It is important that the cause of depression is treated as well as the symptoms to ensure full recovery.

As explained in the 'Risk factors' section, causes of depression can be mental or physical, and treatment needs to be tailored to the individual to be successful.

Treatment for depression depends on the nature and severity of the symptoms, and the local availability of services.

Prescription medication

After consultation with a doctor, anti-depressants are often prescribed to treat the symptoms of depression.

There has been a massive increase in the development and effectiveness of anti-depressant drugs over the last 10 years.  New drugs have fewer side effects than more traditional medication, and are easier to tolerate.

Anti-depressants are widely acknowledged to have an effect on the way the brain reacts to serotonin and noradrenaline  the two neurotransmitters related to depression.  Anti-depressant drugs affect the production of neurotransmitters, their effect on the brain, or the way in which they are broken down.

The doctor will select the medication according to the symptoms, nature and severity of depression.  It can take a short period to find the best drug and dosage, as it is normal for the drugs to take two to three weeks to have an affect.

There are 3 main classes of anti-depressant drugs - monoamine oxidase inhibitors (MAOIs), tricyclic and tetracyclic anti-depressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs).

There are also a number of new drugs emerging that do not fit into the main groups of anti-depressants.  These drugs, such as bupropion and venlafaxine are better tolerated by some people, and have different side-effect profiles than more traditional drugs.

Monoamine oxidase inhibitors (MAOIs)
People taking MAOIs have to follow a strict diet due to reactions between tyramine containing foods and the medication.  MAOIs are effective anti-depressants, which tend to be used when other treatments have failed.  Some examples of MAOIs are Isocarboxazid, Nardil and Parnate.

Tricyclics and tetracyclics (TCAs)
TCAs are considered the classic anti-depressant.  They are also used in the treatment of generalised anxiety disorder, post traumatic stress disorder and many other related illnesses.  Dosage varies according to age, body weight, health and tolerance.  Some examples of TCAs are Amoxapine, clomipramine hydrochloride and dothiepin hydrochloride.  Maprotiline hydrochloride is an example of a tertracyclic anti-depressant.

Selective serotonin re-uptake inhibitors (SSRIs)
Effective in a wide range of disorders, SSRIs are some of the most recently developed anti-depressants.  They generally have fewer side effects than other antidepressants and are commonly prescribed.  Fluoxetine, otherwise known as Prozac, is an SSRI, and has become one of the most widely prescribed anti-depressants in the world.  Other SSRIs are Seroxat (paroxetine) and Lustral (sertraline).

In some people, anti-depressants can cause side effects.  These range from a dry mouth to high blood pressure.  Any concerns about side effects should be discussed with a doctor.  A change in dosage or type of medication can often relieve unwanted effects.

When withdrawing from anti-depressants, the dose should be reduced gradually.  This has many benefits, as it prevents unnecessary side effects when treatment is ended abruptly and may reduce the risk of symptoms returning.

Depending on the severity and the nature of the illness, other medications may be used such as mood-stabilising drugs and tranquillisers.  Your doctor will be able to provide more detailed information about these, as they are specific to the illness suffered from.

Medication with anti-depressants is often given for at least 6 months to avoid risk of relapse.

Psychotherapy

Psychotherapy can be as effective as medication for the treatment of mild depression.  More severe illness can be supplemented with medication.  Doctors may recommend different sorts of therapy, depending on the nature and symptoms of the illness. 

There are many forms of psychotherapy, such as psychiatry, counselling groups, or cognitive behaviour therapy.

Counselling
The aim of counselling is to give a person the opportunity to become more self supporting and resourceful.  Counselling can empower and assist with difficult or stressful changes.  In essence, counselling can help life become more positive and satisfying.

The specific nature of counselling varies according to the person's needs.  Some people may have counselling sessions to help deal with a crisis; whereas others may use it to improve relationships or assist in making a decision.  Depending on the person's need, counselling may take place on an individual basis, with a partner or relation, or as part of a group.

The counsellors role is to enable the person to explore and understand their feelings and make their own decisions on the issues facing them.

Cognitive therapy
Cognitive therapy teaches people to adapt thought processes in order that they can cope with the way they are feeling. 

Early stages of therapy show the person how to recognise negative thought patterns that automatically rush through their mind.  Later stages of therapy teach the person to dispute these negative thoughts and replace them with positive ones.

Cognitive therapy develops a new way of dealing with problems, and provides the opportunity to learn techniques that can prevent symptoms of depression returning.

Specialist treatment

Electroconvulsive therapy (ECT) has been used to treat depression and similar disorders for over 50 years.  Severely agitated older people have the best response rates to ECT.  In certain circumstances, ECT is the best treatment and can be life saving.

The use of ECT is closely regulated and there are clear guidelines on who should receive treatment and how consent is obtained from the patient.

ECT involves causing a controlled seizure using an electrical pulse through the patients head.  The procedure is carried out under sedation and the patient receives a muscle relaxant to reduce movements and injury.  The patient usually receives between 6 and 12 treatments, given twice a week.  Most patients stay in hospital overnight whilst receiving ECT.

The use of ECT appears to increase the amount of brain chemicals that are lower in people suffering from depression.  During the development of ECT, it was observed by doctors that patients who suffered from epilepsy and seizures were less depressed after a fit.  ECT induces a fit, afterwards reducing depression.

As with all treatments for depression, ECT is only considered where it is likely to work.  There are side effects including headaches, muscular pain and short-term memory loss.  ECT does not cause long-term brain damage.

Complementary and alternative medicine (CAM)

Relaxation
Relaxation is one of the best stress relievers.  Once relaxation skills have been learnt, they can be used at any time to remove stress and pressure from a persons life.

Relaxation skills can be mastered in many ways, including classes, literature and audio visual methods.

St Johns Wort (hypericum perforatum)
St Johns Wort, a herbal remedy, has been used for medical purposes for over 2000 years.  As well as having an anti-depressant effect, it also has anti-viral and anti-fungal properties.

Although studies have shown that it is as effective as tricyclic drugs for treating mild to moderate depression, it should not be used in conjunction with prescribed anti-depressants.  St Johns Wort can change the performance of the prescribed medication and cause unwanted effects. 

If a person is using prescribed anti-depressants and St Johns Wort, care needs to be taken when they cease the herbal remedy, due to the possible rise of the level of prescribed drug in the body.  You should consult you doctor or pharmacist if you are taking any medication and wish to use or stop using St Johns Wort.

03/06/2009