Dealing with Depression

Depression treatment options and trends

/ Author:  / Reviewed by: Joseph V. Madia, MD

Depression is a common problem, and based on recent research, shows no signs for becoming less common. Because of this, many people have either suffered from depression themselves, or know someone close to them who have dealt with the disorder.

So what are the treatment options for this all too common condition? And what do the trends related to depression treatment tell us about the state of the disorder in the United States?

Treatment Choices

The two most common treatments for depression are psychotherapy and medication. A combination of both is also an option chosen by many patients and doctors.

According to the National Institute of Mental Health (NIMH), most antidepressants function by interacting with neurotransmitters, which are chemicals in the brain. Serotonin and norepinephrine are the most common neurotransmitters that interact with antidepressants, but some also work with the neurotransmitter dopamine.

The specific reasons behind the success of antidepressants are still unknown, as “scientists have found these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work,” reports NIMH.

The newest and now most common type of these medications are called selective serotonin reuptake inhibitors (SSRIs), like Paxil, Zoloft, Lexapro and Prozac, which typically have less side effects than older antidepressants. However, a variety of side effects are still an issue for some, and may range from headaches to insomnia.

Doctors help determine the best medication and dosage for each individual patient, as well as deciding when and if it is time to stop taking the medication. NIMH does recommend antidepressants be taken for at least four to six weeks before a full effect is achieved.

Psychotherapy is another common treatment option for people with depression. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are two of the most frequently utilized types for the disorder.

CBT aims to correct negative thought patterns, change problematic behaviors and see things in a more positive light while IPT focuses on difficult relationships that may be contributing to depression.

According to NIMH, psychotherapy may be the best choice for those with mild to moderate depression, while those with severe cases might benefit most from medication.

“For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back,” reports NIMH.

Again, doctors can help patients determine which course of action is best for their particular case.

Depression by the Numbers

A December 2010 study by Steven C. Marcus, PhD, from Philadelphia Veterans Affairs Medical Center, and Mark Olfson, MD, MPH (Masters of Public Health) from Columbia University explored the rates and types of depression treatments in the US over the past two decades.

The study, which was published in the Archives of General Psychiatry, used data from two Medical Expenditure Panel Surveys (in 1998 and 2007), nationally representative surveys sponsored by the Agency for Healthcare Research and Quality (AHRQ). In 1998, 22,953 adults participated in the survey, and in 2007, 29,370 participated.

According to the authors, during the 1990s the percent of the population undergoing treatment for depression increased at a fairly sharp rate, from 0.73 percent of the population in 1987 to 2.33 percent of the population in 1997.

During this same time period, the use of antidepressants among these patients increased from 37.3 percent to 74.5 percent, while the use of psychotherapy decreased from 71.1 percent to 60.2 percent.

In new data, the trends have continued, but slowed significantly. Between 1998 and 2007, the rate of depression treatment increased slightly from 2.37 percent to 2.88 percent. The same was true of antidepressant use, which went from 73.8 percent of those being treated with depression to 75.3 percent.

The largest change was in the continued decline of psychotherapy, which went from being used by 53.6 percent of patients being treated for depression in 1998 to 43.1 percent in 2007. The average number of visits and money spent associated with psychotherapy also decreased among these patients.

The reasons for these trends are yet to be determined conclusively, but more research is sure to follow. The rise in antidepressant use may be due to the newer medications available (like the SSRIs mentioned earlier) that have less serious side effects compared to older antidepressants.

The decrease in psychotherapy may be due to a combination of factors, including patient preferences, availability of psychotherapists and insurance coverage that may provide greater discounts for antidepressants than psychotherapy.

The authors note that as health care reform develops in the US, these trends and the management of depression may change in unknown new ways. Time will tell on this front, and research will surely continue to better understand the reasons behind changes in depression management.

Furthermore, new medications and treatment options are also likely to develop, especially if the trends continue and more and more people begin to seek treatment for depression. 

In the meantime, a variety of different antidepressants, psychotherapy and combination methods are available.  Both medical doctors and mental health specialists can help patients find the best treatment for them, and help ease the pain of depression.

Reviewed by: 
Review Date: 
October 14, 2012