Treating depression
Antidepressant medication
Although depression has been recognised for over two thousand years, the modern era of treatment with effective drugs has only occurred over the last 50-60 years. In spite of advances in our understanding all mainstream antidepressants act in a similar way, increasing the function or serotonin and/or noradrenaline. However only 50-70% of people with depression are helped by taking anti-depressant drugs which means that we need to understand why some people don’t benefit and to develop new types of treatment.
Psychological / Complementary therapies
Specific psychological treatments such as cognitive behavioural therapy, interpersonal psychotherapy and behavioural activation are also effective treatments for depression but, like antidepressants, don’t work for everyone.
There is more limited evidenced for other approaches that may help to alleviate the symptoms of depression in some people. The best evidence is for St. John's Wort, exercise and light therapy (for seasonal affective disorder).
Physical treatments
For severe and treatment-resistant depression electroconvulsive therapy (ECT) is very effective and can be life-saving. ECT is viewed a controversial treatment by some people.
Newer techniques include vagus nerve stimulation, transcranial magnetic stimulation and deep brain stimulation but these are best thought of as experimental at present.
Staying well
There is a lot of emphasis on getting better from depression but it is not often realised that staying well is an equally big challenge. The most risky time for relapse is just after getting better and this is why antidepressants need to be continued for 6-9 months after full improvement or else there is a greater than 50% chance of relapse over that period.
In addition depression is a recurrent illness for many people and it can come back even without new stresses or triggers. Each time depression comes back there is a risk that the sufferer will have a long illness or at the worst not fully recover. The best evidence for preventing depression coming back is continuing antidepressants, sometimes indefinitely. There is also some evidence that certain types of psychological treatment can help prevent recurrence.
If you have been treated for depression make sure you ask your doctor/therapist about your risk of relapse and how to reduce this.
