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- What is depression?
- Symptoms of depression
- Causes of depression
- Prevention of depression
- Risk factors for depression
- Complications of depression
- When to see a doctor about depression
- Diagnosis of depression
- Conventional treatment of depression
- Alternative/complementary treatment of depression
- Living with depression
- Caring for someone with depression
Conventional treatment of depression
Treatment may include a combination of medication, individual therapy and community support. Some medical experts believe that electroconvulsive therapy (ECT) can be helpful for depression that has been unresponsive to any type of medication therapy.
The conventional treatment of depression depends on the severity of the symptoms.
Mild depression
Mild depression is often only treated with the following therapies (medication is not normally given for people with mild depression that has not occurred previously):
- Counselling - your doctor may recommend you engage in some counselling with a qualified psychologist or psychiatrist and depending on your income level, Medicare (in Australia) covers a proportion of the costs of counselling for a specific number of counselling sessions
- Online Cognitive Behavioural Therapy (CBT) course - CBT helps you lean to think differently, in a less negative way about yourself and your life. CBT teaches that negative thinking can be a "bad habit" that needs to be untaught. The Australian National University provides an excellent and free CBT course for people who suffer from mild to moderate depression
- More exercise - your doctor may recommend you engage in more exercise each day (depending on your fitness level and health) as exercise can help reduce feelings of depression more quickly than other therapies and is especially beneficial for people with mild depression
- Self Help Books - your doctor may recommend a self help book on depression to provide more in-depth strategies for reducing symptoms
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Moderate depression
Moderate depression is often treated with the following therapies, either independently or in combination, based depending on diagnosis of symptoms:
- Medication - your doctor may try to prescribe some form of anti-depressant medication for your symptoms depending on the severity and duration. The most commonly prescribed anti-depressant medications are:
- Benzodiazepines - these drugs have a mild tranquilising effect, which is why they are often prescribed for people with depression and who have severe insomnia associated with their condition. Benzodiazepines also help to reduce anxiety associated with depression. Benzodiazepines are prescribed at a low and regular dose, but only for a short period. This class of drugs have relatively few side effects (compared with some other types of medications) other than rebound wakefulness in some people, but if taken long term, they can become highly addictive. People who become addicted to benzodiazepines become dependent on them just to feel normal and without taking this drug, they often feel worse than they did prior to when they starting to take it. Examples of benzodiazepines: Lorazepan (Ativan®), Chlordiazepoxide (Librium®), Oxazepam (Oxazepam®), Diazepam (Valium®), Alprazolam (Xanax®)
- Monoamine Oxidase Inhibitors (MAOI) - these medications are the oldest class of anti-depressant medications and they should not be taken in combination with any type of SSRI drugs or St John's Wort as the combination can produce serious (and fatal) side effects. MAOIs can produce serious side effects and their use must be strictly monitored to prevent this from occurring. People are often prescribed MAOIs when other types of anti-depressants have not worked to reduce symptoms. MAOI are the least often prescribed anti-depressants as they have such a large range of side effects and a restrictive diet needs to be followed when taking them. Examples of MAOIs are: Phenelzine (Nardil®), Tranylcypromine (Parnate®), Isocarboxazid (Marplan®),
People taking MAOIs should avoid the following food (to reduce possible adverse effects):- Alcohol
- Avocados
- Broad beans
- Cheese (any type)
- Fermented soy extract
- Salami
- Meat or yeast extract
- Pickled herring
- Food that is stale or going off, especially meat, fish, offal, poultry or game
- Mood stabilisers - these medications are normally prescribed for people with depression in bipolar disorder to help reduce symptoms. Examples of mood stabilisers are: Valproate (Epilim®), Valproate Semisodium (Depakote®), Carbamazepine (Tegretrol®)
- Selective Serotonin Reuptake Inhibitors (SSRI) - these drugs are a newer class of anti-depressant medications which alter the levels of serotonin in the brain (they increase the levels of serotonin to control mood) and to reduce low mood symptoms. SSRIs were a recent anti-depressant medication development, only available from around 30 years ago. These drugs can also produce side effects but these are usually milder in comparison to older antidepressants (MAOI) and side effects normally decrease after some time, for most people. Examples of SSRIs are: Citalopram (Cipramil®), Fluvoxamine (Faverin®), Paroxetine (Seroxat®), Fluoxetine (Prozac®), Sertraline (Lustral®).
SSRI should not be taken in combination with St John's Wort, or any other type of anti-depressants, or MAOI as they can cause a fatal reaction - Tranquilisers - these drugs are another classes of tranquilisers that can be prescribed (which are different to benzodiazepines) that can reduce anxiety symptoms associated with depression very quickly. Some of these different types of tranquilisers may also have fever side effects than benzodiazepines. These tranquilisers are best when used over a short-term, should not be used with MAOIs and should not be used with alcohol. Examples of other tranquilisers are: Buspirone (Buspar®), Hydroxyzine
- Tricyclics - these drugs are an older type of anti-depressant medication which work as well as SSRIs for reducing symptoms of depression. Tricyclics help to increase levels of serotonin and norepinephrine which help to stabilise the mood. These drugs have some side effects which can usually be reduced by lowering the dose or changing to another type of tricyclic medication, but even despite this, a great number of people abandon this medication due to the side effects that they produce. Examples of tricyclics: Amitriptyline (Triptafen®), Clomipramine (Anafranil®), Dosulepin/Dothiepin (Prothiaden®), Doxepin (Sinequan®), Imipramine (Tofranil®), Nortriptyline (Motival®)
- Psychotherapy - this involves any or all of the following treatment options which can be provided by a psychologist, psychiatrist, or qualified counsellor, or through self-help means:
- Cognitive Behavioural Therapy (CBT) - CBT helps you lean to think differently, in a less negative way about yourself and your life. CBT teaches that negative thinking and even depression can be a "bad habit" that need to be untaught
- Mindfulness and Acceptance - mindfulness acceptance therapy is about being present in the moment and relishing it for what it is without stressing about the past or the future. Mindfulness is about allowing yourself to experience a situation and to observe how it makes you feel without judgement, without worry and without negative thinking. It is one way to help accept yourself and be less negative
- Online CBT Therapy - the Australian National University provides an excellent and free CBT course for people who suffer from mild to moderate depression
- Self Help Books - another useful strategy for people with mild to moderate depression is to use self-help books by qualified authors who can provide detailed advice on how to conquer the symptoms of depression step-by-step, usually through some form of CBT or mindfulness therapy
Severe (major) depression
People with severe (or major) depression will be offered the same medications as people with moderate depression (above), but at higher doses.
People with really severe depression that has not responded to any form of medication or other therapy can also be offered electroconvulsive therapy (ECT).
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a procedure where the person's brain is hooked up to electric wiring and a level of electric currents is passed through the wires to the brain. This form of "electric shock" therapy will cause a brief seizure, which also causes some changes in the brain chemistry. The person will be anaesthetised first, to prevent any pain from this procedure before the electric current is allowed to pass through the brain. ECT normally occurs over two to three treatments (sometimes more for really severe cases).
Proponents of ECT suggest that it helps to alleviate symptoms of certain mental illness in people, as it uses precisely calculated electrical currents that are administered carefully by specialists and aims to provide benefits with little risk.
Despite this, ECT remains a very very controversial therapy, even since it was introduced over 70 years ago as there are a number of possible side effects and risks following the procedure, including:
- Cognitive impairment - straight after an ECT treatment people experience confusion in the though processes, they wont know where they are, or why they are there. This cognitive impairment last seconds to minutes after the ECT procedure but usually goes away after ECT treatment has been totally completed
- Medical complications - in any procedure where anaesthesia is used, there is a small risk of death and prior to the ECT there are a number of tests that are performed to determine eligibility for this procedure
- Memory loss - ECT can cause memory loss, ranging from inability to remember events (from weeks to months) leading up to the procedure, to inability to recall events after the procedure and for a very rare few, these memory loses are permanent
- Physical pain - many people experience a range of physical problems after the procedure, including nausea, vomiting, headache, muscle ache or jaw pain
The depressed people who are in any of the following groups only are offered electroconvulsive therapy (ECT):
- People who are severely depressed and have major psychosis
- People who are severely depressed and are suicidal or refuse to eat at all
- People who are severely depressed, have bipolar disorder and whose mania hasn't improved with any type of medication or other treatment
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