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Pharmaceutical treatment of depression really hasn't made any great strides since the introduction of Prozac (fluoxetine) in the 1990's. An entirely different kind of treatment known as transcranial direct current stimulation, however, offers new hope.

One of the seldom-mentioned facts about the medical treatment of depression is that most drugs for treating depression don't work for most of the people who use them.

Even when the "right" antidepressant is found, relapses of the disease are common. Researchers in the UK have found that:

  • 25% to 40% of people who are successfully treated for major depression will have another bout with the disease within two years, and
  • 60% of people who are successfully treated for major depression with antidepressant medications will have another episode of the disease within five years, and, even more depressingly,
  • 30% of people who experience major depression never respond to medication at all.

In about 1 in 3 cases, depression becomes "refractory" to pharmaceutical treatment. In refractory depression, there simply are no drugs that work, and people stay depressed indefinitely. In the US and UK, and in most other industrialized countries, about 1% of the population suffers ongoing, crippling major depression.

No Single Antidepressant Works for Everyone

Some psychiatrists theorize that what the medical profession diagnoses as "depression" may have different causes in different people. For over 20 years, medications have focused on increasing levels of certain neurotransmitters in the brain, especially serotonin, but not everyone who has depression has a deficiency of the same neurotransmitter, or necessarily any deficiencies of any neurotransmitters at all.

Despite the fact that psychiatrists know that it is usually necessary to try several different antidepressants for several weeks and to adjust their doses until patients eventually get well, there is very strong resistance to the idea that the pharmaceutical industry cannot provide a magic bullet for major depression. So determined is the medical establishment to find a single, economical treatment for depression that the EU has rejected the diagnosis "refractory depression" since 2010.

If Not Antidepressants, Then What?

The mainstay of treatment for depression for decades, of course, was talk therapy. Various schools of psychoanalysis offered frameworks for guiding ways of thinking about the self that, in theory, led to relief from the disease. Talk therapy, of course, requires far more of the doctor's time than the current medical models allow.

Other therapies for depression include exercise, music, diet, yoga, and, Americans may be surprised to learn, paid vacation time and paid travel to spa resorts specializing in depression treatment (offered to citizens of Norway and Russia). These commonsense remedies for depression, unfortunately, are beyond most budgets for treatment. The good news is that at least one new technology for treating depression, known as transcranial direct current stimulation, or tDCS for short, may be the "magic bullet" that finally relieves "untreatable" major depression.

Continue reading after recommendations

  • Brunoni AR, Valiengo L, Baccaro A, Zanão TA, de Oliveira JF, Goulart A, Boggio PS, Lotufo PA, Benseñor IM, Fregni F. The Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study: Results From a Factorial, Randomized, Controlled Trial. JAMA Psychiatry. 2013 Feb 6:1-9. doi: 10.1001/2013.jamapsychiatry.32. [Epub ahead of print]
  • Taylor D, Carlyle JA, McPherson S, Rost F, Thomas R, Fonagy P. Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression. BMC Psychiatry. 2012 Jun 11. 12(1):60. [Epub ahead of print]

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