Augmentation
Psychiatrists these days usually see people who are more seriously disturbed,
or who haven’t responded to antidepressants that other doctors have pre-
scribed. Often, psychiatrists will try to achieve a better effect by combining
two antidepressants with different properties, or combining antidepressants
with other kinds of medications like lithium, BuSpar, or anticonvulsants.
The general idea is to try and strike the exact chemical chord that will res-
onate with a particular depression. Augmentation techniques, when used
carefully by skillful psychiatrists, can work wonders. The technique can
be disastrous in the hands of psychiatrists who are less skilled.
The very best psychiatrists and the very worst rely on augmentation.
The way to know which kind you’re dealing with is by the amount of time
spent in appointments, the number of questions asked, how well previous
sessions are remembered, and the level of insistence that people under
medical treatment be involved in psychotherapy and other activities as well.
The best psychiatrists are the first to admit that medication can’t do it all.
Professional rivalries aside, the evidence is clear that depression is a
complex disorder that requires complex and coordinated treatment, not
just throwing a lot of drugs at the problem.
Sometimes augmentation works, but at other times it results in dif-
ficulty determining whether the problems come from the disease or all
the medications used to treat it.
Electrotherapy
What used to be called shock treatments still have a place in the treatment
of depression, though in a more sophisticated and gentle form. Electrical
jolts applied to various areas of the brain, sometimes in voltages strong
enough to cause convulsions, can actually improve some kinds of depres-
sions, especially those in which the patient is practically bedridden and
hasn’t responded to medication.
Needless to say, this sort of treatment is a last resort because of all
the possible side effects. There was a time however, from the 1940s to the
mid-1970s, before the advent of SSRIs, that shock was used in private psy-
chiatric hospitals as a treatment for almost everything. Many people who
168 ❧Explosions into Sadness