Depression is the most common of all psychiatric illnesses. It is estimated that at any one time worldwide, 300m—400m people suffer from depression. Depression cuts across all socioeconomic and racial barriers. Like most medical illnesses, we are learning that depression sometimes has a genetic component. Social and personal factors also play a role, but you often find that depression will run in families. Most depressions come with a certain amount of anxiety, which is why anti-depressants treat both depression and anxiety. Like most illnesses, depression can be seen as a spectrum, and those depressions can sometimes be treated with ECT in a hospital. Today, ECT is nothing like the ECT seen in One Flew Over the Cuckoo’s Nest. ECT is a safe and effective treatment for depression with minimal side effects.
There are numerous medications for depression. Zoloft, Paxil, and Wellbutrin are among them. These anti-depressants work by altering the chemical imbalances in the brain, but they must first reach an effective level in the blood. This usually takes 4-6 weeks after starting the medication. If the medication is effective, it continues to become more effective as time passes. After a certain amount of time, the patient is again questioned about the severity of his symptoms. If they are still too severe, the dose of the anti-depressant may be raised or another medication may be tried in tandem or separately from the original medication. Prescribers try to find the “least effective dose,” that is, the lowest dose that brings the symptoms under control.
Usually, medications alone do. not control all the symptoms and therapy is needed. The best treatment for depression is psychotherapy plus medication. The medication allows the therapy to proceed easier and the therapy makes the medication more effective. Medications, which are helpful in the short term, are not a long-term cure for depression. Many people are on anti-depressant their entire lives. But, permanently helpful changes in the individual can only be accomplished with psychotherapy.
In the 1970s, psychiatrists used to do therapy and medicate their patients when necessary. Because of the changes in medicine, today medication is prescribed by psychiatrists and the therapy is usually done by social workers or psychologists.
You are never supposed to go off your anti-depressant without asking your prescribing psychiatrist. There are a number of reasons for this. When going off any medication it is best to be titrated off. Titrated means that you go backwards taking less and less medication each week until you are off. By bringing chemical changes to the body slowly you can avoid withdrawal. Withdrawal is very unpleasant and occurs when the body is shocked by the sudden loss of a needed chemical. Another reason to ask your psychiatrist if you should stop the medication is that the depression may return much faster than it formed in the first place. A suicidal type of depression can return in two days if a patient suddenly stops medication.
Jonathan Bellin, LCSW, received his MSW from Yeshiva University in 1993. In addition to his teletherapy based private practice, Jonathan works for an Internet-based mental health company that is found in 26 states. The company is publicly funded and trades on the NASDAQ stock exchange. Jonathan treats individuals 20 and older and has experience treating depression, anxiety, bipolar disorder, post-traumatic stress disorder, and obsessive compulsive disorder, among other syndromes.
