Severe depression is a major "side effect" of life which per se  affects memory and quality of life. However, numerous depression treatments are available. Anti-depressant medication which differently affect transmittors regulating moods can be tried out in combination with psychotherapy, such as cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, acceptance and commitment therapy, and mindfulness techniques. If everything is tried out and nothing helps, and the person is suicidal, electroconvulsive therapy (ECT) offers immediate relief of even severe depression. Eventual headache is tolerable. Temporary memory loss may occur. An other option is Transcranial magnetic stimulation (TMS) for people who do not respond to antidepressants. During TMS a treatment coil to the scalp sends brief magnetic pulses to stimulate nerve cells involved in mood regulation and depression.

I am not sure if I understand this question. You are of course aware of the devastating effects on cognition and QoL that severe depression itself leads to. But some therapies, such as electroconvulsive therapy, may have a major impact on cognitive functioning, but not on QoL. Antidepressants may lead to adverse effects that have negative influence on QoL, but to a lesser degree on cognition. Psychotherapy in severe depression is less efficacious that antidepressants and ECT, and thus this therapy modality will probably lead to reduced QoL.

If  you could explore your question somewhat more, maybe other researchers could engage in the discussion.

Thank you, Dr. Aakhus for your comment. 

The question came to my mind as I assist very often - as a non professional caretaker, the work that pays for my school - persons with severe depression and I witness their struggle with depression itself - as Dr. Kvist rightfuly observed - but also with the side effect of medicins, that is, above all, in some cases, impairment in the use of machinery and memory loss.

I study dentistry. As one  may never know what can happen in life, I wondered how a dentist could better manage the treatment of such a disabling condition in order to still maintain the ability requested by this delicate profession and continue working not being a danger to the patients. If there are more 'merciful' drugs or alternative solutions. Of course, they would benefit anybody.

 It may be difficult to have this discussion without more details, but I took the chance of asking, as it is important for me as perhaps for other professionals. I hope this circumstance doesn't make my question scientifically irrelevant.

I was also strongly impressed by the death of Robin Williams, maybe one of the reasons I asked the question in the first place.

Then I think it all became clearer. Your use of the term severe depression indicates that the depressive state is characterised by significant functional decline in daily activities in addition to the depressive symptoms. Thus, I don't think that people that suffers from severe depression is able to work at all during the acute stage, due to the depression itself, not the side-effects from treatment. Parallel with the depressive symptoms, patients often suffer from anxiety and indecisiveness. These symptoms are rarely compatible with working as a dentist! As the depression improves one might be able to work to some degree and even more when improvement continues. The prognosis is excellent for most people who suffer from a depressive episode. To my knowledge, Mr Williams had had multiple episodes of depression, either as part of a bipolar disorder or a recurrent depressive disorder. These disorders are more complicated to manage, but still with good prognosis for many patients. I think it also is important to bear in mind that most people who suffer from depression, have mild depression, which rarely affects daily life, although treatment strategies, such as social networking, physical activity and self-help services, for instance www.moodgym.org (cognitive therapy) or www.depression.org.nz/ (problem solving therapy) might help.

For a non-psychotherapist, a good recommendation for depressed patient would be Dr. David Burns's book "Feeling Good" (see Amazon link below). It has been shown to be more effective than antidepressants for severely depressed patients.

http://www.amazon.com/gp/product/0380810336/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0380810336&linkCode=as2&tag=nye-20&linkId=SPUNTRQKL2ZH75JA

Blake, I'm surprised you found a PDF version. I didn't know it was available. I'd love if you could send me a link.

David Burns's book is most interesting to read. Thank you for indicating it to me. It may take me some time to read and reflect on it, but I already begin to see what a difference can make for a depressed person receiving such an active and purposeful support from a therapist.

Dear Blake,

The Black Dog Institute (part of our university) is a reputable research organisation addressing the diagnosis, treatment and prevention of mood disorders such as depression and bipolar disorder.  If it would be helpful for further investigation, their website provides several  resources including information on varied approaches to treatment:

http://www.blackdoginstitute.org.au/

Kind regards,

Anne-Nicole

When depression diagnosis is established, if treatment is needed, it has to be made, in my experience (35 y.) by test and try which is detailed in my book in french "La dépression et son traitement : aspects méconnus" L'Harmattan Paris 2011.

I attach the english abstract.

If the medication is not well tolerated, it is not going to be efficient. Start with low dosages, increase if no effect (and good tolerance) after 2 to 3 weeks, untill effect (positive or negative).

If badly tolerated or of low eficiency, change the medication and increase the dosage, step-by-step, as soon as effect culminates. After reaching the maximum : change if result < 50% or, if >50>%, add another medication, preferably of an other class, and so forth.

My results are 80 % perfect, 15% good and 5 % failure Not so bad !

Thank you, dr. Maroy, for sharing with us your work. It comes naturally accepting your careful and experienced reasoning.

Until I will have read your book, allow me to agree wih you on the fact that there remains very little space for those who believe in the separation between mind and body. Stress - with its hormones, the glucocorticoids - has been mentioned as the chemical link between psychological suffering and physical ilness - to cite prof. Robert Sapolsy. I have recently learned that the tight relationship between stress and high blood pressure is more complex that I have thought, with the RAS -renine -angiotensine system- able to promote stress and neuronal damage and therefore effects on psyche and behaviour. That anti-hypertensive drugs like Candesartan, blocker of the angiotensin II receptor, do have stress-lowering and antidepressant effects, along with influences upon metabolism - like increasing insulin sensitivity. It really is fascinating.