Causes and Treatments for Depression

Drugs alone are not enough to deal with severe depression. Fresh research has shown that an ability to spot when you are slipping into a depression, coping skills to prevent it from taking hold, and a combination of psychological therapy and medication produce the best results.

Professor Jan Scott of the Institute of Psychiatry told delegates that antidepressants alone did not prevent recurrent bouts of depression. Three recent randomised controlled trials had shown that patients have a better chance of remaining free from depression from 1-4 years when they are treated with a combination of drugs and therapy, usually cognitive behavioural therapy (CBT).

One study in 2000 showed that 48% of patients remained free of depression on a combination of treatment, compared with 29% who were just given antidepressants and 33% who just had therapy.

Dr Dominic Lam, senior lecturer in clinical psychology at the Institute of Psychiatry, is conducting a study looking at the use of CBT in manic depression (bipolar disorder). He found that lithium, which is the first-line treatment for this condition and used to prevent attacks, had little or no impact on 20% to 40% of patients. Other drugs used to ward off depression also failed to work in around a third.

In his study, Dr Lam and his team randomly allocated 103 patients with bipolar disorder into two groups – one the control group who had medication but little or no psychiatric input and the other group which had 12 -20 session of CBT. He found that the CBT group were better at coping with mania and depression – they were measured every six months for 30 months.

Dr Lam told delegates that it was important for patients to monitor their mood and recognise signals that heralded another episode of depression. He also stressed the importance of routine and sleep. “Patients need to monitor early warning signs and regulate their behaviour using CBT,” said Dr Lam. “In this way they can deal with dysfunctional beliefs, for example that they must excel in everything or be happy all the time. Routine is important to control the mania.”

One of his patients, a professional man whose work carried a considerable amount of responsibility, said he was helped by realising he had a serious mental illness that required medication. “The discreet surveillance of mood and efforts to deal with the early signs allows me to assume a measure of control and hence develop a sense of security against the possible social and professional consequences of undetected illness,” the patient said.

Logging on to beat depression.

People suffering from depression are turning to the Internet for help rather than going to the doctor.

A survey carried out among people using special Internet sites for depression sufferers has found that a third had not sought any medical help. Around one person in seven had revealed their illness on the Internet for the first time and had never discussed it with anyone else.

The findings from researchers in London, Oxford and Toronto were revealed today at the annual conference of the Royal College of Psychiatrists. They conclude that sharing information with other sufferers on the Internet can be helpful for people with depression.

“Our findings do not support a view of the Internet as harmful. We found that many users felt able to discuss subjects that they were unable to discuss elsewhere. Health related virtual communities may present an opportunity to integrate online detection of mental health morbidity with other services, with significant implications for worldwide healthcare.”

The research involved posting a questionnaire on mental health related websites run by the European Internet company Netdoktor. The national websites in Austria, Denmark, Germany, Norway, Sweden and the UK provide registered users with health information plus opportunities to e-mail questions to experts and share experiences with other users.

Just over 2000 people replied to the questionnaire and, of these just over a half met the criteria for having a major depressive illness. The highest rate of depression was recorded among people using the UK site at 64%. Overall, 49% were not receiving any treatment and 35% were not known to health services.

Seven out of 10 reported they learned more about their medication from using the Internet and just under half said they felt less isolated.

The researchers say the anonymity of the Internet may be attractive to people who can discuss their problems without ever being identified. “Our findings suggest that unmet need exists online. Significant numbers were seeking help online without going to formal health services.” They add that the Internet may be useful in helping to support people who suffer from stigmatising conditions but who are put off seeking help from traditional services.