All about ECT - Electroconvulsive Therapy - for Depression Treatment

What is ECT?

Electroconvulsive therapy (ECT) is a procedure in which a brief application of electric stimulus is used to produce a generalized seizure.  It is not known how or why ECT works or what the electrically stimulated seizure does to the brain.  In the U.S. during the 1940’s and 50’s, the treatment was administered mostly to people with severe mental illnesses.  During the last few decades, researchers have been attempting to identify the effectiveness of ECT, to learn how and why it works, to understand its risks and adverse side effects, and to determine the best treatment technique.  Today, ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals. 

What conditions does electroconvulsive therapy treat?

Electroconvulsive therapy may help people who have the following conditions:

• Severe depression with insomnia (trouble sleeping), weight change, feelings of hopelessness or guilt and thoughts of suicide (hurting or killing yourself) or homicide (hurting or killing someone else).


• Severe depression that does not respond to antidepressants (medicines used to treat depression) or counseling.


• Severe depression in patients who can't take antidepressants.


• Severe mania that does not respond to medication. Symptoms of severe mania may include talking too much, insomnia, weight loss or impulsive behavior.


• Schizophrenia that does not respond to medication.

How does ECT work?

Traditionally, it was believed that ECT works by using an electrical shock to cause a seizure (a short period of irregular brain activity) in the brain. This seizure releases many chemicals in the brain. These chemicals, called neurotransmitters, deliver messages from one brain cell to another. The release of these chemicals makes the brain cells work better. A person's mood will improve when his or her brain cells and chemical messengers work better.



Update 03-19-2012: The recent study revealed absolutely different mechanism of ECT action on the brain affected by depression. The clinical depression causes "over-communication" in
the brain that may make it difficult for people with depression to think and
concentrate, said study researcher Jennifer Perrin, a mental health researcher
at the University of Aberdeen in Scotland. The ECT treatment appeared to turn
down an overactive connection between brain regions responsible for mood and
emotion and those responsible for thinking and concentrating. Perrin likened the mechanism to dialing down a stereo that's too loud.

What steps are taken to prepare a person for ECT treatment?

First, a doctor will perform a physical exam to make sure you're physically able to handle the treatment. If you are, you will meet with an anesthesiologist, a doctor who specializes in giving anesthesia. Anesthesia is medicine used to put you in a sleep-like state so that you don't feel any pain or discomfort. The anesthesiologist will examine your heart and lungs to see if it is safe for you to have anesthesia. You may need to have some blood tests and an electrocardiogram (a test showing the rhythm of your heart) before your first ECT treatment.

How is it administered?

ECT treatment is generally administered in the morning, before breakfast. Prior to the actual treatment, the patient is given general anesthesia and a muscle relaxant.  Electrodes are then attached to the patients scalp and an electric current is applied which causes a brief convulsion.  Minutes later, the patient awakens confused and without memory of events surrounding the treatment.  This treatment is usually repeated three times a week for approximately one month.  The number of treatments varies from six to twelve.  It is often recommended that the patient maintain a regimen of medication, after the ECT treatments, to reduce the chance of relapse.

To maximize the benefits of ECT, it is crucial that the patient’s illness be accurately diagnosed and that the risks and adverse side effects to be weighed against those of alternative treatments.  The risks and side effects involved with the use ECT are related to the misuse of equipment, ill-trained staff, incorrect methods of administration, persistent memory loss, and transient post-treatment confusion.

ECT Approaches: RIGHT UNILATERAL TREATMENT versus BILATERAL ECT TREATMENTS

There are primarily two types of electrode placements used for the delivery of ECT. Differences between these two techniques include the area of the brain stimulated, timing of response and potential side effects.

To generate a seizure with a right unilateral treatment, one electrode is placed on the crown of the head and the other on the right temple. Those receiving the right unilateral treatments may respond somewhat more slowly than those who receive bilateral treatments. This difference is usually no greater than 1 to 2 treatments. Right unilateral treatment is typically associated with less memory side effects. Patients who do not respond to right unilateral treatments may require a switch to bilateral placement.

Bilateral ECT treatment involves placing the electrodes on both temples. This treatment may be associated with more acute memory side effects than right unilateral treatments. Bilateral ECT is indicated for severe mental illnesses including depression with psychosis, manic episodes of bipolar disorder, psychosis related to schizophrenia and catatonia.

You and your doctor will work together to determine which treatment option is best for you. Specific recommendations will be made after carefully evaluating your concerns, medical/psychiatric history, and the severity of your symptoms.

What are some side effects of ECT?

Side effects may result from the anesthesia, the ECT treatment or both. Common side effects include temporary short-term memory loss, confusion, nausea, muscle aches and headache. Some people may have longer-lasting problems with memory after ECT.

Sometimes a person's blood pressure or heart rhythm changes. If these changes occur, they are carefully watched during the ECT treatments and are immediately treated.

The mechanism linking ECT to memory is not well understood, but about one third of patients experience a significant loss. The ability to remember should come back after treatment, but specific memories might not. Research suggests that factors contributing the most to cognitive problems are the use of a high electrical dose and the placement of electrodes on both temples, rather than just on the side of the head associated with the patient's non-dominant half of the brain. The difficulty for practitioners—as well as fuel for debate—is that when both temples are used, a patient might not require as high a dose of electricity to achieve the necessary rejiggering of brain circuitry.

How distressing is ECT to Patients?

While there are certainly patients who perceive the treatment as terrifying and shameful, and some patients who report distress about persistent memory loss, many speak positively of the benefits. An article entitled "Are Patients Shocked by ECT?" reported on interviews with 72 consecutive patients treated with ECT. The patients were asked whether they were frightened or angered by the experience, how they looked back at the treatment, & whether they would do it again. Of the patients interviewed, 54% considered a trip to the dentist more distressing, many praised the treatment, & 81% said they would agree to have ECT again. Those are comforting statistics about a treatment that has an ugly name and unfavorable connotations, while sometimes offering amazing and occasionally even life-saving results.

Why is ECT so controversial?

After 60 years of use, ECT is still the most controversial psychiatric treatment.  Much of the controversy surrounding ECT revolves around its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization.

Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort.  It is also unclear whether or not ECT is effective.  In some cases, the numbers are extremely favorable, citing 80 percent improvement in severely depressed patients, after ECT.  However, other studies indicate that the relapse is high, even for patients who take medication after ECT.  Some researchers insist that no study proves that ECT is effective for more than four weeks.

During the last decade, the “typical” ECT patient has changed from low-income males under 40, to middle-income women over 65.  This coincides with changing demographics. The increase in the elderly population and Medicare, and the push by insurance companies to provide fast, “medical” treatment rather than talk therapy.  Unfortunately, concerns have been raised concerning inappropriate and even dangerous treatment of elderly patients with heart conditions, and the administration of ECT without proper patient consent.

Is ECT an option?

The patient and physician should discuss all options available before deciding on any treatment.  If ECT is recommended, the patient should be given a complete medical examination including a history, physical, neurological examination, EKG and laboratory test.  Medications need to be noted and monitored closely, as should cardiac conditions and hypertension.  The patient and family should be educated and informed about the procedure via videos, written material, discussion, and any other means available before a written consent is signed.

The procedure should be administered by trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist to administer the anesthesia.  The seizure initiated by the electrical stimulus varies from person to person and should be monitored carefully by the administration team.  Monitoring should be done by an EEG or “cuff” technique.

The nature of ECT, its history of abuse, unfavorable medical and media reports, and testimony from former patients all contribute to the debate surrounding its use.  Research should continue, and techniques should be refined to maximize the efficacy and minimize the risks and side effects resulting from ECT.

Video Presentation:

Electroconvulsive Therapy (ECT)

Sources and Additional Information:

http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect

http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/058.html

http://health.usnews.com/articles/health/brain-and-behavior/2009/07/15/brain-stimulation-electroconvulsive-therapy.html

http://www.medhelp.org/lib/ect.htm

http://www.psych.med.umich.edu/ECT/how-does-ECT-work.asp

http://news.yahoo.com/shock-therapys-mystery-closer-being-solved-203609232.html

Effectiveness of Psychodynamic and Psychoanalytic Psychotherapy Approaches

Many modern practitioners claim that psychoanalytic or psychodynamic approaches in the treatment of depression have little research to support their use at this time. It is widely acknowledged that while most therapists may make use of psychodynamic theoretical constructs to help conceptualize an individual’s personality or specific case, it is likely that applied approaches in these areas are ineffective and should be avoided.



However, multiple recent researches provide a serious supportive data that the long-term psychoanalytic or psychodynamic approaches may offer deeper treatment for the “underground” depression causes, than more accepted short-term therapeutic approaches as CBT and IPT, described earlier.

Depression Explanations under Psychodynamic Theories





There are multiple explanations that fall under the psychodynamic "umbrella" that explain why a person develops depressive symptoms. Psychoanalysts historically believed that depression was caused by anger converted into self-hatred ("anger turned inward"). A typical scenario regarding how this transformation was thought to play out may be helpful is further explaining this theory. Neurotic parents who are inconsistent (both overindulgent and demanding), lacking in warmth, inconsiderate, angry, or driven by their own selfish needs create a unpredictable, hostile world for a child. As a result, the child feels alone, confused, helpless and ultimately, angry. However, the child also knows that the powerful parents are his or her only means of survival. So, out of fear, love, and guilt, the child represses anger toward the parents and turns it inwards so that it becomes an anger directed towards him or herself. A "despised" self-concept starts to form, and the child finds it comfortable to think thoughts along the lines of "I am an unlovable and bad person." At the same time, the child also strives to present a perfect, idealized (and therefore acceptable) facade to the parents as a means of compensating for perceived weaknesses that make him or her "unacceptable". Caught between the belief that he or she is unacceptable, and the imperative to act perfectly to obtain parental love, the child becomes "neurotic" or prone to experiencing exaggerated anxiety and/or depression feelings. The child also feels a perpetual sense that he or she is not good enough, no matter how hard he or she tries.

This neurotic need to please (and perpetual failure to do so) can easily spread beyond the situation in which it first appears, such that the child might start to feel a neurotic need to be loved by everyone, including all peers, all family members, co-workers, etc. The goal of a traditional psychodynamic psychotherapy might be to help the child (now an adult in therapy) to gain insight into the mistaken foundations of his or her belief in his or her badness and inadequacy so that the need to punish himself/herself and to be perfect decreases.

Psychodynamic Theory Assumptions

• Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.


• Manifest symptoms are caused by latent (hidden) disturbances.


• Typical causes include unresolved issues during development or repressed trauma.


• Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.

Psychodynamic Theory Overview

Psychodynamic Theory is one of the oldest theories in psychology in which patients are treated are viewed within a model of illness that attempts to identify something that may be lacking. Each individual is perceived to be made up from a dynamic that begins in early childhood and continually progresses throughout life. This way of thinking, however, is generally considered a watered-down version of the more conservative and rigid psychoanalytic school of thought. Psychoanalysis in itself emphasizes the belief that all adult problems are directly related to events in one’s childhood. Very few therapists today can afford to practice strict psychoanalysis anymore, and as a result, it is typically practiced only by psychiatrists who have spent many personal hours being analyzed themselves as well as attending psychoanalytic institute. This is more than likely the kind of therapy people imagine when they think of therapy in terms of a “shrink.”

Therapists who practice this theory have a tendency to look at individuals as the composite of their parental upbringing. Their focus is on the means for settling conflicts between themselves and their parents as well as within themselves. Psychodynamic therapists tend to believe in the theoretical constructs of the ego (which acts as a force similar to a referee) and the superego (known as the conscience) as well as an id that exists inside all of us that tends to act as a devil’s advocate working against the thought process of the conscience. All of these constructs work together to make up the personality and the role of the unconscious is emphasized meaning that contrary to what else you may think, what you don’t know can indeed hurt you and more often than not, it does just that.

The development of an adult’s personality is viewed in terms of whether he or she was able to successfully maneuver through the psychosexual stage of childhood development. Because of this belief, adults are unlikely to know how they are screwed up and as a result may not even recognize the signs of mental distress or mental disorder. Most psychotherapists tend to view adults with varying degrees of “bad.”

Psychodynamic therapy vs. Psychoanalysis

Psychoanalytic therapy is based upon psychoanalysis but is less intensive, with clients attending between three to seven sessions a week. Psychoanalytic therapy is often beneficial for individuals who want to understand more about themselves. It is particularly helpful for those who feel their difficulties have affected them for a long period of time and need relieving of mental and emotional distress.

Together, the therapist and the client try to understand the inner life of the client through deep exploration. Uncovering an individual's unconscious needs and thoughts may help them to understand how past experiences have affected them, and how they can work through these to live a more fulfilling life.

Psychodynamic counseling or psychotherapy evolved from psychoanalytic theory, however it tends to focus on more immediate problems, be more practically based and shorter term than psychoanalytic therapy. Carl Jung, Alfred Adler, Otto Rank and Melanie Klein are all widely recognized for further developing the concept and application of psychodynamics.

Psychodynamic therapy focuses on unconscious thought processes which manifest themselves in a client's behavior. The approach seeks to increase a client's self-awareness and understanding of how the past has influenced present thoughts and behaviors, by exploring their unconscious patterns.

Clients are encouraged to explore unresolved issues and conflicts, and to talk about important people and relationships in their life. Transference (when clients transfer feelings they have toward important people in their life onto the therapist) is encouraged during sessions.

Compared to psychoanalytic therapy, psychodynamic therapy seeks to provide a quicker solution for more immediate problems.

While there are many similarities between psychoanalysis and Psychodynamic therapy still there are some differences, here are some of similarities and differences among them:

• Both methods depend on understanding the relationship between the conscious and the unconscious mind.


• Psychoanalysis requires daily visits to the psychoanalyst, while Psychodynamic sessions are usually just once a week.


• While during psychoanalytical treatment patient lies on a couch with the analyst sitting out of sight behind him/her, during the psychodynamic session the client and the psychotherapist sit face-to-face.


• In Psychodynamic therapy the therapist usually talks less and stays silent for longer periods.


• Treatment length can range from 1 to 12 sessions, to about 20 sessions, and to several years, while psychoanalytical brief therapy is not common.


• Both methods involve more understanding for the thoughts and emotions more than cognitive behavior therapy where deep understanding may not be that necessary.

Common Elements to Psychoanalysis and Psychodynamic Psychotherapy

Therapeutic Neutrality

The psychotherapist’s job is not to be a nanny or a friend; rather, the psychotherapist must help clients understand their unconscious motivation. Hence the psychotherapist must act with a certain therapeutic distance, or therapeutic neutrality, never acting from personal desire, and always keeping every word and action of the therapeutic relationship (also called the therapeutic alliance) deliberately focused on the clinical process of healing. 

Transference

It is common, and even expected, for the client to experience feelings for the psychotherapist that are called a transference reaction; these feelingsare really no different than common “love” or hate. The psychoanalyst Jacques taught that this common “love” is a belief in another; that is, it is a belief that the other person has some knowledge you lack. (Hate, being the reciprocal of love, means that your belief in the other person has, for some reason, dissolved.) And in this transference the client’s intense belief in the psychotherapist can cause some difficult problems that must be resolved within the psychotherapeutic work.

For example, your feelings can resemble the mixed feelings (i.e., love and hate) you had in childhood for your parents, and you can begin to treat your psychotherapist according to these feelings, all out of proportion to what is actually happening in the psychotherapy. In such a case, you need to realize that the psychotherapist is only doing his or her job of bringing these feelings to light; it’s your feelings, not the person of the psychotherapist, that are important.

Also, you can come to believe that your psychotherapist has the personal ability to redeem your sense of inner worthlessness, and so you can start to feel special and become very fond of, or even sexually attracted to, him or her. The therapeutic cure, however, must come from facing—not seducing—your inner emptiness.

So if transference isn’t handled carefully it will lead to disaster. For example, many clients have had their lives ruined by sexual affairs with their psychotherapists, all because the psychotherapist took the client’s erotic feelings personally and failed to help the client understand their clinical meaning.





Transference can also frighten you into terminating psychotherapy prematurely, rather than working through the feelings—especially the angry feelings—within the treatment. For example, during the therapeutic process you will experience many emotions that are similar to the intense and confusing emotions you felt as a child. Disappointment. Anger. Confusion. Feeling misunderstood. Feeling devalued. Feeling abandoned. Many different events—some of them just chance occurrences during psychotherapy and some of them deliberate therapeutic interventions by the psychotherapist—will trigger these emotions. (Experiencing these negative reactions to the psychotherapy process itself is called a negative transference.) Just remember that when you feel an emotion in psychotherapy, the therapeutic task will be to name it as an emotion and understand it as an emotion—not get caught in it as if it were your helpless destiny. For if you get caught in it, you will feel victimized and will blame the psychotherapist for your pain, and the entire therapeutic process will feel like judgment and criticism. And then, in deep bitterness, you will want to “get away” from the psychotherapy just as you wanted to get away from the original emotions as a child.

Counter-transference

Counter-transference can be considered the reverse of transference; that is, the term describes the psychotherapist’s unconsciously activated reactions to the client. If these feelings are taken personally, the psychotherapist could become angry, abusive, spiteful, indifferent, or even seductive. If the counter-transference gets too intense the psychotherapist might have to end the treatment and refer the client to someone else, for the client’s own protection.

Counter-transference, however, should be distinguished from the psychotherapist’s in-the-moment feelings about the psychotherapeutic situation, because these feelings can be used clinically. For example, if your psychotherapist begins to feel bored, it could be an indication that you are unconsciously avoiding an important issue.

Therefore, the psychotherapist’s emotional reactions to the treatment are neither “right” nor “wrong.” The real issue is whether these feelings are used clinically, for therapeutic benefit.                                     

Free Association

In the technical language of psychoanalysis, free association is a mental process by which one word or image spontaneously brings to mind other words or images. In both psychoanalysis and psychodynamic psychotherapy it can be very important for you to just say what comes to your mind, without censoring yourself, because this process allows your psychotherapist to make interpretations about your psychological defenses. For example, as you identify a thought or mental image that occurs along with a feeling, you can focus your attention on that thought or image and ask yourself what other thoughts or images come to mind. Following the “tracks” of a string of associations can lead you to the original experience that engendered the feeling in the first place.

           

The greatest hindrance to free association—and to the progress of psychotherapy itself—is the childhood experience of having to guard the things you say and do so as to avoid getting criticized by a demanding parent. When this defense continues into adulthood, it not only obstructs your capacity for honest and intimate interpersonal communication, but it also causes you to feel afraid of saying anything spontaneously in psychotherapy. Not knowing what is hidden in your unconscious, you will feel terrified that anything you say might be more revealing of the truth than you would like.

The simple, but hard, solution to this dilemma is to commit yourself to getting to the truth of your life, no matter how painful it may be. In all reality, the truth won’t kill you; on the contrary, the truth will set you free from your slavery to unconscious fear.                                                                                                    

Resistance

One final therapeutic concept to consider is resistance. Freud defined resistance as “whatever interrupts the progress of analytic work,” such as being late, missing a session, “holding back” your thoughts in the moment (i.e., refusing to speak about them) or avoiding a particular issue. In its most simple and practical sense, resistance results from fear, often the fear of having to face and relinquish one’s victim anger. In other words, the task of treatment is the complex and frightening task of being able to recognize and overcome the tendency to lie to yourself.

Nevertheless, Lacan warned us not to confuse resistance with defense and formulated the famous statement that “there is no other resistance to analysis than that of the analyst himself.” In other words, if the psychotherapist makes interpretations or interventions that are clinically inaccurate, the client will get defensive, and that will interrupt the therapeutic work. In plain English, this means that a client will only explore therapeutic material so far as is comfortable in the moment; the psychotherapist, therefore, must always be aware of just how far the client is willing to go and not “push” the client beyond these temporary limits. Imprudent attempts to push a client can end up pushing the client right out of psychotherapy.

Sources and Additional Information:

http://depression.about.com/cs/treatments/a/treatments.htm

http://www.depression-doctor.com/psychodynamic-theory.html

http://www.2knowmyself.com/Psychodynamic_therapy_for_depression

http://www.guidetopsychology.com/txtypes.htm

http://www.counselling-directory.org.uk/psychoanalytical.html

http://info.epmhmr.org/poc/view_doc.php?type=doc&id=13003&cn=5

Interpersonal Therapy: Proven Anti-Depression Treatment

What Is Interpersonal Therapy?

Interpersonal therapy (IPT) is a type of treatment for patients with depression which focuses on past and present social roles and interpersonal interactions. During treatment, the therapist generally chooses one or two problem areas in the patient's current life to focus on. Examples of areas covered are disputes with friends, family or co-workers, grief and loss and role transitions, such as retirement or divorce.

IPT does not attempt to delve into inner conflicts resulting from past experiences. Rather it attempts to help the patient find better ways to deal with current problems.

Historical Background

• IPT has no specific theoretical origin although its theoretical basis can be seen as coming from the work of Sullivan, Meyer and Bowlby. Whilst Sullivan wrote of a type of "interpersonal therapy" in the 1930s, this was more in the form of a long term analytic but relational based therapy and would not be seen to resemble the current form of IPT. Attachment theorists view the experience of loss and to a lesser degree disordered attachment as underlying much of human psychopathology. IPT can be seen as indirectly addressing these issues within the therapeutic frame.


• The current form of the treatment was developed by the late Gerald Klerman and Myrna Weissman in the 1980s as a means of operationalizing the interpersonal approach to psychotherapy for a series of treatment studies in depression conducted in the United States. Since that time it has been modified for a variety of other indications including Dysthymia, Bulimia Nervosa, Substance Misuse, Somatization and depression in a variety of clinical settings. Preliminary studies in Anorexia Nervosa, Bipolar Disorder, PTSD and some anxiety disorders are underway. In each adaptation the fundamentals of the treatment manual are adhered to, however different components are emphasized.

Interpersonal Therapy

Subtypes of Interpersonal Therapy

There are two subtypes of IPT. The first type is used for the short-term treatment of a depressive episode. The patient and therapist typically meet weekly for two to four months and treatment ends once the symptoms subside. The second type is maintenance treatment (IPT-M), which is long-term treatment with the goal of preventing or reducing the number of future episodes of depression. IPT-M may consist of monthly sessions over a period of two to three years.

Structure and Duration of Sessions

• IPT usually runs from 12 to 16 one hour sessions that usually occur weekly. The initial sessions are devoted to information gathering and clarifying the nature of the patient's illness and interpersonal experience. The patient's illness is then formulated and explained in interpersonal terms and the nature and structure of the IPT sessions are explained. This phase of treatment concludes with the composition of the "interpersonal inventory" which is essentially a register of all the key relationships in the individual's life. Within the interpersonal inventory relationships are categorized according to the four areas mentioned above.

• Sessions 3 - 14 are devoted to addressing the problematic relationship areas and there is little focus upon the specific illness process apart from enquiries as to symptom severity and response to treatment modalities.

• The final sessions 15 - 16 focus upon termination, which is usually formulated as a loss experience from which the patient can learn a great deal about their own responses to loss and how well the modifications attempted in the therapeutic process have evolved.

Four Basic Problem Areas Identified by Interpersonal Therapy

IPT identifies four basic problem areas which contribute to depression. The therapist helps the patient determine which area is the most responsible for his depression and therapy is then directed at helping the patient deal with this problem area.

The four basic problem areas recognized by Interpersonal Therapy are:

• Interpersonal Disputes

These tend to occur in marital, family, social or work settings. They can be conceptualized as a situation in which the patient and other parties have diverging expectations of a situation and that this conflict is excessive enough to lead to significant distress. One example may be a marital dispute in which a wife's attempts to use initiative leads to conflict with her spouse. In these circumstances IPT would aim to define how intractable the dispute was, identify sources of misunderstanding via faulty communication and invalid or unreasonable expectations and the aim to intervene by communication training, problem solving or other techniques that aim to facilitate change in the situation.

• Role Transitions

Role transitions are situations in which the patient has to adapt to a change in life circumstances. These may be developmental crises, adjustments in work or social settings or adaptations following life events or relationship dissolutions. In those who develop depression, these transitions are experienced as losses and hence contribute to the development of psychopathology. IPT aims to help the patient with role transitions to reappraise the old and new roles, to identify sources of difficulty in the new role and fashion solutions for these. In many cases clarification of inconsistencies or clear errors in the patient's cognitions as well as problem solving and encouragement of affect within the therapeutic frame are suitable interventions.

• Grief

Grief is simply defined in IPT as "loss through death". Whilst many clinicians would formulate sequelae of severe medical e.g. loss of function illness as grief, in IPT the term is reserved specifically for bereavement. In IPT, if grief is formulated as an issue of relevance in the interpersonal inventory, the assumption of the patient and therapist is that the grieving process has been complicated by delay or in many cases excess. The IPT therapist will help to reconstruct the patient's relationship with the deceased and by encouraging affect as well as clarification and empathic listening help facilitate the mourning process with the aim of helping the patient to establish new relationships.

• Interpersonal Deficits

These would be diagnosed when a patient reports impoverished interpersonal relationships in terms of both number and quality of the relationships described. In many cases the interpersonal inventory will be sparse and the patient and therapist will need to focus upon both old relationships as well as the relationship with the therapist. In the former common themes should be identified and linked to current circumstances. In using the therapeutic relationship the therapist aims to identify problematic processes occurring such as excess dependency or hostility and aim to modify these within the therapeutic frame. In this way the therapeutic relationship can serve as a template for further relationships which the therapist will aim to help the patient create. This group of problems is common in the more chronic affective disorders such a dysthymia in which significant degrees of social impoverishment have occurred either before or after the illness.

Interpersonal Therapy

Techniques used in IPT

• IPT utilizes several techniques within the therapeutic process. Many of these are modified interventions borrowed from other therapies such as cognitive-behavior therapy and brief crisis intervention.

• The use of various questioning styles such as "Clarification" which seeks to obviate the patient's biases in describing interpersonal issues as well as "Supportive Listening" are often therapeutic within themselves. "Role playing" and "Communication Analysis" are highly behavioral interventions and are invaluable tools in intervening in interpersonal disputes. The "Encouragement of Affect" allows the patient to experience unpleasant or unwanted affects (that have perhaps resulted in the deployment of pathogenic defense mechanisms) safely within the therapeutic frame. This process allows the patient to acknowledge the affective component of an interpersonal issue e.g. grief and helps the patient to accept it as a part of their experience. The "Use of the Therapeutic Relationship" has been described earlier.

• There is some degree of debate as to whether therapists should be more or less active in the conduct of the sessions other than keep the focus on interpersonal issues. There are clearly no distinct guidelines in this area although the goal of IPT is to facilitate the process of the patient generating their own interventions and thus progressively phasing the therapist out of the process. It is likely that the process of patient initiated changes is the likely mechanism to account for the observation that symptomatic improvement arising from IPT often peaks 3 - 6 months subsequent to the termination of treatment.

Conclusion

IPT is most useful for people who are in the midst of recent conflicts with significant others and/or have experienced difficulty adjusting to stressful life transitions. As with CBT, patients who are unable or unwilling to practice skills taught in therapy are not likely to gain significant symptom relief. Most therapists recommend that clients remain in ongoing, maintenance therapy if that is possible. Maintenance IPT (IPT-M) is often used following termination of the short-term phase of therapy. Recent research suggests that IPT-M may prevent future episodes of depression, particularly in women.

In clinical trials, both CBT and IPT have been found to be effective treatments for depression. There is no certain way to know up front (without actually trying them) whether one form of therapy will be a better fit for patients than the other. The available studies are too small and specific to recommend a specific type of person who would benefit best from one or another type of therapy. Just as patients may need to try different types of antidepressant medication, the may also need to try different types of therapy, or even different therapists within a particular therapeutic approach to gain maximum relief.

Sources and Additional Information:

http://depression.about.com/od/psychotherapy/a/interpersonal.htm

http://interpersonalpsychotherapy.org/

http://www.apa.org/divisions/div12/rev_est/ipt_depr.html

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13026&cn=5

Cognitive-Behavioral Therapy: A Proven Anti-Depression Treatment

Cognitive-behavioral therapy is the most popular and commonly used therapy for depression treatment. Hundreds of research studies have been conducted which verify its safety and effectiveness in treating this disorder. Modern cognitive behavioral therapy (CBT) was developed independently by two separate individuals: Aaron Beck, a psychiatrist, and Albert Ellis, a clinical psychologist. Both Beck and Ellis began working on their versions of the therapy in and around the late 1950s and early 60s. Both versions of the therapy are founded on the single basic idea that cognition, in the form of thoughts and preconceived judgments, precedes and determines people's emotional responses. In other words, what people think about an event that has occurred determines how they will feel about that event. Depression happens because people develop a disposition to view situations and circumstances in habitually negative and biased ways, leading them to habitually experience negative feelings and emotions as a result.

Cognitive Behavioral Therapy for Depression

Cognitive behavioral therapy (CBT) is a brief treatment for depression that involves two main types of strategies – cognitive and behavioral. Cognitive therapy s designed to teach individuals to (1) identify depressive patterns of thinking, and (2) replace negative thinking with more realistic interpretations, predictions, and assumptions. Through cognitive therapy, people are taught to not automatically assume their beliefs are true, but rather to challenge their thoughts by examining the evidence supporting and contradicting their negative beliefs. By broadening one’s perspective and shifting one’s thinking, cognitive therapy can be an effective tool for combating depression.

Another group of strategies that are used in CBT are more behavioral in nature. These involve changing depression by changing the patients’ behavior. One behavioral technique, known as behavioral activation, involves forcing yourself to do things even though you lack the interest, energy, or motivation. For example, you might go to a party even though you are feeling too tired and you are convinced you will not enjoy yourself. Or, despite feeling overwhelmed with the idea of applying for a new job, you might still prepare a new resume and send it out. More often than not, forcing yourself to confront a situation instead of avoiding it leads to more enjoyment than you might expect, as well as other benefits.

CBT is a relatively brief form of treatment, lasting from ten to twelve sessions. Therapy begins by establishing a supportive environment for the patient. Educating the patient about how depression may be caused by cognitive distortions is the next step. The types of faulty thinking are discussed (e.g., "all or nothing thinking," "misattribution of blame," "overgeneralization," etc.) and the patient is encouraged to begin noting his or her thoughts as they occur throughout the day. This is done so that the individual may understand how common and often these thoughts are occurring.

In cognitive-behavioral therapy, emphasis is placed on discussing the thoughts and the behaviors associated with depression rather than the emotions themselves. The rationale for this is that it is believed that by changing thoughts and behaviors the emotions will also change. Because of this approach, cognitive-behavioral therapy is short-term (usually under two dozen sessions) and works best for people experiencing a quite a bit of distress related to their depression. Individuals who are able to approach a problem from a unique perspective and who are more cognitively-oriented will to do best with this approach.

Note that for mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence. Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.

CBT differs from traditional talking therapy in several respects. 

• Length. Unlike with psychoanalysis, which can last for years, the average number of CBT sessions is 12. The length of the therapy is often determined in advance, at the beginning of treatment.


• Structure. Most CBT therapists have a "lesson plan" for each session that includes a set of specific techniques and goals for the patient to learn.


• Homework. More so than other forms of therapy, CBT requires the patient to actively identify the triggers of their negative thinking and to "practice" alternative responses. Patients may be asked to keep a journal of their thoughts or to actively schedule challenging situations for themselves.

Cognitive Behavioral Therapy for Depression

Cognitive Factors in Depression

Self-evaluation

Self-evaluation is a process that is ongoing. Therapists evaluate how we are managing life tasks, and evaluate whether we are doing what we should, saying what we should, or acting the way we should. In depression, self-evaluation is generally negative and critical. When a mistake occurs, we think, "I messed up. I'm no good at anything. It's my fault things went wrong." When someone is depressed, he/she tends to take responsibility for everything that goes wrong, and tends to give others credit for things that turn out fine. A psychologist assumes that self-evaluation, in depressed individuals, is too critical, and feeds low self-esteem and a sense of failure.

Identification of Skill Deficits

Sometimes a depressed person may accurately identify a skill deficit. "I'm not good at telling people what I want from them." This is usually coupled with negative self-evaluation, "therefore, it's my fault that I didn't get what I want."  However, in depression, the person assumes that he/she cannot learn how to do what is necessary to achieve a better outcome. The depressed person believes that he/she cannot learn how to act differently. Accurate identification of social skill deficits complicates depression, because it provides a reality base for the other irrational and exaggerated negative perceptions of the depressed person. If the skill deficit is real, then the depressed person assumes that all of the other negative self-assessments must be real too.



Further, when depressed, a person is more likely to identify negative characteristics of self, and less likely to see the positive. The result is a long list of the "things I cannot do," or "tasks I'm no good at," or "mistakes I've made." Psychologists help depressed persons identify their social skill deficits, and also help them develop a plan to improve those skills. This part of cognitive therapy is more behavioral, as the psychologist teaches the depressed person how to manage their life problems better.

Evaluation of Life Experiences

When depressed, a person will focus on minor negative aspects of what was otherwise a positive life experience. For example, after a vacation at the beach, the depressed person will remember the one day it rained, rather than the six days of sunshine. If anything goes wrong, the depressed person evaluates the entire experience as a failure, or as a negative life experience. As a result, memories are almost always negative.





This is reflective of unrealistic expectations. Nothing in life ever works out just as you want. If we expect perfection, we will always be disappointed. Psychologists help you to develop realistic expectations about life, and help you determine what you need versus what you want. After all, most of the things that don't work out are little things. And even when important problems develop, we can either resolve the problem, or regroup, recover, and start again, with hope for a better future. In depression, the hope is missing.

Self-talk

Self-talk is a way of describing all the things we say to ourselves all day long as we confront obstacles, make decisions, and resolve problems. Self-talk is not "talking to yourself" in a literal sense, although it sometimes does involve talking out loud (depending on the person). There is a myth, that when you talk to yourself, it is a sign of "craziness" or mental illness. That idea stems from the "voices" or auditory hallucinations experienced in severe forms of mental illness, such as schizophrenia. When a person hears voices, he/she thinks it is someone else talking to them. The self-talk we are describing here is not like that at all. We all engage in self-talk.





Usually, it is part of our thinking process, or what we call "stream of consciousness." As we are presented with problems, or decisions, we might think, "Okay, how do I handle this?' or "This looks like it is difficult, I better ask for help." or "I know how to fix this!"

Self-talk is not bad, or wrong, or a sign of psychological problems. It is normal. But, negative self-talk prevents us from solving problems, and can contribute to a variety of psychological problems, including depression. When faced with a problem, if our self-talk is negative, it can immobilize us. "I can't do this, I'm just going to foul it up again" or "I'll probably get fired after they see how incompetent I am." Psychologists help depressed individuals identify negative self-talk, and also teach them how to challenge these negative statements, and how to replace them with positive self-talk.

Automatic thoughts

Automatic thoughts are repetitive, automatic self-statements that we always say to ourselves in certain situations. They can be positive or negative. Psychological problems develop when our automatic thoughts are consistently negative. They are automatic, because they are not the result of an analysis of the problem, they are a "knee-jerk" reaction to specific situations. For example, in social situations, do you always presume the other person dislikes you, or thinks you are stupid? When automatic thoughts control our emotional response to people, problems, and events, we ignore evidence that contradicts the automatic thought. If we cannot ignore it, we explain the evidence in terms of the automatic thought.

For example, if we talk to someone and they smile, they are really laughing at us, rather than being pleased to see us. The automatic thoughts create an expectancy of something negative. Since many things in life are vague, and can be interpreted in many ways, we learn how to negatively evaluate the world, so it agrees with our negative automatic thoughts. Psychologists help you to identify your negative automatic thoughts, and how to develop positive challenges to those negative ideas.

Irrational Ideas and Beliefs

Albert Ellis first presented the idea that irrational beliefs are at the core of most psychological problems. We could also call these beliefs unrealistic, incorrect, or maladaptive. Psychologists have also suggested that these ideas are irrational because they are not logical, or are based on false assumptions. Some examples of irrational beliefs:

§         I cannot be happy unless everyone likes me. 

§         If I do what is expected of me, my life will be wonderful. 

§         Bad things don't happen to good people. 

§         Good things don't happen to bad people. 

§         In the end, bad people will always get punished. 

§         If I am intelligent (or work hard), I will be successful.

What makes these ideas irrational, or maladaptive, is the belief that they are always correct. Sure, working hard will increase your chances for success, but success is not guaranteed. But, there are times when we do everything right, and we still don't get what we want. For some people, this leads to the conclusion that they are lazy, no good, incompetent, or weak. The result is a loss of self-esteem, and sometimes, depression. Psychologists help you to identify your irrational ideas, and also how to evaluate which ideas are irrational and which are not. Finally, the ideas need to be changed to reflect the real world.

Overgeneralizing or Catastrophizing

Catastrophizing is a negative overgeneralization. It is "making a mountain out of a mole hill!" For example:

• One person at work does not like you, and tells you, so you know it's not mistaken judgment. You then assume no one at work likes you, or you assume that you must be a terrible person if he/she does not like you.


• You make a small mistake on a project, and assume that you will be fired when the boss finds out.


• You try your hand at a new hobby, and it does not turn out well. You conclude, "I'm no good at anything."

We all make mistakes. If you overgeneralize one, or even a few mistakes, to the conclusion that you are bad, incompetent, or useless, you might become depressed. Psychologists help you identify and change negative overgeneralizations.

Cognitive Distortions 

Cognitive distortions are another way of describing the irrational ideas, overgeneralizing of simple mistakes, or developing false assumptions about what other people think about us, or expect from us. We are distorting reality by the way we are evaluating a situation. The concept of cognitive distortion highlights the importance of perceptions, assumptions and judgments in coping with the world.  Psychologists help us determine what evaluations are distortions by providing objective feedback about our evaluations of the world, and by teaching us how to change the way we perceive problems.

Pessimistic Thinking

Pessimistic thinking does not cause depression, but it appears to be easier to become depressed if you tend to view the world with considerable pessimism. After all, pessimism is a tendency to think that things won't work out as you wish, that you won't get what you want. Pessimism feeds the negative cognitive distortions and self-talk. On the other hand, optimism appears to create some protection from depression.

Hopelessness is a central feature of depression, along with helplessness. If you view your world as bad, filled with problems, and don't think you can do anything about the problems, you will feel helpless. If you don't believe your life will improve, if you think the future is bleak, then you will begin to feel hopeless. Pessimism encourages these negative assessments of your life.  Optimism prevents you from reaching those conclusions. In fact, psychologists have researched ways to learn how to be more optimistic, as a way of fighting depression.

Sources and Additional Information:

http://depression.about.com/cs/treatments/a/treatments.htm

http://www.depressiontreatment.com/articles/146/Depression-Treatment

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

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13024&cn=5

http://www.health.com/health/condition-article/0,,20188803_2,00.html

Overview of Treatment Approaches for Clinical Depression

First of you should be aware that depression, even in the most severe forms, is a highly treatable disorder. However, as with many mental illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

There are several valid reasons for seeking and obtaining treatment for depression:

• The treatment can result in health improvements that would not occur otherwise.


• The treatment is likely to result in quicker recovery.


• The treatment can result in a more complete recovery, with fewer leftover symptoms.


• The treatment can help to prevent relapse.

The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional.



The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide.



Once diagnosed, a person with depression can be treated with a number of methods. Although there are claims supporting the effectiveness of many different treatment approaches for depression, there are relatively few of them that have been tested thoroughly and supported through well-controlled research studies. You should know upfront that research does not predict individual responses to the specific depression treatments. In other words, just because it works for some (or even most) people does not mean it will work for you. It’s important to keep this in mind as you or a loved one undergoes treatment for depression, because the first treatment or set of treatments tried may not be effective.

Most clinicians practicing today believe that depression is caused by an equal combination of biological (including genetics), social, and psychological factors. A treatment approach that focuses exclusively on one of these factors is not likely to be as beneficial as a treatment approach that addresses both psychological and biological aspects (through, for example, psychotherapy and medication). Depression remains a complicated, complex disorder and researchers are only beginning to fully grasp the multitude of factors — personal, genetic, biological, societal, and environmental — that are involved. Any explanation or approach which emphasizes only one factor as the cause of depression is misleading and simplistic. Individuals should avoid accepting a simplistic answer to such a devastating and complex disorder.

Treatment for depression, like for most mental disorders, usually relies on psychotherapy and medication for the quickest, strongest effects. Treatment is usually begun immediately after the initial clinical interview with a mental health professional.

Depression treatment takes time, and patience is needed.

We will just list the possible approaches to treat depressive disorder in this introductory post, while giving more related information in the separate reviews.

Depression Treatment Approaches:

• Therapy.

There are a wide number of different types of effective therapeutic approaches utilized for the treatment of depression today. These range from cognitive behavioral therapy, to behavioral therapy, to interpersonal therapy, to rational emotive therapy, to family and psychodynamic approaches. Both individual and group modalities are commonly used, depending upon the severity of the depressive episode and the local resources within an individual’s community.

• Medications.

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

• Hospitalization.

Hospitalization of an individual is necessary when that person has attempted suicide or has serious suicidal ideation or plan for doing so. Such suicidal intentions must be carefully and fully assessed during an initial meeting with the client. The individual must be imminent danger of harming themselves (or another). Daily, routine daily functioning will likely be negatively affected by the presence of a clear and severe major depression. Most individuals who suffer from major depression, however, are usually only mildly suicidal and most also often lack the energy or will (at least initially) to carry out any suicidal plan.

§         Electroconvulsive Therapy (ECT).



For cases in which medication and/or psychotherapy does not help alleviate a person's treatment–resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.

§         Repetitive Transcranial Magnetic Stimulation (rTMS).

Reptitive transcranial magnetic stimulation (rTMS) utilizes an electromagnet placed on the scalp that generates magnetic field pulses roughly the strength of an MRI scan. The magnetic pulses pass readily through the skull and stimulate the underlying cerebral cortex. Low frequency (once per second) TMS has been shown to induce sustained reductions in cortical activation in multiple studies.

§         Self-Help.

Self-help methods for the treatment of depression may be very successful for some individuals. Support groups are especially effective, since they allow the individual an opportunity to socialize and be with others who suffer from similar feelings. Many support groups exist both online and off where depression sufferers can share their commons experiences and feelings. 

• Alternative Therapies.

There are many alternatives approaches to treat depression, widely publicized in the press and online, however, you should be very cautious trusting the modern gurus your life and well-being. While many of them have not been clinically proven and recognized by the doctors, you might find some of the ways to be helpful and complimentary to your conventional treatment approaches. Always consult with your doctor or therapist before trying them. Among the most popular methods are physical activities, folate supplements, St. John’s wort, essential fatty acids, acupuncture, etc.

Sources and Additional Information:

http://www.depressiontreatment.com/articles/146/Depression-Treatment

http://psychcentral.com/lib/2006/depression-treatment/

http://depression.about.com/cs/treatments/a/treatments.htm

http://www.realmentalhealth.com/depression/depression_02_3.asp

May Alcohol Trigger Genetic Marker for Depression?

Alcohol and Depression

According to the National Institute of Mental Health (NIMH), a depressive disorder “interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.” Depression is a brain disorder and although research is still being conducted to determine the exact causes, the NIMH states “it likely results from a combination of genetic, biochemical, environmental, and psychological factors.  ”Alcohol is a well-known depressant drug, which means it relaxes the body and causes a person’s reaction time and mood to be altered through slowing down the central nervous system. Since alcohol has a direct impact on the brain, and it also alters a person’s biochemistry, the possibility that alcohol may trigger depression has been worth scientific study.

New Zealand Study

In New Zealand, a new study has been conducted to determine if alcohol may cause depression. Previous researches have identified a link between alcohol abuse or dependence and major depression. But it hasn't been determined whether one disorder causes the other, or whether a common genetic or environmental factor increases the risk for both conditions.

This new study included 1,055 people born in 1977 who were assessed for alcohol abuse and depression at ages 17 to 18, 20 to 21, and 24 to 25. The number of participants who met criteria for alcohol problems and major depression were: 19.4 percent and 18.2 percent, respectively, at ages 17 to 18; 22.4 percent and 18.2 percent at ages 20 to 21; and 13.6 percent and 13.8 percent at ages 24 to 25.

At all ages, alcohol abuse or dependence was associated with a 1.9 times increased risk of major depression, said David M. Ferguson and colleagues at the Christchurch School of Medicine and Health Sciences.

"This analysis suggested that the best-fitting model was one in which there was a unidirectional association from alcohol abuse or dependence to major depression but no reverse effect from major depression to alcohol abuse or dependence," they wrote.

"The underlying mechanisms that give rise to such an association are unclear; however, it has been proposed that this link may arise from genetic processes in which the use of alcohol acts to trigger genetic markers that increase the risk of major depression. In addition, further research suggests that alcohol's depressant characteristics may lead to periods of depressed affect among those with alcohol abuse or dependence."

In addition, alcohol abuse may cause social, financial and legal problems that cause stress and increase the risk of depression, said the researchers, who added that further research is required to fully understand the connection between alcohol abuse and depression.

The study was published in the March issue of the Archives of General Psychiatry.

Physiological Effects of Alcohol - Role in Depression

In this chapter, we will present several quotes by media and medical specialists related to the topic of discussion:

• Alcohol has been found to lower serotonin and norepinephrine levels.
  
  {"Food and Mood," Natural Medicine Chest, Conquer Depression Without Drugs, Let's Live magazine, Jan. 2000}.


• "Alcohol is a depressant. People with depression shouldn't drink alcohol", says Sherry Rogers, MD, in her 1997 book on "Depression." She says that studies show that doctors miss diagnosing over 66% of the people who are depressed. Alcohol temporarily blunts the effects of stress hormones. It typically leaves you feeling worse than ever because it depresses the brain and nervous system. One study looked at people who consumed one drink a day. After three months abstinence, their scores on standard depression inventories improved.
  
  {The Brain, "You Can Control Your Emotional Wellness," USA WEEKEND, Jan. 3, 1999, Jim Thorton, health reporter}.


• People with manic-depressive disorder should not drink alcohol.
  
  {James F. Balch, MD, newspaper columnist and radio broadcaster, 1990}.


• Although important for all ages, in older people folic acid deficiency contributes to aging brain processes and increased risk of Alzheimer’s disease and vascular dementia. Depression is also common in those with folate deficiency.
  
  {British Medical Journal, 2002}.


• Andrew Weil, in his Self Healing newsletter (Jan. 2000) tells us alcohol use can lower levels of folic acid. The presence of alcohol hastens the breakdown of antioxidants in the blood, speeding their elimination from the body.


• When alcohol wears off, you will be more depressed than ever.
  
  {Ann Landers' to readers, Dec. 5, 1993, as well as many other medical sources}


• Depression and alcohol problems often go together, but the evidence suggests that in men alcohol use preceded the depression, whereas in women the depression precedes the alcohol use. {American Journal of Epidemiology, "Study Links Depression and Alcohol Problems," Washington Post Health, Dec. 16, 1997}.

Why Alcohol Might Cause Depression

Since alcohol is a known depressant, it stands to reason people with depression shouldn’t drink. This applies to people suffering from manic depression as well.

The depression caused by alcohol actually starts with your physical body. First, alcohol lowers the serotonin and norepinephrine levels in your brain. These chemicals are the chemicals that give you your good feelings - a feeling of well being, and they help you to feel normal. The anti-depressant drugs were designed build these chemicals back up.  After a long drinking career, since alcohol can take these brain chemicals down to ground zero, it can take a long time for the anti-depressants to bring these brain chemical levels back to where they need to be.

Alcohol also temporarily nullifies the effects of stress hormones. This is why after drinking you feel worse than ever, because alcohol depresses your nervous system and your brain. A study was done that followed people who were only drinking one drink a day and after these people stopped drinking for 3 months, their depression scores improved. And that is only at one drink a day, so it is easy to imagine the impact the kind of volume an alcoholic takes in every day can have.

Alcohol also wipes out vitamins from your system after a drinking session. A folic acid deficiency will contribute the brain aging and in older people, dementia. The folic acid deficiency also contributes to overall depression. Further, the alcohol in your system also breaks down and speeds the elimination of antioxidants in your blood. Antioxidants are critically important to our health because antioxidants fight free radicals and free radical damage causes diseases and aging. Our immune system actually creates the antioxidants which then neutralize the free radicals.

Alcohol can activate a gene that has been linked to depression and other mental issues.  The result of this activation can cause not only depression, but in extreme cases seizures, and manic depressive episodes.

It is still hard to figure out which came first - the depression or the drinking problem. But if the depression came first, drinking escalates the disastrous process. 

Alcohol as Antidepressant

It is an urban myth, commonly accepted by a general public, that alcohol can be used as antidepressant. Are there any substantial facts in this statement? Probably, not. Alcohol is a depressant. Physically speaking, drinking makes you more depressed. Mentally speaking, alcohol may, at best, only provide limited a temporary relief from symptoms. If you're drunk you may be able to ignore your real life problems for limited period, while you are under influence. Yes, alcohol gives very limited and temporary relief. The depression will still be there the day after and added to that possibly a hangover or guilt/shame which might even worsen the depression. For some people, getting drunk may cause to think more about what's wrong in his or her life and perhaps be more honest than otherwise while sober. Drinking alcohol can also cause a person to deal with the depression by delving more into it, hopefully resolving it, as opposed to keeping it buried inside. However, this mild probability of the positive effect is completely overwhelmed by the possible negative consequences.

Alcohol Mixing with Antidepressant Drugs

If you already taking medications for depression treatment you should think twice, before mixing it with alcohol. Actually, most of the antidepressants have a warning note on the package asking not to consume, while you take them. What are the potential problems you might experience?

A few things might happen if you mix antidepressants and alcohol:

• You may feel more depressed. Alcohol can worsen depression symptoms, so by drinking it, you could counteract effects of your medication and lessen its benefit.


• You may become more intoxicated than usual. Some antidepressants may cause you to feel more intoxicated than normal when combined with alcohol, which can impair your judgment and ability to drive or do other tasks that require focus and attention.


• The side effects from your medication may worsen. Some antidepressants cause drowsiness, and so does alcohol. Mixing the two could make you sleepy, which is dangerous in situations where you need to be alert.


• Deadly reactions can occur with monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan) phenelzine (Nardil) and tranylcypromine (Parnate). When combined with certain types of beverages and foods, these antidepressants can cause a dangerous spike in blood pressure, leading to a stroke. If you take an MAOI, be sure you know what's safe to eat and drink, and which alcoholic beverages can cause a reaction.

Sources and Additional Information:

http://www.forbes.com/feeds/hscout/2009/03/06/hscout624658.html?loomia_ow=t0:a41:g12:r1:c0.156031:b22504928&partner=loomia

http://www.gatehouseacademy.com/blog/2009/03/16/does-alcohol-cause-depression/

http://depression.about.com/od/drugsalcohol/a/alcoholanddep.htm

http://howistoppeddrinking.org/how-alcohol-causes-depression

http://www.mayoclinic.com/health/antidepressants-and-alcohol/AN01653