Doctors put heads together to tackle difficult-to-treat depression

A recent report from the Medical Journal of Australia provides new insight into some of the causes of failed treatments for patients with depression as well as alternatives that may help tackle the condition more effectively.

Prevalence of depression
According to the Centers for Disease Control and Prevention, one in 10 Americans currently suffers from depression. Persons between 45 and 64 years of age, women and those with education below the high school level are at higher risk of depression, as well as those who are unemployed or unable to work. Since symptoms can sometimes result from temporary physical illness, the National Institute of Mental Health recommends physical examinations before diagnoses of depression.

The 1997 Australian National Survey of Health and Wellbeing found that 7.2 percent of participants experienced a mood or affective disorder within 12 months of the survey. Clear evidence of undertreatment was found, with only 35 percent of those with sustained mental health problems receiving consultations within that same 12-month period. A repeated study in 2008 found near-identical results.

Treatment implications
Despite psychological and pharmacological therapies, many patients report lingering or unchanged depression symptoms, and the Medical Journal of Australia provides some information about the possible implications of this problem.

Patients with depression often suffer from PTSD, schizophrenia or anxiety disorder, or are depressed as a result of serious health concerns like cancer. Those with a physical illness are at high risk of depression and people with depression are likewise at high risk of physical illness, causing depression and demoralization (as a result of a physical illness) to be difficult to distinguish. Pain syndromes are particularly hard to treat, according to the paper, and require long-term treatment plans from general practitioners.

One problem with this situation, though, is that most general practitioners are not psychiatric or psychological specialists. The report suggests that practitioners taking on depressive patients should recommend psychological therapy, especially when treatments remain ineffective.

For those patients unresponsive to first- and second-line treatments, cognitive behavioral and interpersonal therapy have been shown to be effective alone and in conjunction with medications. A last resort can be electroconvulsive therapy or the recently developed magnetic seizure therapy, which has been shown to have fewer side effects than electroshock treatment.

Doctors may recommend that patients take medication alongside other treatment plans, suggesting that they buy Paxil, buy Effexor or take other known effective pharmaceuticals. The report notes that mentalization-based techniques are also becoming increasingly popular, and general practitioners can be of great use because they have a wide knowledge of medical histories and can more easily pinpoint stressors and supports to determine comprehensive treatment plans.