Depression is one of the most common mental health problems (right up there with anxiety). It also commonly co-occurs with chronic illnesses. If you’re feeling depressed, or have been diagnosed with Major Depressive Disorder, it’s really important you are treating it in some form. As a therapist-in-training, I see many clients with depression – some with both depression and anxiety, some with perinatal depression, some with depression and chronic illness – and there are a lot of evidence-based treatments out there. It’s really important to know that you don’t have to suffer alone. So I thought this week, we’d talk about some common treatments, and some up-and-coming ones for depression. I also have an entire podcast episode dedicated to depression and chronic illness this week, which you can access here.
For chronic illness, depression most frequently occurs in people with Alzheimer’s, autoimmune diseases of all sorts, cancer, coronary heart disease, diabetes, epilepsy, HIV/AIDS, hypothyroidism, and Parkinson’s. I got into the criteria for major depressive disorder in the podcast episode, so definitely check that out for more information. When it comes to treating depression, the two most common routes are anti-depressant medications and psychotherapy. Anti-depressants most commonly come in the form of SSRIs (selective serotonin reuptake inhibitors) that alter our brain chemistry because it is implicated in depression (our brains are not the only thing that is implicated though). There is a lot of research that supports anti-depressants in treating depression, though research also shows that it works as well as a placebo. In other words, if you believe it will help it will. Now don’t get me wrong, I fully support someone taking medication (unless you’re pregnant or breast-feeding and can’t – thus why I see many perinatal moms in my practice), however what a lot of people find is that just taking medication isn’t enough to see significant improvements in their symptoms, and many people don’t want to rely on medication forever.
That’s where option 2 comes in: psychotherapy. As a student, I see about 10 clients a week plus I co-facilitate a group for 2 hours a week. There is a lot of research that supports the use of psychotherapy. My podcast episode on anxiety, which you can access here, breaks down how much your therapist and you each contribute to your outcomes in therapy, which is important to know. As for what type of therapy, there are many to choose from and they all have good outcomes. CBT (cognitive-behavioural therapy) and it’s third-wave counterparts (DBT, ACT, SFT, etc) are the most common. Typically this involves a combination of talk therapy, where you tell your therapist about your thoughts and feelings, and then the therapist giving you some things to try out in session that you can also practice between sessions (some people call it “homework” but I don’t like that term). Another option for therapy is psychodynamic, which involves talk therapy plus the therapist often makes interpretations. And then there are the therapies that rely mostly on talk, utilizing the therapeutic relationship, such as person-centred, existential, etc. All of these can help and are something I highly recommend. There is also evidence that different lengths of therapy are beneficial as well, from one session of drop-in counselling to short-term (10-20 sessions) of CBT or long-term (more than 20 sessions) of person-centred therapy.
If you are in immediate crisis because of self-harm, abuse, trauma, and suicidal thoughts/plans, then please contact your local help line. I’ve put some numbers in the show notes for my podcast on depression. A quick Google search can help you find them in your country. If you don’t like talking on the phone, there are some organization that offer texting services. I volunteered for Kids Help Phone in Canada which had switched to primarily a texting hotline since many young people prefer to text. You are strong for reaching out because it is not easy to.
In terms of other treatments, a few are available for treatment-resistant and severe depression. Electroconvulsive therapy (ECT), which used to be called “shock therapy” can be helpful for people with severe depression, though there are some potential harmful side effects, and psychiatrists don’t commonly use this unless necessary. Transcranial Magnetic Stimulation (TMS) is another option for treatment-resistant depression where magnetic pulses stimulate the nerves in your brain. Newly approved in Canada (and how I got the idea for this post) is the use of Ketamine for treatment-resistant depression. Ketamine is a dissociative drug that has a lot of research supporting its use for depression. It activates your glutamate, dopamine and serotonin receptors in your brain. It takes effect much quicker than anti-depressants and has shown to decrease suicidal ideation. So far research shows no long-term side-effects, though because it is a psychedelic drug, there is the chance of substance dependency.
Whether or not you have chronic illness, if you have depression there is hope for recovery, and lots of options available. Talk to your GP, your psychiatrist, a psychotherapist or whomever else is or could be part of your mental health care team. That way, you can keep making the most of it.