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Understanding Depression -- Diagnosis and Treatment

Psychotherapy for Depression

Psychotherapy is an important part of treatment for depression. In cases of mild-to-moderate depression, psychotherapy may be used alone to relieve symptoms. More often, it is used in conjunction with medication to alleviate depression.

Commonly used forms of psychotherapy are cognitive, behavioral, and interpersonal therapies.

  • Cognitive therapies challenge the negative thought patterns that accompany depressed moods and teach you new ways to think more positively.
  • Behavior therapies concentrate on changing patterns of behavior.
  • Interpersonal therapies help you examine how relationships affect your moods.

Other Treatments for Depression

Electroconvulsive Therapy (ECT)

ECT involves the application of an electric current through electrodes on the head. These are not felt by the patient, who is asleep under general anesthesia. Although doctors are still uncertain exactly how ECT works, it is thought that by producing a brief seizure, a course of several treatments of ECT conducted over a few weeks can bring about relief from depression. Its techniques have been refined in the past 20 years in order to minimize side effects, such as memory loss, and today ECT is considered to be as safe, or even safer, than many drugs used to treat depression and for some people, more effective.

ECT is usually considered after a number of other options have been tried because it may require hospitalization and general anesthesia. It's also considered if rapid results are vital, as with suicidal patients or those who refuse to eat or drink. ECT should not be thought of as a "last resort"; it is extremely effective and may work before other treatments have been tried and failed.

Usually given three times a week for two to four weeks, treatments generally involve 6 to 12 sessions and are sometimes followed by a gradual “taper down” in frequency over several weeks. Some people benefit from ongoing “maintenance” treatment over longer periods to prevent relapse when medicines alone may be ineffective.

Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS, which involves passing strong magnetic currents through the brain, is another option for treating depression. rTMS has been used effectively at times to treat major depression and depression that does not respond to other forms of treatment (treatment-resistant depression). However, to date, studies have not found rTMS to be as effective as ECT.

Vagal nerve stimulators (VNS)

VNS is used to treat select cases of severe or recurrent depression. This surgical treatment involves the use of a pulse generator implanted under the collar bone that sends out pulses of electricity to stimulate the vagus nerve in an attempt to affect the brain's mood centers.

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