Depression affects approximately 18.8 million adults in the U.S. and is the nation's leading cause of disability. Yet mental health experts say the front-line treatment for serious cases, antidepressant drugs, works only about half the time and can have troubling side effects, such as weight gain, sexual dysfunction, and even suicidal behavior. As a result, there has been renewed interest in finding nonpharmacological approaches to treating depression other than psychotherapy, which psychiatrists say is often ineffective by itself.
Research is ongoing, but promising nondrug therapies have emerged over the last decade. One source of optimism is transcranial magnetic stimulation, or TMS, a noninvasive procedure that activates the brain's emotive centers. While it's still under investigation, there is strong evidence that it has antidepressive effects, says Dr. Sarah Lisanby, associate professor of psychiatry and director of the magnetic stimulation laboratory at Columbia Medical School.
In this procedure, doctors hold a paddle-shaped device emitting a powerful magnetic field over the patient's forehead, causing neurons in the prefrontal cortex of the brain to fire. "This is a region of the brain known to be underactive when a person is depressed," says Dr. Lisanby. In this regard, TMS is similar to electroconvulsant therapy, during which a patient's brain receives a powerful electric shock. Although ECT helps patients about 80% of the time, it requires anesthesia and can induce memory loss. TMS is performed without sedation and does not cause amnesia. A list of researchers conducting TMS clinical trials can be found at www.ists.unibe.ch.
A more invasive approach is a surgically implanted pacemaker-like device that stimulates the vagus nerve in the neck. The Food & Drug Administration had already approved the so-called neurostimulator, manufactured by Cyberonics (CYBX), for treating epilepsy when it gave preliminary approval in February for its use in managing depression. The company hopes to get final approval by yearend. "This all came about because the epilepsy patients with the device reported improved mood," said Dr. Mark George, professor of psychiatry and neurology at Medical University of South Carolina in Charleston. He's a lead investigator in a clinical trial that found the unit had the same effect for severely depressed individuals. It costs about $25,000 to have the neurostimulator implanted in the chest with wires running up to the neck. Patients can expect a recurring $15,000 expense to replace the battery every 5 to 10 years.
The psychiatric community is also placing more stock in herbs and dietary supplements. Although studies in the U.S. have been mixed, St. John's Wort is gaining more acceptance as a depression remedy, several psychiatrists say. The response rate for the herb is slightly lower than it is for drugs like Prozac and Zoloft but with fewer side effects, says Dr. David Mischoulon, assistant professor of psychiatry at Harvard Medical School. At a standard dose of 900 mg to 1200 mg per day, stomach upset and light sensitivity are probably the worst you can expect. Several studies in the U.S. and Europe also show that 1 gram of fish oil per day or 400 mg to 1,600 mg daily of SAMe, an amino acid derivative, work about as well as St. John's Wort.
Light therapy can chase away the blues, too. Studies indicate that sitting in front of a briefcase-size light box for 30 minutes a day can improve mood even among the severely depressed. The boxes cost $150 to $300 and are often covered by insurance if prescribed by a physician.
Exercise may be the least expensive strategy. Recent clinical studies have shown it's as effective as antidepressants in improving mood. An appropriate dose is three hours of moderate activity per week, says a study published in the January, 2005, American Journal of Preventive Medicine. "The kind of exercise is probably irrelevant as long as you do it long enough," says Andrea Dunn, director of behavioral research at the Cooper Institute in Denver and study co-author. It's possible to walk away from your woe.
By Kate Murphy