Shock Therapy, Medication Best for Depression

Antidepressant medications and electroconvulsive therapy, when warranted, are the most effective treatments for moderate to severe depression, despite the concerns both have raised in the public mind.

That’s the conclusion of an analysis of the last five years of research into depression. The study, led by scientists at the University of Edinburgh in Scotland, appeared in the January 14th issue of The Lancet.

“The paper is a little bit corrective for what they call this ‘moral panic’ around the claim that antidepressants can facilitate suicidal ideation or behavior,” said Dr. Jon A. Shaw, director of child and adolescent psychiatry at the University Of Miami School Of Medicine. “It’s a judicious attempt to try to stabilize the debate, and really address what the empirical evidence really demonstrates.”

Electroconvulsive therapy (ECT), also called shock therapy, has suffered an image problem as well.

Diagnosis of depression is common all over the world, affecting some 15 to 17 percent of people over their lifetime, according to the study. It is twice as common among women as men. Regardless of who is affected, depression can be incapacitating and perhaps even fatal.

Yet, according to the study, only 25 to 50 percent of patients seek professional medical help for their depression.

That may or may not have to do with recent controversy surrounding treatment. In 2004, the FDA issued an advisory warning that suicidal behavior could increase after treatment with antidepressants known as serotonin reuptake inhibitors (SSRIs), especially in children and adolescents. More recent studies, though, contradict that finding.

The new study pointed to the efficacy of depression medications, describing them as the “mainstay of antidepressant therapy.” Their benefits, stated the authors, seem to outweigh the “publicly perceived risk.”

“The FDA is a cautious regulatory body, and they need to be cautious,” said Dr. Catherine Birndorf, an assistant professor of psychiatry and obstetrics and gynecology at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City. “On the other hand, it can cause hysteria because people take it to be cause-and-effect. They don’t really understand that they (the FDA) are warning us there may be a correlation.”

“It’s probably a somewhat hysterical response that antidepressants in acute-phase depression facilitates suicidal behavior,” Shaw added. “There’s no evidence to really support that.”

ECT was deemed by the study as the most effective depression treatment, especially if it presents with psychotic symptoms, despite public and professional misgivings. The paper also addressed other physical treatments for depression, such as neurosurgery, transcranial magnetic stimulation, magnetic seizure therapy and vagal nerve stimulation, but indicated that most of these are still considered experimental.

© Copyright 2007 Insight Journal Online Magazine.

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