Can depression be cured without medication?

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

The increased demands in many areas of life, the resistant economic crises to which we have had to cope and a long list of circumstances have contributed decisively to it.

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.

• Related article: "The 6 types of mood disorders"

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 due to its adaptive properties. Depression, however, is an important 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 as necessary for the diagnosis to be made. The person who suffers from it feels emotionally dejected most of the time, which coexists with a loss substantial interest in engaging in activities that were previously rewarding or significant.

It is relatively common for people with depression to occasionally think about removing the life, or that a series of thoughts related to death or death enter the scene of his mind. To die. There may also be persistent fatigue that lasts for most of the day, and which is reciprocally related to the difficult emotions that characterize this psychopathological mood alteration.

Some people even refer to alterations in executive processes such as attention or concentration, all of which depend on the activity of the prefrontal cortex, which ends up manifesting itself vehemently through the obstruction in the ability to take 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).

By last, 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). On a psychomotor level, there are occasionally some additional alterations, perceived as slowing down or acceleration of movement and / or thought, which can be echoed in the way we interact with the rest.

These symptoms must be maintained for two weeks or more and alter the quality of life of the person, or generate 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 episodeOtherwise, the appropriate diagnosis would be 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?

• You may be interested: "Types of antidepressants: characteristics and effects"

And so... 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 subject, and studies have even been conducted frequently. comparative studies to try to elucidate which of these modalities provides a greater benefit to the people who decide to opt for them in a 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 placebo; which is one of the most frequent measurements 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 losses that may arise of its use. They are not usually recommended in minors; and taking extreme precautions in pregnant, epileptic or suicidal people. The Latin phrase primum non nocere (the priority is to do no harm) is used to represent the search for this balance.

Inhibitors of the enzyme monoamine oxidase (MAO-A), practically in disuse, reduced depressive symptoms significantly but increased the risk of hypertensive crisis when were combined with the intake of foods rich in tyramine (through an abrupt increase in noradrenaline). 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 cholinergic receptors adrenergic.

Selective serotonin reuptake inhibitors (SSRIs) were the first specifically synthesized antidepressant drug with the purpose of acting on the state of mind, since in the previous ones this therapeutic application was discovered by simple chance. 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 (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 should evaluate with the doctor, attending to 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 be prioritized in cases where it is possible. However, whatever the choice, psychological treatment should be present (at least as a combined treatment).

• You may be interested: "Types of depression: its symptoms, causes and characteristics"

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 could to require. As a last resort, there is always a percentage of patients who do not respond substantially to one or another treatment strategyTherefore, 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 the distorted thoughts that could mediate more difficult emotions, learn problem-solving strategies, incorporate pleasant activities into daily life, enhance the use of social resources, facilitate 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 patients cases where its application is recommended, it reduces in a much more evident way the tendency to relapse (which is very frequent in this pathology). It does, however, suppose a series of significant learning that is incorporated into the collection of strategies that the person already has, and that enable them to cope with stress and future adversity.

Nevertheless, 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 dejection makes this disposition difficult. It is also necessary to put into practice a series of tasks outside the office itself and be patient regarding improvement (which may come somewhat later than in SSRIs, which require two to three weeks for it).

Perhaps the very fact that the benefit of psychotherapy is not immediate, together with the need to articulate a sustained effort for the self-care, has motivated the extensive use of antidepressants in our society and the limited availability of other strategies in the system sanitary. To get into the process implicit in a psychological treatment (whose length is usually 20 sessions weekly), we must equip ourselves with the necessary motivation, which will 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 easily 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 are going through a depressive process.

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

In case our emotional symptoms are due to the fact that some relevant purpose in 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 ultimate goal after the corresponding achievement of the links precedents. With that small reinforcements are introduced that maintain the behavior and motivation towards the goal.

The practice of physical exercise, especially aerobic (since there is still insufficient data on anaerobic), has also proven to be a powerful natural antidepressant; like 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 from 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 (As this is always subject to an in-depth analysis of the person, the intensity of their symptoms, their needs and their circumstances).

Bibliographic references:

• Cipriani, A., Furukawa, T., Salanti, G., Chaimani, A., Atkinson, L. and Ogawa, Y. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391, 1357-1366.
• Morley, J.E. (2017). The Effectiveness and Harms of Antidepressants. Journal of the American Medical Directors Association, 18 (4), 279-281.