Are you unhappy, worried about your life, and things don’t seem to matter?
It might be depression. And that should mean change of some sort. What that means can vary: it can mean eating healthier and exercising, to seeing a therapist and taking medication.
It’s important to realize what we know about depression – and what we don’t.
First, we aren’t sure what causes depression. While often depression can be linked to a significant event, it also often just happens, so to speak. It seems to make more sense for depression without a reason to require treatment.
And we don’t know how much of depression is normal. If someone just lost their parents, for instance, or was diagnosed with a fatal disease, it only makes sense for them to feel down – depressed. Making it more complicated, most depressive feelings pass with time.
The standard medical treatment for depression is, nowadays, medication. But there are reasons to hesitate before turning to medications, like how little we know about them. Also, they have only OK results – they work in about 60% of people who take them, as opposed to about 30% who respond to a placebo, or a sugar pill.
And that’s at best. Some studies have shown significantly lower success rates, and how well antidepressants work over the long run also seems to be lower.
Worse. Medications for depression often have serious side effects, including sexual dysfunction and can even cause suicidal thoughts. And they can be physically addictive.
On the other hand, antidepressants can help and are sometimes lifesaving. There is a reason that millions of people have taken them, and it’s not all due to adroit marketing by pharmaceutical companies. A good therapist can help you weight the pros and cons of medication and help find the right path.
Treatment – initial evaluation
If you’re concerned about possibly having depression, you should see both a regular doctor and a therapist for an evaluation. There are many physical causes of depression. Vitamin B12 deficiencies, for instance, as well as low levels of folic acid can cause depression. And physical conditions like hypothyroidism also can cause poor mood.
As such, the first step for treating depression should be a phyiscal work up to eliminate these and other conditions. Tests should be done for thyroid hormone levels and to ensure both proper levels of nutrients and proper digestive working.
Dietary modification and exercise are worth a try as an initial treatment for depression. Some doctors claim to see astonishing transformations from that alone, and several studies have shown that vigorous exercise works as well as medication for treating depression.
Seeing a therapist is a very good idea. Their expertise and ability to help you with your problems can be phenomenal just by itself. The fact is that therapy has been shown to be just as effective as medications for treating depression – with the only side effect being a smaller wallet.
Treatment – SSRIs
If you decide to go onto medication, a decision that shouldn’t be made lightly and should ideally come after trying the ideas above, most likely your doctor will recommend an SSRI.
The SSRIs are now the most commonly prescribed medication for depression. They are so called because they are Selective Serotonin Reuptake Inhibitors. What does that mean? Well, imagine two cells in your brain. There’s a gap in between the two, which is full of chemicals and substances, including serotonin. This stuff interacts with receptors on the cell, activating and creating all sorts of activity.
The SSRIs prevent cells from taking up serotonin, or removing it from the space in between the cells. That keeps serotonin around longer, which means it activates more of the receptors for it.
Why this does anything to improve mood we simply don’t know. Serotonin is a widely used neurotransmitter, and substances that effect it have unpredictable effects. Some pain killers effect it, as well as LSD, which causes hallucinations.
The SSRIs work in about 2/3 of patients who use them. In terms of side effects, they very commonly cause sexual dysfunction like inability to orgasm and some digestive issues. Shockingly, they have been linked to a significant increase in suicidal thinking, perhaps doubling the risk of it.
Treatment – Tricylics, MAO-inhibitors
These are older classes of medication but work on similar neurochemicals that the SSRIs do. The tricylclics might be slightly more effective than the SSRIs, but there are very good reason that both these medications are not used typically for initial treatment.
Tricylclics can be fatal in overdoses, and have other significant side effects. MAO inhibitors are also somewhat toxic and make the user extremely sensitive to certain foods, like cheese. If one of those foods are eaten, a life threatening increase in blood pressure can happen.
Treatment – if things don’t improve
If the ideas above don’t help with your depression, several things should be considered.
First, the depression may be caused by a related mood condition called Bipolar Disorder. Bipolar disorder often causes depression that does not respond to typical antidepressant treatment.
Second, switching medications is definitely worth considering. Several studies have shown that a significant percentage of people who don’t respond to initial treatment do to their second, or third medication. Importantly, there are medications that don’t work on serotonin that may work if an SSRI doesn’t.
In some cases, it might be worth considering adding a different class of medication. Antipsychotics have shown some but modest ability to help treat depression. Stimulants like Ritalin and Adderall might help increase energy and motivation.
In the worst case scenarios, physical interventions like electro-shock therapy might work. Electro-shock therapy is actually the most effective treatment for depression we have, but comes with serious side effects like memory loss.
Depression is a serious problem and medications can help. That said, there are limitations to both our understanding of the condition and the pills to treat it. If you’re feeling depressed, you might want to consider if it makes sense. As direct/rude as it may sound, if your life is crappy, why would you expect to feel otherwise?
The best treatment would seem to be seeing a therapist who very well understands the relevant issues. They can guide medication decisions as well as help you with the problems in your life that may be causing the depression.
Never lose hope. Never give up. There is a combination of dietary change, exercise, therapy and medication that will change things for the better. Sometimes clouds cover the sun, but that doesn’t it isn’t there – or that it won’t shine again, soon.
If you are feeling actively suicidal, please consider getting immediate help.
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Thanks for reading!