Treatment for Major Depressive Disorder (MDD)
Several types of treatment for major depression are available, and the type chosen depends on the individual and the severity of their illness. There are three basic types of treatment for depression in common use today: psychotherapy, medications and electroconvulsive therapy (ECT). Now there is NeuroStar TMS Therapy as a second line treatment after failing one medication at a therapeutic dose for 4-6 weeks.
Psychotherapy – There are several types of psychotherapy that have been shown to be effective for depression including cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that some individuals with mild to moderate depression can at times be treated successfully with either of these therapies used alone. Other research on Major Depressive Disorder has indicated that the use of medication and psychotherapy together is more useful than either one utilized alone.
Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while training people how to break the behavioral patterns that contribute to their illness.To individuals open to exploring their faith and spirituality, the Asbury Counseling Center offers direction in a Christ centered approach to issues of guilt,forgiveness, negativity,compulsive behaviors etc.
Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life situations that may have contributed to an individual’s depression.
Trancranial Magnetic Stimulation (TMS Therapy) – TMS Therapy is a new for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment. TMS stands for “transcranial magnetic stimulation.”TMS Therapy is a treatment that can be performed in a psychiatrist’s office, under their supervision, using a medical device called the TMS Therapy system. TMS Therapy is;
- Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
- Non-systemic, meaning that it is not taken by mouth and does not circulate in the blood stream throughout the body.
The typical initial treatment course consists of 5 treatments per week over a 4-6 week period, for an average of 26-36 total treatments. Each treatment session lasts approximately 37.5-60 minutes.
Medication – The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neuro- transmitters like serotonin, dopamine and norepinephrine can be modulated with antidepressants. The response to medication is gradual often taking 4-6 weeks to fully respond. Five groups of antidepressant medications are most often prescribed for depression:Selective serotonin reuptake inhibitors (SSRIs) – useful as a first-line treatment, they act specifically on the neurotransmitter serotonin. In general, SSRIs cause fewer side effects than TCAs and MAOIs.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – useful as first-line treatments in people taking an anti-depressant for the first time and for people who have not responded to other medications. In general, SNRIs cause fewer side effects than TCA and MAOIs.
- Dopamine reuptake blocker – a newer antidepressant medication, it acts on the neurotransmitters dopamine and norepinephrine. In general, this class of medication causes fewer side effects than TCAs and MAOIs.
- Tricyclic antidepressants (TCAs) – still widely used for severe depression. TCAs elevate mood in depressed individuals, re-establish their normal sleep, appetite and energy level. Greater side effects of the tricyclic antidepressants often may limit their usefulness in some individuals.
- Monoamine oxidase inhibitors (MAOIs) – are often effective in individuals who do not respond to other medications or who have “atypical” depressions with marked anxiety, excessive sleeping, irritability, hypochondria or phobic characteristics. These medications are harder to use and require following a low tyramine diet.
Electroconvulsive therapy (ECT) – ECT is an effective treatment for severe depressive episodes. ECT employs the use of anesthesia and muscle relaxers during the procedure which involves the application of an electrical field to the head in order to produce a physical seizure.
For individuals where medication, psychotherapy, and a combination of the two prove to be ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT is often used. ECT may also be indicated for those who are not able to take antidepressant medications and do not respond to psychotherapy. Side effects on memory recall are troublesome for some individuals. These treatments are given in a hospital setting.
Vagus Nerve Stimulation (VNS Therapy™) – is a non-drug treatment available specifically for treatment-resistant depression. The actual procedure takes about an hour and is usually performed under general anesthesia on an outpatient basis. Two small incisions are required: one on the upper chest area for the pulse generator and one on the left neck for the thin, flexible wires that connect the pulse generator to the vagus nerve. This treatment is infrequently utilized.