|
Treatment
---------
Q. What sorts of psychotherapy are effective for depression?
Two effective methods of psychotherapy for people with depressions
are cognitive therapy and interpersonal therapy. Both psychoanalysis,
and insight oriented psychotherapy have not been shown to be
effective treatments for people with a depressive disorder. Cognitive
(and cognitive-behavioral) therapists can be found in most major
cities.
While many therapists call themselves cognitive therapists and
interpersonal therapists, only a few have had proper training.
Medication
----------
Q. Do certain drugs work best with certain depressive illnesses? What
are the guidelines for choosing a drug?
There are very few kinds of depression for which there are specific
antidepressant treatments. When it comes to people with Bipolar
Disorder who are depressed there are some major problems. Most
importantly, with any antidepressant, there is a possibility that the
antidepressant treatment will cause depressed bipolar people not just
to come out of their depressions, but to develop manic episodes. The
possibility of an antidepressant causing mania is least when the
antidepressant is bupropion (Wellbutrin). The possibility of mania is
greatly reduced if depressed bipolar folks are on a mood stabilizer
such as lithium, Tegretol or Depakote when they are started on an
antidepressant.
Q. How do you tell when a treatment is not working? How do you know when
to switch treatments?
Antidepressant treatment is clearly not working when the individual
receiving the treatment remains depressed or becomes depressed again.
When a recently started antidepressant fails to cause improvement,
the depressed individual often asks that the medication be stopped,
and a new one started. It generally does not make sense to change
antidepressants until 8-weeks at the maximum tolerated dose have
elapsed. With some tricyclic antidepressants, it is important to
check the blood level of the antidepressant before it is stopped. The
blood test can tell if the amount in the blood has been adequate.
Only after an adequate trial of one antidepressant should another be
tried. To have been on four antidepressants in an 8-week period means
that one has not had an adequate trial on any of them.
Q. How do antidepressants relieve depression?
There are several classes of antidepressants, all of which seem to
work by increasing levels of certain neurotransmitters (most commonly
serotonin, norepinephrine, and dopamine) in the brain. It is not
entirely clear why increasing neurotransmitter levels should reduce
the severity of a depression. One theory holds that the increased
concentration of neurotransmitters causes changes in the brain's
concentration of molecules, receptors, to which these transmitters
bind. In some unknown way it is the changes in the receptors that are
thought responsible for improvement.
Q. Are Antidepressants just "happy pills?"
No matter what their exact mode of action may be, it is clear that
antidepressants are not "happy pills." There is no street-market in
antidepressants, for unlike "speed" which will improve the mood of
almost everybody, antidepressants only improve the mood of depressed
people. Also unlike the almost instant effects of speed, the
mood-improving effects of antidepressants develop slowly over a
number of weeks. "Speed" induces a highly artificial state,
antidepressants cause the brain to slowly increase its production of
naturally occurring neurotransmitters.
Q. What percentage of depressed people will respond to antidepressants?
Generally, about 2/3 of depressed people will respond to any given
antidepressant. People who do not respond to the first antidepressant
they have taken, have an excellent chance of responding to another.
Q. What does it feel like to respond to an antidepressant? Will I feel
euphoric if my depression responds to an antidepressant?
The most common description of the effects of antidepressants is that
of feeling the depression gradually lift, and for the person to feel
normal again. People who have responded to antidepressants are not
euphoric. They are not unfeeling automatons. The are still able to
feel sad when bad things happen, and they are able to feel very happy
in response to happy events. The sadness they feel with
disappointments is not depression, but is the sadness anyone feels
when disappointed or when having experienced a loss. Antidepressants
do not bring about happiness, they just relieve depression. Happiness
is not something that can be had from a pill.
|