THROUGHOUT my four decades as a doctor, I have been particularly drawn to the treatment of depression. Actually, I prefer to use the term depressive illness, as a patient’s ability to function socially and at work, overall health and life expectancy are all lowered, so it’s as much an illness as any ‘physical’ condition.
Importantly, I must stress that many, if not most, patients with depressive illness do not feel low or sad – feeling low following bereavement, financial crisis, or relationship breakdown, for example, is a normal, even appropriate, reaction.
As someone who’s made it his life’s work to diagnose those considered ‘undiagnosable’, I have seen legions of patients in whom the ill-defined symptoms of depressive illness – predominantly fatigue, headache, unexplained weight loss and decline of libido – have eluded investigation.
All too often, patients end up in the alternative therapy world, ready prey for self-promoting quacks and charlatans.
In the early 1980s, there was a breakthrough in treatment with fluoxetine (Prozac). Many patients with depressive illness who hadn’t responded to earlier antidepressants responded well to this and the other selective serotonin reuptake inhibitor (SSRI) drugs.
Despite the arrival of many new drug therapies since, there are still patients who fail to benefit.
Now we have a rush of new options, including digital neuropsychology, online ‘brain training’ which can activate new pathways and thinking.
Transcranial magnetic stimulation is newly approved by the National Institute for Health and Care Excellence, and involves a magnetic coil being placed close to the sides of the head to ‘rebalance’ activity in the sides of the brain, which scans have shown is disrupted in patients with depressive illness.
And chronotherapy focuses on resetting the body clock, which in turn resets the brain chemistry and feel-good hormones.
However, despite the good news about treatment, sometimes the more difficult aspect is persuading patients their condition is due to depressive illness, as there is no test to ‘prove’ it.
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