Medical marijuana is an effective treatment for depression: True or False?

As any point of discussion, related to the medical marijuana use, the possibility to use cannabis for the clinical depression draws a lot of controversy both in the medical scientific world and among general population common views. As expected, different researchers come to the opposite conclusions on the subject. While I, personally, find the marijuana positive impact conclusions more scientifically supported by obtained results, I will provide both points of view to your consideration.

Probably, the most logical conclusion has been made as result of the recent Canadian Study, which somehow balances the negative and positive view in regards to Marijuana use for clinical depression treatment.

THC, the active ingredient in marijuana, increases serotonin when smoked in low doses, similar to SSRI antidepressants, such as Prozac, according to researchers from McGill University and Le Centre de Recherche Fernand Seguin of Hфpital in Quebec and l’Universitй de Montrйal in Montreal.

But at higher doses, the effect reverses itself and can actually worsen depression and other psychiatric conditions like psychosis.

During the study, published in the October 24, 2007 issue of The Journal of Neuroscience, laboratory rats were injected with the synthetic cannabinoid WIN55, 212-2 and then tested with the Forced Swim test - a test to measure “depression” in animals.

The researchers observed an antidepressant effect of cannabinoids and an increased activity in the neurons that produce serotonin. However, increasing the cannabinoid dose beyond a set point completely undid the benefits, said Dr. Gabriella Gobbi of McGill University and Le Centre de Recherche Fernand Seguin of Hфpital Louis-H. Lafontaine.

"So we actually demonstrated a double effect: At low doses it increases serotonin, but at higher doses the effect is devastating, completely reversed," she said in a news release.

The antidepressant and intoxicating effects of cannabis are due to its chemical similarity to natural substances in the brain known as "endo-cannabinoids," which are released under conditions of high stress or pain, said Gobbi. They interact with the brain through structures called cannabinoid CB1 receptors. The study demonstrated that these receptors have a direct effect on the cells producing serotonin, which is a neurotransmitter that regulates the mood, she said.

Let’s review other specialists’ points on the topic, but let’s make our own mind, how solid provided arguments are.

PRO - Cannabis use for Depression Treatment

1. Frank Lucido, MD, a private practice physician, stated in his article "Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience," available on his website:

With appropriate use of medical cannabis, many of these patients have been able to reduce or eliminate the use of opiates and other pain pills, ritalin, tranquilizers, sleeping pills, anti-depressants and other psychiatric medicines...

2. George McMahon, an author and medical marijuana patient of the U.S. Federal Drug Administration’s Investigational New Drug (IND) Program, stated in his 2003 book Prescription Pot:

People who have never struggled with a life threatening or disabling illness often do not comprehend how debilitating the resulting depression can be. Long days spent struggling with sickness can wear patients down, suppress their appetites and slowly destroy their wills to live. This psychological damage can result in physiological effects that may be the difference between living and dying.

The elevated mood associated with cannabis definitely affected my health in a positive manner. I was more engaged with life. I took walks and rode my bike, things I never considered doing before in my depressed state, even if I had been physically capable. I ate regular meals and I slept better at night. All of these individual factors contributed to a better overall sense of well-being.

3. Tod Mikuriya, MD, a psychiatrist and medical coordinator, co-wrote in the 1997 book Marijuana Medical Handbook:

The power of cannabis to fight depression is perhaps its most important property.

4. The Journal of Clinical Investigation stated in an Oct. 13, 2005 article "Cannabinoids Promote Embryonic and Adult Hippocampus Neurogenesis and Produce Anxiolytic- and Antidepressant-like Effects" by Xia Zhang et al.:

We show that 1 month after chronic HU210 [high-potency cannabinoid] treatment, rats display increased newborn neurons [brain cell growth] in the hippocampal dentate gyrus [a portion of the brain] and significantly reduced measures of anxiety- and depression-like behavior. Thus, cannabinoids appear to be the only illicit drug whose capacity to produce increased hippocampal newborn neurons is positively correlated with its anxiolytic- and antidepressant-like effects.

5. The Journal of Acquired Immune Deficiency Syndrome, stated in a Jan. 2004 article on a study designed by Prentiss, Power, Balmas, Tzuang and Israelski "to examine the prevalence and patterns of smoked marijuana and perceived benefit" among 252 HIV patients:

Overall prevalence of smoked marijuana in the previous month was 23%. Reported benefits included relief of anxiety and/or depression (57%), improved appetite (53%), increased pleasure (33%), and relief of pain (28%).

6. Jay Cavanaugh, PhD, National Director for the American Alliance for Medical Cannabis, wrote in his 2003 article "Cannabis and Depression," published on the American Alliance For Medical Cannabis website:

Numerous patients report significant improvement and stabilization with their bipolar disorder when they utilize adjunctive therapy with medical cannabis. While some mental health professionals worry about the impact of cannabis on aggravating manic states, most bipolar patients trying cannabis find they ’cycle’ less often and find significant improvement in overall mood. Bipolar disorders vary tremendously in the time spent in the depressive versus manic states. Those who experience extended depressive episodes are more likely to be helped with cannabis.

Patients who use cannabis to ’relax’ may be treating the anxiousness sometimes associated with depression. Cannabis aids the insomnia sometimes present in depression and can improve appetite. Better pain control with cannabis can reduce chronic pain related depression. While cannabis cannot yet be considered a primary treatment of major depression it may improve mood when used under physicians supervision and in combination with therapy and/or SSRI’s.

7. Bill Zimmerman, PhD, former President of the Americans For Medical Rights, stated in his 1998 book Is Marijuana the Right Medicine For You?:

Some patients have found the mood altering effects of marijuana to be helpful for treating mood disorders such as anxiety, depression and bipolar (manic-depressive) illness. Using marijuana to treat mood disorders was described in medical writings in the 19th and early 20th centuries...

However, using marijuana to treat mood disorders can be very tricky... If you intend to use marijuana for this purpose, it is very important that you thoroughly discuss it with your doctor. Patients who respond well report that marijuana not only diminishes their undesirable moods, it also motivates them to productivity. For some of these patients, depression was a by-product of a debilitating disease or illness for which marijuana provided a welcome remedy. For others, the marijuana seems to have acted directly on the depression.

The mental component of the pre-menstrual syndrome (PMS) often causes psychological problems and is now technically classified as an atypical (not typical) depression. Many women report benefit from using marijuana to improve the symptoms of PMS.

CON - Cannabis use for Depression Treatment

1. Health Services at Columbia University (HSC), in the GoAskAlice section of their website, stated in a Feb. 4, 2005 response to a question from "a concerned boyfriend" who asked "She says smoking pot is like self-medicating - it is better than using anti-depressants. She also claims smoking pot helps with depression because of how it helps produce Seratonin in the body.... Does smoking pot really help with managing your anxiety, depression, etc.?":

Marijuana DOES NOT produce serotonin. However, it does affect a substance in the brain called anandamide. Anandamide causes a soothing sensation in the body when it reacts with THC (tetrahydrocannabinol), the active substance in marijuana. It is the anandamide that causes your girlfriend to relax when using marijuana in low to medium doses....

While marijuana use may seem like a soother to your girlfriend, she may need to know about the negative effects... Marijuana appears to increase the risk of developing depression and/or schizophrenia the more that one uses it....

[Y]our girlfriend believes that she is self-medicating, when she may be contributing to her depression. Her depression could manifest itself in the future, since marijuana users typically withdraw from social situations, adding to depression.

Also consider what it is about antidepressants that are so abhorrent to your girlfriend. Why would marijuana, an illegal substance, be preferable to a controlled medication taken under medical advisement to manage her stress and depression?...

[S]he may agree to see her medical or primary care provider for a medical exam and evaluation. If she then has a diagnosis of depression and/or anxiety, or is referred to someone who specializes in working with people with these conditions, then chances are she will feel better than when she ’prescribes’ marijuana for herself.

2. Karen Cameron, RNC, MSN, Correspondent for WebMD, stated in a June 14, 2004 WebMD article "Are Depression and Marijuana Linked?":

It is pretty well known that the psychoactive chemicals in marijuana interfere with the balancing process that antidepressants work toward.



As you may already know, depression is a biochemical illness -- an imbalance in chemicals in the brain. Those antidepressants help things become better balanced, but they can’t do the job nearly as well if one is smoking marijuana.



Marijuana contributes to depression and destroys natural sleep. There really is no good reason to continue smoking it.

3. The UK’s National Health Service (NHS) stated in its Feb. 9, 2006 website article "Does Cannabis Interact With Antidepressants Or Lithium?":

It is not clear how often cannabis itself can cause depression, but research suggests that this can happen. It is therefore recommended that if you are depressed, and you use cannabis regularly, you should try giving up and see if that helps. One small study suggests that a chemical in cannabis might cause severe anxiety and unease in people with moderate to severe depression.

Tachycardia (an abnormally fast heart-beat), dizziness, anxiety, drowsiness, nausea, vomiting, difficulty sleeping and confusion are all possible side effects of cannabis. These side effects can also be caused by certain antidepressants, so using cannabis at the same time can make them worse.

Laboratory work suggests that cannabis might affect the way these [anti-depressant] medicines work. It is not clear what affect this may have on people, so MAOIs and cannabis should not be taken together.

There is no published research that has looked at taking these medicines and cannabis. However, they are too new to be sure and a problem might have been missed. Therefore the newer antidepressants should not be taken with cannabis due to lack of information.

4. Nancy Schimelpfening, the About Guide to Depression for About.com, stated in her About.com article "Is It A Bad Idea to Use Marijuana to Relieve Depression":

Although there is preliminary evidence that marijuana may have antidepressant properties, many argue there are also some important drawbacks to it’s usage. There is a well-known phenomenon called ’amotivational syndrome’ in which chronic cannabis users become apathetic, socially withdrawn, and perform at a level of everyday functioning well below their capacity prior to their marijuana use.

Although the depressed person may feel relief from their symptoms, this may be an illusion of well-being if the person loses motivation and productivity. Furthermore, if the drug is smoked, it can be far more harmful to the respiratory system that tobacco use because of the fact that it is not filtered.

I would also like to mention a USC College study finding no link between symptoms of depression and regular marijuana use, denying popular accusation of Marijuana as being one of the suspects for the depression development. The study results confirmed that Marijuana smokers are less depressed than those who never smoke. Interesting is that study results were not expected even by the researchers.

College doctoral candidate Tom Denson co-authored the study on marijuana and depression to be published in the journal, Addictive Behaviors. Denson wrote the report with psychologist Mitch Earleywine, a former College associate professor and author of Understanding Marijuana (Oxford University Press, 2002).



While the study found that those who smoke marijuana for medical reasons were more depressed than other smokers, they were less depressed overall than nonsmokers.



Rather, daily or weekly marijuana users - including those smoking the drug for medical rather than recreational reasons - had fewer symptoms of depression than nonusers. Further, marijuana users were more likely to report positive moods and fewer somatic complaints such as sleeplessness, poor appetite and trouble completing their daily routine, the study stated.



The Internet study questioned more than 4,400 marijuana users and non-users. The researchers said the online study made it possible to include the severely depressed or those who would not participate in an in-person or telephone survey about an illicit drug.

After a story about the study appeared in the Nov. 18, 2005 Albany Times Union, Denson received correspondence from researchers who said their similar-smaller scale studies resulted in the same findings.

Sources and Additional Information:

http://medicalmarijuana.procon.org/viewanswers.asp?questionID=000226

http://www.foxnews.com/story/0,2933,304996,00.html

http://health.usnews.com/articles/health/brain-and-behavior/2008/05/09/teen-depression-worsened-by-marijuana-government-says.html

http://www.doctordeluca.com/Library/WOD/WPS3-MedMj/DecreasedDepressionInMjUsers05.pdf

Montgomery-Asberg Depression Rating Scale

The Montgomery-Asberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders. It was designed by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD), which would be more sensitive to the changes brought on by antidepressants and other forms of treatment. There is, however, a high degree of statistical correlation between scores on the two measures.

The rating should be based on a clinical interview moving from broadly phrased questions about symptoms to more detailed ones which allow a precise rating of severity. The rater must decide whether the rating lies on the defined scale steps (0, 2, 4, 6) or between them (1, 3, 5) and then report the appropriate number. The items should be rated with regards to the state of the patient over the past week. 1 - APPARENT SADNESS - Representing despondency, gloom and despair, (more than just ordinary transient low spirits) reflected in speech, facial expression, and posture. Rate by depth and inability to brighten up. 0 No sadness 1 2 Looks dispirited but does brighten up without difficulty 3 4 Appears sad and unhappy most of the time 5 6 Looks miserable all the time. Extremely despondent. 2 - REPORTED SADNESS - Representing reports of depressed mood, regardless of whether it is reflected in appearance or not. Includes low spirits, despondency or the feeling of being beyond help and without hope. Rate according to intensity, duration and the extent to which the mood is reported to be influenced by events. 0 Occasional sadness in keeping with the circumstances. 1 2 Sad or low but brightens up without difficulty. 3 4 Pervasive feelings of sadness or gloominess. The mood is still influenced by external circumstances. 5 6 Continuous or unvarying sadness, misery or despondency. 3 - INNER TENSION - Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread or anguish. Rate according to intensity, frequency, duration and the extent of reassurance called for. 0 Placid. Only fleeting inner tension. 1 2 Occasional feelings of edginess and ill-defined discomfort 3 4 Continuous feelings of inner tension or intermittent panic which the patient can only master with some difficulty. 5 6 Unrelenting dread or anguish. Overwhelming panic. 4 - REDUCED SLEEP - Representing the experience of reduced duration or depth of sleep compared to the subject’s own normal pattern when well. 0 Sleeps as usual. 1 2 Slight difficulty dropping off to sleep or slightly reduced, light or fitful sleep 3 4 Sleep reduced or broken by at least two hours. 5 6 Less than two or three hours sleep. 5 - REDUCED APPETITE - Representing the feeling of a loss of appetite compared with when well. Rate by loss of desire for food or the need to force oneself to eat. 0 Normal or increased appetite. 1 2 Slightly reduced appetite 3 4 No appetite. Food is tasteless. 5 6 Needs persuasion to eat at all. 6 - CONCENTRATION DIFFICULTIES - Representing difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration. Rate according to intensity, frequency, and degree of incapacity produced. 0 No difficulties in concentrating. 1 2 Occasional difficulties in collecting one’s thoughts. 3 4 Difficulties in concentrating and sustaining thought which reduces ability to read or hold a conversation. 5 6 Unable to read or converse without great difficulty. 7 - LASSITUDE - Representing a difficulty getting started or slowness initiating and performing everyday activities. 0 Hardly any difficulties in getting started. No sluggishness. 1 2 Difficulties in starting activities. 3 4 Difficulties in starting simple routine activities, which are carried out with effort. 5 6 Complete lassitude. Unable to do anything without help. 8 - INABILITY TO FEEL - Representing the subjective experience of reduced interest in the surroundings, or activities that normally give pleasure.The ability to react with adequate emotion to circumstances or people is reduced. 0 Normal interest in the surroundings and in other people. 1 2 Reduced ability to enjoy usual interests. 3 4 Loss of interest in the surroundings. Loss of feelings for friends and acquaintances. 5 6 The experience of being emotionally paralyzed, inability to feel anger, grief or pleasure and a complete or even painful failure to feel for close relatives and friends. 9 - PESSIMISTIC THOUGHTS - Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin. 0 No pessimistic thoughts. 1 2 Fluctuating ideas of failure, self-reproach or self-depreciation. 3 4 Persistent self-accusations, or definite but still rational ideas of guilt or sin. Increasingly pessimistic about the future. 5 6 Delusions of ruin, remorse and unredeemable sin. Self-accusations which are absurd and unshakable. 10 - SUICIDAL THOUGHTS - Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicidal attempts should not in themselves influence the rating. 0 Enjoys life or takes it as it comes. 1 2 Weary of life. Only fleeting suicidal thoughts. 3 4 Probably better off dead. Suicidal thoughts are common, and suicide is considered as a possible solution, but without specific plans or intention. 5 6 Explicit plans for suicide when there is an opportunity. Active preparations for suicide.

The Montgomery-sberg Depression Rating Scale (MADRS) is administered by a trained interviewer, takes 20 minutes to complete and was designed as a measure of change in studies of the treatment of depression. It was developed by taking items from a longer scale. It is widely used in treatment trials, in both young and older patients. Specific instructions are given regarding the ratings and there is a comparative lack of emphasis on somatic symptoms, making it useful for the assessment of depression in people with physical illness. Cut-off scores have been suggested by Snaith:

• 0-6 indicates the absence of depression (or recovery in the setting of a clinical trial);
  
  
• 7-19, mild depression;
  
  
• 20-34, moderate depression; and
  
  
• 35 and above, severe depression.

Sources and Additional Information:

http://www.psy-world.com/madrs.htm

http://en.wikipedia.org/wiki/Montgomery-%C3%85sberg_Depression_Rating_Scale

http://www.fda.gov/ohrms/dockets/AC/07/briefing/2007-4273b1_04-DescriptionofMADRSHAMDDepressionR(1).pdf

Medications for Major Depression – Types, Effects, and Approaches

The first medication used to treat depression was "discovered" while researchers were studying another medical disorder. Iproniazid was originally developed as a treatment for tuberculosis in the 1950's. Once it became clear that antidepressant medications were possible, medical science focused attention towards researching and developing depression-specific medications (as well as many other medications useful for treating mental illness).

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

Modern antidepressant medications are thought to have their effect based on their ability to alter the balance of neurochemicals and neurochemical receptors at the synapse level within the brain. Selective serotonin reuptake inhibitors (SSRIs) and their newer antidepressant cousins, the serotonin norepinephrine reuptake inhibitors (SNRIs), are today considered first choice medication treatment for the treatment of Major Depression. Other medications, including the older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are used as second-line choices.

Four groups of antidepressant medications are most often prescribed for depression:

• Selective serotonin reuptake inhibitors (SSRIs) act specifically on the neurotransmitter serotonin. They are the most common agents prescribed for depression worldwide. These agents block the reuptake of serotonin from the synapse to the nerve, thus artificially increasing the serotonin that is available in the synapse (this is functional serotonin, since it can become involved in signal transmission, the cardinal function of neurotransmitters). SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).


• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second-most popular antidepressants worldwide. These agents block the reuptake of both serotonin and norepinephrine from the synapse into the nerve (thus increasing the amounts of these chemicals that can participate in signal transmission). SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).


• Bupropion (Wellbutrin) is a very popular antidepressant medication classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). It acts by blocking the reuptake of dopamine and norepinephrine.


• Mirtazapine (Remeron) works differently from the compounds discussed above. Mirtazapine targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits.


• Tricyclic antidepressants (TCAs) are older agents seldom used now as first-line treatment. They work similarly to the SNRIs, but have other neurochemical properties which result in very high side effect rates, as compared to almost all other antidepressants. They are sometimes used in cases where other antidepressants have not worked. TCAs include amitriptyline (Elavil, Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Norpramin, Tofranil), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).


• Monoamine oxidase inhibitors (MAOIs) are also seldom used now. They work by inactivating enzymes in the brain which catabolize (chew up) serotonin, norepinephrine, and dopamine from the synapse, thus increasing the levels of these chemicals in the brain. They can sometimes be effective for people who do not respond to other medications or who have “atypical” depression with marked anxiety, excessive sleeping, irritability, hypochondria, or phobic characteristics. However, they are the least safe antidepressants to use, as they have important medication interactions and require adherence to a particular diet. MAOIs include phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine sulfate (Parnate).


• Non-antidepressant adjunctive agents. Often psychiatrists will combine the antidepressants mentioned above with each other (we call this a “combination”) or with agents which are not antidepressants themselves (we call this “augmentation”). These latter agents can include the atypical antipsychotic agents [aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), risperidone (Risperdal)], buspirone (Buspar), thyroid hormone (triiodothyonine, or “T3”), the stimulants [methylphenidate (Ritalin), dextroaphetamine (Aderall)], dopamine receptor agonists [pramipexole (Mirapex), ropinirole (Requipp)], lithium, lamotrigine (Lamictal), s-adenosyl methionine (SAMe), pindolol, and steroid hormones (testosterone, estrogen, DHEA).

Antidepressants are medications and like all medications, they should be used only as prescribed by a physician. Medications can be dangerous and even lethal when taken in a haphazard manner. For example, specific antidepressants are considered unsafe for pregnant or nursing women. You should only obtain medication from a reputable drugstore and only as indicated on a prescription notice from your doctor. Any concerns about the safety of particular medications should be discussed with your doctor.

Even though antidepressants impact a person's levels of neurotransmitters within hours, they usually take several weeks to exert a noticeable effect on mood. This is because antidepressant drugs are thought to cause new receptors to grow within the synapses, and this growth process takes a few weeks. As a result, the effects of antidepressant medications are not instantly apparent, but may take several weeks to build up to levels that impact someone's mood. When treatment effects occur, they occur gradually.

Patients often fail to notice the positive effect that the medication is having, but generally family and friends will notice. It is important to keep taking an antidepressant as prescribed for several weeks before making a decision about whether or not it is effective. Up to six weeks may be required to know if a drug will work.

You may have to try several different antidepressant medications before finding one that works well. Even within a family of similar antidepressant medications, some people do better with one than with others. Decisions about when it is time to try new medications are best made when the patient, physician, and the psychotherapist (if one is present) work together as a team. Depressed patients often discount or ignore positive changes brought about by antidepressant medication. Health care professionals can counter this tendency to ignore positive change by offering their more objective observations, while patients can contribute their own impression regarding positive effects and troubling side-effects.

The dosage of antidepressants varies, depending on the type of drug, the person's body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.

Many people are concerned about having to take antidepressants for the rest of their lives. Typically, individuals begin taking antidepressants when their depression is at its worst. The medication, combined with psychotherapy, will allow most people to get to a point where they can gradually decrease or discontinue their use of antidepressants and maintain well-being by using skills learned in psychotherapy. However, for those individuals whose depression returns when they stop using medication, long-term use of antidepressants may be essential.

Sources and Additional Information:

http://resources.atcmhmr.com/poc/view_doc.php?type=doc&id=13017&cn=5

http://www.psychologyinfo.com/depression/medication.htm

http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7725

Evidence-Based and Other Treatments for Major Depression

Psychotherapy is a talk therapy in which people work with trained professional therapists to discuss their problems and learn new skills. Psychotherapy can help depressed individuals to talk about their experiences and feel listened to, gain insight into (and often some measure of control over) the thinking processes that lead to depressed moods, explore the contribution of past experiences to present day distress, and learn practical coping skills that can help decrease the likelihood of developing future depressive episodes.

Мany different professions train their members as psychotherapists. Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, counselors, psychoanalysts, or even professionals from other disciplines. Each profession brings something different to the psychotherapy table. Psychiatrists who offer psychotherapy are also able to prescribe medication, unlike most other professional therapists who compensate by aligning themselves with doctors who can prescribe for their patients when that is necessary. Psychologists have special training in mental health assessment as well as psychotherapy. Social workers can also offer mental health assessment (although not as broadly or comprehensively as psychologists) and treatment as well as link people to community and institutional resources.

There isn't one type of psychotherapy; there are many. Psychotherapy is not a unified field. Accordingly, psychotherapists may employ any of a number of different approaches and techniques. The major schools of thought that dominate current psychotherapy thinking include psychodynamic, cognitive-behavioral, family systems, and (to a lesser extent) humanistic schools. Each of these schools has a unique perspective on what causes people to have mental problems and how best to fix those problems. However, all types of psychotherapy aim to teach individuals about their depression, help individuals understand, express and control their feelings more effectively, and transform negative thoughts, attitudes, behaviors and relationships for the better.

Evidence-Based Treatments

Historically, psychotherapy was not an evidence-driven field. Therapists trained in a particular school or approach to mental health and learned from practical experience what worked and what did not. With the exception of the behavioral approaches, which have always been scientifically based, most older forms of psychotherapy have not been subjected to rigorous scientific tests to see how well they work.

Thankfully, the last twenty-five years or so has seen a growing interest in the development of evidence-based or empirically supported therapies (EBTs). EBTs are standardized psychotherapy treatments that have been subjected to scientific clinical studies and which have shown substantial evidence of efficacy. The term "efficacy" is a tricky term. It refers to how well an intervention helps people recover during a clinical study. Efficacy is not quite the same thing as "effectiveness" which refers to how well a therapy works under real world conditions. Unfortunately, true effectiveness is much harder to study than efficacy. Though they are not perfect therapies by any means, modern empirically based therapies represent the state of the art and the best that the therapy professions currently have to offer patients. If you are depressed and have the opportunity to receive an evidence-based form of psychotherapy that has been specifically designed to help you overcome your depression, you should feel very comfortable deciding to participate in that therapy.

Psychotherapies that fit the definition of "empirically supported" meet several different criteria. These therapies have a specified focus (e.g., they target depression), are intended for a defined treatment population (e.g., African American women between the ages of 20 and 50), and follow a well-defined treatment protocol. Typically, clinicians follow a treatment manual, which specifies the number of sessions to be offered, what to talk about and teach during those sessions, and what techniques are to be employed during those sessions.

Evidence-based therapies are highly structured for a reason; they aim to teach specific skills to specific patients who will benefit from them. EBTs are not designed to be open-ended or free-form in nature but rather to achieve a specific aim. Patients generally appreciate the no-nonsense approach to treatment taken by many EBTs, but some will benefit from a more traditional open-ended and free-form mode of therapy. It is quite alright to follow a more structured EBT therapy with a more traditional supportive psychotherapy, or to participate in both EBT and supportive forms of therapy at the same time if these options prove helpful or useful to patients.

EBTs are increasingly becoming a gold standard for mental health care for a few different reasons. Health care companies like EBTs because they have scientific data that support their use (therefore offering greater accountability) and also because they are short-term in nature. Health insurance and managed care companies are interested in having clinicians be able to justify the number of treatment sessions necessary to treat particular disorders and EBTs offer a science-based way to do just that. Many patients like the shortness and focus of EBTs as well.

Cognitive Behavioral Therapy and Interpersonal Therapy are two EBT psychotherapies, which have documented success in treating groups of people with depression in clinical trials. As with medication therapy, not all people with depression will be helped by evidence-based therapies. Keeping this in mind, we conclude our discussion of psychotherapy and depression with brief introductions to other varieties of psychotherapy that can also be helpful.

Other Therapeutic Approaches

Among other approaches, used for the depression treatment, are:

• Psychoanalysis.


• Psychodynamic Therapy.


• Person-centered psychotherapy.


• Existential therapy.


• Reminiscence therapy.


• Group therapy.


• Emotion-focused therapy.


• Alderian therapy.


• Contemplative therapy.


• Self-acceptance training.


• Journal therapy.


• Problem-solving therapy


• Process therapy.


• Light therapy.


• Music therapy.


• Art therapy.


• Dance therapy.


• Yoga therapy.


• Projection variations with time.


• Relaxation training.


• Holistic approach.


• Other methods of psychotherapy.

Sources and Additional Information: http://www.gulfbend.org/poc/view_doc.php?type=doc&id=13023&cn=5

http://depressionam.com/treatment-psychotherapy/

http://www.mspp.net/jackimEBT.htm