments if your depressive symptoms return. Because rTMS is so ne, there are no long-term studies to review.

2. Magnetic Seizure Therapy

Magnetic seizure therapy (MST) is a novel brain-stimulation method using high intensity repetitive transcranial magnetic stimulation in order to induce a therapeutic seizure. The procedure is done under general anesthesia and performed in an electroconvulsive therapy suite with a team of professionals.

MST enables doctors to target specific brain areas in a more focalized fashion than is possible with ECT. Individuals who have undergone MST reported a decrease in their depressive symptoms with no side effects—no memory loss, confusion, forgetfulness, or muscle strain.

FUTURE TECHNOLOGIES

As human beings, we share similar biological designs of flesh, bone, and blood. Despite having such similarities, the fields of mental illness and neurobiology demonstrate that we’re not a “one size fits all” society.

Treatments work for some, but not for all. Medications work for others, while many find no relief. Research tells us that the future of treating mental illness will move from a universal approach to a more personalized one.

Coming down the pike is the field of personalized medicine.

Already given the shorthand abbreviation “PM,” personalized medicine is described as “the delivery of the right medicine to the right patient at the right dosage.” Personalized medicine will build on advances in genetics, therapeutic delivery, and computational biology to create targeted therapies and targeted medications for your unique genetic makeup. As a result, this tailored approach will work more successfully, with few if any side effects, and be more cost-efficient.

Biometrics, sometimes called biomimicry, an innovative science that studies nature and imitates its design, is an up-and-coming field. Researchers promise the creation of artificial neural systems and artificial brain structures to help alleviate depression. Furthermore, bionic brain implants will potentially serve as an elegant replacement for ECT, VNS, and DBS treatments of today.

Already in test and delivery stages are gene therapy (which alters or replaces defective genes), stem cell therapy” (which helps replacement cells take the form of defective or missing cells), and nanomedicine” (which sends treatment to the brain directly through the bloodstream).

When I think about the future of mental-illness treatment, I brim with excitement. Breakthroughs in science come from creative minds that think out of the box—and from courageous individuals who participate in the research and development of these technologies. The gratitude we owe them is enormous.