UNDERSTANDING DEPRESSION




What is depression?

How does clinical depression differ from everyday periods of sadness?

Is there any kind of reliable medical test which can confirm that a person is depressed?

Are anti-depressant medications the only effective way to treat clinical depression?

What treatments for depression are unproven or poorly supported by research?







What is depression?
The concept of clinical depression is often misunderstood. Everyone occasionally experiences a sad, blue, "down" emotional state which we refer to as "depression." However, clinical depression consists of deep, prolonged sadness, often accompanied by at least some of the following: Back to Top




How does clinical depression differ from everyday periods of sadness?
Periodic, even frequent episodes of sadness, "feeling down",and having "the blues" is a normal part of life. Normal mood states always include some variability in our emotions. Throughout a week and even a single day, we are supposed to experience periods of joy and sadness. The normal mood state includes rather frequent variations between feeling happy and feeling somewhat depressed or down. These normal variations do not mean a person has bi-polar or manic-depressive disorder.

Clinical depression becomes a probable diagnosis when a person experiences intense episodes of depression frequently, over a prolonged period of time. Usually the individual becomes aware that they are depressed much more often than they are happy.
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Is there any kind of reliable medical test which can confirm that a person is depressed?
At this point in time there exists no reliable medical testing (e.g. blood or hormone tests, etc.) to confirm a case of clinical depression. Most likely such tests will be created in the future, although probably not for many years to come. At this time, the best way to diagnose a case of clinical depression is to undergo a thorough diagnostic evaluation from a licensed clinical psychologist or psychiatrist who is experienced in the treatment of depression.
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Are anti-depressant medications the only effective way to treat clinical depression?
Clinical research shows that anti-depressant drugs, on average, tend to be very effective for about 2/3 of the people who take them. This is about 2 times as effective as placebo preparations (i.e., chemically inert pills). However, there are effective alternatives to drugs in the treatment of depression:

1. Cognitive-Behavioral Therapy (CBT) Numerous studies have shown CBT to be as effective as anti-depressant medication in the treatment of depression. CBT also provides more protection against future episodes of depression because it helps a person develop the tools necessary to change counter-productive thinking and behaviors which can lead to or worsen depression.

2. St. John's Wort/hypericum
 This non-prescription herbal remedy shows some promise in treating mild to moderate depression. However, good clinical research on its effectiveness and safety is very limited. The United States National Institute of Health is conducting a double-blind study on St. John's Wort comparing it to placebo and a known-to-be-effective anti-depressant. The results of the study are due in a few more years. To the best of my research and knowledge, NO other herbal or natural remedies have shown scientific promise for the effective treatment of depression.

3. Electro-Convulsive Therapy (ECT)
Previously known as "shock treatment", ECT is actually a relatively painless and safe treatment for moderate to severe depression. It tends to work more quickly than medication and is considered safe for a variety of patients (e.g. the elderly). Many people are wary of ECT, but it reliably can produce remarkable, rapid improvement for a significant number of people with depression.

4. Treatment of Medical Conditions
Clinical depression is frequently a secondary condition, or "side effect" of another type of medical condition (e.g. diabetes, thyroid problems, heart disease, hormonal imbalances, cancer, HIV/AIDS, etc.). If the primary medical disorder is effectively treated, the depression will sometimes be alleviated. Therefore, everyone experiencing a clinical depressive episode should undergo a thorough physical medical exam complete with blood work and urinanalysis.

5. Exercise; Nutrition; Sleep; Recreation/Vacation; Social Activities; Spirituality; Philosophy for Life
All of these are most likely essential to good physical and psychological health. We simply cannot ignore the important basics of good health and expect to feel well. However, it is probably not wise, for example, to expect a new, rigorous exercise program to "cure" a serious condition like clinical depression all by itself. Each of the variables listed above should be seen as helpful and essential components of a comprehensive treatment plan which may also include medical (e.g. medication) and psychological (e.g. cognitive behavioral therapy) interventions.

6. Time
Remarkably, most episodes of clinical depression left untreated do tend to improve after significant periods of time has passed (i.e. approximately 6 months to one year.) This may attest to the human body's ability to marshall its bio-chemical resources and essentially "heal itself". However, for those who experience at least one major depressive episode in their lifetime, the likelihood of depression recurring is very high. Consequently it may be prudent to seek treatment early in the course of a depressive episode. One must also consider the emotional and physical pain, suffering and impairment that can occur while waiting for time to heal a depressive episode.

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What treatments for depression are unproven or poorly supported by research?
Based on scientific data and my years of clinical experience, the following, in my opinion, have not been shown to be effective in the treatment of clinical depression:

- Acupuncture and its variations
- Herbal remedies (other than St. John's Wort/hypericum)
- Vitamins, minerals, nutritional supplements (except for cases where a medically-confirmed vitamin deficiency exists)
- "New Age" remedies, (e.g. crystals, life-energy waves, magnetism, etc.)
- Faith healing (although prayer and meditation may be a useful adjunct to treatment)
- Hypnosis
- Chiropractic
- Massage "Therapy"

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