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Medical Edge Newspaper Column from Mayo Clinic

IF ‘DEPRESSION’ DOESN’T IMPROVE, IT MAY BE MISDIAGNOSED

DEAR MAYO CLINIC: I have a 27-year-old son who has been suffering from depression for four years. He is under a doctor’s care and has tried numerous medications without relief. What other treatment options are available?

ANSWER: The first thing to consider when depression doesn’t improve with treatment is whether depression is the correct diagnosis.

Is there a medical problem that is appearing as depression, such as hypothyroidism? Is alcohol or other substance abuse triggering the depression or interfering with treatment? Is there another mental illness present such as an eating disorder, obsessive-compulsive disorder or even schizophrenia? Or could your son be suffering from a personality disorder? If any or several of these conditions are present, appropriate treatment efforts may also help associated depression.

Initial treatment approaches for depression are usually medications, or psychotherapy, or both. For chronic depression (present for two years or longer), research tells us that the combination of medications and psychotherapy offers the best chance of response.

Cognitive behavioral therapy has been widely researched and has been shown to be effective in treating depression and other mental disorders. It can be used alone or in combination with medication. CBT uses thought (cognitive) and action (behavior) strategies to help counter symptoms of depression. CBT can be effective in as few as six to 12 treatments over several months. CBT can even help reduce the likelihood of recurrent depression.

Several types of antidepressants are available for use. When a person doesn’t respond to a medication, it can be helpful to try a different one. Sometimes combining different types of antidepressants is beneficial.

Antidepressants may take up to two months to work at any given dose. If higher dosages are necessary, it is important to give the new dose a full two months to see if it works, unless side effects limit usage. If antidepressants are helpful, they usually need to be continued for months or years. Always work closely with your health-care provider, keeping him or her informed of progress or problems.

Electroconvulsive therapy remains a safe, effective option for severe or treatment-resistant depression. This is a procedure in which electrical currents are passed through the brain to trigger a seizure. Although researchers don’t fully understand just how ECT works, it’s thought that the seizure causes changes in brain chemistry. Given in a series over several weeks, ECT can help alleviate the symptoms of severe depression.

— Keith Kramlinger, M.D., Psychiatry and Psychology, Mayo Clinic, Rochester, Minn

Additional Resources:
Treatment of Depression
Appointment Information
More Information on Depression

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.