Depression, even in its most severe form, is highly treatable. As with many illnesses, getting treatment early is more effective and reduces the chance of recurrence. And because it often co-occurs with other illnesses in older adults, untreated depression may delay recovery from or worsen the outcome of other illnesses. It is important to remember that a person with depression cannot simply "snap out of it."
Treatment choices differ for each person, and sometimes different treatments must be tried until one works for a particular person. It is important to keep trying until you find something that works for you.
The most common forms of treatment for depression are medication and psychotherapy.
Medications called antidepressants work to normalize brain chemicals called neurotransmitters, notably serotonin, norepinephrine, and dopamine. Scientists studying depression have found that these chemicals, and possibly others, are involved in regulating mood, but they are unsure of exactly how they work.
The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa) and several others. SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta). Another newer antidepressant that is different from both SSRIs and SNRIs but is very popular is bupropion (Wellbutrin). These newer drugs are more popular than the older classes of antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs), because they tend to have fewer side effects. However, medications affect everyone differently. Therefore, for some people, tricyclics or MAOIs may be the best choice.
People taking MAOIs must follow strict food and medicine guidelines to avoid potentially serious interactions. They must avoid substances that contain high levels of the chemical tyramine which is found in many cheeses, wines, and pickles and in some medications including decongestants. MAOIs interact with tyramine in a way that may cause a sharp rise in blood pressure, possibly leading to a stroke. A doctor should give a patient taking an MAOI a complete list of foods, medicines, and substances to avoid.
For all types of antidepressants, patients must take regular doses for at least three to four weeks, sometimes longer, before they are likely to feel the full benefit. They should continue taking the medication for an amount of time specified by their doctor, even if they are feeling better, to prevent the depression from returning.
Stopping medication should be done only under a doctor's supervision. They need to be gradually stopped to give the body time to adjust. Although they are not habit-forming or addictive, antidepressants should not be stopped abruptly because that can cause withdrawal symptoms or lead to a relapse. Some people, such as those whose depression is chronic or keeps returning, may need to stay on the medication for a long time.
Older adults who are experiencing their first episode of depression also may want to stay on antidepressant medication for a while, even if their symptoms have disappeared. Recent research shows that patients age 70 and older who took antidepressant medication for two years after they became symptom-free were 60 percent less likely to experience a relapse than those who stopped taking the medication.
If one medication does not work, patients should be willing to try another. Research has shown that patients who do not get well after taking a first medication increase their chances of getting well after switching to a different medication or adding another medication to their first one.
The most common side effects of antidepressant medications include headache, nausea, insomnia or nervousness, agitation or a jittery feeling, and sexual problems. Often they are mild and temporary. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.
For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking antidepressants.
In some rare cases, antidepressant medications may lead to suicidal thoughts or actions. However, there is no evidence that they may have this unintended effect among older adults.
In addition to antidepressants, some people use the herb St. John's wort to treat depression. A bushy, wild-growing plant with yellow flowers, the herb has been used for centuries in many folk and herbal remedies. Today in Europe, it is widely used to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.
The National Institutes of Health recently conducted a clinical trial to find out if the herb was effective in treating adults suffering from major depression. (A clinical trial is a research study with people to find out if a drug, treatment, or therapy is safe and effective.) The trial found that St. John's wort was no more effective than a placebo, or sugar pill, in treating major depression. Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.
Other research has shown that St. John's wort can interact unfavorably with other drugs. On February 10, 2000, the FDA issued a Public Health Advisory stating that the herb appears to interfere with certain drugs used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. Because of these potential interactions, older adults should always consult with their doctors before taking any herbal supplement.
Several types of psychotherapy -- or "talk therapy" -- can help people with depression. Some treatments are short-term, lasting 10 to 20 weeks, and others are longer, depending on the person's needs.
Two main types of psychotherapies -- cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) -- have been shown to be effective in treating depression.
By teaching new ways of thinking and behaving, CBT (cognitive-behavioral therapy) helps people change negative habits that may contribute to their depression. IPT (interpersonal therapy) helps people understand and work through troubled personal relationships or events that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best treatment option. However, sometimes psychotherapy alone is not enough. A study examining depression treatment among older adults found that patients who got better with medication and IPT were less likely to have the depression return if they continued their combination treatment for at least two years.
When medication and/or psychotherapy does not help improve a person's depression, electroconvulsive therapy (ECT) sometimes is used. ECT, once known as "shock therapy," used to have a very bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not gotten better or improved with other treatments.
Before electroconvulsive therapy is given, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse from ECT. A patient typically will have ECT several times a week, and often will also need to take an antidepressant or mood stabilizing medication to prevent the depression from returning. Although some patients will need only a few courses of ECT, others may need follow-up treatments, usually once a week at first, then gradually decreasing to monthly for up to one year.
Electroconvulsive therapy may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear up soon after treatment.
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