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DEPRESSIVE DISORDERS TREATMENTS |
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Major depressive and dysthymic disorders
are typically treated with antidepressants or psychosocial therapy.
Psychosocial therapy focuses on the personal and interpersonal
issues behind depression, while antidepressant medication is
prescribed to provide more immediate relief for the symptoms of the
disorder. When used together correctly, therapy and antidepressants
are a powerful treatment plan for the depressed patient. Antidepressants Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) reduce depression by increasing levels of serotonin, a neurotransmitter. Some clinicians prefer SSRIs for treatment of dysthymic disorder. Anxiety, diarrhea, drowsiness, headache, sweating, nausea, poor sexual functioning, and insomnia are all possible side effects of SSRIs. Tricyclic antidepressants (TCAs) are less expensive than SSRIs, but have more severe side-effects, which may include persistent dry mouth, sedation, dizziness, and cardiac arrhythmias. Because of these side effects, caution is taken when prescribing TCAs to elderly patients. TCAs include amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). A ten-day supply of TCAs can be lethal if ingested all at once, so these drugs may not be a preferred treatment option for patients at risk for suicide. Monoamine oxidase inhibitors (MAO inhibitors) such as tranylcypromine (Parnate) and phenelzine (Nardil) block the action of monoamine oxidase (MAO), an enzyme in the central nervous system. Patients taking MAOIs must cut foods high in tyramine (found in aged cheeses and meats) out of their diet to avoid potentially serious hypertensive side effects. Heterocyclics include bupropion (Wellbutrin) and trazodone (Desyrel). Bupropion should not be prescribed to patients with a seizure disorder. Side effects of the drug may include agitation, anxiety, confusion, tremor, dry mouth, fast or irregular heartbeat, headache, low blood pressure, and insomnia. Because trazodone has a sedative effect, it is useful in treating depressed patients with insomnia. Other possible side effects of trazodone include dry mouth, gastrointestinal distress, dizziness, and headache. Psychosocial therapy Psychotherapy explores an individual's life to bring to light possible contributing causes of the present depression. During treatment, the therapist helps the patient to become self-aware of his or her thinking patterns and how they came to be. There are several different subtypes of psychotherapy, but all have the common goal of helping the patient develop healthy problem solving and coping skills. Cognitive-behavioral therapy assumes that the patient's faulty thinking is causing the current depression and focuses on changing the depressed patient's thought patterns and perceptions. The therapist helps the patient identify negative or distorted thought patterns and the emotions and behavior that accompany them, and then retrains the depressed individual to recognize the thinking and react differently to it. Electroconvulsant therapy ECT, or electroconvulsive therapy, is usually employed after all therapy and pharmaceutical treatment options have been explored. However, it is sometimes used early in treatment when severe depression is present and the patient refuses oral medication, or when the patient is becoming dehydrated, extremely suicidal, or psychotic. The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. ECT is given under general anesthesia and patients are administered a muscle relaxant to prevent convulsions. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that the electrical current modifies the electrochemical processes of the brain, consequently relieving depression. Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Memory loss, typically transient, has also been reported in ECT patients. Alternative treatment St. John's wort (Hypericum perforatum) is used throughout Europe to treat depressive symptoms. Unlike traditional prescription antidepressants, this herbal antidepressant has few reported side effects. Some users may experience high blood pressure, headaches, stiff neck, nausea, and vomiting. As of early 1998, U.S. clinical trials organized by the National Institute of Mental Health were still in the planning phase. Its efficacy in severe depression is very uncertain. Homeopathic treatment can also be very therapuetic in treating depression. Good nutrition, proper sleep, exercise, and full engagement in life are very important to a healthy mental state. |
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| DEPRESSIVE DISORDERS RELATED ITEMS | ||
