Depression

01.Introduction

Our sister publication in the US, Consumer Reports, recently surveyed more than 1500 of their members who had sought professional help for depression, anxiety or both.

Key findings

• Respondents who stuck with talking therapies (psychotherapies) for at least seven sessions reported as much improvement as those who used medication alone.
• People who used both talking and medication fared even better.

For talking therapies, Consumer Reports found the type of therapist didn’t really matter much – psychologists, social workers and licensed professional counsellors received equal “helpfulness” ratings from those who had undergone talking therapy for depression.

The survey also found that some drugs have an edge over others. People who took medications from the SSRI class of antidepressants reported lower rates of side effects than those taking SNRIs – a newer, often more expensive class of antidepressant.

Respondents also reported they found SSRI treatment at least as helpful as treatment with SNRIs.

Types of depression

In Australia, too, the first-line option for treating depression is to use antidepressant medication and talking (psycho) therapies. The most effective method
depends partly on the type of depression:

• Melancholic depression is the severe form. Middleaged or elderly people are more prone than young people, and it often strikes out of the blue. Sufferers may wake at 3am and not be able to fall sleep again, despite feeling exhausted all day. Weight loss is common because their appetite can disappear and they may have to force themselves to eat. Their movements may slow, or they may become agitated – pacing or wringing their hands. There’s a total loss of interest and pleasure in activities that used to be fun. Thankfully, melancholic depression responds dramatically to the right kind of treatment, which is usually the more powerful classes of antidepressant. Talking therapy alone is unlikely to be effective, while weaker antidepressants may or may not help.
• Non-melancholic depression is less severe and much more common. With this form, a person is unhappy most of the time, but their mood may lift occasionally – for example, when distracted by work or socialising. Untreated, it still saps the pleasure from life and damages the ability to work and have successful relationships. People with either kind of depression may often think about death and even attempt suicide. All treatments for non-melancholic depression – including antidepressant medication, St John’s wort (see The Lowdown on St John’s Wort, right) and rates of side effects than those taking SNRIs – a newer, often more expensive class of antidepressant. Respondents also reported they found SSRI treatment at least as helpful as treatment with SNRIs.