Major depression is one of the most prevalent mental disorders in the world, along with those that belong to the anxiety category. In parallel, the use of antidepressants is becoming more common in society every day.
The increase in demands in many areas of life, the resistant economic crises that we have had to face and a long list 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 common mood disorder manifests itself.
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 due to 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 of them (or both) must be present in a necessary way 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 in getting involved in activities that were previously rewarding or meaningful.
It is relatively common for people with depression to occasionally think about taking their own life, or for a series of thoughts related to death or dying to burst onto the scene of their mind. Persistent fatigue that lasts for most of the day may also be seen and which is reciprocally related to the difficult emotions that characterize this psychopathological mood alteration.
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 ends up manifesting vehemently through hindrance in the ability to make decisions. Likewise, rumination can be frequent (obsessive thoughts that are perceived as intrusive) and with content consistent with the mood (guilt, failure or pessimism about the future).
Finally, important changes in habits may arise that are necessary for the care of the body, such as diet (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 or acceleration of movement and/or thought, which can have its echo in the way we interact with others.
These symptoms must persist for two weeks or more and alter the person’s quality of life, or cause deterioration in the areas of functioning that are relevant to them. In addition, It is important to confirm that you have never had a previous manic episode, otherwise the appropriate diagnosis would be Bipolar Disorder Type I (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?
And so… can depression be cured without medication?
Pharmacological treatment and psychotherapy are the two great tools that we have to combat depressive disorder. The effectiveness of both has been studied extensively in the scientific literature on the subject, and comparative studies have even been frequently carried out to try to elucidate which of these modalities provides a greater benefit to people who decide to opt for them in a case of need. .
The most recent studies on the issue, including the National Institute for Health and Care Excellence’s comprehensive meta-analysis (NICE, 2017), indicate that the effect of antidepressants is slightly greater 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 make it possible to more efficiently balance the balance between benefits and harms that could arise from their use. They are not usually recommended in minors ; and taking extreme caution in people who are 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.
Monoamine oxidase enzyme inhibitors (MAO-A), practically out of use, significantly reduced depressive symptoms but increased the risk of hypertensive crises when combined with the intake of foods rich in tyramine (through an abrupt increase in norepinephrine). Tricyclics, considered the most effective in reducing the symptoms of depression, generate a long list of side effects associated with the blockade of muscarinic, histamine and adrenergic cholinergic receptors.
Selective serotonin reuptake inhibitors (SSRIs) were the first antidepressant drug synthesized specifically with the purpose of acting on mood, since in the previous ones this therapeutic application was discovered by simple chance. SSRIs are a family of six different medications that have better tolerability and adequate efficacy, but are also associated with side effects on sexuality and gastrointestinal activity (as they are two functions regulated by the neurotransmitter on which they affect).
So that, The use of psychotropic drugs is an option that the patient must evaluate together with the doctor, taking into account a reflection on the severity of the symptoms 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 a combined treatment).
How can psychological treatment help combat depression?
Psychotherapy should be the priority in cases of mild or moderate depression, and its use should also be considered in more severe cases, combining it in a harmonious way with the use of psychotropic drugs that the person may require. As a last resort, There is always a percentage of patients who do not respond substantially to one or another treatment strategy so opting 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 whose purpose is diverse (depending on the needs detected): better understand depression and its causes, restructure distorted thoughts that could mediate the most difficult emotions, learn problem-solving strategies, incorporate pleasant activities into daily life, enhance the use of social resources, facilitating the expression of discomfort and a long etcetera.
The main advantage of psychological treatment over the use of psychotropic drugs is that, being at least as effective in cases where their application is recommended, it much more obviously reduces the tendency to relapse (which is very common in this pathology). . It entails, however, 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.
Nevertheless, Psychological treatments require active effort to improve, something that must occasionally be stimulated before and during the intervention, since there are many patients whose state of physical and emotional depression makes this disposition difficult. It is also necessary to carry out a series of tasks outside the consultation itself and be patient regarding the improvement (which may come somewhat later than with SSRIs, which require two to three weeks to achieve).
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 enter into the process implicit in psychological treatment (the length of which is usually 20 weekly sessions), we must equip ourselves with the necessary motivation, which will also have to be stimulated by the therapist.
Beyond the psychological and pharmacological treatment itself, There are also some recommendations based on healthy lifestyles, which have been proven to be effective in simply improving mood. Below we present some of them.
What other things can I do to improve my mood?
Scientific literature has found evidence of a series of habits that can be useful for those going through a depressive process.
Some studies have shown that engaging in prosocial activities, such as volunteering for causes we consider worthy, can substantially improve mood. Spending time with those people around us with whom we have a constructive bond can also be helpful, since 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 in our life is not developing in the way we thought it would, it may be useful to reinterpret objectives to turn them into a succession of small, more easily achievable steps, maintaining the ultimate goal after the corresponding achievement of the preceding links. With that Small reinforcements are introduced that maintain behavior and motivation towards the goal
The practice of physical exercise, especially aerobic exercise (since there is still not enough data on anaerobic exercise), has also proven to be a powerful natural antidepressant; as do walks in the 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 from it at some point in their lives. If you consider that your symptoms are compatible with it, Do not hesitate to ask a health professional to assess which would be the most recommended therapeutic option (since this is always subject to an in-depth analysis of the person, the intensity of their symptoms, their needs and their circumstances).
