Depression Treatment

Numerous depression treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most people.

In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Many people with depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy.

If you have severe depression, a doctor, loved one or guardian may need to guide your care until you’re well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Here’s a closer look at your depression treatment options.

Medications
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood.

Types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. People with liver disease shouldn’t take duloxetine.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It’s one of the few antidepressants that doesn’t cause sexual side effects. At high doses, bupropion may increase your risk of having seizures.
• Atypical antidepressants. These medications are called atypical because they don’t fit neatly into another antidepressant category. They include trazodone (Desyrel) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep.
• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more severe side effects, a tricyclic antidepressant generally isn’t prescribed unless you’ve tried an SSRI first without an improvement in your depression. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Older adults taking these medications are susceptible to memory problems, confusion and hallucinations. Tricyclic antidepressants are also known to cause weight gain.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven’t worked. That’s because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods such as certain cheeses, pickles and wines and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs.
• Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication
Everyone’s different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don’t stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Don’t give up until you find an antidepressant or medication that’s suitable for you — you’re likely to find one that works and that doesn’t have intolerable side effects.

If antidepressant treatment doesn’t seem to be working, your doctor may recommend a blood test to check for specific genes that affect how your body uses antidepressants. The cytochrome P450 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well your body can or can’t process (metabolize) a medication. This may help identify which antidepressant might be a good choice for you. These genetic tests aren’t widely available, so they’re an option only for people who have access to a clinic that offers them.

Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.

The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get your depression symptoms under control.

Psychotherapy
Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help ease depression symptoms such as hopelessness and anger. It may also help you adjust to a crisis or other current difficulty.

There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones. It’s based on the idea that your own thoughts — not other people or situations — determine how you feel or behave. Even if an unwanted situation doesn’t change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other types of counseling commonly used to treat depression.

Electroconvulsive therapy (ECT)
In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain. Although many people are leery of ECT and its side effects, it typically offers immediate relief of even severe depression when other treatments don’t work. It’s unclear how this therapy relieves the signs and symptoms of depression. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also have memory loss.

ECT is usually used for people who don’t get better with medications and for those at high risk of suicide. ECT may be an option if you have severe depression when you’re pregnant and can’t take your regular medications. It can also be an effective treatment for older adults who have severe depression and can’t take antidepressants for health reasons.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization is may be necessary if you aren’t able to care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These programs provide the support and counseling you need while you get symptoms under control.

Other treatments for depression
If standard depression treatment hasn’t been effective, your psychiatrist may consider whether you might benefit from a less commonly used procedure, such as:

• Vagus nerve stimulation. This treatment uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. This may be an option if you have chronic, treatment-resistant depression.
• Transcranial magnetic stimulation. With this treatment, powerful magnetic fields are used to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain.

Lifestyle and home remedies
Depression generally isn’t an illness that you can treat on your own. But you can do some things for yourself that will help. In addition to professional treatment, follow these self-care steps:

• Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments, even if you don’t feel like going. Even if you’re feeling well, resist any temptation to skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
• Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask family members or friends to help watch for warning signs.
• Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity you enjoy.
• Avoid alcohol and illicit drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.
• Get plenty of sleep. Sleeping well is especially important when you’re depressed. If you’re having trouble sleeping, talk to your doctor about what you can do.

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