Can depression be cured without medication?

Major depression is one of the most prevalent mental disorders worldwide, along with those belonging to the anxiety category. In parallel, the use of antidepressants is becoming more common in society every day.

Increased demands in many areas of life, the tough economic crises that we have had to face and a long etcetera of circumstances have contributed decisively to this.

In this article we will delve into the question of whether depression can be cured without medication , which necessarily implies knowing in advance how this habitual mood disorder manifests itself.

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What is depression

First of all, it is important to note that depression and sadness are not two equivalent realities. The first describes an emotion that belongs to the normal range of human experience, and that has been forged throughout the evolution of our species for its adaptive properties. Depression, however, is a relevant clinical phenomenon that can profoundly compromise the quality of life of those who suffer from it. They are, therefore, different.

The core symptoms of major depression are sadness and anhedonia (severe difficulty experiencing pleasure), and one (or both) must be present as necessary for the diagnosis to be made. The person who suffers from it feels emotionally depressed most of the time, which coexists with a substantial loss of interest for engaging in activities that previously were gratifying or significant.

It is relatively common for people with depression to occasionally think about killing themselves, or a series of thoughts related to death or dying burst onto the stage of their minds. Persistent fatigue that lasts for most of the day can also be seen , and it is reciprocally related to the difficult emotions that characterize this psychopathological alteration of mood.

Some people refer to alterations in executive processes such as attention or concentration, all of them depending on the activity of the prefrontal cortex, which ends up manifesting itself vehemently through the hindering of decision-making capacity. Likewise, rumination can be frequent (obsessive thoughts that are perceived as intruders) and with content consistent with the mood (guilt, failure or pessimism about the future).

Finally, important changes in habits that are necessary for the care of the body may arise , such as diet (which can lead to 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 accelerating movement and / or thought, which may have an echo in the way we interact with others.

These symptoms must be maintained for two weeks or more and alter the person’s quality of life, or generate deterioration in the areas of operation that are relevant to them. Likewise, it is important to confirm that a previous manic episode was never suffered , since otherwise the appropriate diagnosis would be that of Type I Bipolar Disorder (whose treatment requires stabilizers or anticonvulsants). With this knowledge at our disposal, we can delve into the initial question: can depression be cured without medication?

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And then … can depression be cured without medication?

Pharmacological treatment and psychotherapy are the two great tools we have to combat depressive disorder. The efficacy of both has been extensively studied in the scientific literature on the matter, and comparative studies have even been conducted frequently to try to elucidate which of these modalities provides a greater benefit to people who decide to opt for them in case of need. .

The most recent studies on the issue, including the comprehensive meta-analysis of the National Institute for Health and Care Excellence (NICE, 2017), indicate that the effect of antidepressants is slightly higher than that of placebo ; which is one of the most frequent measures to determine the therapeutic quality of a chemical compound. However, there are numerous criticisms that have arisen from different authors regarding the interpretation of these results.

Generally, the use of psychotropic drugs should be chosen for severe cases of depression, which would allow a more efficient balancing of the balance between benefits and harm that may result from its use. They are not usually recommended in minors ; and extreme caution in pregnant, epileptic or with clear suicidal ideas. The Latin phrase primum non nocere (the priority is to do no harm) is used to represent the search for this balance.

The practically obsolete monoamine oxidase enzyme inhibitors (MAOI-A) significantly reduced depressive symptoms but increased the risk of hypertensive crisis when combined with the intake of foods rich in tyramine (through an abrupt increase in norepinephrine). Tricyclics, considered the most effective in reducing depression symptoms, generate a long list of side effects associated with blocking muscarinic, histamine and adrenergic cholinergic receptors.

Selective serotonin reuptake inhibitors (SSRIs) were the first antidepressant drug specifically synthesized for the purpose of acting on mood, as this therapeutic application was discovered by chance by the previous ones. 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 (since they are two functions regulated by the neurotransmitter they affect).

Thus, the use of psychotropic drugs is an option that the patient should evaluate together with the doctor , attending to a reflection on the severity of the symptoms that are suffered and the potential side effects of the compound. A balance in which the search for balance prevails, and in which the use of psychotherapy should perhaps be prioritized in cases where it is possible. However, whatever the choice, psychological treatment should be present (at least as combination treatment).

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How can psychological treatment help fight depression?

Psychotherapy should be the priority in cases of mild or moderate depression, and its use should also be considered in the most severe cases, combining it in a harmonious way with the use of the psychotropic drug that the person may require. Ultimately, there is always a percentage of patients who do not respond substantially to one or the other treatment strategy , so choosing to use both approaches at the same time (in severe cases) has proven to be the most effective.

Psychological treatment provides the person with a series of tools for life , the purpose of which is diverse (depending on the needs detected): better understanding depression and its causes, restructuring distorted thoughts that could mediate the most difficult emotions, learning problem solving strategies, incorporating pleasant activities into daily life, promoting the use of social resources, facilitating the expression of discomfort and a long etcetera.

The main advantage of psychological treatment compared to the use of psychotropic drugs is that, being at least as effective in cases where its application is recommended, it reduces the tendency to relapse much more clearly (which is very frequent in this pathology) . However, it involves a series of significant learnings that are incorporated into the stock of strategies that the person already has, and that enable them to deal with future stress and adversity.

However, psychological treatments require an active effort to improve , something that occasionally must be stimulated before and during the intervention, since there are not a few patients whose state of physical and emotional depression makes this disposition difficult. It is also necessary to carry out a series of tasks outside of the consultation itself and be patient about the improvement (which may come somewhat later than in SSRIs, which require two to three weeks to do so).

Perhaps the very fact that the benefit of psychotherapy is not immediate, together with the need to articulate a sustained effort for self-care, has motivated the extensive use of antidepressants in our society and the limited availability of other strategies in the health system. To go into the implicit process of psychological treatment (which usually lasts 20 weekly sessions), we must equip ourselves with 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 simply improving mood. Here are some of them.

What other things can I do to improve my mood?

The scientific literature has found evidence of a series of habits that can be useful for those who go through a depressive process.

Some studies have shown that engaging in prosocial-type activities, such as volunteering for causes we consider worthy of it, can substantially improve mood. Spending time with those around us with whom we have a constructive bond can also be helpful, as it would allow us to express the emotions we harbor and be the object of attentive and understanding listening .

In the event that our emotional symptoms are due to the fact that some relevant purpose of our life is not developing in the way we think it would, it may be useful to reinterpret objectives to turn them into a succession of small steps more easily achievable, keeping the last end after the corresponding achievement of the preceding links. This introduces small reinforcements that maintain behavior and motivation towards the goal .

The practice of physical exercise, especially aerobic (since there are still insufficient data on anaerobic), has also been shown to be a powerful natural antidepressant; as well as walks in sunlight, which stimulate the production of melatonin from the pineal gland (a hormone widely spread in the animal kingdom), helping to reduce insomnia that frequently coexists with depression.

In conclusion, depression does not imply deficiencies in any aspect of character or way of being, since all people are susceptible to suffering it at some point in their lives. In case you consider that your symptoms are compatible with it, do not hesitate to ask a health professional to assess what would be the most recommended therapeutic option (since this is always subject to an in-depth analysis of the person, the intensity your symptoms, your needs and your circumstances).


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