How can depression be treated?

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Stacy Wiegman, PharmD
Pharmacy Specialist

The following are medications that can be used to treat depression:

Citalopram, a selective serotonin reuptake inhibitor (SSRI), increases the availability of serotonin between nerve cells. Serotonin is important because it helps to send messages between nerve cells by activating receptors on each. An adequate amount of serotonin is necessary to allow the message to continue. After the message passes between cells, the first cell absorbs the remaining serotonin. Citalopram prevents this absorption, known as "reuptake," allowing for additional activation of the nerve cell.

Viibryd (vilazodone) is thought to treat depression and improve mood by raising the levels of the chemical serotonin in the brain. Serotonin is a chemical that transmits messages between nerve cells in your brain. People with depression are thought to have low levels of serotonin.

Mirtazapine acts on increasing chemicals in the brain that can help treat depressive thoughts and other depression symptoms. Similar to other antidepressants, mirtazapine helps to elevate mood and lift depression.

Nortriptyline treats depression by helping to even out a chemical imbalance that may cause certain kinds of depression.

Zyprexa Zydis (olanzapine) treats certain types of depression when used in combination with Prozac (fluoxetine). Zyprexa Zydis is prescribed for depression associated with bipolar disorder in adults, and can also be used for what is known as treatment-resistant depression in adults.

The type of treatment will depend on the severity and cause of depression. In mild cases, psychotherapy (a treatment that involves talking to a counselor or psychologist who helps you understand and overcome your depression) may be effective on its own.

Commonly, psychotherapy is combined with medication, most of which alter the neurotransmitter chemicals in your brain that affect your mood. In severe cases, electroconvulsive therapy (ECT) may quickly lessen the symptoms of depression. Magnetic stimulation or nerve stimulation in the brain has also been shown to have effective results.

Dr. Marsha Lucas
Psychology Specialist

Depression is a multifaceted condition that requires treating the whole person. In this WisePatient video, neuropsychologist Marsha Lucas, PhD, makes a strong case for holistic treatment for depression.

Donna Hill Howes, RN
Family Practitioner

A diagnosis of depression is your gateway to feeling better and taking control of your health. Although you may be worried about the side effects of the medication you have been prescribed or feel angry that you have to live with a depressive disorder, you can take steps to make these concerns manageable. The first step is to form a solid team with your health-care providers. They may include a psychiatrist, psychologist, neurologist, and/or a general practitioner. Then you should learn all about depression, what it is, what stresses may increase your depression, and the mood changes that depression may trigger. This will help you stick to your doctors' recommended treatment plan. It is also helpful to join a support group for people with depression. Support groups can help ease the sense of isolation that may accompany depression. They also can help you discover various ways to cope with the challenges of living with and treating depression. Recovery may take some time, so try to stay focused on your personal goals, learn stress management techniques, such as  meditation, deep abdominal breathing, music therapy, yoga, or tai chi, and explore ways to bring focus and enjoyment into your days by doing hobbies, exercise, and recreational activities. 

Dr. Tarique D. Perera, MD
Psychiatrist (Therapist)

Traditional depression treatment includes talk therapy, medication and lifestyle changes. In this video, Tarique Perera, MD, a psychiatrist with Contemporary Care of Connecticut, explains that treatment is a multi-pronged, individualized approach.

Depression is an illness of the brain that usually requires some form of treatment. It is important for you to recognize this, to take the illness seriously and to take good care of yourself. Depression can make even the simplest parts of daily living very difficult. There are some things you can do to make yourself feel better, even if only slightly. 

  • Consider some form of exercise daily. Exercise is good for both physical and mental health. Establishing a regular exercise routine will help maintain a healthy weight and reduce stress levels, important for someone with depression.
  • Try to eat a healthy balanced diet every day. A healthy diet, which includes whole grains, fresh fruits and vegetables, protein, and is low in fat, will help keep your body healthy.
  • There are many relaxation techniques to lower your stress, including meditation and deep breathing, which can help with depression. These techniques, widely used around the world, are a low-cost way to lower stress.
  • Maintain healthy sleep habits, as much as possible. Set up a regular routine for bedtime and morning to be sure you are getting enough sleep, but not too much sleep.
  • Avoid and reduce stress. Stress, both at work and home, can increase your feelings of depression. It is important to avoid stress in your daily life.
  • Keep your working hours predictable and manageable. Openly communicate with family members and loved ones about what is going on in your life to foster better relationships and elicit their support.
  • Limit or curtail alcohol or substance use or abuse. Use of these substances may worsen your symptoms of depression or interfere with your prescribed medications.
  • Create a daily routine. Organizing and planning your day will help to manage the many daily life tasks that you have to do. Create and maintain a monthly calendar.
  • Be patient with yourself. For someone with depression, even the smallest tasks can seem impossible. If you can’t find the energy to go for a walk today, then just stand outside for a little while and get some fresh air. If you can’t make a healthy meal for yourself, try to eat a piece of fruit. If you are finding yourself unable to sleep, consider learning meditation or other relaxation techniques. If you are sleeping all of the time, consider ways to spend less time in bed.

These things will not make your depression go away, but they may make your day feel a little bit easier.

There are several strategies that exist for the treatment of depressive disorders. There are six classes of medications for depression, two forms of therapy and one alternative therapy: 

Medications

  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)
  • Atypical antidepressants
  • Stimulants  

Therapeutic approaches

  • Cognitive behavioral therapy (CBT)
  • Interpersonal therapy (IPT)

Non-medication and non-therapy alternative treatment

  • Electroconvulsive therapy (ECT)

The doctor may initially choose one treatment and later move to another or a combination of two or more treatments based on response. No single strategy has been determined to be more effective than any other for patients with mild to moderate depression. However, there does appear to be benefit to combining treatment modalities for those people who have either severe or recurrent depression. For people who need an immediate response to treatment, such as those who are highly suicidal, pregnant, anorexic, psychotic or suffering from severe depression, ECT is the treatment of choice—it has been proven more effective than medication or therapy alone or in combination. 

Dr. Thomas Jensen
Psychiatrist (Therapist)

In transcranial magnetic stimulation (TCMS) or repetitive transcranial magnetic stimulation (rTMS), a series of magnetic pulses are applied to precise brain areas. The treatment has been approved by the Food and Drug Administration (FDA) for depression, though not specifically for bipolar depression.

Dr. John Preston, PsyD
Psychology Specialist

First, an important issue. Severe depression can occur in the context of unipolar disorder or bipolar disorder. These disorders are very different. Treatments that are effective with unipolar depression often do not work with bipolar disorder, and vice versa. In fact, any treatment that may reduce depressive symptoms can provoke manic episodes in bipolar disorder (especially bipolar I). Having the correct diagnosis is extremely important and misdiagnoses are a common cause of treatment failure. Here I’ll outline treatment options only for unipolar major depression.

  1. Psychotherapy: in particular these forms of psychotherapy: cognitive therapy, behavior therapy and interpersonal therapy for depression.
  2. It is very common for depressed people to withdraw (stop doing things such as going out to eat, visiting with friends, going to church, etc.). Remarkably one treatment for depression that often is very effective is to have loved ones strongly encourage the depressed person to stay engaged in such activities.
  3. Prescription antidepressants. It’s very common that failures occur because of doses being too low and/or treatment does not last long enough. A list of antidepressants are available on my web site (free download): www.Psyd-fx.com
  4. Over-the-counter antidepressants: SAMe, St. John’s wort, 5-HTP (available OTC but should never be taken except under medical supervision) !
  5. Augmentation: here other drugs are added to antidepressants. Many types of augmentation are available; here are the most common and effective: thyroid hormone, atypical antipsychotics (Seroquel; Abilify), lithium, BuSpar, and 2 antidepressants added together such as Prozac and Wellbutrin.
  6. The medication Clozaril should always be considered if nothing else works.
  7. Exercise: best approach: 2 ten minute periods of exercise a day (aerobic: must huff and puff, but ok to do brisk walking if not very fit; jog, run or swim if more fit).
  8. Make sure sleep is adequate: common reasons for impaired sleep: sleep apnea, excessive caffeine use (more than 2 cups of coffee a day), alcohol can destroy sleep, staying up too late.
  9. Bright light therapy: Use of commercially available light boxes (generally exposure time is 10-20 minutes each morning) or going outside without sun glasses also works. Use sunscreen. What matters is the amount of light entering the eye. Not for use if a person has eye diseases.
  10. ECT (shock therapy): for treatment resistant cases and psychotic depressions
Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

More About this Book

Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

When you have depression, it can feel like there's no way out. To begin changing the way you feel, you'll need an arsenal of proven techniques for lifting your mood and preventing relapse. The...

Depression can be treated using a variety of medical and psychological interventions. The most common treatment modalities are antidepressant medications and individual psychotherapy. Since depression often responds well to treatment, patients with symptoms are encouraged to seek out medical attention. In some cases, the treatment of depression requires several different approaches. For example, in severe cases of depression, a combination of different medications and psychotherapy is often most effective. In some cases of treatment-resistant or refractory depression, certain devices may prove useful.

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) and relaxation therapy 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.

Take the RealAge Test!
Don't ignore signs of depression. Instead, do these things:
  • Visit a doctor or clinic. Depression is often overlooked. It can also be confused with other problems. A doctor can help you know if your symptoms come from depression, another illness, or both.
  • Stick with your treatment. The two main treatments for depression are counseling (talk therapy) and medicine. You and your doctor should decide together what's best for you. But once you have a treatment plan, stick with it! Keep any appointments with a counselor. Take any medicine as directed. Keep taking your medicine even if you feel better. If you stop medicine too soon, your depression may come back.
  • Set your own goals for recovery. You may not feel like sticking to your goals at first. But try to do it anyway. You will be glad you did. Here are some areas to work on:
Healthy relationships. Having a close friend or loved one to share your concerns and plans with can really help. Don't pull back from other people right now. Instead, set goals to get the support you need. Phone a friend every day. Attend scheduled events. Join a support group. Leave the house at least once each day. Volunteer.

Healthy body. Taking care of your body will help your mind too. Set goals to make sure this happens. Go for a walk every day. Drink 8 cups of water every day. Eat 2 cups of fruits and 2 cups of vegetables every day. Avoid alcohol. Try to get 8 hours of sleep every night.

Healthy spirit. Right now, it's good to reconnect with things that used to be fun, fulfilling, and meaningful for you. Do your hobby every day. Listen to music. Meditate. Pray. Keep a journal. Go to the movies once a week. Read a great book.

Call 911 or go to the hospital emergency room if you feel so low that you feel like hurting or killing yourself. You can always get the help you need!
Dr. Lara Honos-Webb, PhD
Psychology Specialist
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.
Listening to Depression: How Understanding Your Pain Can Heal Your Life

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Listening to Depression: How Understanding Your Pain Can Heal Your Life

A New Way of Thinking About DepressionWhat does it really mean to be depressed? You know depression as a collection of symptoms—fatigue, listlessness, feelings of worthlessness—and the source of...
Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Even severe depression is highly treatable. The first step is to seek help from a medical professional. Your doctor may want to do some blood tests to rule out other conditions such as a thyroid disorder, which can trigger depression. Certain medications also can exacerbate the problem.

For most people, a combination of antidepressant medication and psychotherapy is the most effective treatment. There are several different classes of medication and different types of talk therapy, so you should speak with your doctor about finding a treatment that works best for you. Many of these medications have side effects.

This content originally appeared on doctoroz.com

Most people with depression get better when they get treatment.

Once identified, depression almost always can be treated either by therapy, medicine called antidepressants, or both. Some people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with combined treatment—therapy and antidepressants.

This answer is based on source information from National Women's Health Information Center.

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.

Conventional medicine views depression as a neurological disorder—both a result of various neurochemicals failing to cross synapses in the brain or be absorbed normally by adjacent cells; and as a result of deficiencies of these molecules and other cellular nutrients, such as vitamin B-12. Conventional doctors prescribe anti-depression medications, which are designed to compensate for whatever is lacking or functioning sub-optimally. They may also prescribe psychiatric or psychological counseling or consider dramatic treatments such as electroshock therapy. Counseling attempts to understand and treat the bio-psycho-social contributors to depression and resolve them via talk therapy. Electro-shock, though rarely used anymore, actually seeks to destroy brain tissue—in turn forcing the brain to reorganize the way neurons communicate with each other.

Dr. Thomas Li, MD
Internist
Depression is as important to treat as cancer, says Thomas Li, MD, in Advanced Internal Medicine of Rose Medical Center in Denver. In this video, he discusses how depression treatment should involve a team of specialists.

Continue Learning about Depression Treatment

Depression Treatment

Depression Treatment

Because it is a multi-faceted condition, treatment for depression is multi-faceted as well. Minor depression can often be treated with therapy and a few simple lifestyle changes, while chronic or major depression treatment can req...

uire medication in addition to therapy. In some severe cases, electroconvulsive therapy (ECT) may be used. It's important to work with your mental health professional to determine which course of treatment for your type of depression is most appropriate.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.