Exercises May Ease Depression Just as Well as Medications

In many cases of depression, although they may seem like a torture, exercises may be the right treatment technique for recovery.
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Overview of The Natural Depression Treatment Posibilities

Many of the persons suffering from mild to moderate forms of depression will make up their mind on the treatment from the beginning and chose either an entirely drugs therapy either combined therapies.
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Diagnosis and treatment

First thing needed to be done is a complex physical exam to rule out any possibilities for physical illnesses like a viral infection, or medical treatments that can cause the same kinds of symptoms. If those options are eliminated, the next step is a psychological evaluation which can be done by the physician or by a recommended psychologist or psychiatrist.

The most accurate diagnosis is achieved if the evaluation includes a complete history of the symptoms; when they appeared, how severe were they, for how long did they manifest, were they treated, if so with what medications. Further information will consist of alcohol or drugs used, thoughts of death or suicide, other members of the family encountering the same symptoms or medical history of mental conditions, treatments and effects in the family.

As an ending to the evaluation, a mental status exam will determine if the patterns of speech and thoughts or the subject's memory were affected.

The treatment will be chosen depending on the results of the evaluation. The treatment options include various antidepressant medications and psychotherapies. The results of the evaluation will establish whether psychological therapy alone is required to learn more effective ways to deal with life's problems, including depression, or antidepressant medication will help relieving the symptoms, or, in some cases, a combined treatment of both therapy and medication.

In the severe or even life threatening cases, as well as in some cases that cannot be treated with antidepressants, or, antidepressants are not effective; ECT (electroconvulsive therapy) is used to relief symptoms. In the past few years, the ECT technique was greatly improved. This treatment consists in electroshocks that cause a brief seizure within the brain. The procedure only lasts for 30 seconds, it is done under brief anaesthesia so the electrical stimulus is not consciously felt by the patient, and it needs at least several sessions usually given at the rate of three per week.

Medications

In the treatment for depressive disorders there are several types of antidepressants. These include newer medications chiefly the selective serotonin reuptake inhibitors (SSRIs) the tricyclics, and the monoamine oxidase inhibitors (MAOIs). Tricyclics are known to produce more side effects then SSRIs and other newer medications that affect neurotransmitters such as dopamine or norepinephrine. In many cases, for choosing the best treatment, more medications must be tried and checked for effects. After establishing which the best medication is, the dosage may need adjustments. Although antidepressants need up to 8 weeks before achieving full therapeutic effect, in some cases, the effects may appear earlier.

In some cases, the patients may be tempted to stop the treatment before time, considering that they no longer need it or that it has no benefit over them. It is very important that the treatment is continued until it achieves the chances it needs for working. Yet, in some cases, the side effects may be the first to appear. Any antidepressant medication needs to be taken for a longer period, 4 – 9 months after it has shown his effects or else the depression may reappear. Also, very important is the way the medication is stopped. Some antidepressants may need gradually stopping to allow the body time for adjustments. Anyway, a treatment can not be stopped without the doctor's advice. In some cases of bipolar disorder and chronic major depression, the treatment could be indefinite.

As any other medication that is prescribed for more then a few days, antidepressants need a close regular monitoring from the doctor in order to adjust the dosage to an optimum level and to assess effects.

MAO inhibitors are chosen in few cases as the best treatment options. This kind of medications requires some specific rules as avoiding certain foods or other medication. For example, the interaction of MAO inhibitors with tyramine, which is found in some foods, may lead to a stroke. In these cases, the patient will be given a list of the forbidden foods that he will need to follow. Not all antidepressants meet food restrictions.

No other medication should be combined with antidepressants without the doctor's approval. If an individual will need other treatments, from other specialists in different fields of medicine, those specialists will be told about the ongoing treatment. Some medications taken alone may have only benefic effects but when combined with others, may cause severe side effects or damage. Other cases of combinations of drugs or alcohol with antidepressants may also produce side effects or reduce the effects of the antidepressants. Yet, in some cases, when the patient is not an alcohol consumer, the doctor may allow a small quantity to be used while taking antidepressants.

Antidepressants do not include antianxiety drugs or sedatives. In some cases, they may be prescribed along with the antidepressants, but alone they have no effect over depression. Amphetamines or other stimulants, though they are not antidepressants, may be prescribed by doctors for treating some cases of medically ill depressed patients. They require close medical observation.

If one has any questions or unclear information about antidepressants or other medication prescribed, he or she should ask the doctor.

Though it has a small range between good effects and toxicity, thus needing close monitoring from the doctor, lithium, has been for many years a good treatment of choice bipolar disorder because of its effect in smoothing the mood swings encountered with this disorder. This treatment is not recommended if prior thyroid, kidney, or heart disorders or epilepsy. Different other medications have been also found effective in controlling the mood swing. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol®) and valproate (Depakote®). Both of these medications have gained high rates and approval in clinical practice and valproate has been approved by the FDA for first-line treatment of acute mania. Other anticonvulsants that are being used now include lamotrigine (Lamictal®) and gabapentin (Neurontin®): which are still studied for their role in treatment hierarchy of bipolar disorder.

Most cases of bipolar disorder are treated with a combination of lithium, an anticonvulsant and a medication for anxiety, insomnia or depression. Usually, treatments that use combined medication require close medical surveillance.

In some cases, antidepressants may cause some mild and temporary side effects. These effects, also called adverse effects, are only annoying and not serious, yet, they should be reported to the doctor right away. Here are examples of the side effects and what can be done:

  • - Constipation. It can be reduced by eating cereals, prunes and vegetables.
  • - Dry mouth. Brush your teeth daily, drink sips of water or chew sugarfree gum.
  • - Bladder problems and urinary issues. Contact the doctor for guidance.
  • - Sexual functioning may change. If they worry, consult with the doctor.
  • - Drowsiness. During the day, it passes away soon. Usually, the antidepressants with sedative effects are prescribed to be taken at night, before going to bed for a better sleep and minimal daytime drowsiness. However, if a person is feeling drowsy should not drive or operate heave equipment.
  • - Dizziness. Slow down your movements.
  • - Blurred vision. It usually passes soon and doesn't require new prescription for glasses.

 

The different types of side effects of the newer antidepressants:

  • - Nausea. It is usually temporary and transient after each dose
  • - Headache. It usually goes away
  • - Sexual functioning may change. If they worry, consult with the doctor
  • - Agitation. If it appears for the first time after the medication is taken and is more than transient, you should consult with your doctor.
  • - Nervousness and insomnia. These side effects may occur during the first few weeks; they will go away either with dosage reduction, or in time.

Therapy with herbs

The interest for herbal treatments for both depression and anxiety has risen in the past few years. A very widely used herb around Europe for treating mild to moderate depression is St. John's wort (Hypericum perforatum), gained interest recently in the U.S. too. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany , Hypericum is used in the treatment of depression more than any other antidepressant. Yet, those treatments have only been studied on short term and using different dosage.

When the interest for St. John's wort increased, the National Institute of Health started a 3 year study supported by three NIH components the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. At this study, a group of 336 patients were participating, all suffering from moderate severity major depression. They were randomly assigned for an 8 week trial with three different treatments equally spread. One third received a uniform dose of St. John's wort, another third sertraline (SSRI) which is usually used for treating depression and the final third a placebo. (a pill that looks exactly like the SSRI and the St. John's wort, but has no active ingredients). Those patients who responded well were kept under observation for an additional 18 weeks. Two scales were used for measuring the patients' conditions, one of them for depression and the second one for overall health. On the scale for depression, the differences were barely significant, but on the overall scale, the antidepressant s treated patients scored higher than the other two categories. The study did not support the use of St. John's wort in the treatment for major disorder; ongoing NIH-supported research is examining a possible role for St. John's wort in the treatment of depression on milder forms.

On 10 February 2000, FDA issued a Public Health Advisory on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of transplants. Doctors are supposed to communicate their patients about the possibility for these drugs to interact.

Ephedra, gingko biloba, echinacea and ginseng are a few other herbal supplements sometimes used but that haven't been studied on a large scale or for long term. However, don't take any herbal supplements without consulting with a doctor first.

Self care for depression

Depressive disorders interfere with a person's ability to see reality. They give feelings like exhaustion, worthlessness, helplessness, and hopelessness. Those can be very discouraging feelings and may make one believe he or she should give up. It is important to acknowledge that those feelings do not represent reality and may create a false image of the circumstances. When a treatment begins to take effect, negativism fades away.

Meanwhile a patient should:

  • - Resolve problems or situations with small steps by dividing them into smaller tasks, and do what you can as you can.
  • - Try to have other people around you and confide in someone; it is usually better than being alone and secretive.
  • - Do things that may make you feel better
  • - Be reasonable and realistic in your purposes, and assume a reasonable amount of responsibility.
  • - Practice physical exercise, go to a movie or a ballgame, or participate in religious, social, or other activities.
  • - Don't expect sudden improvement in your moods.
  • - Don't make any major decisions until the depression has lifted. Before deciding to make a significant transition, change jobs, get married or divorced discuss it with others who know you well and have a more objective point of view on your situation.
  • don't expect to snap out of the depression. You will feel better day-by-day.
  • - Don't forget that positive thinking will replace the negative thinking that is generated by the depression and will disappear as soon as your treatment will start working.
  • - Allow your family and friends help you.

A depressed person can be helped by family and friends.

The first and most important thing one can do for friend or relative suffering from depression is to persuade him to see a doctor and seek treatment. This may require to make yourself the appointment or even to accompany the subject to the doctor. In some cases you may have to monitor over the subject to take his medication according to plan and doctor's recommendation and support and encourage him or her until the treatment becomes effective. The depressed person should also be encouraged to obey any of the doctor's recommendations regarding alcohol use during treatment. Another very important thing is to provide emotional support. You need to be patient and understanding, talk to the depressed person and also be a good listener, point out reality and give him or her hope. In case of remarks about death or suicide, report them to the doctor. Take him or her out for walks, to the movies or any shows. Offer him or her the possibilities to participate to old hobbies and other activities that used to be pleasant for the depressed person. A depressed person needs a nice company but not over demanding because it may trigger the feeling of failure.

Understand and ensure the depressed person that healing may be a long term process but it can be achieved with patience and understanding and he or she will feel a lot better.

Psychotherapies

A depressed person can be helped by many forms of therapies from the shortest (10 – 20 weeks) to the longest and most complex. Talking therapies will help a depressed person to overcome the difficulties he or she encounters and to change many feelings or false created images. A behavioral therapist will help the patient change his behavior that has so far shown his depressed nature and maybe led to unpleasant situations to a new and better behavior, happier and more rewarding.

Interpersonal therapy and cognitive/ behavioral therapy are two of the most helpful short term therapies researched. The interpersonal therapy helps the patient deal with his personal relationships that are disturbed. The cognitive therapists will help changing the negative behavior and thinking created by depression.

Psychodynamic therapy focuses on the patient's conflicted feelings. Usually, those therapies are reserved for a future phase of the depression, after the medication had effect on the symptoms. In most cases, the severe forms of depression, or those which are recurrent are treated with medications or ECT together with therapies.

Who can help?

The first possible way to seek help for emotional problems would be to check the Yellow Pages under "mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals," or "physicians". You will find there names, addresses and phone numbers. In a crisis situation you can also call for temporary help the emergency room of any hospital. They will provide you with the necessary information on how and where to seek further help.

Here are the types of specialists that can provide help and treatment or can make a referral:

  • - Employee assistance programs
  • - Local medical and/or psychiatric societies
  • - Hospital psychiatry departments and outpatient clinics
  • - University- or medical school-affiliated programs
  • - State hospital outpatient clinics
  • - Family service, social agencies, or clergy
  • - Private clinics and facilities
  • - Family doctors
  • - Mental health specialists like psychiatrists, psychologists, social workers, or mental health counselors
  • - Health maintenance organizations
  • - Community mental health centers