Depression

Treating Medical Depression Needs a Medication

Medical depression. Clinical depression. Major depression. As we say on our main Depression page, we use the word “depression” to mean so many things that it’s hard to know what a person is talking about without asking. We all known about feeling bored and blue on a lonely, too-quiet Sunday afternoon. The medical condition of depression means a down, sad (or irritable) mood on most days, an empty, hopeless feeling, maybe shedding some tears, too. Medically depressed people don’t necessarily want anything, don’t want to do anything. They have no energy and can’t decide anything. They feel anxious and nervous and their sleep is troubled and not restful. When a person’s brain changes such that the person becomes depressed it’s a medical condition that requires capable medical care to help the person get better. So let’s talk about how to successfully treat the medical condition of depression.

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What’s the Story on Medication for Treating Depression?

First, we need to emphasize that to get well faster and stay well medication alone is likely not enough. The best path to wellness is a combination of medication and psychotherapy. But for the moment we’re talking about just the medicines. There are many, many medications that work well for treating depression. There are at least 30 such medications, and maybe over 40 of them, depending on how you count. If you add the number of generic medications to the brand medications, it’s even a higher number. So there’s little doubt that a person can sort through all these and find one or two (or several) that work with few side effects.

A Reader Asked:

If Treating Depression Is That Easy, What’s the Problem?

Here’s the problem. There are many medications that work, but maybe only a few of the many that work for you, for one, specific person. You see, not all medications for depression work for everybody. Some work for some people and others work for other people. And when you’re already upset and depressed, you’re literally not in the mood for trial-and-error. It’s taking a person who can’t make a decision and asking them to make a whole bunch of decisions.

Let’s say a depressed person tries a medication that doesn’t work, then tries a second, and then a third. Big government studies show that by the third medication about 70% of people with depression will find an antidepressant that works, that treats their depression. That’s 7 out of 10 depressed people that are helped before or at least by the time they get to a third medication.

The Next Question Might Be: What About That Other 30% That Aren’t Helped?

Nobody knows for certain how that final, unhelped 30% eventually do. No studies have been done to see how many people are helped by the fourth or fifth or sixth medication. But, doctors treating depressed people don’t give up. It’s true, though, that it takes a force of will for a depressed person to keep slogging through medication failure after medication failure trying to find one that helps. And most depressed people don’t have “force-of-will”. Especially after three, some people just give up. But talk to doctors with office practices. Ask whether only 70% of the depressed people they see are ever helped by medication. These doctors will say no, not true. Over time, with care and patience, many more than 70% get well.

Fake “News” and Talk Shows That Medications for Depression Don’t Work at All

Medications for treating depression do work. The right medication in the right person works remarkably well. Please hear that fact loud and clear. The medications approved by our FDA for treating depression do work. There is an old saying we’re sure you have heard before. It’s been around since the 1800s. “Figures don’t lie, but liars figure.” People with a bias and/or some personal axe to grind can and do twist the numbers. A devious person can rearrange data and show the numbers in a way makes what is false seem true. So please just take this to heart: medications for treating depression do work.

Don’t Forget Therapy. It’s Necessary for Treating Depression

As we said above, medication alone is not enough. A combination of medication and psychotherapy is best. You can’t hand someone a bottle of pills and that’s the end of it. This is actually true for almost any medical condition. Here’s what we mean. Take diabetes. People with Type I diabetes need insulin. Type 1 diabetes often starts in childhood or teenage years. If they don’t get insulin they will die. If a teenager suddenly develops Type I diabetes, how well would she do if her doctor gave her a vial of insulin, a syringe, and a needle and said, “There you are.” And that was it. No instructions, no explanations. That teenager would do badly and maybe die of diabetes in a short time. That’s why everywhere there are diabetes education clinics. These clinics teach new diabetics how to use their insulin, stay healthy, and live life well.

Therapy Is Like A “Depression Education Clinic”

The medical condition of depression needs this same education on what it is and how to treat it. A person with depression needs a guide for treating depression even more than someone with diabetes. Usually people with diabetes have brains that work well, at least when their diabetes is controlled. People with depression have a foggy brain. It’s working hard but still often not thinking clearly. Emotion drives a depressed person’s thoughts. All this means that you can’t just leave a bottle of depression medication on the doorstep of a depressed person and expect him to get well. The person with depression needs a guide. They need instruction and education about depression and its treatment in addition to the right medication.

Every Person With Medical Depression Needs Psychotherapy

“Psychotherapy” is a supposedly fancy term from long ago. In 1853 an English psychiatrist, Walter Cooper Dendy, invented the term “psychotherapy”. (He actually called it “psycho-therapeia”.) Since then many doctors have used the word to mean many things. But for treating depression it really comes down to just learning. Education. Learning about depression, what it is and where it comes from. Learn about yourself, what happened to you so that now you’re depressed. What is this illness that got you down? Every depressed person needs a guide through the jungle of depression.

When The Best Medications Aren’t Enough – Plan B

There are many good medications, you find one through trial-and-error. But there are rare times when a person can’t find any medication that treats their depression. A good plan B is ECT. There are times when ECT is safer than medication, like during pregnancy or for the frail elderly. There’s one famous movie, and it’s sad that it’s famous, that shows ECT just after it’s invention 80 years ago. It’s unfortunate that this 45-year-old movie stars a great actor that plays the role with success. This old flick has driven everyone in stark terror away from ECT. This move does not portray today’s reality. A lot has changed in 80 years. Today’s ECT is actually a gentle mode of treatment. As we said, during pregnancy or for the frail elderly it can be safer than medication.

Ketamine – A New Depression Rescue Medication

Ketamine a fast-acting rescue medication for depression that, when it works, can stop a depression in just a few hours. But it’s not a sure cure. It doesn’t help about a third of the people who try it. So, it’s not always a “magic bullet”. But for people for whom it works, ketamine might become more popular than ECT.

Ketamine for Depression is an Old Idea and an Older Drug

It was over 10 years ago that people at the National Institutes of Health (U.S.) realized that this old medication, ketamine, could treat depression very fast. It treats even severe depressions where nothing else ever worked, including depressions that had gone on for years. Ketamine itself has been around longer than 10 years. It’s been available for almost 60 years, since 1963, and it’s used in medical clinics and in veterinary medicine.

It’s Like Ketamine. The FDA Has Approved Esketamine Nasal Spray (Spravato®)

Of course, this is no longer news. The FDA approved Spravato® in March, 2019. But it is important that we now have it and it’s available. And it’s a nasal spray, not a needle stick. Esketamine is important. And it will remain important in treating depression for a long time.

Esketamine is the First Really New Depression Medication in Over 30 Years

Esketamine works in the brain in a way like no other approved depression medication.

Summary

If you’re depressed the likelihood is that you would prefer to give up, to quit. Your depression has worked its black magic on your brain and convinced you that there is no hope, that nothing will work. But, you’ll have to take our word for it, you need to struggle forward. Push yourself to get out and see a doctor. There’s so much available to treat your depression if you pursue it. If the depressed person of interest is not you but is someone you know, drag him or her into treatment. It really does help.

 Helpful links:

National Institute of Mental Health on Depression Treatment and Therapies

The Mayo Clinic on Depression Diagnosis and Treatment

National Alliance on Mental Illness on Depression Overview and Treatment

Anxiety and Depression Association of America on Depression Treatment

The Good News About Depression

The current state of treating depression, even major clinical depression, is all good news. The medications and therapies for depression work well, and better medications are in discovery. The combination of the right medication and quality psychotherapy is a dynamite effective approach. Every depression treatment plan is (or should be) based on this model. So be encouraged that everything is getting better. As always, we remain on your side to praise what works, debunk anything that doesn’t work, and encourage you to better health and better care.

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Signs and Symptoms of Major Depression

Depression is a medical condition, a physical brain disorder. Its most obvious symptom is a depressed mood on most days. Depressed mood meaning a sad, feeling empty, hopeless, maybe crying. In children and teenagers it might be more of an irritable mood than depressed. The person with a major depression isn’t interested in anything and nothing seems to be fun. Eating and sleeping can go either way. Eating too much or not enough and sleeping too much or insomnia. More on that below. Mostly a depressed person has a low energy level and doesn’t want to do much. They often feel worthless or guilty, and can’t make decisions or think clearly. They might complain of fatigue, of having no energy. But some depressed people get agitated and restless. They might keep thinking about death and suicide. Anxiety can mix in with depression. They are upset and distressed.

A Reader in the UK Asked:

What Is Depression, Really?

The website reader who sent this question asked what’s really going on in depression? What is it? Okay, it’s a brain disorder, but what does that mean. The answer: We don’t know. Or, to be fair, medical science has not fully and clearly defined all the little bits and pieces of brain and body chemistry that are there when a person is depressed, and which brain areas are involved and which circuits aren’t right. There is more to be found. For example, why do most antidepressants take four to six weeks to work while ketamine and esketamine sometimes work in a day or two?

What we do know, or what we think we know, comes from seventy years of seeing which medications successfully treat depression, at least for most people most of the time. The first good medications for depressed mood were discovered accidently. The first, iproniazid, was actually made for treating tuberculosis. Along the way, people noticed the patients with tuberculosis who were also depressed and got iproniazid became less depressed. Learning how these first few antidepressants worked showed the way to find more, new antidepressants. It has been a slow step by step journey from one medication that works to the next one that works. The hope is always that the newer ones will work at least a bit better or with fewer side effects. But, of course, this isn’t always true. Sometimes they just cost more.

It’s Confusing Because the Word “Depression” Means So Many Things

We all toss out the word “depression” to mean we’re bored, or tired, lonely. It describes moods of all sorts. If a friend or relative says they’re depressed we usually know they mean. But with someone we don’t know, “I’m depressed” can me almost anything. “I’m depressed” might mean a brief and minor down feeling.” Being both bored and depressed might be the “Sunday afternoon blues”. Yet depression can refer to the worst medical, clinical, down, dark mood, with hopelessness and suicidal thinking. And even at times, with completed suicide. Dead. Such a terrible, life-threatening depression needs real and urgent medical care. And we say “depression” to mean every shade and type of moodiness between the least and the worst.

More on Eating and Sleep in Depression

A depressed person’s appetite and eating, and their sleep, is usually not normal. But, one depressed person to the next, it can vary in either direction. One person might eat a lot to sooth their soul (comfort food like a cupcake with lots of icing, or a Coca Cola and Cheetos, or a bag of thin mints at bedtime) and eat too much, gaining weight. Another might have no appetite and eat very little resulting in weight loss and getting skinny. Sleeping can also be one of two extremes. Either bad insomnia and can’t sleep a wink or sleep as an escape from the world and sleeping a lot. But, whether sleeping too little or a lot, depressed people do not feel rested after sleeping. They’re always tired. Their body and brain are just not right.

Spotting Depression from Across the Room 

A good friend might be able to tell if you have a bad depression. A close relative who cares about you might also be able to tell. There are many easy, short computer or paper-and-pencil tests (see explanation of Beck’s Inventory below) that will say whether you might have a medical depression. An experienced and skilled doctor can probably spot depression in a person from across the room. The bottom line is, seeing depression and telling if a person is depressed is not a mystery.

Beck’s Depression Inventory Helps You Test Yourself

The Indiana State Medical Association has provided a site for physicians called “Doctor Your Spirit”. The site is to help doctors pursue their own health and wellness, avoid burnout, and recognize depression in themselves. The link below is to the site’s free Beck’s Depression Inventory, a famous and highly regarded self-test for depression. Click on the link. Download and print the three-page test and take the test in the privacy of your own home. You score the test yourself. The directions for adding up your score are at the bottom of the Inventory.

https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf

Information About Treatment for Depression

Here’s a link to our free page on treating depression.

When We At Nerdsy (NRDC) Say Depression We Mean Medical Major Depression

To be clear, then, when we who work at the NeuroSci R&D Consultancy use the word “depression” we mean medical depression. On this website and on this page we mean medical depressed mood, clinical depression.

Different Types of Clinical Depression

There are different types of major depression. There’s bipolar disorder, or manic-depressive disorder. Bipolar depression is a time of down mood sandwiched between times of mania. Depression without ever having mania is called unipolar depression. Then there are depressions that are unusual, that is, not typical. No puzzle here, as they are referred to as Atypical Depressions. And “psychotic” depressions are another type, during which one loses touch with reality. And then there’s postpartum depression after childbirth. Premenstrual dysphoric disorder is bad depression (and again, we mean real serious depression) associated with one’s monthly period. But really they’re all severe and possibly dangerous depressions. They are all brain-based disorders, medical conditions just as much as diabetes, heart failure, or a broken arm. And just like these other medical conditions, depression needs real medical treatment.

So, What Are Lonely Saturday Night Blues or Sunday Afternoon Blues?

So what are lonely Saturday night blues or a Sunday afternoon slump if not depressions? If you’re feeling down and lonely on a Saturday night but a friend and a hot fudge sundae makes the world great again, that’s not the kind of medical depression we’re talking about. The same with a Sunday afternoon droop. Moodiness is not medical. We do like hot fudge sundaes, though, and they’re better with friends. (Here’s a boldfaced plug to subscribe to our site: A one month subscription to our site costs about one-sixth of the cost of a good hot fudge sundae.)

Depression is a Common Medical Condition

This severe type of depression, medical depression, is common, sadly, really common. Worldwide, among all of the medical and surgical conditions, it’s the fourth leading cause of disability. One out of every 10 people on this planet will have at least one episode of major medical depression at some time during their life. So the likelihood is that you know someone who has had such a depression.

A Reader in New Jersey Asked:

If someone is down why not just give them an “upper”?

That is, why not just maximally stimulate everything? Well, it’s been tried again and again for over a 100 years, and…

It doesn’t work.

One might think that if you give a depressed person an “upper” drug, like an amphetamine or cocaine, their mood should go up. Problem is, it just doesn’t work right. Maybe they would feel up and energetic for a few hours, but then the “up” stops and down they crash. And “crash” is the right word because when they come down they are more depressed than they were before they took the stimulant drug. Odd as it might seem, the “upper” drugs don’t treat depression well at all.

More on Trying to Treat Depression with Amphetamines

So maybe a depressed person takes a stimulant drug and for a few hours they might feel a bit better. After that first few hours the depressed mood is back, maybe even worse. The stimulant can be used again but this second time it takes a higher dose to boost mood and energy. Each attempt to stop the depression with an upper drug requires a higher dose. Within a few days of chasing this up and down roller coaster there is no stimulant dose high enough to change the depression. But with higher and higher doses of the drug the side effects add up to full-blown toxicity. Keep pushing the dose and soon the person is on their way in an ambulance to the nearest Emergency Department, hopefully not dying in transit.

Slow But Sure, Well, Almost Sure, To Treat Depression

Another odd thing that medical science has not yet understood is that almost all of the medications that do eventually work to treat depression take weeks for the benefit to become obvious. Not good. We need a quickly-acting treatment for depression. Maybe ketamine or esketamine, which is being used more and more, will be the drugs to save the day.

What To Do If You Are the One Who’s Medically Depressed

Get help.

If you find yourself in the valley of a clinical depression, go see a professional. See an experienced physician, a psychiatrist, to get a firm diagnosis and get a prescription for a medication. Then, get into therapy. The good news is that there are many medications and a variety of therapies that work well. The surest cure is medication plus therapy together. Sometimes you need more than one medication and a second one is added to help the first one work better. When doctors use ketamine or esketamine a second medication is also started. One works fast but the benefit might fade over time and one starts working more slowly but, once it works, it will keep working for a long time. And remember that each person is an individual and needs a treatment plan that is specially made for that person.  Medical care for depression is not “one-size-fits-all”.

Helpful links:

Depression – National Institutes of Health, National Institute of Mental Health

Depression – National Library of Medicine (United States), Medline Plus

Depression (major depressive disorder) – The Mayo Clinic

What is Depression? – American Psychiatric Association