Major depression is one of the most prevalent mental disorders in the world, along with those falling under the category of anxiety. At the same time, the use of antidepressants is increasingly common in society.
The increasing demands in many areas of life, the resilient economic crises we have had to face and a long list of other circumstances have contributed decisively.
In this article we will delve into the question of whether depression can be cured without medicationThis necessarily implies knowing in advance how this common mood disorder manifests itself.
What is depression
First, it’s important to note that depression and sadness are not equal realities. The first describes an emotion which belongs to the normal range of human experience, and which has been forged throughout the evolution of our species by its adaptive properties. Depression, however, is a clinically relevant phenomenon that can profoundly compromise the quality of life of those who suffer from it. They are therefore different.
The nuclear symptoms of major depression are sadness and anhedonia (Severe difficulty in experiencing pleasure), and one (or both) must be present for a diagnosis to be made. The sufferer feels emotionally depressed most of the time, which coexists with a substantial loss of interest in engaging in activities that were previously rewarding or meaningful to them.
It is relatively common for people with depression to occasionally think about killing themselves or have a series of thoughts related to death or agony on the stage of their mind. Persistent fatigue that lasts most of the day can also be observed, And which is reciprocally linked to the difficult emotions which characterize this psychopathological alteration in mood.
Some people even report alterations in executive processes such as attention or concentration, all of which depend on the activity of the prefrontal cortex, which eventually manifests itself vehemently through the barrier to the ability to make decisions. Likewise, rumors can be frequent (obsessive thoughts that are perceived as intruders) and with content consistent with mood (guilt, failure or pessimism about the future).
To finish, significant changes in the habits necessary for body care may occur, Such as food (which can cause weight gain or loss) or sleep (due to excess or deficit). At the psychomotor level, some additional alterations occasionally occur, perceived as slowing down or speeding up movement and / or thinking, which can impact the way we interact with others.
These symptoms must be maintained for at least two weeks and affect the person’s quality of life, or lead to deterioration in the areas of functioning that affect them. Likewise, it is important to confirm that he has never suffered from a previous manic episodeOtherwise, the appropriate diagnosis would be bipolar I disorder (treatment requires stabilizers or anticonvulsants). With this knowledge at our disposal, we can address the initial question: Can depression be cured without medication?
And then … can depression be cured without medication?
Pharmacological treatment and psychotherapy are the two main tools with which we rely to fight against depressive disorder. The effectiveness of both has been widely studied in the scientific literature on the subject, and even comparative studies have often been conducted to try to elucidate which of these modalities offers greater benefit to people who decide to opt for them in case of need. .
Recent studies on the issue, including a comprehensive meta-analysis from the National Institute for Health and Care Excellence (NICE, 2017), indicate that the effect of antidepressants is slightly greater than that of placebo; which is one of the most common measurements to determine the therapeutic quality of a chemical compound. However, many criticisms emerge from different authors regarding the interpretation of these results.
The use of psychotropic drugs should generally be chosen for severe cases of depression, which would allow a more effective balance to be struck between the advantages and disadvantages that may result from their use. They are generally not recommended for minors; and extreme caution in pregnant, epileptic or clear suicidal ideation. The Latin expression primum non nocere (the priority is not to hurt) is used to represent the search for this balance.
Monoamine oxidase enzyme (MAOI-A) inhibitors, virtually obsoleteThey significantly reduced depressive symptoms but increased the risk of hypertensive crises when combined with the consumption of foods rich in tyramine (by a sharp increase in norepinephrine). Tricyclics, considered to be the most effective in reducing symptoms of depression, generate a long list of side effects associated with blockade of muscarinic, histamine and adrenergic cholinergic receptors.
The selective serotonin reuptake inhibitors (SSRIs) were the first antidepressants specifically synthesized with the aim of acting on mood, because in the first case, this therapeutic application was discovered by mere chance. SSRIs are a family of six different drugs that have better tolerability and adequate efficacy, but are also associated with side effects on sexuality and gastrointestinal activity (as these are two functions regulated by the neurotransmitter they affect).
Therefore, the use of psychotropic drugs is an option that the patient should discuss with the doctor, In response to a reflection on the severity of the symptoms experienced and the potential side effects of the compound. A balance in which the search for balance prevails, and in which you may need to prioritize the use of psychotherapy when possible. However, whatever the choice, psychological treatment must be present (at least in combination).
How Can Psychological Treatment Help Fight Depression?
Psychotherapy should be the priority in cases of mild or moderate depression, and its use in more severe cases should also be considered by combining it harmoniously with the use of the psychotropic drug that the person may need. At the end, there is always a percentage of patients who do not respond substantially to either treatment strategyThe choice to use both approaches at the same time (in severe cases) has therefore proved to be the most effective.
Psychological treatment provides the person with a series of tools for life, With the diverse purpose (depending on the needs detected): better understand depression and its causes, restructure distorted thoughts that could intervene in the most difficult emotions, learn problem-solving strategies, integrate pleasant activities in life daily, enhance the use of social resources, facilitate the expression of discomfort and a long and so on.
The main advantage of psychological treatment over the use of psychotropic drugs is that, being at least as effective in cases where its application is recommended, it much more clearly reduces the tendency to relapse (which is very common in this pathology). It does, however, involve a series of meaningful learnings which are incorporated into the set of strategies the person already possesses and which enable them to cope with future stress and adversity.
However, psychological treatments require active effort to improve, Which sometimes needs to be stimulated before and during intervention, because there are many patients whose state of physical and emotional depression makes this disposition difficult. You also need to implement a number of tasks outside of your own consultation and be patient with improvement (which may come a bit later than in SSRIs, which take two to three weeks to do).
Perhaps the very fact that the benefit of psychotherapy is not immediate, as well as the need to articulate a sustained effort of self-management, has motivated the intensive use of antidepressants in our society and the limited availability of other strategies in the health system. To dive into the implicit process of psychological treatment (the extension is generally 20 sessions per week), you have to acquire the necessary motivation, which must also be stimulated by the therapist.
Beyond the psychological and pharmacological treatment itself, there are also some recommendations based on healthy lifestyles, Which have been shown to be effective in easily improving mood. Here are a few.
What can I do to improve my mood?
The scientific literature has found evidence for a number of habits that can be helpful for those going through a depressive process.
Some studies have shown that engaging in prosocial-type activities, such as volunteering for causes we deem worthy, can dramatically improve mood. Spending time with people in our environment with whom we have a constructive bond can also be useful, because it would allow us to express the emotions that we nourish and to be the object of an attentive and understanding listening.
In the event that our emotional symptoms are due to a relevant goal in our life not developing as we think it is, it can be helpful to reinterpret the goals to turn them into a series of small steps. ultimate goal after the corresponding realization of the previous links. with that small reinforcements are introduced which keep behavior and motivation towards the goal.
Exercise, especially aerobics (because there is not enough data on anaerobes), has also been shown to be a powerful natural antidepressant; as do sun walks, which stimulate the production of melatonin from the pineal gland (a hormone widely used in the animal kingdom), helping to reduce insomnia that often coexists with depression.
In conclusion, depression does not imply deficiencies in any aspect of character or way of being, as all people are susceptible to suffering from it at some point in their life. In case you think your symptoms are compatible with this, do not hesitate to ask a healthcare professional to assess what would be the most recommended treatment option (Because it is always the subject of a thorough analysis of the person, the intensity of their symptoms, their needs and their situation).
- Cipriani, A., Furukawa, T., Salanti, G., Chaimani, A., Atkinson, L. and Ogawa, Y. (2018). Comparative efficacy and acceptability of 21 antidepressants for the acute treatment of adults with major depressive disorder: systematic review and network meta-analysis. The Lancet, 391, 1357-1366.
- Morley, JE (2017). The effectiveness and harm of antidepressants. Journal of the American Association of Medical Directors, 18 (4), 279-281.