Depression is one of the most common mental disorders in the United States. National Institutes of Health statistics from 2015 show that an estimated 16.1 million American adults ages 18 or older — that’s almost 7 percent of all U.S. adults — had at least one major depressive episode in the previous year. Depression also carries the heaviest burden of disability among mental and behavioral disorders, according to the World Health Organization. The good news is that depression is highly treatable.
[See: Am I Just Sad — or Actually Depressed?]
“The vast major of the time, treatments work well and get people back to 100 percent,” says Dr. James Potash, professor and chair of psychiatry at the University of Iowa Hospitals and Clinics.
There are numerous treatment options, depending on the individual, which makes seeing a mental health professional so important. “There is no best way to treat depression. There is your way, what works for you,” says Michael D. Yapko, a clinical psychologist and lecturer specializing in depression. “Some people get worse from treatments instead of better [at first], and that is part of seeing a competent professional who sees your pathway into depression and can help you develop a pathway out that speaks to your personal experiences.”
Lifestyle Changes and Therapy
Treatment typically starts with seeing your primary care physician, who will explore and address other possible causes of depressive symptoms, such as undiagnosed thyroid problems or sleep disruption like sleep apnea. Some medications for other illnesses can cause depression-like symptoms, so changing those meds may help.
For mild cases, lifestyle changes can be extremely successful. Exercise, in fact, is perhaps the best treatment to try first. Regular exercise has been proven in numerous research studies to work as well as, if not better than, drugs for some cases of depression, and carries none of the side effects.
Many primary care doctors prescribe medication as well, but some mental health experts believe this is too often an “easy fix” that patients should avoid if possible. Antidepressant medications “are only slightly better than a placebo,” Yapko says, and they have side effects that can range from digestive problems and fatigue to erectile dysfunction and low libido. Before starting medication, it makes sense to see a mental health specialist, such as a psychologist, psychiatrist or licensed counselor, who can determine if meds are really in order.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
This specialist will take a full mental health history and work with the patient to tailor a treatment program. It may include some of the lifestyle changes mentioned above. It may also add some form of therapy or counseling. The American Academy of Family Physicians describes common types of therapy:
— Family counseling helps patients understand and resolve problems within the family.
— Cognitive therapy, also called cognitive behavioral therapy, involves changing how one thinks about something in order to change feelings and behaviors.
— Behavior therapy, sometimes called behavior modification therapy, is intended to replace unhealthy behaviors with healthy ones, using rewards and positive reinforcement.
— Psychoanalysis explores memories and feelings from the past, which helps people understand their actions and feelings.
— Group therapy, led by a qualified professional, involves a small group of people who have similar issues or problems and can support each other.
— Couples therapy or marriage counseling helps couples communicate and work through problems in healthy, constructive ways.
“Cognitive behavioral therapy is arguably the best researched model, and it has held up remarkably well under the scrutiny of scientific inquiry,” Yapko says. CBT focuses on helping people gather and use information more skillfully and healthfully. “Depressed people think things and make the mistake of believing themselves,” he says. “They need to learn to step outside their own thinking to see if there is evidence for it, and CBT teaches that abundantly.”
CBT is not for everyone, however, and it’s not unusual for patients to try more than one mode of therapy until they find the one that works best for them. And in more severe cases, a combination of therapy and medication may work better than therapy alone.
Treating More Severe Cases
Not all depression cases respond to these treatments. For those patients, brain stimulation therapies can be an option. Brain stimulation therapies deliver electricity or magnetic energy to stimulate or inhibit brain function. This energy can be delivered through electrodes on the scalp or implanted in the brain. These newer therapies work well, says Carl Tishler, a private practitioner and adjunct associate professor of psychiatry and psychology at The Ohio State University. “We don’t know why it works, but the brain is an electrochemical organ, and by charging it up, people function better and are less depressed,” he says. “Then you can move in with medications or psychotherapy to help stabilize the patient.”
[See: 7 Apps to Mind Your Mental Health.]
Electroconvulsive therapy, or ECT, formerly known as electroshock therapy, is also an option, though it’s considered only for severe, treatment-resistant depression, bipolar disorder or schizophrenia, or when the patient’s life is in danger. The National Institute of Mental Health states that ECT may be better than medication because it begins to work sooner, often within a week, and older patients respond especially quickly. ECT also can reduce the chances of relapse when patients start follow-up treatments. “ECT has gotten a bad name, but it does have a place in the field,” Tishler says.
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What Is the Best Way to Treat Depression? originally appeared on usnews.com
