What is depression and what can I do about it?

Depression is a treatable mental illness. There are three components to the management of depression:

• Support, ranging from discussing practical solutions and contributing stresses, to educating family members.
• Psychotherapy, also known as talking therapies, such as cognitive behavioral therapy (CBT).
• Drug treatment, specifically antidepressants.

Psychotherapy

Psychological or talking therapies for depression include cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and problem-solving treatment. In mild cases of depression, psychotherapies are the first option for treatment; in moderate and severe cases, they may be used alongside other treatment.

CBT and interpersonal therapy are the two main types of psychotherapy used in depression. CBT may be delivered in individual sessions with a therapist, face-to-face, in groups, or over the telephone. Some recent studies suggest that CBT may be delivered effectively through a computer

Interpersonal therapy helps patients to identify emotional problems that affect relationships and communication, and how these, in turn, affect mood and can be changed.

Antidepressant medications

Antidepressants are drugs available on prescription from a doctor. Drugs come into use for moderate to severe depression, but are not recommended for children, and will be prescribed only with caution for adolescents.

A number of classes of medication are available in the treatment of depression:

• selective serotonin reuptake inhibitors (SSRIs)
• monoamine oxidase inhibitors (MAOIs)
• tricyclic antidepressants
• atypical antidepressants
• selective serotonin and norepinephrine reuptake inhibitors (SNRI)

Each class of antidepressant acts on a different neurotransmitter. The drugs should be continued as prescribed by the doctor, even after symptoms have improved, to prevent relapse.

A warning from the Food and Drug Administration (FDA) says that “antidepressant medications may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.”

Any concerns should always be raised with a doctor – including any intention to stop taking antidepressants.

Exercise and other therapies

Aerobic exercise may help against mild depression since it raises endorphin levels and stimulates the neurotransmitter norepinephrine, which is related to mood.

Brain stimulation therapies – including electroconvulsive therapy – are also used in depression. Repetitive transcranial magnetic stimulation sends magnetic pulses to the brain and may be effective in major depressive disorder.

Electroconvulsive therapy

Severe cases of depression that have not responded to drug treatment may benefit from electroconvulsive therapy (ECT); this is particularly effective for psychotic depression.

Types

Unipolar and bipolar depression

Symptoms of depression include reduced interest in pleasurable activities and lower mood.

If the predominant feature is a depressed mood, it is called unipolar depression. However, if it is characterized by both manic and depressive episodes separated by periods of normal mood, it is referred to as bipolar disorder (previously called manic depression).

Unipolar depression can involve anxiety and other symptoms – but no manic episodes. However, research shows that for around 40 percent of the time, individuals with bipolar disorder are depressed, making the two conditions difficult to distinguish.

Major depressive disorder with psychotic features

This condition is characterized by depression accompanied by psychosis. Psychosis can involve delusions – false beliefs and detachment from reality, or hallucinations – sensing things that do not exist.

Postpartum depression

Women often experience “baby blues” with a newborn, but postpartum depression – also known as postnatal depression – is more severe.

Major depressive disorder with seasonal pattern

Previously called seasonal affective disorder (SAD), this condition is related to the reduced daylight of winter – the depression occurs during this season but lifts for the rest of the year and in response to light therapy.

Countries with long or severe winters seem to be affected more by this condition.