KIRA STEIN, MD, APC

ADULT PSYCHIATRY - BOARD CERTIFIED ABPN


Treatment Options for Different Types of Depression

Treatment Options for Different Types of Depression


30 August, 2011

Depression Treatment Options For Different Types of Depression

While major depressive disorder can often be a disabling condition, the fact remains that it is highly treatable, with multiple depression treatment approaches available to the modern patient.  Being able to manage depression ishttp://www.dreamstime.com/royalty-free-stock-photos-doctor-patient-explaining-diagnosis-to-her-female-image33438088one of the things that make psychiatry and psychology such rewarding professions. There are different types, or severities, of depression.  For each level of depression, there are usually different depression treatment approaches.

Psychotherapy as a Depression Treatment

Talk therapy comes in various forms, including group, couples, and individual psychotherapy.  Therapy is designed to provide depressed patients with the skills and self-awareness needed to adjust their thought patterns and behaviors in order to manage their symptoms and overcome life stressors.  Psychotherapy is drug free and non-invasive, and the types of depression treatments used in psychotherapy can include:

• Supportive psychotherapy
• Psychodynamic psychotherapy
• Meditation and mindfulness therapy
• Interpersonal psychotherapy
• Cognitive behavioral therapy (CBT) and Dialectical Behavioral Therapy (DBT)

For mild-to-moderate depressions, psychotherapy is often sufficient to achieve remission.  Psychotherapy can take time to take effect, however, and moderate-to-severe depressions can result in difficulties with cognition and motivation that can interfere with psychotherapy, necessitating different depression treatment options.

Antidepressant Medication May Be Needed As A Depression Treatment

Antidepressant medications, another form of depression treatment, are also used to help depressed patients manage their emotions, theoretically by altering neurotransmitter levels in the brain. Neurotransmitters are thought to modulate brain activity, and can be altered through medications to shift the balance from depression to a healthier mood. There are a number of systemic risks associated with taking antidepressants, however, which can include loss of sexual desire, problem with orgasm, nausea, constipation, loose stools, weight gain or loss, anxiety, sedation, seizures, dry mouth and teeth-grinding.  While many people respond to medication depression treatment, some people do not, and require a different depression treatment approach.

There Are Other Depression Treatment Options

Augmentation agents can include antipsychotic medications, anticonvulsants, mood stabilizers, and thyroid hormones. Many patients have seen marked improvement when these agents are added to an antidepressant, but there are also additional risks when taking these medications. For example, antipsychotic medications can be associated with significant weight gain, elevated cholesterol, and diabetes, as well as the development of movement disorders.  If blood levels are not carefully monitored, lithium can reach toxic blood levels, Depakote can cause problems in the liver and pancreas, and inappropriate thyroid hormone replacement can cause bone, heart and anxiety problems, among other potential complications.

Vagus nerve stimulation (VNS) is a more invasive depression treatment.  A stimulator is surgically placed in the patient’s chest, and a wire is run up the patient’s neck, underneath the skin, where it generates electric pulses to stimulate the vagas nerve. It is believed that the vagus nerve triggers various parts of the brain to release neurotransmitters, thereby modulating emotion and mood.  VNS placement involves a minimally invasive procedure, with associated risks.  Associated voice hoarseness usually wears off, but for a minority of cases, it persists indefinitely.

Electroconvulsive therapy (ECT) is a depression treatment that has shown an 80% response rate in depressed patients.  It is an invasive procedure that involves the induction of a seizure, and is performed while a patient is anesthetized.  ECT is not a surgical procedure, but complications from anesthesia can occur and, while associated memory loss is usually transient, it can persist for some.

Transcranial Magnetic stimulation (TMS) is an innovative new depression treatment, and it is a breakthrough in the scientific and clinical treatment of many types of depression.  TMS is indicated for the treatment of mild, moderate or severe major depressive disorder that has failed to fully respond to one complete trial of an antidepressant medication.  TMS itself does not involve the introduction of medications.  There is nothing invasive about the depression treatment procedure, as only magnetic pulses are applied from outside the head in the treatment of the depressed patient. TMS can be used alone as monotherapy, but is often used as an augmentation procedure to medication management in patients who have responded partially to drug therapy.  TMS has been proven to be a safe and effective depression treatment through stimulating or inhibiting activity in the brain to regulate mood.


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