Updated Treatment Guidelines Combine Modern Methods with Depression Medication

The latest guidelines from the American Psychiatric Association (APA) offer a wider range of treatments for clinical depression. It took an APA steering committee five years to research and develop the new guidelines, which hadn't been updated in ten years.  The new guidelines reflect modern scientific research, and include up-to-the-minute treatment options like vagus nerve stimulation and transcranial magnetic stimulation, while reinforcing the effectiveness of traditional depression drugs.

The guidelines recommend therapy, in particular cognitive behavior therapy and interpersonal therapy, for mild to moderate depression, as well as the newer classes of depression medication.  These include SSRI antidepressants (selective serotonin reuptake inhibitors) such as Prozac and Zoloft, and the SNRIs (serotonin-norepinephrine reuptake inhibitors) such as Effexor and Cymbalta. The NDRI (norepinephrine-dopamine reuptake inhibitor) Wellbutrin is another new class of depression medication.  Exercise is also recommended to improve symptoms.

Depression medication is strongly recommended for more serious depression.  ''Talking therapy can be additionally helpful, but if you have a serious depression the odds are you are going to require these medications," explains Dr. Joel Yager, a professor of psychiatry at the University of Colorado School of Medicine. The guidelines also stress the value of antidepressants maintenance treatment, suggesting that someone who has had three or more depressive episodes should stay on depression drugs, much as a type 1 diabetic stays on insulin.

For treatment resistant depression (depression that hasn't improved after trying two or more antidepressant drugs) the guidelines highlight the effectiveness of electroconvulsive therapy (ECT). With ECT, an electrical current is delivered to the brain to induce a controlled seizure, which results in a release of neurochemicals.

Suggested resistant depression treatments have been expanded to include the older class of depression medication, the monoamine oxidase inhibitors (MAOIs), and two modern options: vagus nerve stimulation and transcranial magnetic stimulation. Vagus nerve stimulation (VNS) involves implanting a pacemaker-like device to stimulate the vagus nerve (the longest of the 12 cranial nerves) with pulses of electricity - a technique used to treat epilepsy.  Transcranial magnetic stimulation (TMS) induces weak electrical currents in the brain using a rapidly changing magnetic field.

Most depression treatments call for patience and trial and error. Antidepressant drugs may take two to six weeks to become effective, and are not without side effects. Common effects of antidepressants are upset stomach, weight gain, fatigue, dizziness, insomnia and sexual dysfunction. Side effects tend to be fewer with Wellbutrin and Wellbutrin XL, and don't include weight gain or sexual problems. Wellbutrin is also available as economical generic Wellbutrin, and is frequently prescribed along with SSRI antidepressants for added effect.  The bottom line, says Dr. Ian Cook, Director of the University of California's Los Angeles Depression Research and Clinic Program, is "People can expect for the most part they will recover with treatment."