Treatment for depression varies according to the cause of the condition and its severity. Conventional methods include psychotherapy, antidepressant drugs, and electroconvulsive therapy (ECT). Alternative therapies are particularly effective for minor depression, but for more serious depressions they should be considered as complementary treatments, not replacements for conventional methods. Major or chronic depression should be treated by a psychiatrist.

Conventional Treatment

Unipolar depression is one of the most treatable of the mental disorders. There are several prescription medications available to treat this condition. Given enough time and patience, it is usually possible to customize the treatment, get the right match, and achieve a good outcome.

The tools for treating depression can be divided into the somatic and the psychological.

Somatic treatments include:

Antidepressant medications

Electro convulsive therapy (ECT)

Light therapy

Psychotherapies for depression include:

Cognitive therapy

Behavioral therapy

Interpersonal therapy

Insight-oriented therapy

For those suffering from Major Depressive Disorder, antidepressant medications are very effective-the overall odds that an antidepressant treatment will work eventually are probably at least 90 percent. But you have to be patient and persistent. It may take several weeks for the medication to begin working, and a couple of months before it has reached its optimum effect. It might also take time and effort to find the most effective medication for you and to determine its proper dose. Some people must endure several trials of different antidepressants until they find the one that is a winner for them.

Bright light therapy is the treatment of choice for seasonal affective disorder or seasonal depression. Sitting in front of a bright light for an hour in the early morning extends the perceived length of your day and convinces the brain that it is summertime even during the winter months.
The Behavioral Treatment For Depression

Victims of depression experience very little pleasure. They often do very few things. This, in turn, fosters their sense of isolation, hopelessness, and depression. The result is that they are unwilling to venture out of their shell.

The behavioral treatment for depression aims at reversing this vicious cycle caused by loss of pleasure and inactivity. It does so by encouraging the patient to take part in pleasurable activities. It is often hard to get the victims to start on these activities. They are often convinced that it won’t do any good and that they are wasting their time. Once they get started, however, they will be surprised to learn that it is possible to feel some pleasure.

As you embark into psychotherapy, don’t expect anything miraculous to happen in the beginning. This will take time. Take small steps such as eating some ice cream, watching a favorite television show, taking a bath, or sitting in the sun, etc. If you enjoy it, spend more time doing it. Once you recognize that doing pleasurable things is still rewarding, you will participate in more activity. This will lead to a greater sense of control, hopefulness for recovery, and ultimately an improvement in mood.

Common Sense Techniques for Relieving Depression

The following techniques are good for getting relief from depression. Try any two of these for a quick relief.

1. Aerobic Exercise: Twenty to thirty minutes of bicycling, swimming, dancing, running, or brisk walking can relieve most common, mild depressions. It has been proven that depressed people who had never exercised improved considerably when starting an intensive exercise program which included long distance walking and jogging. They found a new zest for life, became more stress-tolerant, and improved their self-image. Details.
2. Take a Stimulating Shower: Start showering with warm water, gradually making it hotter. Then decrease the temperature as low as you can stand it. Cold water stimulates the nerves close to the surface of the skin and is rejuvenating. Do not do this if you have a serious illness or are pregnant, premenstrual, or menstruating.
3. Deep Breathing Exercises: In just ten minutes, you can oxygenate your body and relieve your depression by practicing deep breathing and relaxation. Details.
4. Movement and Breathing Meditation: Do five minutes of acupressure breathing exercise, “Letting Go of Depression.” This exercise will deepen your breathing and enable you to feel better and in control. Details.

Other Suggestions

Two hours of early-morning sun help lift depression. Spend as much time as possible outdoors.
Take daily walks, preferably in the park or along the sea shore, to connect with nature and appreciate the beauty it offers. Fresh air and deep breathing exercises are both good in aiding relaxation and promoting good oxygenation of the entire body.

Avoid spending a lot of time in concrete buildings. Some scientists suggest that overexposure to electro-magnetic smog from computer terminals and kitchen appliances, especially the microwave oven, upsets the balance of the body’s own electromagnetic field and leads to depression.

A complete change of environment, such as a vacation in the mountains, is extremely helpful.

Give yourself a “treat” or special activity occasionally, such as fresh flowers.

Get plenty of rest. Overtiredness and depleted nerves create a feeling of depression.

Massage by a family member or an understanding friend is very comforting and improves the outlook on life, especially under stressful emotional situations.

Take up journaling: If you’re uncomfortable talking about your depression with others or have no one whom you can share your thoughts with, you can write down your feelings in a journal. Writing will help you organize your thoughts and provide an outlet for your feelings. This can help dissolve unpleasant emotions. We recommend that you set aside 20 to 30 minutes daily to jot down your thoughts, feelings, and observations about life.

Volunteering and helping others is another way to focus on someone other than yourself and your own problems. Keep yourself busy. Take up projects and hobbies such as gardening, woodworking, traveling, and other projects. This will prevent you from dwelling on whatever is making you feel unhappy. Write down a list of goals you want to accomplish in the next week or month and dive into them. Always have something to look forward to and you’ll be less susceptible to the blues. Staying active gives you a sense of purpose for the future. And that is an effective antidote to depression.

Add 5 drops of rose oil to sweet almond oil or your regular massage oil and get a massage to uplift your spirits.

Drugs, caffeine, cigarettes and contraceptives induce depression. Paint solvents or any toxic chemicals are also capable of producing symptoms of depression. Avoid contacts with these.

Avoid black tea, and alcohol. Use herbs in cooking, fresh in salads, and as spices. Eat more wheat germ, which is an energizer. Pears, apples, and nuts contain bromine which assists the nervous system in functioning properly.

Do not keep a grudge. It takes an enormous amount of emotional energy to hold a grudge, and a guilty conscience damages the health. Learn the art of forgiving.

Set your day’s tasks by prioritizing, and be realistic in your goal setting.

Melodious, harmonious music can uplift and influence the psyche and improve the outlook on life. However, the selection of music is important. Music with repetitive, loud rhythms and dissonant and/or atonal arrangements actually causes depression in some people. The soothing influence of music relaxes cramped muscles, improves the function of the glands and promotes good digestion.

Find a friend to share your feelings with. If you are in a seemingly hopeless situation, share it with someone who can look at it from a different point of view. Simply knowing someone cares and wants to listen helps.

Have a good cry. If talking about your problems leads to tears, go ahead and cry. Crying is a wonderful release-especially if you know what you’re crying about.

Sit down and analyze the situation. A lot of times, if you can pinpoint the source of your depression, you’ll feel a lot better. Once you understand the problem, you can begin to figure out what you need to do about it. Sometimes when you start to gauge your assumptions against reality, you may find things aren’t as you think they are. For example, if you are depressed because you suspect that your lover may be cheating on you go ahead and ask. You may be wrong.

Sound/Music Therapy

Slow, relaxing music helps some people deal with the root causes of their depression, such as anger, frustration, sadness or anxiety. Listening to the music for at least 20 minutes each day can help slow down your heart rate and other body functions and can help you focus on your feelings.

Music therapy consists of using music therapeutically to address physical, psychological, cognitive, behavioral and/or social functioning.

According to The American Music Therapy Association (AMTA), music therapy is an effective and valid treatment for persons who have psychosocial, affective, cognitive and communicative needs. Research results and clinical experiences attest to the viability of music therapy even in those who are resistive to other treatment approaches. Music is a form of sensory stimulation that provokes responses due to the familiarity, predictability and feelings of security associated with it. Music therapy is also powerful, but, at the same time, non-threatening medium.

Music therapists use music activities, both instrumental and vocal, which are designed to facilitate changes that are non-musical in nature. Music therapy programs are custom designed for each individual. Music therapists work as part of a multidisciplinary team of healers. Both individual and group therapy are offered based on the needs of the individual.

According to AMTA, music therapy intervention provides opportunities to:

Explore personal feelings and therapeutic issues such as self-esteem or personal insight

Make positive changes in mood and emotional states

Have a sense of control over life through successful experiences

Enhance awareness of self and environment

Express oneself both verbally and non-verbally

Develop coping and relaxation skills

Support healthy feelings and thoughts

Improve reality testing and problem solving skills

Interact socially with others

Develop independence and decision making skills

Improve concentration and attention span

Adopt positive forms of behavior

Resolve conflicts leading to stronger family and peer relationships

Studies show that 74 percent of people seeking help for depression go to their primary care physician, and that 50 percent of these cases are misdiagnosed. Of the cases that are correctly diagnosed by a general practitioner, 80 percent are given too little medication for too short a time. Some of this mishandling may occur because the patients are treated for physical symptoms, such as sleep problems, fatigue or weight loss, without considering depression as a possible root cause. When diagnosing for depression, tests should be given to rule out any organic factors - such as nutrient deficiencies, hypothyroidism, reactions to drugs - that can produce similar symptoms. And here are the steps to do a correct diagnosis:

According to DSM-IV, the diagnostic manual from American Psychiatric Association, criteria used by mental health professionals, you have Major Depressive Disorder if:

You have had an episode of depression lasting at least two weeks with at least five of the following symptoms:
(1) You are depressed, sad, blue, tearful.
(2) You have lost interest or pleasure in things you previously liked to do.
(3) Your appetite is much less or much greater than usual and you have lost or gained weight.
(4) You have a lot of trouble sleeping or sleep too much.
(5) You are so agitated, restless, or slowed down that others have begun to notice.
(6) You are tired and have no energy.
(7) You feel worthless or excessively guilty about things you have done or not done.
(8) You have trouble concentrating, thinking clearly, or making decisions.
(9) You feel you would be better off dead or have thoughts about killing yourself.

These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships.

The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness.

Your depression is not just a normal reaction to the death of a loved one.

It is important to recognize that most of us go through ups and downs in our life periodically, as a result of events such as death of a loved one, loss of a job, serious illnesses in the family, etc. These are not signs of clinical depression as we get out of them in a short period of time and spring back to our normal activities. The clinical depression is characterized by persistent depression. At least 5 of the above conditions have to be satisfied to be classified as major depression. It is important for you to recognize the signs of the illness that requires treatment as opposed to occasional “blues.”

This is the most severe and dangerous type of depression with the highest rate of suicide, aggression, and need for hospitalization. The victims lose their grip on reality and experience either wildly distorted beliefs (delusions) or wildly distorted perceptions (hallucinations). They need hospitalization and aggressive treatment to get them back to reality.

Typically, the delusions or hallucinations are filled with negative feelings about themselves. They may be convinced that they are responsible for the ills of the world. They may feel that their insides are “rotting out.” They may hear voices calling their name, cursing and criticizing them, saying they deserve to die, or rehashing past misdeeds.

People with psychotic depression are at the highest risk to hurt themselves and other people. They have a potentially deadly combination: low self- esteem, poor judgment, delusional thinking, and hallucinations.

The initial goal of treatment is to eliminate the psychotic symptoms as quickly as possible. This usually involves taking the combination of an antipsychotic medication and an antidepressant medication. If this does not work, electro convulsive therapy (ECT) is indicated, that has a 95 percent chance of success. This depressions is very severe and dangerous. Stay on the medication for a long time to avoid possible recurrences.

Clinical depression affects mood, mind, body, and behavior. Research has shown that in the United States more than 17 million people- one in ten adults- experience depression each year, and nearly two thirds do not get the help they need. The WHO Collaborative Study of Psychological Problems in General Health Care screened nearly 26,000 individuals attending primary care facilities in 14 countries and found that 10.4% of patients had current depression. The Depression Research in European Society survey involving 78,463 adults, found a 6-month prevalence rate of 17.0% for depressive disorders. Similarly, the U.S. National Comorbidity Survey found that 17.3% of the general population had experienced an episode of major depression and 24.5% had suffered from an anxiety disorder at some time during their lives. Treatment can alleviate the symptoms in over 80 percent of cases. Yet, because it often goes unrecognized, depression continues to cause unnecessary suffering. Women experience depression at roughly twice the rate of men.

Everyone has felt sad at times. Depressed individuals tend to rationalize their depression and deny their illness as something normal. They feel that their feeling of sadness has some rational foundation.

Most people believe that if they are coping with a tragic event or difficult situation, they have a right to be depressed. They also think that their depression will be relieved as soon as the tragedy is alleviated. It is true that if your feeling of sadness is associated with a stressful event in your life, you could get out of it soon enough. However, if your depression is ongoing for six months or more, then your brain chemistry may have changed as a result of the prolonged sadness. You could be clinically depressed.

Depression can strike at any age, including in childhood. Studies in the United States showed that 1.8 percent of prepubertal children and 4.7 percent of 14 to 17-year-olds have some form of depression. However, the common time of onset is early middle age, and depression is particularly rife among the elderly, as a reaction to the facts of growing older - the death of a spouse or friends, the physical limitations of age and the impending confrontation with death. Elderly widowers are particularly susceptible to suicide.

Depression is one of the most common psychiatric disorders. Because it is so common, many people feel that if they ignore the depression, it will disappear. Prolonged “depression” can result in symptoms such as decreased or increased appetite, either insomnia or hypersomnia, anhedonia (loss of pleasure), either agitation or fatigue, poor concentration, increased self-criticism and excessive guilt. This may be the clue that your illness has progressed to the stage that it needs to be treated.

If left untreated, depression may lead to suicidal ideation or attempt. Suicide is a real threat in depression. Elderly white males are in the highest risk category for suicide, although women are also susceptible. A seven-year study showed mortality in older women increased a few percentage points when they had one to two symptoms of depression. Women with more than 10 depressive symptoms had a mortality rate fivefold greater than that of women with no such symptoms.

Depressed patients have a twofold greater risk of developing diabetes than that of normal individuals.
Among those with existing diabetes, 30% also have depression. In addition, depression occurs in 50% of patients with multiple sclerosis, 40% with cancer and 60% with dementia. There is also a strong relationship between depression and cardiac illnesses. Results from a recent study (July, 2000) show that the prevalence of asthma is much greater in individuals with high levels of depression and anxiety. This study showed that adults with higher levels of anxiety and depression are more than twice as likely to develop asthma as compared to those with lower levels.

Depression was 9 times more likely to develop in patients with anxiety disorders compared with those with no other illness and 6 times more likely in patients with 2 or more chronic medical conditions.

Up to 40% of patients with cancer suffer from depression or anxiety. Patients experiencing chronic pain or side effects from chemotherapy are particularly at risk for developing depression. Studies have shown that the presence of depression or anxiety has a detrimental effect on the recovery from cancer, response to cancer therapy and the death rate of cancer patients.

Depression is also frequently found in patients with cardiac disease. Up to 33% of patients develop depression after suffering a myocardial infarction. The relationship between cardiac disease and depression is complex. There is some evidence that depression may actually lead to cardiovascular disease. Depression occurs in about half of all patients who experience a cerebrovascular accident and is associated with poor functional recovery. The patients who are depressed have a higher probability of dying after myocardial or cerebral infarction compared to those who are not suffering from depression. Thus, depression can adversely affect your recovery from illnesses such as cancer, heart disease, gastrointestinal diseases, etc. Having an optimistic attitude is one of the best treatment you can have.

Depression is very treatable with medication (selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants and monoamine oxidase (MAO) inhibitors are commonly used), psychotherapies and electroconvulsive therapy (ECT). For mild depression, there are a number of complementary therapies and herbs that are useful. Lifestyle interventions such as stress management techniques, diet and nutrition changes, exercise, etc. can make a marked difference in your outlook.

Major depression often goes undiagnosed because it is confused with the normal feelings that may arise because of a specific life situation. It is estimated that only about 20% of those with depression seek treatment. Also of concern is minor but chronic depression, also known as dysthymia, which can last two years or more. Although the exact causes are unknown, researchers currently believe that both forms are caused by a malfunction of the brain’s neurotransmitters, chemicals (particularly nor- epinephrine and serotonin) that modulate moods.

Untreated depression is costly. A RAND Corporation study found that patients with depressive symptoms spend more days in bed than those with diabetes, arthritis, back problems, lung problems, or gastrointestinal disorders. The World Health Organization Global Burden of Disease Survey estimates that by the year 2020, major depression will be second only to ischemic heart disease in the amount of disability experienced by sufferers. Several studies have consistently demonstrated that individuals with depression and anxiety disorders experience impaired physical and role functioning, more days in bed due to illness, more work days lost, increased impairment at work, and high use of health services. The disability caused by depression and anxiety is just as great as that caused by other common medical conditions, such as hypertension, diabetes, and arthritis. Comorbidity of depression with anxiety or medical illness further increases the disability experienced by sufferers.

Estimates of the total cost of depression to the US in 1990 range from $30 to $44 billion. Of the $44 billion figure, depression accounts for close to $12 billion in lost work days each year. Additionally, more than $11 billion in other costs accrue from deceased productivity due to symptoms that sap energy, affect work habits, cause problems with concentration, memory, and decision-making. And costs escalate still further if a worker’s untreated depression contributes to alcoholism or drug abuse.

More business costs result when an employee or colleague has a family member suffering from depression. The depression of a spouse or child can disrupt working hours, lead to days absent from work, effect concentration and morale, and. decrease productivity.

Caution
There is a distinct difference between feeling “depressed” and having a depressive illness. If you have low spirits for a while, don’t be concerned. However, if you feel you can’t lift yourself out of your misery, you should seek professional help.