Medication, Shock Therapy Best for Fighting Depression

These approaches most effective for moderate to severe illlness, study says

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, appears in the Jan. 14 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), sometimes called shock therapy, has also suffered an image problem.

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

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

This may or may not have to do with recent controversy surrounding treatment. In 2004, the U.S. Food and Drug Administration issued an advisory warning that suicidal behavior may increase after treatment with antidepressants known as serotonin reuptake inhibitors (SSRIs), especially in children and adolescents. More recent studies, however, have contradicted that finding.

The new study pointed to the effectiveness of medications for depression, describing them as the "mainstay of antidepressant therapy." Their benefits, the authors stated, 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."

Electroconvulsive therapy was deemed by the study as "the most effective treatment for deep depression, especially if it presents with psychotic symptoms" and this, "despite public and professional misgivings." While some may think the treatment to be an artifact of bygone decades it is, in fact, "alive and well for certain types of depression," Birndorf said.

"ECT is not considered for garden-variety depression," Birndorf said. "If it’s more refractory, if other treatments have failed or it’s suicidal depression and you don’t have time to wait around to see if a medication is going to work, it’s considered the gold standard of treatment."

Public perceptions of the treatment, which involves applying electrical shocks to cause seizures in the brain, have tended to the brutal and bizarre and are not accurate, Birndorf added.

"It’s highly humane," she said. "The myth of what it is and what it looks like is still rampant, and doesn’t appeal to our culture."

"The efficacy is well-demonstrated," Shaw added. "If used appropriately, it is sometimes lifesaving."

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.

More information

The National Institute of Mental Health has more on depression.