Depression Treatment: Most people throughout North America and indeed the world never get treatment for depression. This is a shame, because for most, treatment is simple and highly effective. It’s generally at least as effective, for example, as the treatments for asthma and arthritis.
For a variety of reasons, most books, websites, and lecturers will urge their audience to seek the care of a licensed professional. This is in general good advice, and in the United States and elsewhere legally only a licensed professional can make a diagnosis or prescribe a course of treatment.
It is important to understand your choices, however, and being an informed and active consumer will allow you to obtain care that is most likely to be helpful to you. It used to be that people who recognized a need for treatment had two basic choices: see a therapist for talk therapy, or see a doctor for medication. It is now clear that as with any type of illness, there is much a person can do to help their condition on their own, and indeed self-help should be part of all treatment.
Self-help: Although self-help as part of treatment with a professional is always a good idea, before embarking on a self-help only approach, realize that depression is a confusing and dangerous illness. Over 30,000 die from suicide each year in the U.S. alone, nearly as many as die in automobile accidents. Depression causes most of these suicides. Depression distorts judgment. If it is starting to weaken your will to live, don’t trifle with it. If in your own fully honest self-evaluation, there is any chance you might attempt suicide, there is no question: you must promptly secure high quality assistance from a professional.
Medication Overview:: The public often views the prospect of taking a medication for depression with inappropriate alarm. Just as taking aspirin for a back sprain can both relieve pain and allow more rapid physical rehabilitation, medications for depression can both relieve symptoms and speed return to a more satisfying and less stressful life.
It is also likely that there is a significant overall health benefit from treating depression. Untreated depression doubles the mortality the year following a heart attack, and is associated with substantially worse prognosis in diabetes, asthma, and at least some forms of cancer. Other data suggests it increases mortality across the entire population, including those without other specific diseases.
In contrast to these known risks of untreated depression, there are virtually no established significant long-term medical risks for any of the modern medications for depression. In fact, such over-the-counter staples such as aspirin and ibuprofen have more prominent side-effects, can cause more progressive damage to vital organs, and are far deadlier in an overdose.
Antidepressant Medications: There are over 15 medications approved by the U.S. FDA for the treatment of depression. All are effective, and research has not proven one to be more potent than any other. Although scientists have determined a considerable amount about the sites these medications bind to in the brain, there is little understanding of why such binding relieves depression or about the biochemical causes of depression itself. Other than automated self-report systems like Automated Self-Report Screener™, there are as yet no clinically useful lab tests for depression.
Antidepressant medications are grouped either by their chemical structure or by the sites in the brain to which they bind. In general, the most important distinction is between the risks associated with the older classes of antidepressants, and the relative safety of the newer medications which were released after 1986. While the newer medications tend to be quite safe in the case of an accidental or intentional overdose, the older ones can be deadly.
The key to selecting an antidepressant medication is finding a physician whom you trust. In the United States, all antidepressant medications require the prescription of a licensed clinician. The herbal remedy St. John’s Wort is available without a prescription in most health food stores and in an increasing number of drug and grocery stores. Research demonstrates that it has some antidepressant effect, at least in mild to moderate depression. Choosing a prescription medication should be a collaboration with a physician, in which the physician provides you with expert information and informed advice. Remember the treatment is for you, not your physician, and you should feel guided, not rail-roaded.
Serotonin Reuptake Inhibitors: Also known as SSRIs and SRIs, they are named for their binding to the serotonin reuptake site in the brain. The SSRIs are all structurally distinct from each yet other fit into the same receptor in the brain, like different shape keys that all fit into the same lock. The majority of those taking SSRIs report few or minimal side effects. At the same time, virtually any medication can cause virtually any side-effect in a particular person. The most common SSRI-induced side-effects are decreased sexual interest and difficulty having orgasm, nausea, diarrhea, anxiety, agitation, increased tiredness, insomnia, and changes in appetite.
Physician/Prescriber: In the United States, getting an antidepressant prescription generally requires getting treated by a physician. The major choice among physicians is between a psychiatrist and any other type of doctor. Psychiatrists in general have the most training and experience in using antidepressant medications, but some people simply prefer not to see a psychiatrist. There are non-psychiatrists who are quite expert at prescribing antidepressants, but that is the exception.
There is no certain way to assess the amount of expertise a physician has using antidepressants, but in general, the more patients they have treated with antidepressants, the better. Several hundred or more in the past year is quite active for a psychiatrist, several dozen in the past year is active for a non-psychiatrist. Most physicians no matter what specialty will have a psychiatrist to whom they can refer you. Obstetrician-gynecologists, neurologists, internists, oncologists and primary care physicians all see many patients with depression, and either will be able to provide a referral or treat you themselves.