Depression is not a one-size-fits all mental disorder. There are many types of depression including major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder, psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder and situational depression. It is impractical to expect then that one treatment plan will be effective across all types of depression. A thorough evaluation by a psychologist or psychiatrist will help pin point the specific type of depression so that a specific treatment plan may be developed.
Patients with mild depression may positively respond to strategies that do not include medication. Lifestyle changes for example, including exercising moderately three times per week, have been proven by research to diminish the symptoms of depression. Other strategies include educating oneself about the disorder and avoiding isolation by spending time with trusted friends and family. Talk therapy may also prove to be effective. While these approaches may provide gradual incremental improvement for milder forms of depression, more severe depression may require prescription medications.
Depression is a complex mental disorder and it is not fully understood. However medical science has identified several underlying causes as follows: sexual or physical abuse, grief, drug or alcohol abuse, genetics and unexpected life events. Thyroid disorders and diseases of the endocrine system (hormones) can also cause depression. Chronic illness, including heart disease, kidney disease and diabetes may also contribute to depression. Recognizing the complexity of depression is not difficult; nor is it difficult to understand that use of antidepressants for the treatment of depression must be carefully supervised by a properly trained medical professional. An understanding by the patient as to how the chemistry of antidepressants work may be helpful.
Our brains are composed of complex communication circuits and chemicals called neurotransmitters. Neurotransmitters allow the chemical transmission of signals from one nerve cell to another nerve cell. You may have heard these chemicals referred to as serotonin, dopamine or norepinephrine. Serotonin is found in the brain, bowl and blood platelets. It is believed by some medical scientists to be our body’s primary “mood regulator” and an imbalance of serotonin may lead to depression. At this time science is unsure if decreased levels of serotonin cause depression or if depression causes a decreased level of serotonin. In either case, the relationship has been established and represents the basis of how antidepressants work.
You may also have heard certain antidepressants referred to as SSRIs, selective serotonin reuptake inhibitors. SSRIs are thought to minimize depression by increasing levels of serotonin. Said another way, they enhance nerve cell function by blocking the reabsorption (reuptake) of serotonin in the brain making more serotonin available. This class of antidepressants targets (selects) serotonin and allows the buildup of serotonin between nerve cells thereby affecting emotion and depression.
Antidepressants such as SSRI’s can take two to four weeks to produce effects. They may also cause side effects which may decrease in time. A licensed psychiatrist or psychologists can explain both benefits and potential side effects. In all cases, close supervision by your treatment provider is necessary, and if you are prescribed medication, do not stop taking the medication without first consulting with your health care provider.
Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC