Depression is one of the most common psychological problems, affecting nearly everyone through either personal experience or through depression in a family member. . Each year over 17 million American adults experience a period of clinical depression. The cost in human suffering cannot be estimated. Depression can interfere with normal functioning, and frequently causes problems with work, social and family adjustment.
When you’re depressed, it can feel like you’ll never get out from under its shadow. But take heart. Even the most severe depression is treatable. With the right help and support, you can and will feel better.
Impact of Depression:
- Causes tremendous emotional pain
- Disrupts the lives of millions of people
- Adversely affects the lives of families and friends
- Reduces work productivity and absenteeism
- Has a significant negative impact on the economy, costing an estimated $44 billion a year
There are many effective ways to deal with depression, including exercise, talk therapy, medication, natural supplements, and lifestyle choices. Learning about the treatment options will help you decide what measures are most likely to work best for your particular situation and needs. There are no quick fixes or instant cures, but if you're willing to work on yourself and stick with treatment, you'll find yourself out from under depression's shadow sooner than you think.
The main physical treatments for depression comprise drug treatments and electroconvulsive therapy (ECT). A third physical treatment with as yet narrow application is transcranial magnetic stimulation (TMS), which has been one of the research areas at the Black Dog Institute.
Because of its controversial past many people feel the need to think carefully before having ECT or allowing it to be given to relatives. ECT has a small but important role in treatment, particularly in cases of:
- Psychotic depression
- Severe melancholic depression where there is a high risk of suicide or the patient is too ill to eat, drink or take medications
- Life-threatening mania
- Severe post-natal depression
While there are some short-term side-effects, ECT is relatively safe and, because an anaesthetic is used, not too unpleasant.
A possible alternative to ECT is transcranial magnetic stimulation (TMS). TMS is a procedure used by neurologists, both as a treatment and a diagnostic strategy. A coil is held next to the patient's head and a magnetic field created to stimulate relevant parts of the brain. Unlike ECT, there is no need for a general anaesthetic nor is a convulsion induced.
The evidence in favour of this treatment is not yet in, but it is currently a major area of research. If TMS is shown to be as effective as ECT this would be a distinct advance in the treatment of many mood disorders. No clear evidence about its utility is expected for several years.
The evidence in favour of this treatment is not yet in, but it is currently a major area of research. If TMS is shown to be as effective as ECT this would be a distinct advance in the treatment of many mood disorders. No clear evidence about its utility is expected for several years.
Depression treatment tips:
§ Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first. The severity of your depression is also a factor. The more severe the depression, the more intensive the treatment you're likely to need.
§ It takes time to find the right treatment. It might take some trial and error to find the treatment and supports that works best for you. For example, it might take a few tries to find a therapist that you click with if you decide to pursue therapy. Or you may try an antidepressant, only to find that you don't need it if you take a daily half hour walk. Be open to change and a little experimentation.
§ Don’t rely on medications alone. Although medication can relieve the symptoms of depression, studies show that other treatments, including exercise and therapy, can be just as effective or even more so. What's more, they don't come with unwanted side effects. If you do decide to try medication, remember that medication works best when you pursue therapy as well.
§ Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to trusted family members or friends. Asking for help is not a weakness but a sign of strength.
§ Treatment takes time and commitment. All of these depression treatments take time, and sometimes it might feel overwhelming or frustratingly slow. That is normal. Recovery has its ups and downs.
Drug Treatments
The three groups of drugs most likely to be used for depression are antidepressants, tranquillisers and anti-manic drugs or mood stabilisers.
There are a large number of antidepressants. They have a role in many types of depression and vary in their effectiveness across the more biological depressive conditions.
Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) are three common classes of antidepressants. The latter two are characterised by broader actions. They each work in different ways and have different applications.
Clinicians at the Black Dog Institute firmly believe that it is important to find the right antidepressant as different antidepressants produce different effects and results in different people. If the first antidepressant does not work, it is sensible to move to a different kind of antidepressant. For the biological depressive disorders, more broad action antidepressants are usually more effective.
A well-informed health professional should be able to use their assessment of the type of depression, its likely causes and their understanding of the person to identify the medication most likely to benefit. Finally, being able to decide not to use medication is important too.
Tranquillisers can be classified as 'minor' or 'major' tranquillisers. Minor tranquillisers (typically benzodiazepines) are not helpful in depression; they are addictive and can make the depression worse. Major tranquillisers are very useful in people with apsychotic or melancholic depressionwhere the person is not being helped by other medications.
Tranquillisers can be classified as 'minor' or 'major' tranquillisers. Minor tranquillisers (typically benzodiazepines) are not helpful in depression; they are addictive and can make the depression worse. Major tranquillisers are very useful in people with apsychotic or melancholic depressionwhere the person is not being helped by other medications.
'Anti-manic' drugs or 'mood stabilisers' are of great importance in Bipolar Disorder. Their use in treating mania makes them 'anti-manic', while their ability to reduce the severity and frequency of mood swings makes them ‘mood stabilisers’. Lithium, valproate and carbamazepine are the most common.
It is important to remember that the anti-depressants and mood stabilisers are often necessary both to treat the depression that is occurring now, and to make a relapse in the future less likely. Consequently, people may need to continue taking medication for some time after they are better.
Lifestyle changes that can treat depression
§ Exercise. Regular exercise is a powerful depression fighter. Not only does it boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of activity on most days.
§ Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They'll get you going without the all-too-soon sugar crash.
§ Sleep. Sleep has a strong effect on mood. When you don't get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you're getting enough sleep each night. Very few people do well on less than 7 hours a night. Aim for somewhere between 7 to 9 hours each night.
§ Social Support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.
§ Stress Reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression.
Psychological treatments
There is a wide range of psychological treatments for depression. Some of the main ones are:
- Cognitive Behaviour Therapy (CBT)
- Interpersonal Therapy (IPT)
- Psychotherapies
- Counselling
- Narrative Therapy
CBT, IPT, psychotherapy and counselling all provide either an alternative to medication or work alongside medication. As always, a thorough assessment of the person is needed in order to decide on the best set of approaches.
Cognitive Behaviour Therapy (CBT)
People suffering from depression - particularly 'non-melancholic depression' - will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how the person thinks about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don't even notice the errors of judgement caused by thinking irrationally.
People suffering from depression - particularly 'non-melancholic depression' - will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how the person thinks about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don't even notice the errors of judgement caused by thinking irrationally.
CBT aims to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. It is based on the understanding that thinking negatively is a habit, and, like any other bad habit, it can be broken. CBT is conducted by trained therapists either in one-on-one therapy sessions or in small groups. ‘Homework’ may also be assigned between sessions. Between six and 10 sessions can be required but the number will vary from person to person.
Interpersonal Therapy (IPT)
The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, social roles) and personality. Therefore, the underlying assumption of interpersonal therapy is that depression and interpersonal problems are interrelated. The goal of interpersonal therapy is to understand how these factors are operating in the person's current life situation leading them to become depressed and putting them at risk of future depression. Usually 12-16 sessions of IPT will be required.
The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, social roles) and personality. Therefore, the underlying assumption of interpersonal therapy is that depression and interpersonal problems are interrelated. The goal of interpersonal therapy is to understand how these factors are operating in the person's current life situation leading them to become depressed and putting them at risk of future depression. Usually 12-16 sessions of IPT will be required.
Psychotherapies
Psychotherapy is an extended treatment (months to years) in which a relationship is developed between the therapist and the patient. The relationship is then used to explore aspects of the person's experience in great depth. Understanding the link between past and present and the supportive relationship between therapist and patient are thought to resolve the depression and make the person less vulnerable to becoming depressed again.
Psychotherapy is an extended treatment (months to years) in which a relationship is developed between the therapist and the patient. The relationship is then used to explore aspects of the person's experience in great depth. Understanding the link between past and present and the supportive relationship between therapist and patient are thought to resolve the depression and make the person less vulnerable to becoming depressed again.
Counselling
Counselling encompasses a broad set of approaches and skills that aim to help an individual explore problems and preferred scenarios. Counselling helps people with long-standing problems in the family or at work, as well as sudden major problems (crisis counselling).
Counselling encompasses a broad set of approaches and skills that aim to help an individual explore problems and preferred scenarios. Counselling helps people with long-standing problems in the family or at work, as well as sudden major problems (crisis counselling).
Narrative Therapy
Narrative Therapy is a form of counselling based on understanding the 'stories' that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how the stories may restrict them from overcoming their present difficulties. It sees problems as being separate from people and assists the individual to recognise the range of skills, beliefs and abilities that they already have (but may not recognise) and that they can apply to the problems in their lives.
Narrative Therapy differs from many therapies in that it puts a major emphasis on identifying people's strengths, highlighting evidence of mastering problems in the past. It seeks to build on people’s resilience rather than focus on their negative experiences.
LIFESTYLE FACTORS
Exercise
It is interesting to note that exercise was rated the most effective treatment for depression in the Ultrafeedback study and second most effective in the Black Dog Institute study referred to on this site. Despite this, there is very little research that looks specifically at exercise - a treatment strategy that is accessible to everyone.
It is interesting to note that exercise was rated the most effective treatment for depression in the Ultrafeedback study and second most effective in the Black Dog Institute study referred to on this site. Despite this, there is very little research that looks specifically at exercise - a treatment strategy that is accessible to everyone.
A study by Andrea Dunn PhD et al, Exercise Treatment for Depression: Efficacy and Dose Response (January 2005American Journal of Preventative Medicine) found that the scores for the Hamilton Rating Scale for Depression were reduced by 47% for those who did the equivalent of 35 minutes walking, five days per week. This study, conducted at the Cooper Research Institute in Dallas Texas, shows that as little as three hours of regular exercise a week reduces the symptoms of mild to moderate depression as effectively as Prozac and other antidepressants.
Several of the people interviewed for this book also mention exercise as an important strategy to alleviate the symptoms of depression.
The anecdotal feedback and studies mentioned above confirm the benefits of exercise. Why don’t people embrace this information and exercise more? As I know too well, when you are in the black hole you lack the energy and motivation. It’s difficult to get out of bed, let alone to exercise. This overwhelming feeling of lethargy seems very difficult to shift. Many people also cite lack of time as a reason for not exercising regularly.
Nearly everyone I have spoken to has experienced supreme difficulty exercising whilst depressed - although not one of these people ever reported feeling worse after a walk. Andrea Dunn recommends committing to exercising each day. In the beginning you may only walk for 10 minutes at a time. If you aim to increase the time by 10 minutes each week, you’ll be walking the recommended 30 minutes per day by the third week.
Interestingly, when time is at a premium, three periods of 10 minutes exercise per day can have a similar effect as a 30 minute block.
Of course walking is not the only exercise that will yield results. Swimming, running, cycling, aerobics, dancing, rowing, rollerblading, and others will all be beneficial.
Aerobic exercise in particular, improves blood flow and oxygen to the brain. It has the added benefit of releasing endorphins (natural feel-good chemicals) into the body.
The message is clear: start moving. Exercise only has benefits for people with depression. Unlike medication, there are no detrimental side effects.
Meditation/Relaxation
To manage the frantic pace of modern life it is imperative to take time out and still the mind. This can sometimes seem very difficult when the mind is swamped with the negative thoughts that accompany depression. The art of relaxation doesn’t happen overnight, but like most things improves with regular practise.
To manage the frantic pace of modern life it is imperative to take time out and still the mind. This can sometimes seem very difficult when the mind is swamped with the negative thoughts that accompany depression. The art of relaxation doesn’t happen overnight, but like most things improves with regular practise.
There are many relaxation CDs available, quite often from local libraries. It is often best to try a few different ones and see which works best for you. Likewise, there are many different approaches to meditation. Keep experimenting until you find a style that suits.
In his book, Full Catastrophe Living: How to cope with stress, pain and illness using mindfulness meditation, Jon Kabat Zinn, from the University of Massachusetts Medical Center, describes the excellent results he has achieved for stress and anxiety. Mindfulness meditation is about living in the present moment and neither getting ahead of ourselves, nor dwelling in the past. He guides participants through an eight week course of meditations.
Professor Mark Williams, Zindel Segel and John Teasdale from the University of Wales
MBCT has been used as a relapse prevention strategy with encouraging results. People who had suffered three or more episodes of depression before learning the practice, reduced their relapse rate to 36% compared to 78% in the control group.
The Black Dog Institute is currently involved in trials to evaluate how MBCT can help those in the midst of a depressive episode.
Nutrition
The importance of eating whole healthy foods with minimum fats and processed sugars cannot be over estimated. The Western ‘civilised’ way of eating is far from perfect. Cardiac and diabetes problems are ballooning in the West, and we seem to have lost the basics of good nutrition.
The importance of eating whole healthy foods with minimum fats and processed sugars cannot be over estimated. The Western ‘civilised’ way of eating is far from perfect. Cardiac and diabetes problems are ballooning in the West, and we seem to have lost the basics of good nutrition.
In his book The Great Australian Diet, Dr John Tickell discusses the eating habits of some of the most vital and longest living people in the world, the Okinawan people of Japan
In Potatoes Not Prozac, Kathleen DesMaisons PhD, an addiction and nutrition expert, claims that many people, who are prone to addictive disorders as well as depression, are also sugar sensitive. Their body chemistry reacts in extreme ways to sugar and refined carbohydrates. This changes not only the blood sugar levels, but also the levels of serotonin and beta–endorphins in the brain, creating feelings of exhaustion, hopelessness and despair.
She recommends eating three main meals a day, and consuming mainly complex carbohydrates such as vegetables, whole grain foods and cereals. She also advocates reducing or eliminating refined sugars (including alcohol) and restricting protein consumption to a serve no larger than your fist.
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