How can depression be treated?

Once a person has been diagnosed with depression, there are a number of treatment options.

Common treatments for chronic depression and major depression are psychotherapy to help the patient learn effective coping methods, antidepressant medications to relieve medications, or a combination.

Antidepressant medications can help to normalize neurotransmitters in the brain.

Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Paxil and Zoloft and others, are the newest types of antidepressants. Other commonly prescribed medications are called serotonin and norepinephrine reuptake inhibitors (SNRIs), which include Effexor and Cymbalta. SNRIS and SSRIs generally have fewer side effects than tricyclics and monoamine oxidase inhibitors (MAOIs), which have a history of food and drug interactions. The type of antidepressant that is most effective can differ from person to person. Doctors often encourage patients to try different forms until they find the one that works best.

Antidepressants typically are taken regularly for at least four weeks, and in some cases up to eight weeks, before improvement is noticed. It generally takes six months to 12 months to achieve complete therapeutic effect. In cases of chronic or severe depression, long-term treatment may be required.

Many people who suffer from depression will be prescribed medications as part of their treatment. If you decide that your pain is so great that you need to bolster your resistance to the depression, then you might consider getting evaluated for antidepressant medication treatment. In some cases, people cannot even do the work of exploring the meaning of their depression without some help from these medications. In this way, medication can be a part of your journey to understanding the deeper meaning of your depression. Or, in some cases, the depression may be a side effect of a medication or have another biological cause. Your physician can help you determine if this is the case.

In addition to coping with stressful events, you have the power to make life choices that will change your life so as to relieve stress. Neuroscientist Dr. Mona Lisa Schulz reflects on the effectiveness of antidepressants in her book The New Feminine Brain: How Women Can Develop Their Inner Strengths, Genius, and Intuition. She shares her observation that the leading class of antidepressants, SSRIs (selective serotonin reuptake inhibitors), are often effective but that they do not offer a long-term strategy for healing depression. She writes, "If a patient chooses not to engage in therapy, and doesn't change what is aggravating her mood, no SSRI will prevent the depression's return. SSRIs can't Scotch-tape a woman's mood together for long if she is in an abusive relationship and doesn't do a 'relationship-ectomy' or if she's spending forty hours a week in an irritating job that doesn't use her talents and skills." Medications can help your short-term recovery from depression, but it is worth it to explore the deeper meanings of your depression, so that you can hear its message to change your life over the long term.

Treatment for depression usually involves a combination of drug and psychological therapies.

• Psychotherapy: Psychotherapy involves talking to a healthcare professional about one's problems and life situation. There are several types of psychotherapy that have been shown to be effective for depression including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression can often be treated successfully with either of these therapies used alone. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.
• Medications: Drugs used for depression often take two to four weeks to start having an effect, and 6-12 weeks to have their full effect. The first antidepressant medications were introduced in the 1950s. Research has reported that imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine can be improved with antidepressant use.
• Electroconvulsive therapy: Electroconvulsive therapy (ECT) involves the use of electrical current to stimulate various parts of the brain, and is used mainly in people who have episodes of major depression associated with suicidal tendencies, or in people whose medication has proved to be ineffective. ECT profoundly affects brain metabolism and blood flow to various areas of the brain. How that correlates to easing depression remains unknown, but this therapy is often highly effective. Safety of ECT is controversial, and adverse effects such as confusion, memory loss, headache, hypotension (low blood pressure), and tachycardia (increased heart rate) may occur.
• Hospitalization: Depression is a serious medical illness. Urgent care and hospitalization may be necessary when someone seems to be a danger to themselves or others, or if they are psychotic. A person experiencing extreme major depression should be brought to the hospital immediately to prevent suicide or possible violence to another person. An acute episode is treated with medications and a low-stimulation environment. Depending on the individual's symptoms and history, longer-term hospitalization may be required.

You should read product labels, and discuss all therapies with a qualified healthcare provider. Natural Standard information does not constitute medical advice, diagnosis, or treatment.

Specific treatment for major depression will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include either, or a combination, of the following:

• antidepressant medications (especially when combined with psychotherapy has shown to be very effective in the treatment of depression)
• psychotherapy (most often cognitive-behavioral and/or interpersonal therapy that is focused on changing the individual's distorted views of themselves and the environment around them, working through difficult relationships, and identifying stressors in the environment and how to avoid them)
• family therapy
• electroconvulsive therapy (ECT)

Two-thirds of persons with major depression do not seek the appropriate treatment, although 80 percent of all people with clinical depression who seek treatment improve, usually within weeks. Without treatment, symptoms can persist for weeks, months, or years. Continued treatment may help to prevent reoccurrence of the depressive symptoms.

Antidepressant medication, psychotherapy, and a combination of the two are the most common treatments for depressive illness. However, in addition to adherence to the treatment plan that you develop with your doctor, there are several self-care approaches for managing depression. Several strategies have been rigorously evaluated, and scientific evidence supports their role in managing depression. Physical activity (both aerobic and anaerobic), relaxation therapy, and at least one herbal remedy (St. John's wort) may contribute significantly to alleviating symptoms of depression. Of course, it is important to consult your physician before beginning any exercise program. It is also important to inform him or her about any nutritional supplements or herbs that you are taking so that you can avoid harmful drug interactions.

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There are several treatment options available for depression; most often an antidepressant drug is prescribed. Several classes of antidepressant drugs are available that work on different neurotransmitters in the brain. Therapy provided by a counselor, psychologist or psychiatrist can also be helpful.

Depression is a disorder that can be reliably diagnosed and treated in primary care. Preferable treatment options consist of basic psychosocial support combined with antidepressant medication or psychotherapy, such as cognitive behavior therapy, interpersonal psychotherapy or problem-solving treatment. Antidepressant medications and brief, structured forms of psychotherapy are effective.

Antidepressants can be a very effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild or sub-threshold depression. As an adjunct to care by specialists or in primary health care, self-help is an important approach to help people with depression. Innovative approaches involving self-help books or internet-based self-help programs have been shown to help reduce or treat depression in numerous studies in Western countries.