Position Paper on Treatment of Depression

The Malta Association of Psychiatry (MAP) is concerned about comments in the media regarding depression and its treatment. Depression is unfortunately an increasingly- common mental health problem that is soon expected to become the most common cause of one needing time off work in the developed world. Depression is a serious and often complex illness, and people who suffer from depression need to be understood, supported, and treated with respect, since they suffer tremendously, and since depression in its more severe forms can be considered as a life threatening condition.

Depression is, however, treatable whatever its degree of severity. Thus it is of utmost importance that everyone be able to recognise the symptoms of this mental disorder and to be informed as to what treatment options are effective and backed up with robust clinical research. The mainstay of treatment for depression is psychotherapy and medication. Contrary to some popular perceptions, such medication when indicated is not addictive and neither is it a ‘tranquiliser’. The role of medication is restoring to normal an imbalance of chemicals in the brain.

Transcranial Magnetic Stimulation (TMS) is one treatment option for depression which was granted approval for use in 2002 by the Canadian Association of Health and is proving useful in those resistant to treatment. TMS though it is not recommended as a first line treatment in international guidelines such as the UK’s NICE guidance, or the American Psychiatric Association. Limited availability, low treatment response rates (15-30%), as well as the financial costs do not allow for TMS to be considered as mainstay treatment for depression. The MAP does however support the use of TMS if it is delivered according to standardised protocols, i.e. daily sessions (5 days a week) for a minimum of 2 weeks and typically 4 to 6 weeks before improvement (remission) is confirmed. However here MAP would like highlight that there is no quick fix for treating depression and unfortunately using medication, psychotherapy or TMS all require a certain amount of time before remission from depression takes place. No research is available regarding the safety and efficacy in children as young as age 3 years. Furthermore, in the scientific field, it is known that the use of a magnet in TMS is to stimulate a neurological response and not to balance a magnetic field – the mind does not require a magnetic field to function in a normal fashion.

Depression is a curable condition which, like many other physical health conditions, needs time for treatment to work effectively. There is no magical instant cure for depression and therefore people should be wary of interventions that are marketed as relieving symptoms of depression instantly, and always seek out guidance from their family doctor, or from a community mental health clinic which are resourced with caring professionals as well as printed information regarding mental health problems and recommended treatment modalities.

Furthermore, the MAP is gravely concerned that people who have influence in the community could easily forget their responsibilities and take advantage of patients who are vulnerable due to their desperate desire to feel better. The MAP thus strongly advises all professionals to always remain balanced in their statements and to never forget that Medicine is about the individual and not personal gain.

The MAP would also remind all the media outlets of their own responsibilities towards their audiences, including that health care is a serious matter where people who are tired of suffering become less able to distinguish between realistic and fanciful cures, and that significant harm can come to people who treat professionals on the media with excessive trust, and that it is therefore the responsibility of the media to do their best to offer scientifically-valid viewpoints to the public.

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Read newspaper articles regarding our position paper on Malta Today and the Times of Malta

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