We are not a crisis center. If you or someone you know is suicidal, please call 800-273-TALK or 9-1-1 immediately.
Types of depression and causes
There are three basic types of depression:
Major depression, also called unipolar depression, which is the most common type of depression. It tends to be episodic, but can persistently recur. Symptoms must persist for at least two weeks.
Dysthymia, which is a chronic, unremitting depression. A dysthymia diagnosis requires fewer symptoms than major depression, but must be present for at least two years.
Bipolar disorder, also called manic depression, which is depression alternating with elated or irritable moods and increased energy.
Major depression and dysthymia is twice as prevalent among women than men: 1 in 4 women and 1 in 8 men will experience these types of depression at some point in their lives.
Many factors can cause depression, including biochemistry (a chemical imbalance of mood regulation in the brain), genetics, family history, substance abuse, and an illness or other difficult life events. Some people have mild depression, while in others depression is more severe.
Getting treatment
Regardless of the cause, a person should be treated for depression. One-half of people with depression do not seek treatment because they don't understand their symptoms or have fear of the stigma of mental illness. Yet of those who do, 80% are treated effectively with medication, psychotherapy, or both.
It is important to seek medical help early because:
Untreated depression is long lasting. A depressive episode, left untreated, can last six months, or chronically for years.
Depression can lead to suicide. Depression is the leading cause of suicide, and a suicide occurs every 17 minutes in the United States.
When Depression Won't Go Away
Treatment Resistant Depression (TRD): What is it and what can be done?
Many people with depression respond very well and quickly to treatment. But some people do not respond to the usual course of treatment (talk therapy and/or antidepressants) and need more help. If two to three drug treatments fail, a person may be considered treatment resistant. However, new treatments, especially in the past year, are providing new options and paths out of depression even for those whose illness is considered treatment resistant. We hope this information will help you make informed decisions - choices that can lead to recovery. Every day, we learn more about depression. Every day brings more hope and a brighter future.
It is best to discuss these issues and options with a psychiatrist that specializes in treatment-resistant depression. You may need more than one psychiatrist's opinion. These psychiatrists often work at psychiatric hospitals or large hospitals.
1. Diagnosis and Medication Issues
Treatment Issue
Ask yourself
What to consider
More information
Proper diagnosis
Are you suffering from bipolar disorder or major depression?
Proper diagnosis by a psychiatrist who treats patients with bipolar disorder. Possible second opinion. Two thirds of those with bipolar disorder are misdiagnosed, often with depression. Those suffering from bipolar disorder, which brings rapid swings between "highs" and "lows" in mood, can be mistakenly diagnosed as having major depression during their "down" cycles. The two illnesses require different treatments and medications. Bipolar Disorder requires mood stabilizers - which are different medications than the antidepressants used to combat depression.
Have you received adequate medication for enough time?
Star*D Study - Most comprehensive U.S. study of treatment alternatives. Conclusion: Even when initial treatment fails, as many as two-thirds of patients recover adding or switching medications.
Have you exhausted all choices for medications and therapy?
Have you tried talk therapy? Have you tried only newer antidepressants such as SSRIs and SNRIs?
A combination of medication and talk therapy is effective in treating depression. Other classes of antidepressants, including MAO inhibitors and tricyclics may help. The MAO inhibitor patch is new alternative, approved by the FDA recently.
Do you have any other illnesses that contribute to your depression?
Do you have any other medical illnesses such as a thyroid condition, anemia, cardiac abnormalities, anxiety disorder, or alcohol or drug problems that need to be addressed?
Make sure your doctor does a comprehensive examination for other conditions. Let your doctor know about aconditions you are aware of. Also tell your doctor if you are drinking alcohol or taking drugs.
2. Alternative Treatments to Medications (and Talk Therapy)
Treatment
Procedure/Considerations
Electroconvulsive (ECT) therapy.
FDA Approved.Patient is anaesthetized; an electrical current is then passed through the brain, inducing a seizureHigh success rate and according to the National Institute for Mental Health, "much improved" in recent years.Concerns: Risks associated with seizure, memory loss, and general anesthesia.
Vagus Nerve Stimulator(VNS Therapy)
FDA Approved.Pacemaker-like device is implanted in chest to stimulate the areas of the brain regulating moods.
Repetitive Transcranial Magnetic Stimulation (rTMS) (TMS Therapy)
FDA Approved.Pulses of magnetic energy stimulate nerve cells in the brain. This is now FDA approved. See Neuronetics website.
This focus on treatment-resistant depression is made possible by: Cyberonics, SLS Health, Neuronetics, McLean Hospital, WestBridge Community Services, Austen Riggs Center
About Bipolar Disorder
Bipolar disorder (manic depression) is a treatable medical condition that affects people of all genders, races, ages, and income levels. Roughly 5.7 million Americans suffer from the condition. Bipolar disorder runs in families: more than two-thirds of people with bipolar disorder have at least one close relative with the condition or with major depression.
Manic symptoms include:
Increased energy and decreased need for sleep.
Excessive irritability, euphoria, or aggressive behavior.
Increased talkativeness or rapid speech.
Disconnected and racing thoughts.
Impulsive behavior and poor judgment such as spending sprees, erratic driving, or sexual indiscretions.
Inflated self-esteem.
Increased goal-directed activities.
Distractibility.
People with bipolar disorder need to be treated with medication (mood stabilizer), a different class of medication than antidepressants. Antidepressants alone can make their condition worse.
Fifty percent of people with bipolar disorder lack insight or do not realize they are ill. For example, they may believe they are a "high energy person." Often they only go to a doctor complaining of their depression, so the doctor does not realize they also have periods of mania. Therefore, it is essential that family members and friends report manic symptoms to the doctor, so that they can make an accurate diagnosis.
Unfortunately, bipolar disorder is vastly underdiagnosed and treated. On average, it takes 8 years before bipolar disorder is diagnosed. During that time a person suffers needlessly and is at risk for suicide.
