Treatment

Medication is one option

Medication is often effective in treating depression, and many types of medication are available. A healthcare provider can prescribe depression medication, but many people with depression find that medication combined with therapy with a trained mental health care provider offers even more benefit.

Types of antidepressants:

• Reuptake inhibitors: A selective serotonin reuptake inhibitor (SSRI) is often the first choice because it usually works well and the side effects are well tolerated. SSRIs appear to block brain cells from reabsorbing serotonin, thus keeping more of it available in the brain. Other first-line medications are serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs).
• TCAs: Tricyclic antidepressants (TCAs) help keep levels of serotonin and dopamine higher in the brain. They have been used longer than the SSRI drugs and are quite effective. But they sometimes have more side effects than newer drugs and are often prescribed only after SSRIs have been proven ineffective.
• MAOIs: Monoamine oxidase inhibitors, which maintain higher serotonin and dopamine levels in the brain, are often prescribed only after SSRIs and TCAs have been tried. Like all drugs, they can have side effects, but they are safe and effective.
• Other depression medications: Your doctor may turn to other drugs, depending on your individual situation. These include mood stabilizers, anti-anxiety medications, or antipsychotic drugs.

Side effects

Antidepressants carry side effects, but their severity will vary from person to person. Any use of medication requires monitoring by the doctor who prescribed it. If an antidepressant doesn’t work or it causes side effects that are not tolerable, continue to work with your healthcare professional to find the type of medication and dosage that’s right for you. Most people who do not respond to one type of medication still can have a good response to a different one.

Talking it out

Psychotherapy, or talk therapy, is often combined with medication. It offers the chance to identify what contributes to depression and teach new ways of thinking, coping, problem solving, and goal setting. There are many different kinds of therapy available. Some of the options that are promising for treating depression include cognitive behavioral therapy, behavioral activation therapy, interpersonal therapy, and psychodynamic therapy.

By working with a therapist, you can:

• Identify the life problems contributing to depression and learn which parts of the problem you can improve
• Identify negative thinking patterns that contribute to feeling hopeless and helpless
• Explore thoughts and behaviors that create interpersonal tension that can contribute to depression and learn new ways to interact with people
• Regain a feeling of control and pleasure in life

Talk therapy works. Compared to patients treated with antidepressants alone, those who engaged in talk therapy were less likely to experience another bout of depression. One scientific analysis showed that just over 29% of those who engaged in therapy to treat depression had a relapse after treatment ended, compared to 60% of those treated with antidepressants alone. If you stop taking medication, the benefits wear off. With therapy, you have a chance to learn skills that you can draw on long after treatment ends.

Electroconvulsive therapy

Electroconvulsive therapy, or ECT, is one alternative for those who don’t respond to medication. It’s also often used for those who have an increased risk of suicide. It may also be the only treatment available for older patients with serious depression who can’t take medication because of heart ailments or other serious medical disorders.

If your doctor recommends ECT, you will be admitted to the hospital for treatment. Once you’re under general anesthesia, electrical currents are applied and travel through the brain to deliberately create a controlled seizure. This seizure causes the brain to alter the balance of neurotransmitters such as serotonin and norepinephrine. The seizure lasts about 30 seconds. Treatments usually require six to 12 applications. Loss of memory of events that occur right around the time of ECT treatment may occur. However, ECT treatment does not impair your ability to make new memories.

Taking the next step

When the most common treatments don’t work, your healthcare provider may bring up other treatment options.

Two new types of treatment:

• Transcranial magnetic stimulation (TMS). In this experimental treatment, an electromagnetic coil is held at the forehead to produce magnetic fields to stimulate the nerve cells involved in moods and depression.
• Deep brain stimulation. The treatment calls for surgical implantation of electrodes that stimulate the brain. DBS is approved to treat other conditions, including Parkinson’s disease, but it is still experimental for depression.

Hospitalization
In severe depression, when you are unable to care for yourself or if there is immediate danger of harming yourself or someone else, hospitalization may be needed. Unfortunately, many people feel shame about needing this extra level of help in recovering from depression; they fear it marks them as “crazy.” This is not true. A hospital offers a stable environment where you can begin your recovery, away from the stresses that contribute to your depression. It also gives your doctors a chance to try different treatments to find the one that works best.