In the last post, I discussed some of the psychological treatments of depression. Today, I want to give just a basic overview of the medical treatments available for depression.
a. How to decide – In psychiatry, we have flexible protocols by which we make decisions about biological treatment for depression. My rule of thumb is to evaluate a client’s level of functioning. If they are depressed but capable of engaging in psychotherapy, keeping up with their activities of daily living, and maintaining healthy relationships with those around them, medication may not be necessary. If however, a client is suicidal, unable to effectively process information, failing to keep up with daily life activities, or isolating from social supports, medication becomes an imperative for healing.
b. The chemical model of treatment – There are two ways in which the nerves communicate. One is through electrical signaling within each nerve and the other is through chemical releases between the nerves. Initial treatment protocols for depression recommend using medications that impact the nerves indirectly through increases in chemical neurotransmitters. There are two main classes: the SSRIs (or selective serotonin reuptake inhibitors) and the SNRIs (or serotonin norepinephrine reuptake inhibitors). These medications act by increasing the levels of neurotransmitters in the spaces between nerves (the synaptic spaces). With consistent use, these medications are thought to change the structure of nerve cells, making them more responsive to chemical signaling and thus more active. An analogy might be the ongoing stimulation of muscles in the arms and legs during weightlifting which increases the overall ability of the body to handle strenuous activity.
c. The electrical model of treatment – The gold-standard for treatment-resistant depression is still electroconvulsive therapy (ECT). Because of side effects, however, many people are reluctant to consent to this. Fortunately we do have medications and some other modalities of treatment that affect the nerves’ electrical signaling. Often, we will use mood stabilizers like lithium to augment the antidepressants’ chemical effects on the brain. Lithium is thought to affect the channeling system that propagates the electrical impulses of nerves. There is also a new treatment available, approved by the FDA, called Transcranial Magnetic Stimulation (TMS) which has shown promise in treating refractory cases of depression. I did a previous post on this treatment modality so I will not go into great detail on it here.
It is important to understand that medications are an integral part of a comprehensive plan for overcoming depression. They are rarely a stand-alone treatment. Just like with diabetes, if you only take insulin but continue to eat McDonald’s super-sized “Happy” meals, your condition is bound to get worse. In the same way, we must treat depression from all angles and be sure to assess faulty thinking, social stressors, and spiritual maturity as we strive for healing.
Question: What about you? Do you know someone who is wrestling with depression? How have you been able to help?