New Guidelines for Treatment of Depression
American Psychiatric Association Issues Suggestions on Medication and Talk Therapy
Specifics of Depression Treatment Guidelines continued...
For resistant depression, the guidelines also address other potential treatments, including older medications known as monoamine oxidase inhibitor (MAOIs) as well as two newer options: transcranial magnetic stimulation (the use of magnetic fields to stimulate nerve cells in the brain and relieve symptoms) and vagus nerve stimulation (the use of electrical impulses in the brain).
Exercise is addressed as a way to see a modest improvement in mood symptoms, with either aerobic exercise or resistance training a help. "It pumps you up a little bit, makes you feel not as ineffective," Yager says.
Under the guidelines, doctors are also urged to rate their patients' symptoms more specifically than they may do now.
Instead of simply asking “How are you today?" doctors are urged to ask: "On a scale of one to 10, how are you feeling today?" Yager says.
This more specific questioning may help doctors gauge treatment effects better, Yager says, and help patients see a pattern in their moods and symptoms.
This kind of rating approach is used in research studies, Yager says, but most doctors haven't adopted this approach yet.
Under the new guidelines, the value of maintenance treatment is strengthened. "If someone has had three or more episodes of depression, they really should probably stay on their medication continuously the way you would stay on insulin if you are diabetic," Yager tells WebMD.
Treatment during pregnancy should be discussed between a woman and her doctor, Yager says. If a woman is on medications and doing well, then gets pregnant, she should discuss whether to stay on them or not with her doctor. If she wants to come off medications, she should have talk therapy. If depression returns during pregnancy, it can be hazardous to both mother and infant, he says. Depression during pregnancy has been linked to preterm babies. New mothers who are depressed may not be able to care properly for their infants, he says.
The new guidelines ''represent a great step forward," says Ian Cook, MD, director of the University of California, Los Angeles Depression Research and Clinic Program, who reviewed the guidelines for WebMD but was not involved in them.
"They now reflect the current state of the evidence," he says.
What sets the American Psychiatric Association guidelines apart, he says, is that they rely on published scientific research, while other organizations may rely less on published research and more on expert opinion.
Perhaps of most interest to patients, he says, are the wider range of available treatments covered in the guidelines, which should give people hope, says Cook. Cook has served on the speaker's bureau or done consulting work for Wyeth and other antidepressant makers.
"People can expect for the most part they will recover with treatment."