Treatment of Depression

Treatment

Major depressive disorder and bipolar disorder are treated with medication or psychotherapy, or a combination of the two. Medication is used to treat the physical aspect of depression—to relieve symptoms such as loss/gain of appetite, lack of concentration, and irritability, and to clinically balance the brain so that recovery is possible. Psychotherapy is used to treat the mental aspects of the disease, attacking thinking patterns or factors in one's life that may have caused the disease, such as an abusive relationship or lack of self-esteem. Contrary to popular belief, antidepressants are not "happy pills" and do not completely cure depression. Individuals who have bipolar disorder are usually more dependent on medications to balance out their moods, but medication does not cure bipolar disorder, either, and many people stay on drugs for life. There are a number of different hypotheses about what is the most effective medication with which to treat depression. All of the following hypotheses describe different types of antidepressants and are centered around two monoamine neurotransmitters, serotonin and noradrenaline, that were briefly described in the Causes page.

Biogenic Amine Hypothesis states that depression is caused by monoamine deficiency, specifically lacking in serotonin and noradrenaline; therefore, drugs that increase monoamine levels will help control depression. There are two methods of treatment used in accordance with this hypothesis. The first type of medication is an MAOI (monoamine oxidase inhibitor). After neurotransmitters bind to a receptor site on a postsynaptic neuron, the remainder of the neurotransmitter is taken back to the presynaptic neuron, in a process called reuptake. There the neurotransmitter is recycled into storage vessels or metabolized by the MAO enzyme—the process of degradation. MAOIs block MAO and increase the availability of monoamines. Another type of antidepressant, called TCAs (tricylic antidepressants), blocks the reuptake process by preventing the presynaptic neurons from reclaiming the neurotransmitters in the postsynaptic neurons. This also increases the amount of monoamines. However, this hypothesis may be incomplete or incorrect. Tests indicate that TCAs and MAOIs increase the amount of neurotransmitters within hours, but the symptoms of depression are not relieved for weeks. Scientists have developed a few more theories to explain this.
Receptor Sensitivity Hypothesis says that depression is the result of supersensitivity and up-regulation in receptors, which is caused by monoamine deficiency. Monoamines and other neurotransmitters stimulate the receptor sites, the act of which normalizes the response sensitivity. Supersensitivity is when the postsynaptic neuron tries to compensate for lack of stimulation by increasing the responsiveness of the receptors. Sometimes the neuron also ads new receptor sites, which is called up-regulation. MAOIs and TCAs increase the amount of neurotransmitters, which desensitize receptor sites and provide relief from the symptoms of depression. This theory may explain the delay in the Biogenic Amine Hypothesis.
Serotonin-Only Hypothesis claims that serotonin levels play a bigger role in depression than noradrenaline levels. SSRIs, serotonin reuptake inhibitors, block the reuptake of serotonin and have been proven to have fewer side effects than other antidepressants. However, this theory does not explain the delay in relief of symptoms, or what the role of noradrenaline is. Studies have shown that both neurotransmitters play equal roles in depression.
Permissive Hypothesis states that emotional behavior is controlled by a balance of seratonin and noradrenaline. Both the manic and depressive phases of bipolar disorder are characterized by low serotonin levels. When serotonin levels are low and noradrenaline levels rise, it causes mania. When both serotonin and noradrenaline levels fall, it causes depression. A new class of medication, called SNRIs, block the reuptake process of both noradrenaline and serotonin, and cause less side effects than TCAs.

_{Specific areas of the brain, shown in red, are activated after
a depressed person is on antidepressants for several weeks}

Bipolar disorder is also treated with lithium and anticonvulsants. Antidepressants are sometimes used during depressive episodes, and antipsychotic medications may be used, depending on the severity of the disease. Lithium is the most common drug used to treat bipolar disease. Lithium evens out mood swings and prevents both depression and mania. It diminishes severe manic symptoms within 5-14 days, but takes awhile to completely take control. Lithium is a very powerful drug, and side effects can be fairly severe; overdose will result in death. It is unknown why the drug is so effective. Anticonvulsants, such as carbamazepine, are usually used for epilepsy, but some individuals who are afflicted with bipolar disorder respond very well to this type of medication. A newer type of anticonvulsant, divalproex sodium, controls the symptoms of bipolar disorder about as powerfully as lithium, with less side effects. Victims of bipolar disorder usually remain on these medications for indefinite periods of time, sometimes for life. There is no cure. Medications stabilize the disease, but victims must still learn self-monitoring skills to recognize and prevent a major attack of mania or depression. This is where psychotherapy comes into play.

There are several different stages of psychotherapy, although many individuals do not continue past the first stage. There are also different types of psychotherapy, but the following formula has been proven to be the most effective. Supportive counseling is the first stage. This type of counseling is basically used to provide support in dealing with the symptoms of depression, often used when the patient goes on medication. Cognitive therapy is then applied to change troublesome thinking patterns that have caused or contributed to depression. Problem-solving therapy helps individuals change the areas of their lives that are contributing to depression.

Cognitive behavior therapy is a very effective and increasingly more common type of psychotherapy that combines cognitive and behavioral therapy. The cognitive aspect is used to resolve distorted thinking patterns; the behavioral aspect diminishes certain reactions, such as anger, fear, or depression, toward certain situations and teaches one how to calm the mind and body in order to think more clearly. "Homework assignments" are usually given, in order for the patient to practice certain thought and behavioral patterns. The therapy usually only lasts for a few weeks or months, and is most often tried without medication; however, in some cases (such as bipolar disorder) drugs are essential, and sometimes patients use drugs for a short period of time to reduce the symptoms and help the therapy be more effective. Studies show that cognitive behavior therapy is just as effective as drugs in treating depression, and that treatment failure is more likely when drugs are used, because of the side effects they can produce.

One may be afflicted by symptoms of major depressive disorder or bipolar disorder for an entire lifetime. Medication, specifically SSRIs, only helps about 50% of the American population, and 80% of those in cognitive therapy will relapse. Most of those who have suffered from a major depressive episode previously in life will suffer through one again. But treatment can greatly reduce the symptoms and contributing factors to the disease, and help individuals learn to live with remaining symptoms. Given time, one will feel happiness again.

Life with Depression
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