Depression: Off the Couch

Eric Jamison/iStockphoto.com

Depression comes in as many shapes and sizes as the people it affects — and it can come on strong during the cold, dreary winter months. If you feel the symptoms of depression (see “Know the Signs”), there are ways to take control of your own mental health, says Michael McKee, PhD, a psychologist in Cleveland Clinic’s Department of Psychiatry and Psychology.

“Exercise. Just getting out of bed and putting one foot in front of the other. Eating well. Not isolating yourself. All these things have been proven to help,” Dr. McKee says. “Just knowing that you have some control has an antidepressant effect.”

As depression becomes less taboo, more people have sought help through such behavioral changes, or through medication and psychotherapy, or a combination of treatments.

With nearly 30 different choices on the market, antidepressants are the most prescribed drugs in the country, according to the Centers for Disease Control and Prevention. One in 10 Americans takes an antidepressant, according to a review in the Archives of General Psychiatry based on studies from 1996 through 2005. That’s double the number from just a decade earlier.

During the same time period, however, the number of people being treated with psychotherapy decreased by almost a third. This side of the trend troubles Dr. McKee and Donald Malone, MD, Chairman of the Department of Psychiatry and Psychology.

“Very often, medications can be quite helpful for individuals with depression, but sometimes they aren’t,” Dr. Malone says. “The same is true of therapy. It really depends on the person, and sometimes it’s difficult to prejudge who may benefit from medication, therapy or a combination of the two.” Dr. Malone says it is crucial for patients to work with their doctors to arrive at the best treatment options. In fact, the American Psychiatric Association recently issued new guidelines for treating depression based on tailored assessments of individual patients.

Some antidepressants are effective with other conditions. For example, certain serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to help people who have chronic pain combined with depression. And selective serotonin reuptake inhibitors (SSRIs) may be more appropriate for those who also have anxiety or obsessive-compulsive disorder. Overall, no single drug class is best for everyone. In some cases, patients try several medications before finding the one, or the combination, that works for them.

“We choose an initial medication based on a constellation of different things,” Dr. Malone says, “including what’s covered by insurance, the side effects, other conditions a person has, family experience and personal history. A lot goes into the decision- making process, and we can adjust when things don’t work.”

When depression impairs a person’s ability to function, medication alone may not be enough. “When you get to that level of depression,” Dr. Malone says, “many studies have shown that a combination of medications and therapy is really better than either one alone.”

The added benefit of therapy is getting patients to change their thinking and behavior in the long term, says Dr. McKee. Take, for example, a worker who loses his job after years or even decades. Further losses mount: income, daily structure and routines, the sense of identity that comes from a career.

“Those are issues that are more likely to be helped by talking about them,” Dr. McKee says. Talking produces a self-awareness that can be therapeutic on its own.

“Overall, there’s this sort of hopelessness: Life isn’t any fun anymore, and it’s not going to get any better,” Dr. McKee says. “And a helplessness: There’s nothing I can do about it. Healthcare professionals can help patients challenge both of those assumptions and fight those feelings.”