Depression Treatments 1

 

Depression Treatments

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Depression Treatments 2

Abstract

Depression is a disease that is curable.  Is this true or false?  Do

the claims of medications really stand up or do they provide a 

false self-image?  That is the objective of this paper.  The 

treatment of depression through medication has several different 

options.  The phases of treatment are the acute phase; continuation 

treatment, which helps to prevent a relapse; and maintenance 

treatment, which prevents new cases from forming.  The effects of 

antidepressants on the body provide a natural mood elevation 

versus other drugs that provide artificial mood elevations.  Which 

antidepressant is right to treat depression?  The types of 

antidepressants used to treat depression include polycyclic

medication,  monoamine oxide inhibitors, Lithium, psychomotor

stimulants, serotonin uptake inhibitors, and tranquilizers.  The

effects of these medications on depression and the side effects of

these medications are stated.  The evaluations of medications in

relation to their effectiveness are discussed.  The combination of

medication with some other treatment technique is combination

treatment and is used in very severe cases of depression.  The

process of learning about depression in order to help learn

symptoms and side effects is education treatment.  This treatment

has  been shown to help people recover by educating them. 

Overall depression is a treatable and preventable disease.  

Depression Treatments 3

Depression Treatments

KEY WORDS

          Depression is not feeling sad because one's team lost the

game or just feeling sad from time to time.  Depression is a

psychological disorder that affects the brain and causes sad

feelings constantly.  This can cause a person to experience an

empty feeling, leading eventually to a total inability to express

feelings (Goldburg, 1966).  Depression causes psychological

instabilities in the brain that can cause damage.  The

effects can be mild or severe or anyplace in between.  Depression

can be caused by many different factors, some of which include a

medical disorder or a psychological trauma that causes the patient

to become despondent to the outside world.  This may

also be caused by a family history of depressive disorders, by

suicide attempts, by a lack of social support, by stress, by

substance abuse, and by being a female (United States Department

of Health and Human Services [USDHHS], 1993a).  Disturbances

in the emotional, cognitive, behavioral, and somatic regulations are

involved in the cause for this disorder (Harvey & Champe, 1992).

          Treatment is the healing the patient of his/her depression

by some means or another in order to allow the patient a cure or at

least the ability to live a normal or semi-normal life.  The

treatment is not of a specific type and does not cover a specific

period of time.  Treatment could take a few weeks or a few years,

depending on the patient. The time that healing takes is different

Depression Treatments 4

because of the severity and length of the existence of the

condition.  The methods are different, but the most popular ones

are psychotherapy, medication, or both psychotherapy and

medication.  These may not cure a patient but they are highly

effective in counteracting the depression and in most cases curing

it.  The emotional support of family and friends is helpful, almost

essential, to counteract the depression.  The overall effective

procedure to cure the depressed person is a personalized process

for each patient, but most have similar conditions (USDHHS,

1993a). 

          Care is the process of helping the patient during the

treatment period.  This includes helping him/her with emotional

support, physical aid, and other types of support,  such as cheering

him/her up when he/she is feeling despondent to the world around

him/her, or by just being there with him/her.  The physical aspect

of caring would be helping the person do the things that he/she

needs help with.  This may not seem like much, but this is an aspect

that helps in his/her treatment and helps ensure a rapid recovery

(Harvey & Champe, 1992).

          Management is regulating the disease during the treatment

process.  This is more than just taking the right medication and the

proper dosages at the proper times.  This is the never ending

process of maintaining one's health by  proper diet and fitness,  and

other factors that would help to effectively treat the depression to

help prevent a relapse of the depression after the treatment process

Depression Treatments 5

is over.  The management does not stop there because once a

person has an episode he/she can easily have another if

he/she does not take case of him/herself to prevent another

episode.  It is watching the factors that have been known to cause

depression in one's lifestyle, a family member's, or a friend's.  It is

seeing one's doctor about one's condition at regular

intervals to ensure one's mental health (USDHHS, 1992a).

          Antidepressants are the major classification of drugs that are

used to treat and maintain depression.  These drugs potentiate the

actions of the brain hormones, norepinephrine, dopamine, and

serotonin to provide the proper levels of these hormones in the key

areas of the brain.  These drugs are powerful and must be taken

as they are prescribed, because if they are not taken as prescribed,

they can cause damage to the brain and sometimes even death.

These drugs can cure the effects of depression in most people if

they are used properly.  The major sub categories of these drugs

include tricyclic/polycyclic antidepressants, serotonin uptake

inhibitors, monoamine oxidase inhibitors, and drugs used to treat

mania (Harvey & Champe, 1992).

TYPES OF TREATMENT

          The treatment of depression depends on the type and severity

of the depression a patient has been diagnosed to have.  The major

types of depression are major depression, dysthymia, and bipolar

disorder (Gold burg, 1996).  The treatment process

Depression Treatments 6

is long and affects 11 million people in the United States at an

estimated cost of 44 billion dollars in 1991 (Long, 1966).  The

usual treatment process takes place in the medical doctor's office;

in fact, only about 20 percent of those affected seek treatment

in the mental health sector of medicine (Kerr, 1994).

Phases

          The treatment process is composed of three phases.  These

phases treat the depression, maintain the depression, and prevent

future episodes.  The phases incompass all aspects of the treatment

process (USDHHS, 1993b).

Acute Treatment

          The acute treatment is the first phase of treatment and

initially removes all depressive symptoms.  The therapy chosen

depends on the symptoms displayed.  Some common symptoms are

changes in sleep patterns, sex drives, and interpersonal

relationships (Hoopes, 1995).  These symptoms are just a few of

the signs that a person should seek treatment for depression

(USDHHS, 1993a).

          The use of medication is the primary choice for patients if

one or more of the following factors are involved:  most severe

cases, chronic cases, recurrent cases, psychotic or melancholic

patients, previous responses to medication, family history,

patient choice, and failure to respond to psychotherapy (USDHHS,

1993b).  The success of this phase of treatment depends on the

patient, but according to Long, 70 percent of moderate to severe
 

Depression Treatments 7

 patients respond favorably to therapy (1996).

Continuation Treatment

          The continuation phase of treatment focuses on the

prevention of the body relapsing back into a depressive state.  The

treatment method chosen is usually a continuation of the acute

phase.  The continuation lasts from four to nine months after

the initial depression has subsided (USDHHS, 1993b).

Maintenance Treatment

          Once the continuation phase of the treatment has been

successfully completed, the patient could be a candidate for the

maintenance phase of treatment.  This phase prevents new cases

from forming.  This is a necessary phase because approximately

50 percent of patients have  a depressive relapse within two years

(USDHHS, 1993b).  This treatment is recommended by the United

States Department of Health and Human Services for those patients

who have experienced one of the following:

          Three or more depressive episodes;

          Two episodes and a family history of depressive disorder;

          Two episodes and a reoccurrence within one year of

               medication termination;

          Two episodes and the first episode was before the age

               of 20;

          Two episodes and a life threatening episode within the past

               three years (1993b, p. 111).

Depression Treatments 8

ANTIDEPRESSANTS

Antidepressants Effects

          Antidepressants only help people who have a depression

problem.  These drugs are unlike drugs that can improve any

person's mood by creating an artificial high or mood elevation.

Antidepressants cause the neurotransmitters to provide a

natural mood elevation that seldom wears off within a short time.

Artificial mood elevators, such as speed, are highly addictive and

should be avoided at all costs  (Gold burg, 1966).

Selection of Antidepressants

          The selection of the right antidepressant depends on all the

aspects of the patient.  Although most antidepressants have similar

effects, some are more effective than others, depending on the

patient's age, race, sex, and health (Smith, 1969).  According to the

United States Department of Heath and Human Services (1993b, p.

39), medication should be a primary choice in patients who have

one of the following:

          Melancholic, psychotic or severe depression;

          Recurrent episodes of depression;

          Previous responses to medication;

          Poor interepisode recovery;

          Family history;

          Atypical symptoms;

          Maintenance treatment is planned.

Depression Treatments 9

          Factors in the Selection

          Which antidepressant is the right one for the job?  This is a

tough question because of the number of antidepressants on the

market.  All antidepressant medications have similar properties

and healing effects (USDHHS, 1993b).  To help doctors make a

decision based upon such factors as the short term/long term

effects of the medication, prior responses to the medication, the

family history of responses to the medication, other illnesses,

prescription/non-prescription drugs taken, the side effects of

medication, the probability of responses based on the patient's

medical history, the effectiveness of one-a-day dosages,

hindrances to daily routine, the type of depression, the cost of the

medication, the expertise of the doctor, the patient's choice, and

other considerations, a series of aids have been developed by the

United States Department of Health and Human Services.  Such an

aid is presented in Table 1, USDHHS Recommended Regime  for

the Treatment of Depression.   It is notable that the treatment for

this disease takes time, from two to nine months to a year.

Prescribing the Medication

          Once the antidepressant medication is chosen, then comes

the problem of monitoring its effectiveness.  The patient should

follow the prescribed guidelines to ensure that the medication

regime is working properly, and should have a friend or

                                                               
            
                                                                             
               
   Clearly Better     Somewhat Better           Not Better at All                                                                                                                                        
                                                                                                         
                                                                 
                                                                                    
                                                                            
                                                                                    
                  Clearly Better     
                                                                                         
                                                               Not Better
                                                                                                                
         Yes                                                  Relapse                                
                                           
                                                                                                     
            

               Table 1.  Recommended Regime for the Treatment of 

Depression (USDHH,m 1993c, p. 11).

Depression Treatments 11

member administer the medication to lessen the probability of an

overdose, along with keeping the medication in a safe place.  The

person who administers the medication should go with the patient

to the doctor's office.  The patient should remember that the

drugs are non-addictive and are only a temporary measure.  The

patient should educate him/herself on the subject of the disease and

the effects of the medication.  The patient should also monitor

his/her stress level, since stress has been known to cause

depression (Long, 1996).

Side Effects and Dosages Required

          The possible side effects of the medication need to be

considered, even though most of the benefits outweigh the side

effects.  These effects need to be considered in the selection of the

medication.  The dosage chosen also affects the side effects.  The

higher the dosage, the more possible side effects.  The dosage

should start small and gradually increase as it is necessary.  This

gradual increase is necessary, because the medication takes a

while to take effect (see table 1. , Recommended Regime for the

Treatment of Depression).  If the increase is too high or too fast,

the toxicity of the blood due to medication could cause serious

medical problems (Goldburg, 1996;  USDHHS, 1993b).

Type of Antidepressants

          Antidepressants can be classified in categories based on the

effects they have on the body.  The primary types of these

bmedications are Tricyclic/polycyclic drugs (TCA), Monoamine

Depression Treatments 12

 oxide inhibitors (MAOI), Lithium, Psychomotor stimulants, and

others.  Each type has a unique effect on the body, but each also

has side effects  (Clunn & Payne, 1982; Hoopes, 1995; USDHHS

1993b; Wells, 1994)      

TCA

Definition

          Tricyclic/Polycyclic drugs (TCAs) treat depression by

blocking the amounts of norepinephrine, dopamine, and serotonin

that enter the brain through the neuotransmitters.  This blocks the

sertoninergic, adnergic, histamine, and muscarine  receptors in the

brain.  TCAs elevate the mood of the patient, increase physical

activity, and reduce preoccupation.  TCAs can also be used to treat

severe depressions, phobias, and bedwetting (Harvey & Champe,

1992).  The response to these drugs is hindered by delusion,

anxiety, chronicity, or neurotic features that impale their

effectiveness (Hollandworth, 1990).

Side Effects

          These drugs can cause increased cateholamine activity in the

cardiovascular system.  An overdose can be lethal.  TCAs can

cause orthostatic hypotension; they can also cause flare ups of

epilepsy (Harvey & Champe, 1992).  Overdoses of TCAS

can cause other serious problems such as hyperpyrexia, seizures,

cardiac and respiratory failure, and a hyperactive coma (Clunn &

Payne, 1982).

Depression Treatments 13

MOAI

Definition

          Monoamine oxide inhibitors (MOAI) restrict the amount of

Isocaroxazid in the brain along with a few other enzymes.  This

elevates the mood of the patient and causes stimulation of the CNS

receptors in the brain, which control the serotonin level by

controlling the synaptic vesicles.  MOAI can be used to treat

moderate to severe depression, hypersomnia and phobic states

(Harvey & Champe, 1992; Hollandworth, 1990).

Side Effects

          The effects of Lithium include dry mouth, blurred vision,

sweating, tremors, weight gain, dizziness, constipation, increased

pulse rates, confusion, convolution, and irregular heart rates.

 These effects are minor compared to the other possible treatment

procedures (Harvey & Champe, 1992; Hoopes, 1995).

Severe

          Even though Lithium is not as toxic as other medications, it

can be harmful to the body if an extreme overdose is taken. 

Lithium can cause severe harm to a fetus if taken during the early

stages of pregnancy (Hoopes, 1995).

Psychomotor Stimulants

Definition

          Psychomotor stimulants are drugs that work directly on the

central nervous system to cause a mood elevation.  These 

Depression Treatments 14

drugs do wear off in approximately three to four hours.  Therefore,

these drugs are highly addictive and are only prescribed in very

severe cases of depression after all other treatments have failed

(Clunn & Payne, 1982).

Side Effects

          Mild

          The stimulants can cause minor side effects.  They can cause

insomnia, agitation, hypomania, decreased appetite, and an

inability to concentrate.  These effects are relatively minor

compared to the entire problem of addition to the medication

(Clunn & Payne, 1982).

          Severe

          There are greater problems than the addiction problem.

There are risks of possible suicide if a patient becomes depressed

again while being taken off the medication.  Some patients

experience hallucinations and delusions.  A tolerance to the

medication is built up, requiring higher dosages as the treatment

proceeds.  The abuse of the medication is found with high

addiction and with withdrawal (Clunn & Payne, 1982).

Others

Serotonin Uptake Inhibitors

          These drugs block the levels of serotonin that are allowed to

enter the neuotransmitters in the brain.  They are effective

short-term treatments and have fewer side effects than TCAs 

Depression Treatments 15

(Harvey & Champe, 1992).

Tranquilizers

          Some minor tranquilizers have been known to treat minor

depression with little or no side effects.  This treatment is highly

cost effective because tranquilizers do not cost as much as

antidepressants (Wells, 1994).

Evaluation of Medications

          Even though most of these medications are very strong, the

problem of depression still could exist because only two-thirds of

the patients will experience a positive response to medication

therapy (Goldburg, 1996).  In fact, depression is the 12^th most

common reason people visit their doctors.  They make up about 25

percent of the patients a doctor sees on the average (Kerr, 1994). 

Patients must give the medication time to take effect (Long, 1996).

Though some antidepressants may not cure, most do; the use of

them by doctors has gone up from 8.5 percent to 23-30

percent in the past few years (Wells, 1994).

          Medication does have its disadvantages, though, compared

to other possible treatments.  Medication requires repeat visits to

the doctor for dosage adjustments and checks on the effectiveness

of the medication. There are  adverse side effects and possible

risks of suicide during down periods.  Depression related suicide

is the 8th leading cause of death among patients with depression

(Kerr, 1994; Smith, 1969; USDHHS, 1993b)

Depression Treatments 16

The number of patients who fail to complete treatment or become

addicted to the medication is minor and must go on to live normal

lives after treatment.  The important factors in treatment are time, 

tolerance to the medication, and the withdrawal of the medication

from the body (USDHHS, 1993b).

Combination Treatment

           Combination treatment is the use of both medication and

psychotherapy to treat a person.  This method is used only in cases

of severe depression or if either medication or psychotherapy are

not adequate when used separately (USDHHS,993b).

Education Treatment

          Patients who are well informed about the disease, the

treatment methods, and effects of the treatments have a greater

chance of a complete recovery and prevention of a relapse

(USDHHS, 1993b).  This treatment, along with another type, has

proved to help the treatment process.  Patient education guidelines

have been established by the  United States Department of Health

and Human Services.  They are as follows:

          Depression is an illness;

          Recovery is possible;

          Effective treatments are available;

          Complete remission is the goal of treatment;

          Caution to the warning signs of depression are necessary

          (1993b, p. 10).

Depression Treatments 17

EVALUATION

          No one treatment is more powerful or more effective than

the other.  No medication cures all patients.  Though medication

reduces symptoms, prevents relapses, and overtly causes the body

to function better (USDHHS, 1993b), does medication

really do what is claimed or does it simply provide a false

self-image?  For most people, it does cure them of their symptoms

rather than providing an addiction to medication, though that is

always a possible result (USDHHS, 1993b; USDHHS, 1993c).  As

Dr Jerrold Rosebaum stated, "People who don't need these

medications shouldn't take them.  Yet it has allowed me to treat

beyond the boundaries of where I used to treat before" (cited in

Kramer, 1993, p. 43).

Depression Treatments 18

References

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     nursing.  Garden City, NY:  Medical Examination Publishing.

Goldburg, I. K.  (1996).  Depression FAQ.    Retrieved April 14,

     2000  from http://avocadeo.pc.helsinki.fi /%7Ejanne/asdfaq

Harvey, R. A., & Champe, P. C. (Eds).  (1992).  Pharmacology.

     Philadelphia:  J. B. Libbincott.

Holldandsworth, J. G.  (1990).  The physiology of psychological

     disorders:  Schizophrenia, depression, anxiety, and substance

     abuse.  New York:   Plenum.

Hoopes, B.  (1995).  Disorders & illness--mood

     disorders--depression and manic depression.  Retrieved May

     10, 2000 from http://www.cais.com/vikings/ nami/disorder

     /disord6.htm

Kerr, C. P.  (1993).  The transformation of personality.  

     Psychology Today, 26 (4), 42-53.

Kramer, P. D. (1993).  Depression personalities.   Psychological

     Review,  84, 542-553.

Long, P. W.  (1996).  Major depression treatment.  Retrieved

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     .htm#Head_3b

Smith, A.  (1969).  Studies on the effectiveness of antidepressant

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     Health Information.

Depression Treatments 19

United States Department of Health and Human Services.  (1993a).

     Depression in primary care: Vol. 1. Detection and diagnosis.

     (AHCRP Publication No. 93-0550).  Rockville, MD:  Public

     Health Service, Agency for Health Care Policy and Research.

United States Department of Health and Human Services.  (1993b).

     Depression in primary care:  Vol. 2.  Detection and 

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     MD:  Public Health Service, Agency for Health Care Policy

     and Research.

United States Department of Health and Human Services.  (1993c).

     Depression in primary care:  Vol. 3.  Detection and

     diagnosis.  (AHCRP Publication No. 93-0552).  Rockville,

     MD:  Public Health Service, Agency for Health Care Policy

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Wells, K. B.  (1994).  Use of minor tranquilizers and

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     Psychiatry, 151 (5), 694-671.