Living Depression-freeLive Free: You Can Escape Depression

The World Health Organization identified depression as the leading cause of disability in the United States and worldwide in 2001. Unnecessarily so, according to British researchers who find that nearly everyone who seeks treatment improves. But depression does take prisoners: people who are reluctant to talk with their doctors, are afraid of being seen as weak, or think their moods will pass.

The good news is depression does not come with a life sentence. Great strides have been made over the last 40 years with breakthroughs in research, psychotherapy and in the pharmaceutical industry. The key is identifying depression early and getting the right kind of help. Signs of depression that may go unrecognized are:

  • Lack of energy, fatigue
  • Anxiety, restlessness or irritability
  • Loss of interest or pleasure in activities
  • Unintentional weight loss or gain
  • Insomnia or sleeping too much
  • Feelings of worthlessness or inappropriate guilt

The exact cause of depression is not clear, but Magnetic Resonance Imaging scans (soft tissue x-rays) show differences in the brains of people with depression, and research suggests there may be medical, genetic, personality, and situational factors involved.


Antidepressant Medications

Medications are started slowly, and some dosage adjustments may be required. Doctors will work with patients to find the best prescription options. The three main types of antidepressants are all effective in treating depression, although some people respond to certain medications better than others.

The older tricyclic antidepressants may be the best choice for persons on limited incomes. Although dry mouth, dry eyes, constipation or drowsiness are common side effects in the beginning, they tend to become less bothersome after the initial phase of treatment.

Introduction of the Selective Serotonin Reuptake Inhibitors (SSRIs) in the 1980's paved the way for better compliance with fewer side effects. SSRIs act by keeping neurotransmitters available in the brain to help regulate and stabilize mood. These are tolerated better by people with heart problems. Dual-action Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) prevent the excessive uptake of two neurotransmitters at a time.

Novel antidepressants work with three neurotransmitters or the body's natural hormones. These also promise to be effective with fewer side effects and easier dosing.

It takes a few weeks to realize the full benefit of medication therapy. Antidepressants should continue for several months, be re-evaluated periodically, and may continue long-term.


Cognitive Behavioral Therapy

Cognition is a person's perception, judgment, and reasoning. Cognitive therapy (sometimes called cognitive-behavioral therapy or CBT) helps patients recognize and change negative thinking patterns, which in turn guides the behavioral aspect: replacing harmful or negative behaviors with helpful or positive behaviors. CBT is a learned technique and the patient will likely have "homework" assignments to build his skill and confidence. Problem-solving exercises include analyzing a situation in parts:

  • Situation - What's the problem?
  • Perception - How do I feel and what do I think?
  • Options - What are my choices?
  • Decisions - What is the best decision based on what I know?

Cognitive therapy has been widely used since Aaron Beck first introduced it in the 1960's. It's proven to be very effective by itself for mild to moderate depression and, when combined with antidepressants, for severe depression as well.

Patients should look for a doctor or psychiatrist they feel comfortable with and ask for a referral to another doctor if necessary. Doctors, like medications, have different ways of working and no single one is right for everybody. Appropriate treatment, facilitated by a skilled practitioner, can make the difference between just living with depression and living free.