Treatment

Treatment

Depression is a treatable illness, with many therapeutic options available. Increasingly, professionals are viewing major depression as a chronic illness (the condition nearly always returns when treatment is stopped). Therefore, medical intervention and help must be ongoing.

Patients with chronic depression have a number of options, including psychotherapy, antidepressants, or both. In general, the treatment choice depends on the degree and type of depression and other accompanying conditions. It also may depend on age, pregnancy status, or other individual factors.

Unfortunately, an important 2003 study reported that even when depression is diagnosed, only about 20% of Americas with major depression receive adequate treatment. Most patients are treated by their family doctor, who may not have sufficient information or training on dosages or specific drugs that would be best suited for individual cases. Even worse, about half of people with depression, particularly the elderly, do not receive any therapy at all. Lack of health insurance is a major factor in these low treatment rates.

Patients with Major Depression. Numerous studies support a combination of cognitive behavioral therapy (CBT) plus antidepressants (typically an SSRI, such as Prozac) given for at least 60 days. CBT is used to resolve any residual symptoms after medication has been started. Some studies estimate that only 40% of people with chronic depression respond to medications alone compared to 60% who are given combination treatment.

For those who fail medications and psychotherapy, other techniques, such as electroconvulsive therapy (ECT), are safe and effective. In recent years, experimental procedures, such as vagus nerve stimulation and repetitive transcranial magnetic stimulation, have also been found to help in some cases of treatment-resistant depression. Researchers are also investigating new types of drugs (such as ketamine), which may provide a rapid, if temporary, improvement for these patients. However, according to several important 2006 studies, the more treatment strategies that patients need, the less likely they are to recover completely from depression.