Women and Depression: New Treatments and Alternative Therapies

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Therapy and Medication for Depression

Even though more than 80 percent of people with depression are successfully treated with psycho-therapy, medication, or a combination of both, taking action often requires more physical or mental stamina than someone who is depressed can muster. Friends or family members may be needed to take the reins, too. Ask for recommendations of mental health providers or practices that specialize in women's health. Psychologists, licensed social workers, and doctors of education experienced in treating depression can make a diagnosis and provide counseling, but they can't prescribe medication. Most, however, will work with a psychiatrist who can prescribe and, in many cases, also provide therapy.

Cognitive behavioral therapy (CBT) and inter-personal therapy are the two most effective types of talk therapy for depression. Sessions of CBT once a week for 16 to 20 weeks can help women who tend to ruminate to examine more precisely -- and change -- the distorted views that perpetuate their depressions. And cognitive therapy appears to be as effective as medication in the treatment of even severe depression, each yielding a 58 percent response rate in patients after 16 weeks, according to a recent pair of studies published in the Archives of General Psychiatry.

Interpersonal therapy, on the other hand, focuses on what's going on in your relationships that may be contributing to depression, such as grief, marriage problems, difficulty adjusting to motherhood, or other stresses such as a job change or a move to a new town. The treatment course is similar to CBT.

For many people, neither therapy nor antidepressants alone provide sufficient relief (some 30 percent of patients do not respond to their current medications). In fact, depressed individuals appear to improve the most on a combination of therapy and antidepressants, according to a 2004 review of clinical trials involving more than 1,800 patients published in the Archives of General Psychiatry.

But some women such as Mary Bear hesitate before taking medication, believing they should be able to simply pull themselves up by their own bootstraps. "Needing medication was like admitting that I hadn't worked hard enough in therapy," says Bear, who started antidepressants at the suggestion of her internist. "But once I was on it, the medication brought clarity and allowed me to act on the insights I'd gained in therapy and make changes in my life." Others worry about side effects, especially in light of recent reports linking antidepressants to suicide and violent behavior in some children and teens. The FDA is investigating whether these risks apply to adults -- and answers can't come soon enough, given that 75 percent of antidepressant prescriptions are written for women. The FDA has been cracking down, having recently issued warning letters to companies whose ads are felt to mislead or omit important risks and side effects. But it is well established that antidepressants are not addictive and that they won't fundamentally change your personality, meaning you will neither feel like a zombie nor be loaded up on "joy juice." You'll even be able to feel appropriate sadness, but the feeling of dragging around a ball and chain will likely be gone.

Choosing the right type and dose of antidepressants is very much a process of trial and error for doctors and patients. Women tend to respond best to a class of drugs known as selective serotonin reuptake inhibitors, which increase the brain's serotonin. The downside is that some of the side effects can be more problematic for women than for men. "Women can get headaches and nausea, and have more difficulty maintaining concentration, focus, energy, and sexual desire and orgasm," says Dr. Brizendine. Other classes of antidepressants include monoamine oxidase inhibitors, dual-action drugs and tricyclics, which affect both serotonin and norepinephrine (another neurotransmitter). Some women need a combination of antidepressants, while others respond to an antidepressant plus a stimulant to counteract fatigue. Still other women do best when their menstrual cycles are stabilized with continuous oral contraceptives or hormones.

It can take from six to eight weeks for an antidepressant to work, so patience is key. It's crucial to stay on the medication for four to nine months after symptoms disappear to lessen the chances of a relapse. Once a person has had an episode of depression, she is 50 percent more likely to have another, explains Dr. Stotland. A second incidence gives her a 65 to 70 percent chance of having a third. If you feel as though your depression is returning, talk to your doctor about increasing your dose or adding booster therapy sessions every month or two.

While successful treatment doesn't make you immune from ever feeling sad again, it does keep you from getting stuck in a gloomy mood. Today Mary Bear, 43, is remarried, and she has a successful career as a headhunter and a good relationship with her now-17-year-old daughter. "The biggest thing I've learned is to trust my feelings and my intellect," says Bear. "I don't get as down as I used to, and if I have a bad day, I remind myself that everyone has them once in a while. If the mood goes on for more than 10 days, I now know help is within reach."

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