Madhavi Kamireddi, MD, a psychiatrist at the New England Center for Healthy Minds in Acton, explains the different treatments – including medication, talk therapy and transcranial magnetic stimulation – that are available to children and adults suffering from depression.
Is there more depression today, or is it being diagnosed more often?
More people are diagnosed because we have changed how we approach diagnosis and treatment. Primary care physicians now routinely ask patients to complete a simple screening tool that asks them about their depressed mood. If someone is found to be positive for depression, we use a detailed questionnaire with specific criteria that is useful to determine whether their condition is mild, moderate or severe.
Depression has a biological underpinning; the most common theory is that one or more of the neurotransmitters responsible for mood is out of balance. It is different from the normal sadness that occurs in life and tends to interfere with daily functioning over a minimum period of two weeks. The natural course of untreated depression is 11 months to a year. I’ve diagnosed people who say “I don’t want treatment; I think I can wait it out,” but it’s like losing an entire year of your life. Four to six weeks after starting medication, if they respond, they are back to where they were before. Why suffer?
Are the newer antidepressants more effective, with fewer side effects, than earlier ones?
Yes, data shows that approximately 67 percent of patients respond to the first medication they are prescribed. The remaining 33 percent have a good chance of responding to the second medication they try. There are fewer and more tolerable side effects with newer agents; the key is to monitor treatment closely. No two medications are the same; they target specific neurotransmitters via different mechanisms. The patient’s symptoms can guide us to choose a certain class of antidepressant for a targeted response.
We typically start medication at a lower dose to avoid side effects and adjust the dose gradually over one or two weeks to reach a therapeutic dose. Throughout the course of treatment, we use a screening questionnaire to determine whether or not treatment is working. The goal is not just feeling better, but getting and staying well.
Does psychotherapy — talk therapy — usually have a role to play?
Yes, it does, especially when treatment is in its early stages. Patients often wonder “how did I get like that?” They need help in understanding the role depression has played in their lives and that depression is a medical illness, not a character defect or weakness. In the majority of cases, there is a genetic predisposition to depression that, combined with environmental factors, leads to the condition.
Psychotherapy is especially helpful for each individual to recognize their specific triggers and guide them during treatment. Regular sessions with a therapist help patients get integrated back to their normal lives. The goal is to help catch the next episode early and treat it in a timely manner.
Does depression look differently in children than in adults?
In kids, depression often shows up as an irritable or cranky mood — different from adults, who are often more sad and withdrawn. Just because a child seems sad or angry does not mean he or she has depression. If sadness or irritability persists for more than two weeks and affects their normal social activities, interests, schoolwork or family life, they should be evaluated by a professional.
Treatment usually includes a combination of psychotherapy and medication. Without treatment, the consequences of depression can be extremely serious and lethal since over 40 percent of children and adolescents with depression have suicidal thoughts. Also, depressed adolescents may abuse alcohol, marijuana or other drugs as a way of trying to feel better.
Are there any new treatments for depression?
For those who don’t get adequate symptom relief with standard treatment of psychotherapy and medications, we offer transcranial magnetic stimulation (TMS), which delivers magnetic pulses to a targeted area of the brain, causing activation of specific neurotransmitters that affect mood. After mapping the brain to identify the target area, the patient is treated over a six-week period. The FDA approved TMS in 2008 for those 18 years or older. It is quite successful and safe.