Depression is a psychiatric diagnosis classified by the DSM IV as a mood disorder. A depression is characterized by different symptoms, the two main characteristics are a depressive mood and anhedonia , which means loss of the capacity to enjoy or experience pleasure. Other symptoms include insomnia, gaining or loosing weight, tiredness and thought about dead or suicide.
This article will point out the options for curing depression. In most cases the choice for treatment is between antidepressant medication and cognitive therapy. In a mild or moderate depression both forms of treatment show the same success rates. In this article we will focus on medication. For severe depressions antidepressant medicines are first choice for treatment. If both forms of treatment fail, electroconvulsive therapy (ECT) can be an option.
Antidepressant medication can be subdivided in two groups, the tricyclic antidepressants (TCA’s), also called classic antidepressants, and the selective serotonin reuptake inhibitors (SSRI’s), or new generation antidepressants. This second group, the SSRI’s, has fewer side effects than TCA’s and is for that reason the best option to treat mild to moderate depression. A severe depression is treated with TCA’s.
Serotonin is a neurotransmitter; it functions as a messenger between nerves. During a depression there is a lack of serotonin in the brain. The effect of SSRI’s is that the serotonin reuptake is less so there is more serotonin available. Examples of SSRI’s are Citalopram (Celexa or Cipramil), Fluoxetine (Prozac) and Paroxetine (Seroxat). Important to know is that it takes about 4 to 6 weeks till the positive effect of the medication can be evaluated. However, the side effects of the medication can be present from the day you start the medication, this is important to realize because otherwise patients will not longer be motivated for the treatment. Side effects you can expect from SSRI’s are intestinal problems like nausea and diarrhea, headache, weight loss and loss of appetite and agitation
Tricylic antidepressant medicines work in the same way as SSRI’s. When treatment with SSRI’s has no effect or the depression is severe, TCA’s are a good option. Examples of TCA’s are Nortriptyline (Aventyl), Amitriptyline (Elavil) and Clomipramide (Anafranil). Side effects you can expect from TCA’s are a dry mouth, constipation, vision problems, sedation, orthostatic hypotension and gaining weight.
If treatment with both SSRI’s and TCA have no success, it is possible to start with Lithium addition. Lithium is a mood stabilizer that, when uses as augmentation, have proved to be a successful cure for depression.
If the depression turns out to be resistant for therapy with antidepressant medication and Lithium, electroconvulsive therapy is an option. ECT is done under general anesthetic. With electric pulses a seizure is induced. Side effects are contemporary memory loss, stiffness and headache.