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Treating Major Depression

Posted Aug 24 2008 1:49pm
ANNOUNCER: Major depression is more than just suffering from a bad mood. It can affect just about everything you do, from how you sleep at night to how well you perform your job.

JOSEPH FRIEDMAN, MD: The goal of a physician treating somebody with depression: You want to try to restore their life back to some level of normalcy. And typically this is why somebody would come to the doctor, not because their mood is depressed, but because it's beginning to interfere with various aspects of their life.

ANNOUNCER: Those with severe depression can find relief by talking to a professional therapist or taking specific medications. But what works for one person may not always work for you.

JOSEPH FRIEDMAN, MD: No person is the same. Some people may respond to psychotherapy alone. Some people may respond to just medication alone. Some people really require the combination of the two. It's up to the individual physician to tailor the treatment to the individual patient.

ANNOUNCER: In fact, the depression may be so bad that just talking with a therapist may not be enough.

JOSEPH FRIEDMAN, MD: You could say everything that you want to the person and engage them using every type of psychotherapeutic tactic that you know, but they're so caught up in their own internal distress, the severe anxiety, the internal pain of the depression, the sleep deprivation from the insomnia, that they really can't focus on the psychotherapy.

ANNOUNCER: There are several different types of antidepressant medications, which are often effective.

JOSEPH FRIEDMAN, MD: 1987 was really a turning point for the treatment of depression, because that year was the introduction of fluoxetine, which is one of the first members of a class of medications called the selective serotonin reuptake inhibitors. And these drugs differ as a whole class from the older drugs because they have much less side effects.

ANNOUNCER: Older antidepressants, known as tricyclics, can be dangerous if mixed with other drugs. But Prozac and newer medications are associated with their own problems, such as a lower sex drive and weight gain.

JOSEPH FRIEDMAN, MD: The way physicians tailor a treatment is by considering what types of side effects one patient might be more sensitive to than another. And this way you could choose which drug might be appropriate.

ANNOUNCER: Because antidepressants can sometimes take a few weeks to take effect, people with severe depression may need to combine them with sedative drugs at first.

JOSEPH FRIEDMAN, MD: A combination of antidepressants with anti-anxiety drugs, at least perhaps in the beginning of the treatment, would be most helpful, because it could restore somebody's sleep patterns back to normal and can alleviate the anxiety, the internal distress that they feel as a result of the depression.

ANNOUNCER: If such medications and talk therapy fail to work, there is another option known as electroconvulsive therapy.

JOSEPH FRIEDMAN, MD: Electroconvulsive therapy is probably one of the longest-standing, oldest treatments for depression that we have.

ANNOUNCER: This therapy is highly effective, but it involves general anesthesia and attaching electrodes to the head to essentially shock the brain into feeling better.

JOSEPH FRIEDMAN, MD: Now, we don't know why this treatment works, but it works. It is effective. But it is a last resort.

ANNOUNCER: What is important to remember is that people with severe depression now have many treatments that can help.

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