Severe depression life-threatening according to newest health directive

by Carol Forsloff - Severe depression can threaten your life, so it is worth every effort to get it into control according to experts, as it can end in suicide or other serious diseases.

This may mean a combination of antidepressant drugs and talk therapy.  But it cannot be left untreated according to experts from the Centers of Advancing Health.

One big problem facing treatment is that in even the most effective treatment can take four to six weeks to see improvement, and some of the medications have side effects.

“Unfortunately, we have no way of telling which drug will do what for what person,” says John W. Williams, M.D., a professor of medicine and psychiatry at Duke University.

Some research finds that people who show some improvement early on when taking an antidepressant are more likely to achieve complete recovery with that particular medication, says Peter Shapiro, M.D, professor of clinical psychiatry at Columbia University.

He adds that ideally, people show some improvement within two to three weeks—but if not, and if raising the dose and waiting another few weeks doesn’t work, “you’re probably not magically going to have headway eight to 10 weeks later.”

Finding what works takes time and patience.  Experts say it helps to realize that the course of depression treatment is rarely smooth or straightforward. The road is often bumpy and you might have to change directions—but that’s typical of the process.

“The aim for treatment is not reduced misery; it is normalcy,” says Eric Goplerud, a professor of health policy at George Washington University, who himself has suffered depression.

He recommends using a questionnaire called the Patient Health Questionnaire-9 (PHQ-9).

“About a year ago, I was concerned that I was getting into real funk,” he says, describing how he sought both therapy and medication. “Every two weeks, I took the PHQ-9 before I went in for counseling and was able to chart my improvement.” If treatment is working, research shows that you should see about a 50 percent reduction in symptoms within six weeks.

Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital and his colleagues developed another method to track depression and anxiety symptoms, available atwww.outcometracker.org. “Any patient can use it as long as their doctor registers and it’s free for doctors to register,” he says.

According to the largest trial of multiple medication treatment for depression, conducted by the National Institute of Mental Health, about one-third of patients will completely recover with the first drug they try and up to 93 percent will recover by the time they’ve tried four different medications.

If multiple medications fail, see an experienced psychiatrist rather than a general practitioner—or even a psychopharmacologist, who is a psychiatrist specializing in the use of medications.

The good news is that the vast majority of people suffering depression can be helped with currently available treatments—and sometimes, even a medication that has previously failed will work.

“There has been a consensus for a while that if you have had a significant episode of depression and been treated and gotten better, you should stay on your effective dose for at least six months,” Shapiro says. “The risk of relapse is clearly greater for those who discontinue compared to those who maintain for at least six months. And the more episodes of depression you have had in the past, the more likely it is that if you're not on maintenance medication, you will have a relapse going forward.”