Depression : Non-Drug Treatments, Prescribed Treatment

by Food and Drug Administration (FDA)

(Page 3 of 3)

Non-Drug Treatments

In psychotherapy, also called "talk therapy," a person discusses with a mental health professional the feelings, thoughts and behaviors that seem to cause difficulty. The goal of psychotherapy is to help people understand and manage their problems so that they can function better.

"Finding a therapist who believes in recovery is the first step," says Velilla. "Someone who can teach you to think differently and learn new behaviors." She believes that her feelings of neglect, coupled with the eventual divorce of her parents, ultimately triggered many of her bouts with depression. Her own divorce some years later, she says, only heightened her feelings of worthlessness. "My therapist finally put a name to what I'd been feeling since I was 7 years old."

Psychotherapy can help people with bipolar disorder, and their families, identify early warning signs and manage emotional stress, which may help prevent a bipolar episode.

Richard O'Connor, Ph.D., a psychotherapist in Canaan, Conn., and the author of several books on depression, believes that people need to help themselves "break the bad habits in their lives that set them up for depression." Waking up and going to sleep at the same time each day, for example, might help those people prone to bouts of insomnia due to irregular sleep patterns.

A depression sufferer himself, O'Connor came to this belief after many of the people he was treating "thought it was too late for them to help themselves, and they wanted us to pick up the pieces," he says. "People are responsible for their own recovery. They must learn to take care of themselves and structure their lives so that they're less likely to trigger an episode."

When people are unresponsive to psychotherapy and medications, or the combination of the two works too slowly to relieve severe symptoms, such as psychosis or recurring thoughts of suicide, electroconvulsive therapy (ECT) may be considered. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a 30-second seizure within the brain; however, the person does not consciously feel the stimulus. Three sessions per week typically are given for full therapeutic benefit. Like antidepressants, ECT is believed to affect the chemical balance of the brain's neurotransmitters.

Interest is rapidly growing as well in the use of herbs for treating depression. But, according to a study published in the April 10, 2002, issue of the Journal of the American Medical Association, an extract of the popular herb St. John's wort was no more effective for treating major depression of moderate severity than an inactive pill (placebo). The multi-site trial, involving 340 people, also compared the FDA-approved antidepressant drug Zoloft (sertraline) to a placebo as a way to measure how sensitive the trial was to detecting antidepressant effects. Since Zoloft was also found to be no different than the placebo in that study, Laughren says it can best be thought of as a "failed study" that isn't informative about the antidepressant effectiveness of St. John's wort.

The NIMH cautions people who think they may be depressed not to use dietary supplements without first being evaluated by a psychiatrist or examined by a physician. The risks, according to the institute, can outweigh any potential benefits.

Following Prescribed Treatment

Antidepressant drugs are not considered to be candidates for abuse. However, as is the case with any type of medication, use of antidepressants must be carefully monitored to make sure the correct dosage is being given. Care also is needed when antidepressants are discontinued.

As is often seen with antibiotics, people may be tempted to stop antidepressants too soon. They may feel better and think they no longer need the medication, or they may believe the medication isn't working. But quickly stopping certain antidepressants is linked to side effects ranging from flu-like symptoms to sensory disturbances. As a result, new labeling, as specified by the FDA, recommends that patients taper off these medications slowly. If a person encounters problems going off a drug, he or she is advised to consult a physician rather than reduce dosage without supervision.

After spending 11 days in the hospital following the burglary, Earley's son was released to his parents. He is currently awaiting trial on two counts of felony breaking and entering and destruction of property. He is attending a 15-week treatment program that includes routine medications, and he now has a job and hopes to return to college to finish his education.

"He doesn't want to be delusional," says Earley. "He's embarrassed and ashamed about what happened. But now he's got no choice but to admit that he is sick and always will be. The question is, will that be enough to keep him taking his medications?"

When a patient and the health-care provider think that medication can be discontinued or scaled back, they will discuss how best to ease off the medication gradually.

The NIMH says it is important to keep taking prescribed medication until it has had a chance to work, even though side effects may appear before antidepressant activity does.

As for Velilla, "I'm still not taking any medication," she says, "but I think I may not need it after all. I continue to read books that will inspire and give me tools to deal with life. I feel like I am making progress in counseling and in all areas of my life and that makes me feel pretty good and optimistic about recovering."

About the Author

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