Even the most optimistic people have to admit that life has its bleak moments. Whether it’s a stream of negative stories in the news, personal or health problems impacting ourselves or our loved ones, at times we can justifiably feel sad, worried or anxious. Those feelings differ from what we feel when depressed.
Depression is a mood disorder that affects how we feel, think and behave. Symptoms include a pervasive feeling of sadness, losing interest in things that were once considered important and/or enjoyable and having trouble thinking or concentrating (1). Depression can affect our emotions, physical health, relationships and work life. It’s a common and serious health issue: according to a recent community health survey in Canada, almost one in 9 adults experience symptoms of depression during their lifetime (2). Some experts predict depressive disorders will become one of the leading causes of burden of disease (measuring the total impact of the disease, including costs, deaths and illness) worldwide by 2030 (3).
Those with more severe symptoms and/or with more complex forms of the disease (e.g. bipolar disorder) are often referred to specialists but most people seeking help for depression begin by talking to their family doctor or other primary care health professional. Two recent systematic reviews focused specifically on treatments for depression prescribed by family doctors, with the aim of finding out whether they help to relieve depression symptoms.
Antidepressants continue to be the most widely prescribed treatment for depression (1), so one of the research reviews examined commonly used drugs in this category (4). These included “tricyclic and tetracyclic” antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and St. John’s Wort, an herb that is available without a prescription, as well as other types of drugs. The review included 66 randomized controlled trials and more than 15,000 participants aged 37 to 78. People in the study groups were treated for six to 12 weeks after which their depression “scores” were compared to the control group who were given a placebo.
For people who don’t want to take medication, another option is psychological treatments. That was the focus of the second review which included 30 randomized controlled trials with more than 5,000 participants aged 30 to 81 (5). The study groups received six to 16 weeks of treatments such as cognitive behavioural therapy which seeks to change people’s inaccurate or negative thinking patterns. Other treatments included problem-solving therapy, interpersonal therapy, education or counselling. Treatments included individual “face-to-face” sessions with a therapist as well as telephone or computer-based interactions and education.
What the research tells us
Both strategies – certain types of antidepressants and psychological therapy treatments – were found to be more effective in the short term at reducing symptoms of depression, compared with a placebo or no treatment. TCAs, SSRIs and St. John’s Wort all appear to be equally effective, although there was not enough information about the effects when taking these drugs for more than 12 weeks and for some negative side effects from taking these drugs were worse than not receiving any treatment. St. John’s wort can interact with other medications (6), so it is important to always ask your doctor before trying this option.
Of the various psychological treatments, cognitive behavioural therapy appeared to be most effective at improving symptoms of depression. Interestingly, patients benefited even if there was minimal physical contact with the therapist (e.g. sessions were conducted via phone or computer).
And there is no need to choose one approach or the other: other studies show that psychological treatments can offer added benefit for people who are also prescribed medication, reducing depression symptoms more than with drug treatment alone (7,8).
Further research is needed to better determine the long-term benefits of both drug and psychological treatments. Meanwhile, if you recognize the early signs of depression in yourself or a loved one, don’t ignore them. Talk to your doctor and find out about treatment options that can reduce symptoms and potentially prevent a more serious problem.
Mindfulness-based therapy can also prevent relapses for people with depression. Click here to read more.