How quickly can we expect someone to show a positive response to these medications?
Anti-depressants, lithium and anti-convulsants can take two to four weeks to have an effect, although mood stabilizers tend to work more quickly. Typically, people’s response to these drugs doesn’t show up as steady improvement, but will have an uneven pattern, with periods of feeling better followed by small relapses. Anti-depressants tend to work in two phases—they first have a noticeable effect on the person’s physical well-being, and then on their mental well-being. The first symptoms to improve are the physical symptoms of depression; people begin to sleep better, eat more regularly and feel more energetic. Often they get discouraged because their mood isn’t changing and decide too early that the drug isn’t doing anything. If the drug is working, mood will eventually improve.
If it can take two to four weeks for mood to improve, and longer for these medications to take full effect, what do we do in the meantime?
This is a significant problem when people are having thoughts of suicide. The two-phase response to anti-depressants can be dangerous for someone whose energy had been too low to carry out a suicide plan. The initial lift in energy that the medications provide, before they lift the depressed mood, can give the boost they need to put their suicide plan into action. People in this state must be monitored very closely, or if seriously suicidal, they should go to the hospital to remain safe.
What’s the new goal in treating depression?
The common standard of care in depression is getting the person to respond effectively to medication; it’s measured by significant improvement, rather than “cure,” and is defined by an almost complete disappearance of symptoms and a complete recovery of the person’s quality of life. Leading psychiatrists are now recommending “aggressive” treatment of depression—early diagnosis, monitoring that the medication dosage is at the right level, and long-term medication maintenance to prevent relapse. It’s becoming increasingly clear that depression is a “systemic disease.”
Because severe depression is associated with high levels of stress hormones in the body, a lifetime of depression may change people’s immune systems. Recent data shows that a history of depression may be a risk factor in the development of Alzheimer’s disease, stroke, heart disease and cancer. Given these important risks, physicians must make it a high priority to move their patients with depression into recovery.
Are drugs the only effective treatments for people with mood disorders?
Definitely not. Psychosocial interventions such as cognitive therapy and interacting with peers are as important as drug treatments in helping people recover. Cognitive therapy improves people’s understanding of their mental health condition and strengthens their sense of self-esteem and control over their own life. Joining peer support groups and educational classes exposes them to others who are further along in recovery, which can give them hope and optimism.
Recent studies show that for moderate depression, a regular exercise program (30 minutes, three days a week) is an effective treatment.
People with mood disorders must know about these resources and be urged to take advantage of them. However, for people with severe mood disorders, psychosocial interventions are not likely to work on their own—the most effective treatment has been shown to include a combination of psychosocial interventions and medications.