Like many depressed people I have spoken with over the years, you feel as if you want to die because you see no other way to end your suffering. But, you would prefer to live if only you could find a way to feel happy. Although it may be hard to see it when you are feeling deeply depressed, there is hope for you. Depression is a treatable illness and there are many options that may help you. Even if one treatment does not help, this does not mean that another treatment won't.
The first-line treatments for depression, which will help the majority of people, include:
Medications called antidepressants are generally the first treatment that your doctor will try. If you have already tried an antidepressant without success, this does not necessarily mean that you should give up. Sometimes it's a matter of trying a different antidepressant or finding the right combination of antidepressants.
In the STAR*D study, which sought to determine the best treatment strategy when an initial antidepressant fails to work, it was found that about one-third of all patients achieved complete relief from their symptoms with their first antidepressant. In addition, another 10-15% achieved at least 50% improvement in their symptoms. These may seem like rather dismal statistics, but if additional treatment levels were added -- either changing medications or adding additional ones -- recovery rates improved. In fact, 70% of patients experienced complete relief of symptoms when they reached the fourth level of treatment. So don't give up on treatment too early.
Psychotherapy, also known as "talk therapy," is another first-line treatment that your doctor may recommend for your depression, either alone or in combination with an antidepressant. In studies comparing the two, psychotherapy appears to work about as well as antidepressants at helping to alleviate symptoms, although if you are feeling suicidal and need quick relief, psychotherapy alone may not be your best option. Combining it with an antidepressant is probably a better choice since the two treatments together give better results than either treatment alone. Within a matter of weeks, an antidepressant can correct the chemical imbalance that is causing your depression, while psychotherapy can give you the tools needed to cope with your current depression and help prevent future episodes of depression.
If neither of these treatments are successful for you, your doctor may move on to one of the following treatments:
If you are in immediate danger of hurting yourself, you haven't responded well to antidepressants, or there are medical reasons why antidepressants are not a good idea for you, your doctor may opt to prescribe electroconvulsive therapy (ECT). ECT, which involves applying an electrical pulse to the scalp in order to induce a seizure, works rapidly and will provide relief for about 80% of patients. Although the procedure may have undesirable side effects, such as memory loss, it may be a good option for you if you need to feel better quickly.
Transcranial Magnetic Stimulation
This treatment, which involves stimulating a particular area of the brain with magnetic pulses, is less invasive than ECT and has fewer side effects. Like ECT, it is targeted toward individuals who have not responded well to antidepressants.
In a study comparing active treatment with the Neurostar TMS therapy device (currently the only FDA-approved TMS therapy device on the market) with a sham treatment, it was found that the people receiving TMS had significantly greater improvement in their depression symptoms. And in another study, in which all patients received the TMS treatment, about half of patients achieved significant improvement in their symptoms after six weeks of treatment while one-third achieved complete relief.
Although one-third might seem like a low figure, keep in mind that the patients recruited for these studies were individuals who were considered to be non-responders to antidepressant therapy. So, this should represent a percentage of patients above and beyond those who have already responded to antidepressants who could, if they don't give up prematurely, achieve complete remission of symptoms.
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS), which has sometimes been referred to as "a pacemaker for the brain," is a more invasive procedure than ECT or TMS -- a pulse generator must be surgically implanted under the skin of the chest.
According to a 2005 study, 1 in 3 people who received the therapy for at least a year experienced significant improvement in their depression. All of the participants in the study were considered to be resistant to other treatment.
As you can see, there are several treatment options available, and the odds are very good that one of them will help. Please don't give up hope.
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