Depression Treatment, Part 3

by National Institute of Mental Health (NIMH)

(Page 6 of 7)

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is another treatment option that may be particularly useful for individuals whose depression is severe or life threatening, or who cannot take antidepressant medication. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. The exact mechanisms by which ECT exerts its therapeutic effect are not yet known.

In recent years, ECT has much improved. Before treatment, which is done under brief anesthesia, patients are given a muscle relaxant. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) generalized seizure within the brain, which is necessary for therapeutic efficacy. The person receiving ECT does not consciously experience the electrical stimulus.

A typical course of ECT entails six to 12 treatments, administered at a rate of three times per week, on either an inpatient or outpatient basis. To sustain the response to ECT, continuation treatment, often in the form of antidepressant and/or mood stabilizer medication, must be instituted. Some individuals may require maintenance ECT (M ECT), which is delivered on an outpatient basis at a rate usually of one treatment weekly, tapered off to bi weekly to monthly for up to one year.

The most common side effects of ECT are confusion and memory loss for events surrounding the period of ECT treatment. The confusion and disorientation experienced upon awakening after ECT typically clear within an hour. More persistent memory problems are variable and can be minimized with the use of modern treatment techniques, such as application of both stimulus electrodes to the right side of the head (unilateral ECT). A recent study showed no adverse cognitive effects of M ECT after one year.

Herbal Therapy

In the past several years, there has been an increase in public interest in the use of herbs for the treatment of both depression and anxiety. The extract from St. John's wort (Hypericum perforatum), a wild growing plant with yellow flowers, has been used extensively in Europe as a treatment for mild to moderate depression, and it now ranks among the top selling botanical products in the United States. Because of the increase in Americans' use of St. John's wort and the need to answer important remaining questions about the herb's efficacy for long term treatment of depression, the National Institutes of Health (NIH) conducted a clinical trial to determine whether a well standardized extract of St. John's wort is effective in the treatment of adults suffering from major depression of moderate severity. The trial found that St. John's wort was no more effective for treating major depression of moderate severity than an inert pill (placebo). Another study is underway looking at St. John's wort for the treatment of minor depression.

Research from NIH has shown that St. John's wort interacts with some drugs including certain drugs used to control HIV infection. The Food and Drug Administration issued a Public Health Advisory on February 10, 2000, which stated that the herb appears to affect an important metabolic pathway that many prescription drugs use to treat conditions such as heart disease, depression, seizures, certain cancers, and rejection of organ transplants. The same pathway is also responsible for the effectiveness of oral contraceptives to prevent pregnancy. Using the herb may limit the effectiveness of these medications. People taking HIV medications should be especially careful since St. John's wort may reduce the HIV medication levels in the bloodstream and could allow the AIDS virus to rebound, perhaps in a drug resistant form. Health care providers should alert their patients about these potential drug interactions, and patients should always consult their health care provider before taking any herbal supplement.

How to Help Yourself if You Are Depressed

"It affects the way you think. It affects the way you feel. It just simply invades every pore of your skin. It's a blanket that covers everything. The act of pretending to be well was so exhausting. All I could do was shut down. At times you just say 'It's enough already.'"

— Steve Lappen, Writer

Depressive disorders can make one feel exhausted, worthless, helpless, and hopeless. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

• Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, or other activities.

• Set realistic goals and assume a reasonable amount of responsibility.

• Break large tasks into small ones, set some priorities, and do what you can as you can.

• Try to be with other people and to confide in someone; it is usually better than being alone and secretive.

• Participate in activities that may make you feel better.

• Expect your mood to improve gradually, not immediately. Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.

• Postpone important decisions. Before deciding to make a significant transition-change jobs, get married or divorced-discuss it with others who know you well and have a more objective view of your situation.

• Do not expect to 'snap out of' a depression. But do expect to feel a little better day by day.

• Remember, positive thinking will replace the negative thinking as your depression responds to treatment.

• Let your family and friends help you.

About the Author

www.nimh.nih.gov
The National Institute of Mental Health (NIMH) is one of 27 components of the National Institutes of Health (NIH), the Federal government's principal biomedical and behavioral research agency. NIH is part of the U.S. Department of Health and Human Services.