What is Depression?
How is Depression Treated?
Most people, once they acknowledge that they need help, turn to their family physician. In fact, the majority of treatment for depression in Canada is provided by family physicians. As there is no lab test for depression, the family physician relies on your description of symptoms in order to make a diagnosis.
Depression is often described as a “chemical imbalance” in the brain. What this means is that certain neurotransmitters (your brain chemicals) are not at the levels they should be to maintain positive mood. The neurotransmitters that affect mood are serotonin, norepinephrine and dopamine.
Medication
The most common treatment for depression involves medication designed to increase the levels of these neurotransmitters and thus, improve your mood.
There is some evidence that people with mild depression can try other interventions first (such as psychotherapy and lifestyle changes). However, severe depression requires medication (in combination with other treatments) to achieve recovery.
Medication for depression is a complex topic. There are many brands with different chemical formulas, each designed to act somewhat differently in the brain. There are also side effects to consider, and these medications do not act immediately to lift mood. They can take from two to eight weeks to begin to work – a frustrating experience if, in fact, you don’t have the right medication on the first try and must now turn to something else. Stick with it – most people will eventually find one that is right for them. Those, however, who continue to struggle despite trying different medication may be experiencing Treatment Resistant Depression (TRD).
For a complete discussion on medication, please read “Medications and You.”
Electroconvulsive Therapy (ECT)
ECT involves passing a brief electric current through the brain, producing mild seizures during the procedure. It is administered under anesthetic. ECT is used particularly for people who are not responding well to antidepressant medication (as in treatment resistant depression) or who are at high risk of suicide. While research shows ECT to be effective, it remains controversial particularly in relation to reported side effects. Psychiatrists indicate the associated memory losses are minimal and memories soon return. It is important that you (or your support people – if you are not capable) investigate ECT completely before choosing this treatment for yourself.
Repetitive Transcranial Stimulation (rTMS)
A more recent form of electronic brain therapy, rTMS requires a magnetic generator (coil) to be placed near your head. It emits a small electric current called electromagnetic induction. It too is used for people who are not finding the right medication or who are actively suicidal.
Psychotherapy
Research has shown that medication in combination with therapy is the most effective way of treating depression. There are different forms of therapy:
Interpersonal where you and your therapist explore your past hurts, present relationships and future goals and look at ways you can develop a more healthful life.
Marital or Family Therapy involves you and those close to you in joint sessions, where you examine how you can relate to one another in more healthful ways.
Group Therapy brings people together who share a particular problem so they can examine together some of the common ways they have acted – or choices that they have made – that have led to difficulties in their lives. Group members also share tips and coping strategies for more healthy living.
Cognitive Behavioural Therapy (CBT) is the model of therapy that is most associated with the treatment for depression and/or anxiety (as well as other problems). CBT has been extensively researched and has shown positive results. The basic idea of CBT is that your thoughts (cognitions) affect how you feel (mood) and lead to your actions (behaviours). After a while, there is an entrenched cycle where it is hard to determine which came first; negative thoughts and moods leading to unhealthy behaviours, or unhealthy behaviours leading to negative moods and thoughts. Awareness of this cycle helps people interrupt it with more positive thoughts and actions that can lift mood. In Canada, it is rare to have psychotherapy covered under Medicare. Most often, people have to pay out of pocket, which can be expensive.
