How to Treat Depression
The author has made an extensive search for the kinds of treatments available and has created this list of treatments that are likely to work according to individual needs. Usually treatments work best in conjunction with other treatments, e.g. Herbal Medicine or Homeopathic Medicine may work better in conjunction with Cognitive Behavioral Therapy.
Types of Treatment for Depression
See your doctor about Medical Treatment. Your doctor may prescribe some medication or refer you to a Mental Health Specialist for further treatment. Mental Health Specialists (psychiatrists) are trained to prescribe certain drugs and usually provide psychotherapy.
There is increasing consumer awareness about side effects of medication and many doctors are becoming cautious about prescribing medication.
In particular Dr Mercola, see his article here
The three groups of drugs most likely to be used for depression are antidepressants, tranquilizers and anti-manic drugs or mood stabilizers.
There are a large number of antidepressants. They have a role in many types of depression and vary in their effectiveness across the more biological depressive conditions.
Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) are three common classes of antidepressants. The latter two are characterized by broader actions. They each work in different ways and have different applications.
Clinicians at the Black Dog Institute firmly believe that it is important to find the right antidepressant as different antidepressants produce different effects and results in different people. If the first antidepressant does not work, it is sensible to move to a different kind of antidepressant. For the biological depressive disorders, more broad action antidepressants are usually more effective.
A well-informed health professional should be able to use assessment and their understanding of the person to determine the type of depression and its likely causes. The health professional can then identify the medication most likely to benefit or decide to not recommend medication at all. The latter decision is just as important.
Tranquilizers can be classified as ‘minor’ or ‘major’ tranquilizers. Minor tranquilizers (typically benzodiazepines) are not helpful in depression; they are addictive and can make the depression worse. Major tranquilizers are very useful in people with a psychotic or melancholic depression where the person is not being helped by other medications
‘Anti-manic’ drugs or ‘mood stabilizers’ are of great importance in Bipolar Disorder. Their use in treating mania makes them ‘anti-manic’, while their ability to reduce the severity and frequency of mood swings makes them ‘mood stabilizers’. Lithium, valproate and carbamazepine are the most common mood stabilizers.
It is important to remember that the anti-depressants and mood stabilizers are often necessary both to treat the depression that is occurring now, and to make a relapse in the future less likely. Consequently, people may need to continue taking medication for some time after they are better.
There is a wide range of psychological treatments for depression. Some of the main ones are:
- Cognitive Behavior Therapy (CBT)
- Interpersonal Therapy (IPT)
- Acceptance Commitment Therapy (ACT)
- Narrative Therapy
Psychological treatments provide either an alternative to medication or work alongside medication. As always, a thorough assessment of the person should be carried out in order to decide on the best set of approaches.
Cognitive Behavior Therapy (CBT): People suffering from depression – particularly ‘non-melancholic depression’ – will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how they think about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don’t even notice the errors of judgment caused by thinking irrationally.
CBT aims to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. It is based on the understanding that thinking negatively is a habit, and, like any other bad habit, it can be broken.
CBT is conducted by trained therapists either in one-on-one therapy sessions or in small groups. ‘Homework’ may also be assigned between sessions. Between six and ten sessions can be required but the number will vary from person to person.
CBT is one of the more effective treatments available for depression.
Mindfulness Based Cognitive Therapy (MBCT): MBCT includes basic education about depression and several exercises from cognitive therapy that show links between thinking and feeling and how participants can best look after themselves when depression threatens to overwhelm them.
MBCT has been used as a relapse prevention strategy with encouraging results. People who had suffered three or more episodes of depression before learning the practice reduced their relapse rate to 36% compared to 78% in the control group.
Interpersonal Therapy (IPT) The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, and social roles) and personality.
Therefore, the underlying assumption of interpersonal therapy is that depression and interpersonal problems are interrelated.
The goal of interpersonal therapy is to understand how these factors are operating in the person’s current life situation leading them to become depressed and putting them at risk of future depression. Usually 12-16 sessions of IPT will be required.
Acceptance Commitment Therapy (ACT) ACT is a type of CBT. It is thought to work by helping people to stop avoiding difficult experiences, especially by “over thinking” these experiences. Over thinking occurs when people focus on the “verbal commentary” in their mind rather than the experiences themselves.
ACT encourages people to accept their reactions and to experience them without trying to change them. Once the people have done this, they are then encouraged to choose a way to respond to situations that is consistent with their values, and to put those choices into action.
Psychotherapies Psychotherapy is an extended treatment (months to years) in which a relationship is developed between the therapist and the patient. The relationship is then used to explore aspects of the person’s experience in great depth. Understanding the link between past and present and.the supportive relationship between therapist and patient are thought to resolve the depression and make the person less vulnerable to becoming depressed again.
Counseling Counseling encompasses a broad set of approaches and skills that aim to help an individual explore problems and preferred scenarios. Counseling helps people with long-standing problems in the family or at work, as well as sudden major problems (crisis counseling).
Narrative Therapy (NT) Narrative Therapy is a form of counseling based on understanding the ‘stories’ that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how the stories may restrict them from overcoming their present difficulties
NT sees problems as being separate from people and assists the individual to recognize the range of skills, beliefs and abilities that they already have (but may not recognize) and that they can apply to the problems in their lives.
Narrative Therapy differs from many therapies in that it puts a major emphasis on identifying people’s strengths, highlighting evidence of mastering problems in the past. It seeks to build on people’s resilience rather than focus on their negative experiences.
Hypnotherapy The use of Hypnotherapy in treatment of depression has recently come under focus thanks to the investigations by Dr Ernest Rossi, a Clinical Psychologist and Hypnotherapist.
Dr Rossi has had a passionate interest in Psychosocial Genomics since the early seventies. The unraveling of the human genome and the mapping of human genes has broadened this area of research.
The introduction of microarray analysis has now made it possible to analyze changes in gene expression before and after a therapy. Experimentation by Dr Rossi has proved that changes in gene expression do occur after hypnosis.
Another pioneer in the use of Hypnotherapy for depression is Dr Michael Yapko. Dr Yapko has broken down into major categories the factors that contribute to the maintenance of depression and has developed therapy that addresses each of those factors, resulting in a complete system of treatment of depression using Hypnotherapy.
Finally a recent study has shown that when depression is a component of physical illness, better recovery is achieved when Hypnotherapy is used as part of the treatment.
For Hypnotherapy see: http://www.hypnosissydney.net.au
This group covers a wide range of modalities. I have learnt to not dismiss anything offered within this range because no matter how ridiculous or “way out” it may seem, there is always someone who benefits from it. In this book I will focus on the better known complementary therapies.
Acupuncture: Eight small studies were conducted with depressed people that compared acupuncture with “sham” acupuncture (i.e. very shallow insertion of needles with no stimulation). The number of sessions varied between 10 and 30. The pooling together of results from the eight studies found that acupuncture reduced depression symptoms.
How does it work?
Traditional Chinese Medicine (TCM) believes it works by correcting the flow of energy (chi) in the body. Western Medicine believes it may stimulate nerves which results in the release of serotonin and norepinephrine. It is because these neurotransmitters that are thought to be lacking in people suffering depression.
Dance and Movement Therapy (DMT) – DMT combines expressive dancing with more usual psychological therapy approaches to depression, such as discussion of a person’s life difficulties.
A DMT session usually starts with a warm up then a period of expressive dancing or movement. This is followed by a discussion of the client’s feelings and thoughts about the experience and how it relates to their life situation.
DMT appears to be a helpful treatment for depression when used with other established treatments rather than on its own.
Light therapy is the best treatment for Seasonal Affective Disorder (SAD) and may also be useful for depression when used with antidepressants. The best effect is obtained when exposure is 5,000 lux per hour.
It is important the correct kind of light is used and that you are not directly looking at the light. Mild side effects can occur; such as nausea, headache, jumpiness or jitteriness, and eye irritation.
If you wish to find out more or purchase light therapy devices please see: http://www.lighttherapy.com.au/products.php?cat=8
Two studies on massage were carried out: one with depressed children and adolescents and one with depressed pregnant women. The studies compared massage with relaxation therapy.
The result was a short term improvement after one massage and longer term improvements with regular massages over days or weeks.
A professional and caring massage therapist can be found at http://www.massagesydney.biz
Negative Air Ionization
A negative air ionizer is a device that uses high voltage to electrically charge air particles. Breathing these negatively charged particles is thought to improve depression.
A study was carried out with adults who had been depressed for a long time. They were exposed to high density negative ionization one hour each day or to a placebo (low density ionization). Half of these people recovered compared to none who received the placebo.
Another study carried out with people suffering Seasonal Affective Disorder (SAD). This study also confirmed success with Ionization compared to placebo.
For Air ionizing appliances go to: http://www.echolife.com.au/categories/natural-health/appliances.html
There are different types of relaxation training. The most common one teaches the person to relax by voluntary tensing and relaxing specific groups of muscles. Another type of relaxation training involves thinking of relaxing scenes or places.
Several small studies have been carried out. The pooling of results showed that relaxation training reduced depression more than no treatment, but not as effectively as psychological therapies.
Relaxation training can be learnt through a professional or with a CD. Recorded instructions can be found for free on the internet.
Herbal, Homeopathic and Nutritional Supplements
Back in the days when I was depressed most doctors believed that Nutritional Supplements were totally unnecessary. The standard opinion was you get all the vitamins and supplements if you eat properly.
Nothing could be further from the truth! The fact that you are depressed itself indicates that there is something lacking. The mind and body cannot be separated otherwise your brain would keep working if your head was removed from your body.
Furthermore, agricultural practices these days are not geared to producing the most nutritious food. They are more concerned with size, quantity and appearance of the vegetables or fruit. Most of the soils in which the crops are grown have been depleted of nutrients.
Then there’s the use of herbicides, insecticides and other sprays. Organically grown food is much better though usually more expensive.
Therefore it makes sense that if there is a deficiency in emotional and psychological functioning then there could be a nutritional deficiency as well.
Herbs: Mankind has used herbs for millions of years. The World Health Organization reports that 80% of the world population still uses herbs as a primary form of treatment.
The use of herbs for medicinal, religious, cultural or recreational reasons has been well documented and there is now much scientific evidence that supports the traditional use of many herbs.
Herbs are powerful agents and it is recommended you seek consultation with an experienced herbalist to determine which herb or mixture of herbs best suits your condition. The following list is provided for educational reasons only.
St John’s Wort (Hypericum perforatum) this herb has been shown to relieve anxiety and mild depression.
Gotu Kola (Centella asiatica) – A brain tonic
Brahmi (Bacopa moniera) – Another brain tonic, it is calming and assists with learning and memory.
Gingko (Gingko biloba) – Stimulates blood circulation to the body peripherals and hence it brings more oxygen to the brain. It can have a revitalizing effect and improve memory and learning.
Winter Cherry (Withania somnifera) – Can be calming and help with sleep.
Ginseng – There are various forms of Ginseng. The most appropriate one to use would depend on your constitution and various other factors. Contra-indications: Large doses may cause depression, insomnia and nervous disorders. Do not combine with any herbal remedies containing iron, or with Indian or China tea.
Vervain (Verbena officinalis) – Used in the treatment of nervous complaints such as depression and with other remedies in skin complaints.
Homeopathic: There are homeopathic remedies available for depression. Classical homeopaths can prescribe classical remedies. There is also a modern form of homeopathy that is a bridge between allopathic remedies and homeopathic remedies.
Nutritional supplements: A good vitamin B complex assists the nervous system.
5 HTP (5 – hydroxytryptophan) – can increase serotonin levels.
DHA (docosahexaenoic acid) – is found in fish oil. It is important to use fish oil with a high DHA: EPA ratio.
Herbs, homeopathies and nutritional supplements can be used alone or in combination. It is better to get professional advice to avoid unnecessary expenditure on misinformed choices.
It is best to start these treatments with detoxification. This will result in better and more effective absorption of herbs, homeopathies or nutritional supplements. Adequate detoxification can be obtained though Aloe Vera Juice.
See www.medicalherbalist.com.au for herbs,homeopathies and nutritional supplements.