Physical Treatment

The main physical treatments for depression comprise


Drug treatments

Electroconvulsive therapy

A third physical treatment with as yet narrow application is

Transcranial magnetic stimulation.

Drug Treatments

There are three groups of drugs most likely to be used for depression:

Antidepressants

Tranquillisers

Anti-manic drugs or mood stabilisers

Antidepressants

There is a large number of antidepressants - they have a role in many types of depression and vary in their effectiveness across the more biological depressive conditions.

Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) are three common classes of antidepressants. They each work in different ways and have different applications.

At the Institute we believe that they are not, however, equally effective and that it is necessary to find the right antidepressant for each person.

If the first antidepressant does not work, it is sensible to move to a different kind of antidepressant. For the biological depressive disorders, more broad action antidepressants are usually more effective.

A well-informed health provider should be able to use their assessment of the type of depression, its likely causes and their understanding of the person to identify the medication most likely to benefit.

Finally, being able to decide not to use medication is important too.

Tranquillisers

These medications are usually called 'minor' or 'major' tranquillisers.

Minor tranquillisers (typically benzodiazepines) are not helpful in depression; they are addictive and can make the depression worse.

Major tranquillisers are very useful in people with a psychotic depression and in melancholia where the person is not being helped by other medications.

'Anti-manic' drugs or 'mood stabilisers'

These drugs are of great importance in bipolar disorder.

Their use in treating mania makes them 'anti-manic', while their ability to reduce the severity and frequency of mood swings makes them 'mood stabilisers'.

Lithium, valproate and carbamazepine are the most common.

It is important to remember that the anti-depressants and mood stabilisers are often necessary both to treat the depression that is occurring now, and to make a relapse in the future less likely. So people sometimes need to continue taking medication for some time after they are better.

Electroconvulsive Therapy (ECT)

Because of its controversial past many people feel the need to think carefully before having ECT or allowing it to be given to relatives.

Clinicians at the Institute firmly believe that ECT has a small but important role in treatment, particularly in cases of

Psychotic depression

Severe melancholia where there is a high risk of suicide or the patient is too ill to eat, drink or take medications

Life-threatening mania

Severe post-natal depression.

While there are some short-term side-effects, ECT is a relatively safe and, because an anaesthetic is used, not too unpleasant.

Transcranial magnetic stimulation (TMS)

A possible alternative to ECT is transcranial magnetic stimulation (TMS).

Transcranial magnetic stimulation is a procedure used by neurologists, both as a treatment and as diagnostic procedure. A coil is held next to the patient's head and a magnetic field created to stimulate relevant parts of the brain. Unlike ECT, there is no need for a general anaesthetic nor is a convulsion induced.

In our view, the evidence in favour of this treatment is not yet in, but it is a major area of research at the Institute and elsewhere. If TMS is shown to be as effective as ECT this would be a distinct advance in the treatment of many mood disorders. No clear evidence about its utility is expected for a number of years.