The pharmacotherapy of major depressive disorder began over 40 years ago with the development of tricyclic antidepressant medications such as Tofranil and Elavil. The use of specific pharmacotherapy for depression roughly doubled the chance that a patient would begin to stabilize and recover within 4 to 6 weeks. However, these medications had side effects such as sedation and were particularly problematic in overdose situations because they caused cardiac arrhythmia. Also, the lethal dosages were quite low. This situation improved with the introduction of a serotonin-specific reuptake inhibitor medications such as Prozac, Paxil, Zoloft and Effexor which were as effective as the tricyclics, but which proved much safer and better tolerated by patients. Patients who receive cognitive behavioral therapy in addition to antidepressant medications do considerably better clinically than those patients receiving either of these treatment modalities alone. Target symptoms for the antidepressant medications include insomnia, poor appetite, agitation, anxiety, blue moods and feelings of hopelessness and helplessness. Other symptoms are monitored such as fatigue, listlessness and decreased sex drive.
An interesting alternative to traditional combination therapy for depression is light therapy, successfully employed with patients who are suffering from a seasonal depression. More severely depressed patients sometimes require hospitalization and in rare instances, electroconvulsive therapy.
Dr. Covert keeps up with the latest and most effective treatment techniques by participating in continuing medical education programs and professional meetings. One of the more exciting recent developments is the discovery of the effectiveness of the use of atypical neuroleptic medication in combination with antidepressant medications. Once stabilization of depressive symptoms has taken place, continued medication with cognitive behavioral therapy can lead to increased insight, self-awareness and understanding as well as problem solving to prevent future episodes.
