Treating Depression over the Past Fifty Years
Did you know that depression is the second most common condition affecting Americans? The diagnosis of major depressive disorder (MDD) was first introduced in the DSM-III in 1980. Depression can occur in children, adolescents and adults. The illness is characterized by hopelessness and despair. Depression can drastically alter one’s ability to function. The exact causes of depression are unknown, but genetics, childhood trauma and life stressors may contribute to the disorder. The nine symptoms of depression include depressed mood, loss of interest or pleasure, weight loss, insomnia, restlessness, loss of energy, extreme guilt, trouble staying focused and thoughts of suicide, which persist for at least two weeks.
This may be hard to believe, but the most common treatment for mental disorders in the 1940’s and 1950’s was a lobotomy (surgical manipulation or removal of certain parts of the brain). Approximately 50,000 people in the United States received lobotomies during that time. Over the past 50 years, a variety of approaches have been used to treat depression:
Psychotherapy refers to a relationship between a trained therapist and a patient, for the purpose of alleviating symptoms and promoting growth. The therapeutic relationship is intended to be a safe space where the patient can explore their innermost thoughts and feelings. Some of the methods used to treat depression in psychotherapy are as follows:
Cognitive-Behavior Therapy (CBT)
Cognitive Behavior Therapy was developed by Aaron Beck in the 1960’s and 70’s. Beck believed that negative thoughts could lead to depression and anxiety. CBT teaches one how to identify and replace distorted thinking patterns.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy, which is an offshoot of CBT, was developed by Dr. Marsha Linehan as a result of her own mental health experiences in the 1980’s. DBT is often used to treat people who are suicidal or who have Borderline Personality Disorder. The techniques involve changing one’s thinking patterns to improve emotional regulation. Here are some basic DBT skills to address depressive symptoms: https://nowmattersnow.org/skills
Eye Movement Desensitization Reprocessing (EMDR)
EMDR was initially developed by Francine Shapiro in the late 1980’s. Although EMDR is most often used for treatment of trauma, this therapy can be equally as effective for depression. EMDR treats the symptoms of depression by targeting underlying life events, childhood memories, negative beliefs, and triggers. Studies have shown a significant reduction in depressive symptoms following EMDR treatment. There are over 11,000 EMDR providers that are part of the EMDR International Association (https://www.emdria.org).
Self Help Models
Wellness Recovery Action Plan (WRAP) was developed by a group of people with mental health challenges, including Mary Ellen Copeland, Ph.D. WRAP is a personalized wellness and recovery system that allows people to develop a personalized wellness plan. This grassroots approach often includes Peer Support from people with lived experience.
In 1985, the first SSRI, Prozac, was approved by the FDA for treatment of depression. Later, in 1993, the first SNRI, Effexor, was approved. Since that time, multiple variations of these drugs have been released. SSRIs and SNRIs work by regulating the neurotransmitters (body chemicals) serotonin and norepinephrine. While these drugs have provided relief for many, approximately 50 percent of patients do not respond to medication. Oftentimes a change of dose, a different or additional drug is needed to obtain the desired response. Drugs can also include unwanted side effects, including increased suicidal behavior, particularly in young people.
Some people develop what is called treatment resistant depression (TRD). This is defined as depression which has not responded to traditional treatments. In these cases, the following treatments can be used:
Transcranial Magnetic Stimulation (TMS) is a type of brain stimulation therapy. This treatment was approved by the FDA in 2008 for people who have not responded to psychotherapy or antidepressant medication. TMS is a noninvasive treatment that uses electromagnetic pulses to stimulate nerve cells. During the procedure, the technician will place a magnetic coil above the front area of your brain. Each sessions takes about 30 minutes and needs to be repeated daily for about a month. Some people have been able to discontinue medications after this treatment and it is often covered by insurance.
Psychedelic Therapy involves ingesting a psychedelic substance for a therapeutic outcome. Psychedelics have been used for centuries in indigenous communities. These therapies can produce a rapid relief of symptoms. Treatment is typically done in the doctor’s office over a period of several sessions. Some of the common drugs used today are Ketamine (administered intravenously) or esketamine (Spravato), a nasal spray.
The Future of Depression Treatment
Depression and other mental health disorders involve the complex organ of the brain. There is still much to be learned about the brain and how it works. New treatments are being developed to individualize treatment and minimize size effects. One such treatment is Deep Brain Stimulation . The future of depression treatment may look vastly different than it does today, which may bring relief to so many who are suffering from this devastating illness.
If you or someone you love are suffering from depression, please reach out. Our therapists can assist you in your journey to recovery. Our office number is 561-571-1557. Take the first step toward feeling better.