Treatment of depression: multi-angle approach

Nowadays, depression is one of the most crucial diseases in the world. The WHO suggested that depression will be the second harmful disease to the human society within a decade.

There are lots of treatment strategies developed to eliminate depressive symptoms. Pharmacotherapy and psychotherapy are the most dominant, and with rich evidence of the outcome. However, two-thirds of patients do not respond to an antidepressant drug. Although cognitive behavioral therapy is proven to reduce depressive symptoms, it cannot be conducted by every therapist effectively. In addition, not a few patients cannot be relieved from depression with all of pharmacotherapy and psychotherapy.

Physical therapies for treating depression are also challenging. Electroconvulsive therapy (ECT) alleviates rapid and effectively depressive symptoms. But it is costly to perform ECT with safety. Transcutaneous magnetic stimulation also seems to be beneficial, but its effect size is not satisfactory.

In Europe, attempts to arrange circadian rhythm of the patient have been conducted. In light therapy, patients look at the relatively strong light for several minutes in the morning. The eyes of the patients are protected with goggles. The effectiveness of light therapy is explained by a hypothesis derived from the fact people living in an area where daytime is limited are likely to suffer from depression. Its effect is limited so far but certainly observed.

On the other hand, sleep deprivation is likely to seize depression. We often experience elevated mood after an all-night activity. In sleep deprivation therapy, patients are asked to be awake early in the morning, or not to fall asleep late at night. Approximately a half of sleep time are omitted in the therapeutic term. All-night awakening is an alternative, but a more aggressive method. Sleep deprivation has an immediate effect but unfortunately is not long-lasting. The combination with medication or other therapies is recommended.

In Japan, there are millions of patients with depression. But most of them are not consulting with a psychiatrist. Many of them are medicated by a doctor in charge. It is good for Japanese patients to take medication for relatively low-cost thanks to national health insurance. Structured psychotherapy is hardly available in Japan because of a lack of specialists. Identification of early symptoms of depression is crucial to prevent deterioration of depression.

*Sequel