New guidelines by the American Psychiatric Association (APA) state electroconvulsive therapy - a physical therapy may be used to treat major depressive disorder or major depression in patients who don't respond to medications.

This is the first time the medical organization has ever updated since 2000 its guidelines on the assessment and treatments of depression based on research conducted from 1999 through 2006.

The guidelines drafted by a team led by psychiatrist Alan J. Gelenberg say that the shock (and awe?) therapy may serve as the therapy for patients with major depressive disorder who have a high degree of symptom severity and those who do not respond to medications.

"The five-year process of intense review, discussion and thoughtful revision-making has led us to today's release of new guidelines that we believe will improve patient care," Dr. Gelenberg in a press release by the organization. "We are hopeful these guidelines will lead to improved lives for many patients."

The update was based on a review of over 13,00 articles by the organization, more than 1,000 comments, and the revised guidelines have been extensively reviewed by more than 100 stakeholders including experts in psychiatry, allied physician organizations, patient advocacy groups and members of APA.

The major changes in the guidelines have been made in rating scales, new strategies for treatment-resistance depression, exercise and other healthy behaviors and strengthened maintenance treatment recommendation.

In addition to electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and monoamine oxidase inhibitors are also added as potential treatments for patients with severe major depression or treatment-resistant depression.

The guidelines also recognize that regular aerobic exercise or resistance training may modestly improve mood symptoms.

A recent report issued by the Centers for Disease Control and Prevention says as many as 9 percent of adult Americans suffered depression in 2006 and 2008 and 3.4 percent of them had major depression.

Depression is a condition in which a person feels sad, blue, unhappy, miserable or down in the dumps, according to Medline Plus, a government medical source. Major depression refers to a condition in which a person has five or more depressive symptoms for at least two weeks.

The causes for depression remain officially unknown while many possible lifestyle parameters may affect the risk of this condition, according to early studies.

A recent study published in the Sep 7 2010 issue of Journal of Psychopharmacology suggests that maintaining an adequate level of serum vitamin D may help ward off depression in community dwelling individuals.

The study of 3369 middle-aged and older men at the mean age of 60 led by Lee D.M. and colleagues from the University of Manchester in the UK showed those with low serum levels of vitamin D were 70 percent more likely to suffer depression.

Other things that may help cut the depression risk include B-vitamins, plant-based diet, Mediterranean diet, exercise, having a healthy body weight, acupuncture, biofeedback, ayurveda, homeopathy, aromatherapy, and color therapy.