Procedures to treat depression

Everyone gets sad sometimes. It’s all part of being human. But if you're one of the 10 million Canadians with true depression, you know the difference. Today, promising treatments are revolutionizing the course of this potentially devastating illness. Especially if you're only mildly depressed, psychotherapy may be the place to start.  These guidelines will tell you more.

When done well, this type of verbal (and non-verbal) exchange can work as effectively as drugs. Certainly, side effects are less of an issue, and you don't have to worry about interactions with other medicines (this can be particularly important for older people who are taking lots of pills).

There are drawbacks, however. Psychotherapy alone is not effective for severe depression; this give-and-take process can take longer than drugs to work (results in six to eight weeks or more versus four to six weeks with medication) and may not be covered by insurance.

A skilled therapist will often mix and match several therapeutic approaches based on what you're going through.

• Psychodynamic therapy, for example, looks to past experiences to illuminate what you're feeling now.
• Interpersonal therapy, also known as crisis intervention, works especially well when an immediate problem — a child leaving home, a spouse dying — is causing you to feel low.
• Behavioural therapy attempts to change destructive patterns of acting or thinking by honing your social skills, self-control and problem-solving strategies. It’s particularly effective when the problem can be clearly defined and "good behaviour" rewarded.
• Behavioural therapy is often blended with cognitive therapy, which boosts confidence by showing how competent you can be if you're feeling inadequate or doomed to fail.
• In group therapy, you're given a chance to share your feelings (and solutions) with others.
• If your depression is severe and psychotherapy combined with medications still hasn't improved how you feel, your doctor may recommend electroconvulsive therapy (ECT), which shocks the ner­vous system and resets the brain’s chemistry. ECT is considered if you're losing touch with reality (psychosis), or threatening suicide. Experts still aren't sure exactly why ECT works. Electrodes are placed on the head and an electric current is initiated, causing a brief convulsion. General anesthesia is given to prevent sensing pain from muscle contractions. Typically, patients are treated every other day for five to seven sessions. Headache and memory loss sometimes occur, but are almost always temporary. Despite its Hollywood image as being barbaric, ECT is quite safe, and one study showed 80 percent of those with severe depression improved after the treatments.

Exciting research from the University of Illinois indicates that a new technique — repetitive transcranial magnetic stimulation (rTMS) — may ease severe depression. A handheld wire coil is placed over the brain’s left prefrontal cortex; in depressed people it often shows abnormal electrical activity and decreased blood flow. A focused, rapidly fluctuating magnetic field is administered. Unlike ECT, sedation is not necessary and memory problems aren't a risk.