Talking It Out
Another form of support is talk therapy. Meredith sees a clinical social worker; Betty sees a psychologist.
“I get overwhelmed a lot, so we’re trying to work on how I can look at things differently,” says Betty, who sees her therapist once a week. “We’re discussing my crazy schedule and working to create a framework for looking at life that is mine rather than the one I was trained to see growing up.”
A combination of medication and talk therapy is considered the optimal treatment for mood and anxiety disorders. Cognitive-behavioral therapy and interpersonal therapy are the most popular kinds of talk therapy. Interpersonal therapy focuses on relationship issues, while CBT aims to help people change negative patterns of thinking and behavior.
“CBT is designed to teach people skills they can use even when the treatment is done,” says Holl, who specializes in the treatment.
Psychodynamic therapy, which probes deeply into a patient’s past, is thought to be helpful, too.
“You select the therapy according to what you have before you, what the patient tells you,” says Karen Johnson, a psychiatrist and associate chair of psychiatry at Washington Hospital Center. “People often arrive at these conditions not just because of biological changes but because of developmental issues, so the medication alone may not address the problem.”
In addition to psychiatrists, psychologists, and social workers, psychiatric nurses and licensed counselors administer talk therapy. Fees depend on the location and the therapist’s credentials but typically range from $100 to $200 for a 45-minute session.
Most local therapists—especially those in private practice—don’t accept health insurance. Paying out of pocket is often preferred by patients who worry about who might have access to their health information. Those who can’t afford private therapy might try contacting support groups or clinics run by local universities.
In addition to therapy and medication, electroconvulsive therapy—formerly known as shock therapy—is an option. Today’s ECT is gentler than earlier versions and works by causing a seizure via electrical current. Before each treatment, patients take a muscle relaxant and are put under light anesthesia. The procedure can be administered on either an inpatient or outpatient basis and can cause short-term side effects including confusion and memory loss. ECT is used to treat depression, bipolar disorder, mania, and schizophrenia. Researchers don’t understand exactly how ECT works, but it’s thought that over time the seizures trigger a change in brain chemistry that results in an improved mood.
Another treatment, transcranial magnetic stimulation—approved by the Food and Drug Administration last fall—sends electrical currents through the brain via a magnetic field. Patients recline in what looks like a dentist’s chair; they don’t need sedatives or anesthesia. Side effects of the 40-minute TMS treatment are considered mild, but some doctors question its effectiveness.
“It was hoped that TMS would be a more benign replacement for ECT,” says Daniel Z. Lieberman, director of research at George Washington University Medical Center’s Clinical Psychiatric Research Center. “It will not be, and it may not even be as effective as medicine for mood disorders.”
So far, Sibley Memorial Hospital and Walter Reed Army Medical Center in the District and Sheppard Pratt Health System and Johns Hopkins Hospital in Baltimore offer TMS treatment, as do a handful of doctors in private practice, according to Neuronetics, the manufacturer of NeuroStar TMS Therapy.
Light therapy, which mimics outdoor light and causes a biochemical change in the brain that lifts mood, is an option for patients who experience depressive symptoms during winter months, a condition known as seasonal affective disorder.
Hospitalization may be necessary when a person suffering from depression or another disorder experiences extreme distress or is a risk to himself or others.