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DIFFERENT TYPES OF DEPRESSION TREATMENT

Different types of depression require different types of treatment. Selecting the best treatment for a specific patient involves determining his or her type and degree of depression and its possible causes. Both psychotherapeutic and pharmacological modes of treatment are recommended for clinical (severe and prolonged) depression. Drugs often relieve the symptoms of depression, such as loss of sleep or appetite, while psychotherapy can improve a depressed persons social and interpersonal functioning. Treatment may be weighted toward one or the other mode depending on the specific situation. In some cases, psychotherapy alone may be the most successful treatment. The two most common psychotherapeutic therapies for depression are cognitive therapy and interpersonal therapy.

Cognitive therapy aims to help a patient look at life rationally and to correct habitually pessimistic thought patterns. It focuses on the here and now rather than analyzing a patients past. To pull a person out of depression, cognitive therapists usually need 6 to 18 months of weekly sessions comprising reasoning and behavioral exercises.

Interpersonal therapy has also proved successful in the treatment of depression and is sometimes combined with cognitive therapy. It also addresses the present but differs from cognitive therapy in that its primary goal is to correct chronic human relationship problems. Interpersonal therapists focus on patients' relationships with their families and other people.

Antidepressant drugs relieve symptoms in nearly 80 percent of people with chronic depression. Several types of the antidepressant drugs known as tricyclics are available and work by preventing the excessive absorption of mood-lifting neurotransmitters. Tricyclics can take from six weeks to three months to become effective. Newer antidepressant drugs, called tetracyclics, work in one or two weeks.

In recent years, words like Zoloft and Prozac have become such a common part of our vocabulary that it doesn't seem at all unusual to know someone who is taking an antidepressant. Such frequency of use could lead one to think that antidepressants can be taken like aspirin. However, countless emergency room visits occur when people misuse antidepressants, decide to quit by going "cold turkey," or react to the type of antidepressant they are taking. The potency and dosage of each vary greatly. Antidepressants should be prescribed only after a thorough psychological and physiological examination. If your doctor suggests putting you on an antidepressant, ask these questions first:

• What biological indicators are you using to determine whether I really need this drug? (Beware of the health professional who gives you a 5-minute exam, asks if you are feeling down or blue, and prescribes an antidepressant to fix your problems.)
• What is the action of this drug? What will it do, and when will I start to feel the benefits?
• What is your rationale for selecting this antidepressant treatment over other antidepressants that are available?
• What are the side effects of using this drug?
• How long can I be on this medication without significant risk to my health?
• What happens if I stop taking this medication?
• How will you follow up or monitor the levels of this drug in my body? How often will I need to be checked?

Electroconvulsive therapy (ÅÑÒ) is another treatment for depression. A patient given ÅÑÒ is sedated under light general anesthesia, and electric current is applied to the patient's temples for five seconds at a time for a period of about 15 or 20 minutes. Between 10 and 20 percent of people with depression who do not respond to drug therapy are responsive to ÅÑÒ, but because a major risk associated with ÅÑÒ is permanent memory loss, some therapists do not recommend its use under any circumstances.

Clinics have been established in large metropolitan areas to offer group support for depressed people. Some clinics treat all types of depressed people; others restrict themselves to specific groups, such as widows, adolescents, or families and friends of people with depression.

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