HEALTH & WELLNESS: What is the best depression treatment?

GUEST COLUMN

Many of you reading this article will have had first-hand experience of what it means to be depressed. Clinical depression goes by many names: depression, chronic depression, major depression and “the blues.”

Whatever the name, it all refers to the same thing: feeling sad and depressed for weeks or months on end (not just a passing blue mood). It is accompanied by feelings of hopelessness, lack of energy, taking little or no pleasure in things that have given you joy in the past, or in other people and your usual activities. It is often accompanied by irritability, fatigue and problems with sleep, concentration and memory, feelings of worthlessness and sometimes thoughts of suicide.

About one in six people will become depressed at some point in their lives. Most of these people will be familiar with the stigma that it carries.

As bad as that feels, it pales in comparison to the huge burden and suffering that depression causes, both to the person and their family.

The World Health Organization recently predicted that within 20 years, more people will be affected by depression than any other health problem. There should be no surprise that it has been called a silent epidemic and it is anticipated that it will cause more early deaths and severe disability than any other illness.

When the first anti-depressants were created in the 1960s, psychiatrists were delighted that they now had found what seemed to be a cure for depression. Perhaps the best known drug was Prozac, which over time attained something of a cult status.

With Prozac and other selective serotonin re-uptake inhibitors (SSRI), there was a spectacular increase in the number of antidepressant prescriptions.

Antidepressant use has doubled over the last 10 years while psychotherapy use in the same population has decreased. Many people argue that symptom-reduction occurs more quickly with antidepressants when treating depression, making it the best treatment. The problem with this argument is that some individuals relapse once they stop taking the medication.

This last week, the renowned National Institute for Clinical Excellence (NICE) has published updated guidelines that advise doctors to prescribe antidepressants only for severely depressed patients while mild and moderately depressed people should receive psychotherapy. That said, it is always important to consider an individual patient’s situation — e.g., past history, degree of impairment, duration of symptoms and risk of relapse — when choosing treatment options.

The primary objective of the Nice guidelines is to encourage people to learn different skills to overcome current depression, and lower the risk of any future relapse. They particularly support cognitive behaviour therapy, in which people are taught to break habitual ways of seeing things and to think positively.

– column provided by Owen James, a registered psychologist and clinical director of Tri-City Psychology Services, 2227 St. Johns St., Port Moody, 604-939-9988.

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