Standard Treatment for Depression Helps Many

Antidepressant medications and electroconvulsive therapy, when warranted, are the most effective treatments for moderate to severe depression, according to a report in the medical journal The Lancet.

The study, led by researchers at the University of Edinburgh in Scotland, provides this conclusion following a five-year analysis of research into depression and may ease concerns raised in the public mind.

"The paper is a little bit corrective for what they call this 'moral panic' around the claim that antidepressants can facilitate suicidal ideation or behavior," says Dr. Jon A. Shaw, director of child and adolescent psychiatry at the University of Miami School of Medicine.

"It's a judicious attempt to try to stabilize the debate, and really address what the empirical evidence really demonstrates," he explains.

Electroconvulsive therapy (ECT), sometimes called shock therapy, has also suffered an image problem.

Help for Depression Often Not Sought

The diagnosis of depression is common around the world, affecting some 15 percent to 17 percent of people over their lifetime, according to the study.

It is twice as common among women. Regardless of who is affected, depression can be incapacitating and even fatal.

Yet, also according to the study, only 25 percent to 50 percent of patients seek medical help for their depression.

This may or may not have to do with recent controversy surrounding treatment. In 2004, the US Food and Drug Administration (FDA) issued an advisory warning that suicidal behavior may increase after treatment with antidepressants known as serotonin reuptake inhibitors (SSRIs), especially in children and adolescents.

More recent studies, however, have contradicted that finding.

The new study points to the effectiveness of medications for depression, describing them as the "mainstay of antidepressant therapy."

Their benefits seem to outweigh the "publicly perceived risk," the authors state.

"The FDA is a cautious regulatory body, and they need to be cautious," says Dr. Catherine Birndorf, an assistant professor of psychiatry and obstetrics and gynecology at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City.

"On the other hand, it can cause hysteria because people take it to be cause-and-effect," she says. "They don't really understand that they (the FDA) are warning us there may be a correlation."

Dr. Shaw adds, "It's probably a somewhat hysterical response that antidepressants in acute-phase depression facilitates suicidal behavior. There's no evidence to really support that."

ECT Improved, Used for Difficult Cases

Electroconvulsive therapy was deemed by the study as "the most effective treatment for deep depression, especially if it presents with psychotic symptoms" and this, "despite public and professional misgivings."

While some may think the treatment to be an artifact of bygone decades it is, in fact, "alive and well for certain types of depression," says Dr. Birndorf.

"ECT is not considered for garden-variety depression," notes Dr. Birndorf. "If it's more refractory [resistant to ordinary treatment], if other treatments have failed, or it's suicidal depression and you don't have time to wait around to see if a medication is going to work, it's considered the gold standard of treatment."

Public perceptions of the treatment, which involves applying electrical shocks to cause seizures in the brain, have tended to the brutal and bizarre and are not accurate, adds Dr. Birndorf.

"It's highly humane," she says. "The myth of what it is and what it looks like is still rampant, and doesn't appeal to our culture."

"The efficacy [producing the desired effect] is well-demonstrated," Dr. Shaw says. "If used appropriately, it is sometimes lifesaving."

The report also addresses other physical treatments for depression, such as neurosurgery, transcranial magnetic stimulation, magnetic seizure therapy, and vagal nerve stimulation, but indicated that most of these are still considered experimental.

Always consult your physician for more information.