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Physical Treatment
The main physical treatments for depression comprise
A third physical treatment with as yet narrow application is
Drug Treatments
There are three groups of drugs most likely to be used for
depression:
Antidepressants
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There is a large number of antidepressants - they have a
role in many types of depression and vary in their
effectiveness across the more biological depressive
conditions.
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Selective Serotonin Reuptake Inhibitors (SSRIs),
Tricyclics
(TCAs) and
Irreversible Monoamine Oxidase Inhibitors
(MAOIs)
are three common classes of antidepressants. They each work
in different ways and have different applications.
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At the Institute we believe that they are not, however,
equally effective and that it is necessary to find the right
antidepressant for each person.
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If the first antidepressant does not work, it is sensible to
move to a different kind of antidepressant. For the
biological depressive disorders, more broad action
antidepressants are usually more effective.
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A well-informed health provider should be able to use their
assessment of the type of depression, its likely causes and
their understanding of the person to identify the medication
most likely to benefit.
Finally, being able to decide not to use medication is
important too.
Tranquillisers
These medications are usually called 'minor' or 'major'
tranquillisers.
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Minor tranquillisers (typically benzodiazepines) are not
helpful in depression; they are addictive and can make the
depression worse.
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Major tranquillisers are very useful in people with a
psychotic depression
and in
melancholia
where the person is not being helped by other medications.
'Anti-manic' drugs or 'mood stabilisers'
These drugs are of great importance in bipolar disorder.
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Their use in treating mania makes them 'anti-manic', while
their ability to reduce the severity and frequency of mood
swings makes them 'mood
stabilisers'.
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Lithium, valproate and carbamazepine are the most common.
It is important to remember that the anti-depressants and mood
stabilisers are often necessary both to treat the depression
that is occurring now, and to make a relapse in the future
less likely. So people sometimes need to continue taking
medication for some time after they are better.
Electroconvulsive Therapy (ECT)
Because of its controversial past many people feel the need to
think carefully before having ECT or allowing it to be given
to relatives.
Clinicians at the Institute firmly believe that ECT has a
small but important role in treatment, particularly in cases
of
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Psychotic depression
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Severe
melancholia
where there is a high risk of suicide or the patient is too
ill to eat, drink or take medications
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Life-threatening mania
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Severe post-natal depression.
While there are some short-term side-effects, ECT is a
relatively safe and, because an anaesthetic is used, not too
unpleasant.
Transcranial magnetic stimulation (TMS)
A possible alternative to ECT is transcranial magnetic
stimulation (TMS).
Transcranial magnetic stimulation is a procedure used by
neurologists, both as a treatment and as diagnostic procedure.
A coil is held next to the patient's head and a magnetic field
created to stimulate relevant parts of the brain. Unlike ECT,
there is no need for a general anaesthetic nor is a convulsion
induced.
In our view, the evidence in favour of this treatment is not
yet in, but it is a major area of research at the Institute
and elsewhere. If TMS is shown to be as effective as ECT this
would be a distinct advance in the treatment of many mood
disorders. No clear evidence about its utility is expected for
a number of years.
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