Treatments for depression and recovery

Professor Helen Mayberg describes treatments for depression: medication, therapy, or a combination of the two. About 40% of patients recover entirely, while about 10% do not respond.

So one of the things we know about depression, from a clinical point of view, is that we have a number of very effective treatments. There are a number of medications that work on various neurochemical systems in the brain. The primary targets are norepinephrine, serotonin and dopamine. But we also can effectively alleviate depression by psychological treatments: interpersonal psychotherapy and the one that’s been tested the most is cognitive behavioral therapy. By working top-down in the brain we can alleviate symptoms. By working bottom-up in the brain in deep centers, brain stem centers that chemicals work on first, we can affect the brain. But it turns out that while we think that most patients that we treat will get well eventually, it turns out that only about 40% of patients actually get all the way better. It’s very clear that if all your symptoms are not treated, that depression will recur. We’ve also learned over the years that it really is an episodic disorder. You will have an episode of depression, it will eventually go away either with or without treatment, but it will come back. The issue is that about 10% of patients, no matter what we use, no matter what medications we try, no matter what kind of therapy, not even electroconvulsive therapy (shock therapy) can get people out of episode. So our estimates are that a small proportion, but a very significant proportion of patients really aren’t helped by the treatments that we have despite the fact that we have many treatments.