Other Treatments For DepressionWednesday, March 21, 2012 - 15:35
In addition to psychotherapy and medication, other treatments for depression include:
- Over-the-counter alternatives
- Phototherapy for seasonal affective disorder
- Electroconvulsive therapy
- Vagus nerve stimulation (VNS) therapy
Two over-the-counter preparations may be helpful for mild to moderate depression.
- St. John's Wort is an herbal remedy whose mild antidepressant action has been reported by numerous physicians. It is widely prescribed in Europe for mild to moderate depression. A recent definitive U.S. clinical trial did not find it to be efficacious, however.
Most people tolerate it well, but reported side effects include sensitivity to sun, gastrointestinal problems, and allergic reactions. The formula should contain at least 0.3% hypericin, the active ingredient in St. John's Wort.
- SAM-e (S-adenosylmethionine) is a natural component of living cells involved in many of the body's mechanisms. Over-the-counter formulas are derived from yeast. SAM-e is said to have very few side effects. Its efficacy remains controversial.
Need To Know:
Both of these remedies have been used successfully for many years in Europe. Neither is considered a drug, so they are not regulated by the U.S. Food and Drug Administration. Take care to choose a standardized formula.
Most importantly, always consult with your physician before trying either of these over-the-counter remedies. They should not be combined with prescription antidepressants. In cases of major depression, they should not be used to replace prescription medication.
Nice To Know:
A: Aerobic exercise, done on a regular basis, can help ease symptoms of mild to moderate depression. It is believed that regular aerobic exercise stimulates the body's production of endorphins, which are natural painkillers that produce a calming effect on the central nervous system. To reap these benefits, one must engage in continuous aerobic activity for a minimum of 20 minutes, three times a week.
Examples of aerobic exercise include brisk walking, jogging or running, bicycling, swimming, dancing, rowing, and playing racquet sports. Sometimes the mere act of getting out - whether for a brisk walk or a focused session at the gym - can have a revitalizing effect. However, before embarking on any exercise program, always consult with your physician. There may be medical reasons why certain exercises are advisable, while others are not.
It is said that exposure to natural sunlight is the cure for seasonal affective disorder (SAD). Some people with mild to moderate SAD do very well with phototherapy, also known as light therapy. Here is how it works:
- Therapeutic light boxes wired with full-spectrum bulbs are used. Unlike regular household incandescent or fluorescent bulbs, full-spectrum bulbs recreate the full spectrum of colors in sunlight.
- While the light simply appears as white to the naked eye, the brain recognizes the full spectrum. A therapeutic light box must provide at least 2,000 to 10,000 lux (a measure of light).
- A person with SAD sits within three feet of the box for 30 to 60 minutes every morning. The person can read or watch TV as long as the
retinaof the eye is exposed to the light.
Electroconvulsive therapy (ECT) is commonly called shock therapy because a low-voltage electric current is used to cause a seizure. It is the seizure, not the shock, that is therapeutic. ECT is most often reserved for:
- People whose depression is so severe that they are at risk for suicide
- People who do not respond to antidepressant medications
- Those who are unable to take medication, such as pregnant women or people with other medical problems
The methods of conducting ECT have been refined over the years. Today, the success rate of ECT in people suffering from mood disorders is more than 90%.
Need To Know:
ECT was introduced in the 1930s, and in those days it was performed in a somewhat primitive manner. Images from Hollywood have perhaps fostered an unnecessary fear of ECT. In the film "One Flew Over the Cuckoo's Nest," for example, a patient is administered ECT by cold, institutional personnel. In reality, however, modern ECT is administered in a safe, humane, and painless manner.
ECT is performed on an outpatient basis, and hospitalization is not necessary.
- First, the patient is given a muscle relaxant.
- Electrodes are fastened with conducting cream to the skin.
- The patient is then placed under general anesthesia and is asleep while a current is applied.
- The body undergoes mild convulsions for a short period of time. The procedure is carefully monitored by the doctor, anesthesiologist, and nurse.
- Usually a series of treatments is required to lift severe depression. Some people receive six treatments every two to five days, while others may need more treatments over several months.
ECT causes little stress to the body, and most people tolerate it well. The risks of the procedure are associated with the use of general anesthesia. People may feel groggy from the muscle relaxant, and it may take a few hours to recover from the anesthesia. Some may experience temporary memory loss or confusion. Sometimes partial, mild memory loss may persist.
This intervention is approved for use in Canada and Europe for those treatment-resistant depressions that will require long term therapy. It is under FDA review in the U.S. Treatment entails day surgery in which a stimulator (about the size of a small stopwatch) is implanted in the left side of the chest and wired to the left vagus nerve. VNS has already been used for treatment-refractory epilepsy in Europe and the U.S. The device delivers intermittent (30 seconds on, 5 minutes off) stimulation to the left vagus nerve. This treatment is typically added to ongoing antidepressant medications.
VNS seems to gradually reduce depressive symptoms over time in treatment-resistant chronic or recurrent depressions. It may change the neurochemistry involved in depression or regulate brain circuits that control mood, motivation, sleep, appetite, etc.