The Ups And Downs of Depression Treatment
The journey from depression rarely follows a straight line.
What If Antidepressants Blunt Your Emotions?
Alpert points out that a small percentage of patients with depression feel that selective serotonin reuptake inhibitors or SSRIs -- the first line of treatment for most cases of depression -- dull or blunt their emotions.
“A small number,” he says, “will say, ‘I don’t get as sad as I used to get but I don’t get as happy as I used to get either.’”
In some of these patients, Alpert says, the drugs may be interfering with dopamine, which is a brain chemical that affects feelings of pleasure. If that is the case, Alpert might add or switch to bupropion (Wellbutrin) to offset the effect the SSRI is having. Unlike SSRIs, bupropion is aimed at both the serotonin and dopamine systems to bring them into balance.
“I have had patients say they feel numb, or can’t cry, or that their feelings aren’t there like they used to be,” says Melin. “It’s mostly men, and it’s rare. But in the 14 years I’ve been doing this, I’ve never found someone who didn’t have the symptom go away when we switched medications.”
What Can You Do If You Relapse?
When your depression symptoms come back, talk with your doctor. “Maybe you need to increase your dose,” says Alpert. “Or maybe you need to change medications, or add a new one, or add psychotherapy.”
Sometimes, he says, when the depression is severe enough, shock therapy is a useful alternative. “One way or another, we need to step up treatment.”
Weissman agrees. “If a patient is on a medication,” she says, “and hasn’t gotten a reduction in symptoms, that patient should consider asking the doctor to increase the dose, try a different medication, or try psychotherapy.”
Should You Do Talk Therapy for Your Depression?
Often, a few months of talk therapy can help a person going through stressful times. Because so many insurance companies won’t cover psychotherapy, therapists like Weissman have created shorter, goal-oriented approaches that work faster.
Interpersonal psychotherapy or IPT, which Weissman helped develop, is one such approach. It works by getting people to examine life events that triggered a bout of depression. Cognitive therapy is another approach. It works by getting people to recognize distorted attitudes and needlessly negative thoughts.
“It doesn’t change personalities,” Weissman says. “It’s time limited and based on a medical model.”
She thinks the approach is especially helpful for parents who are depressed. Her research has shown that when parents clear away depression, their children are happier and less likely to become depressed or to have other psychiatric problems.
“You get a two-for,” she says. “Parents are less hopeless and helpless and have more interest and affection. It’s hard to be depressed when you’re being warm and attentive and energetic.”