Depression treatment

HOME Depression treatment

Even though depression can be a serious and very painful disease, luckily there are a number of effective treatment options. The first step will always be to go to your doctor, who can help you further in the system and suggest the particular treatment that would be best for you.

Amongst the most widespread forms of treatment of depression are psychotherapy, medicine (both older and newer types), light treatment and - in severe cases - electroshock. Additionally, research is constantly carried out into other types of treatment of which TMS (transcranial magnet stimulation) is particularly promising.

You can read about these forms of treatment in this section.

Department FAQ

Medicinal treatment

Psychotherapy is the designation of psychological treatment and there are various therapeutic areas and many methods. The best scientifically supported method is cognitive therapy. It deals with the way that people think. Psychotherapy is based on a theoretical model, on clinical observations and an equal cooperation between patient and therapist.

  • serotonin

  • noradrenaline

  • dopamine

When we treat depression with antidepressants, the amount of signalling substances in the brain is increased and that makes your mood normal.

During the last 40 years there has been a rapid development in the medicinal treatment of depression. Many types of antidepressants have been developed, which are all effective. If you take this medicine correctly, you can nearly always improve your condition within a relatively short time.

Most people are treated by their GP

The treatment of depression was previously often a task for the specialist. Today most people with depression are given medicinal treatment by their own GP because we now have different types of newer antidepressants. Common to all of them is that they

  • are effective against depression

  • are effective after a relatively short time

  • often have few or short-term adverse effects

  • are not addictive

  • are not poisonous even if an overdose is taken

  • don't require that you go for regular checkups with blood tests etc.

The treatment with antidepressants should always be combined with regular talks with your doctor. During these talks the doctor will give you detailed information about the disease and about the advantages and disadvantages (adverse affects) that the treatment might have.

Follow the doctor's advice

The goal of the treatment of depression is to remove your symptoms, in the same way that insulin removes the symptoms of diabetes. The most important thing for an antidepressant treatment to work is that you take your medicine as prescribed by your doctor. It is a very bad idea to reduce the amount of medicine you take or not to take your medicine every day. There are actually quite a lot of people who take less medicine that they should.

We would like to counteract this trend. We do that by informing you of the purpose of the treatment, its effect and about the adverse effects that can occur. When you are well informed, you will know how important it is to take the medicine in the way that your doctor or psychiatrist prescribed it.

Checkups

Everyone who receives medicinal treatment has to go to their doctor for checkups. It is important to monitor accurately how that treatment is working and when you feel well again. In most cases, there are no problems connected with the treatment. You will become well again on the medicine that your doctor recommends. Two to three weeks will pass before you begin to notice the effect of the medicine. It is therefore very common not to feel well until after four to six weeks of treatment.

In rare cases the medicine and the dose that your doctor has prescribed doesn't work effectively. Luckily, your doctor or psychiatrist have many possibilities of improving your treatment by choosing to

  • point out how important it is to remember taking your medicine correctly

  • continue your treatment for a while longer without making any changes to it

  • give a larger dose of the same medicine

  • change to another antidepressant

  • combine antidepressants with other forms of medicine

  • combine antidepressants and psychotherapy

  • combine antidepressants and ECT

Blood tests

If you are taking one of the newer antidepressants ( SSRI ), it is not necessary to monitor the treatment with blood tests. But if you are taking a TCA (tricyclic antidepressants) the amount of TCA in the blood has to be measured. This is done by taking a blood test eight days after you have started your treatment. The blood test must be taken 12 hours after you took your last dose, and the dose will then be adjusted according to the results of the blood test. The amount of TCA in the blood should be checked regularly during your treatment.

Psychotherapy

Psychotherapy is the designation of psychological treatment and there are various therapeutic areas and many methods. The best scientifically supported method is cognitive therapy. It deals with the way that people think. Psychotherapy is based on a theoretical model, on clinical observations and an equal cooperation between patient and therapist.

If you are depressed, you know a lot about how it feels to be depressed. The therapist on the other hand knows a lot about the course of people's reactions and how changes can happen.

The psychotherapists specialise in the the following areas:

  • cognitive behavioural therapy

  • psychodynamic theory

  • systemic therapy

  • existential humanistic therapy

Cognitive behavioural therapy

Cognitive behavioural therapy's goal is to

  • create a good alliance between you and your therapy

  • make a thorough assessment of your problem

  • find realistic goals for the treatment

  • change the behaviour

  • change the thoughts

  • change the feelings

  • help you achieve the necessary changes

If you are suffering from depression, the therapist will teach you to

  • use methods that will reduce anxiety

  • use methods that will increase your activity and mood

  • build up your social skills

  • build up your self-esteem

  • regulate your feelings

  • solve problems

There are different methods which correspond to different mental problems and conditions. It depends on the individual how much therapy is needed. But an average course of therapy is about 12-20 sessions if you are suffering from moderate depression.

Psychodynamic therapy

The treatment is based on Freud's theory on psychosexual stages, unconscious conflicts and defence mechanisms. In supportive conversations, where the therapist listens sympathetically, the emphasis is on which strategies "the conscious self" (the ego) uses to defend itself against anxiety.

The therapist puts the emphasis on insight. Your therapist furthermore uses methods such as uncovering and interpretation, free associations and interpretation of dreams. The treatment usually lasts for several years and from a scientific point of view its effect has only been documented as being limited.

Systemic therapy

The treatment takes its starting point in your surroundings and relations with others. The therapist often works with your family. What is being said - to whom and when? In systemic therapy, you learn how you can change inappropriate communication and problems in relation to others.

Systemic therapy is also suitable for working with relations and communication in organisations. The treatment varies in duration and consists of solving and advisory conversations. Not a lot of research is being done in this area.

Existential humanistic therapy

Most of the psychotherapeutic schools know and use the ideas of the great humanists. In existential humanistic therapy, the therapist focuses on what is meaningful to you and on your unique way at looking at yourself and the world.

The therapist works with the unpredictable and transient aspects of your life. The treatment consists of supportive conversations, role play, psychodrama etc. It is difficult to do any research in this form of psychotherapy, as the goals are not tangible and specific, and we therefore don't really know the effect.

Electroshock

The most common treatment of depression is with antidepressants and psychotherapy but there are other forms of treatment. One of them is ECT, (an abbreviation which stands for electroconvulsive therapy), which is also called electroshock.

Despite all the rumours, ECT is an effective, quick and gentle treatment of depression. Electroshock can sound like an old-fashioned and dangerous treatment but the truth is that ECT is a save treatment. ECT is the fastest working and most effective treatment of depression. The treatment can be used on both the elderly and on people who are suffering from heart disease or are otherwise frail.

Anaesthesia

You are fully anaesthetized, and you are then given a muscle relaxing injection. We then provoke a convulsive fit by giving a weak electric shock over both temporal regions or over the right temporal region and the crown.

A very small part of the current from the electric shock reaches the brain. The current activates the nerve cells, and if they are activated sufficiently, it triggers a convulsive fit. The convulsive fit is a rhythmic, electric activity in the nerve cells which lasts for 25-60 seconds. As you are anaesthetized and completely relaxed, only small contractions in the muscles are noticeable.

It is phenomena in connection with this convulsive fit which have the antidepressant effect. No collective explanation to the question about how ECT works has yet been found but there are many hypotheses and many research results, which present a certain understanding of the effect mechanisms.

After the treatment, you rest for a short time while we make sure that you are feeling well, and after a few hours you are on your feet again.

It takes place in hospital

In most places you receive ECT treatment three times a week. The number of treatments required often ranges between six and twelve but sometimes it is necessary to give more ECT treatments. It very much depends on the individual.

The ECT treatment always takes place in a hospital, often in a psychiatric ward. In most cases, you would be admitted for one day. But it can happen that you receive your treatment as an out-patient and go home on the same day.

One of the doctors employed in the psychiatric ward will give you the treatment. A doctor or nurse from the Anaesthesia Department will give you the anaesthetic.

Severe depression

If you are suffering from severe depression with psychotic symptoms, we often recommend ECT. It is so painful and sometimes dangerous to be suffering from severe depression that we recommend this treatment even though you are nervous about ECT. Most of those who have received ECT would like to receive ECT again if they develop another depression.

We offer you ECT if you drink or eat so little that your situation is life threatening or if you have serious suicide thoughts. In certain cases ECT can be life saving. We also offer you ECT treatment if your antidepressant medicine hasn't had any effect.

Compulsion

In rare cases, we are forced to use compulsory ECT treatment. This is only considered an option in severe, life threatening depressions, which cannot be treated in any other way.

Some people with depression can feel such low self-esteem that they believe that the depression is a rightly deserved punishment. They therefore do not believe that the depression should be treated. Some patients can get so bewildered and capricious that they cannot make a decision on the question about receiving ECT treatment.

If ECT has to be given compulsorily, you need to have a patient adviser, and all the requirements of the law must be obeyed.

Effective

ECT is the fastest working and most effective treatment of depression. From testing the effect of ECT, it appears that between 70 and 90% of patients become well (with regard to the actual depressive episode). The corresponding figures for patients who are treated with medicine range between 50 and 70%.

The effect of ECT sets in after one to two weeks while the effect of a medicinal treatment sets in after two to four weeks.

Approximately 50% of those who have improved after the ECT treatment unfortunately have a relapse within 6 months. If we use both ECT and preventive antidepressants, the frequency of relapses is reduced.

ECT is therefore not a curative treatment. We always need to follow up the treatment with preventive treatment and monitoring.

Adverse effects

ECT is safe, but a number of patients do experience reduced short term memory after the treatment. Some don't have any adverse effects at all but some can have difficulties remembering events from the time during and around the ECT treatment. For most, the memory function returns to normal again after a few weeks.

A few can have problems for a few months but there is no scientific basis for permanent memory problems. Very few have experienced permanent memory problems. But whether that was caused by the ECT treatment is very uncertain.

Some patients can be confused immediately after the treatment. This confusion is short term and completely temporary. It disappears typically within a few hours.

TMS

Luckily new discoveries in the treatment of depression are continuously being made. One such discovery is TMS (transcranial magnetic stimulation), which is a new and promising form of treatment. We hope that TMS can become supplementary in the treatment of depression but so far it is still at the research stage.

The method has certain similarities to ECT, but unlike ECT it doesn't provoke a convulsive fit. The treatment is furthermore carried out without giving an anaesthetic. Perhaps TMS can replace ECT partially in the future but it is still too unsafe to be able to say anything specific about that.

The treatment is carried out by placing an electromagnet on the scalp over the temple region on either the right or left side of the head. When we send current through a bi-directional coil, a pulsating magnetic field is created. This provokes a localised electrical current in the brain underneath the coil, which activates the brain cells.

Effectiveness

The method is so relatively new that we cannot say anything for certain about its effectiveness. In a number of trials, TMS has however had a quick and safe effect on depressions but there are still many unanswered questions.

Unfortunately, it looks like the effect only lasts a couple of weeks. It is therefore necessary to find a combination of preventive medicinal treatment and TMS.

The only side-effect that has been registered is a mild headache. The headache comes from tension in the muscles around the head and a normal headache tablet will make the headache go away. It is very positive that there are no signs of memory disturbances in connection with TMS treatment.

Light

In this part of the world, light treatment is often used in connection with winter depressions, i.e. depressions that are caused by the lack of daylight in the winter. Read about light treatment under winter depression.