Depression Treatment

A person's treatment depends on the severity of symptoms. Mild depression can be treated by counseling alone, while people with more severe depression are treated by a combination of counseling and medication.

Common depression treatments include:

• Non-drug therapies
• Medications
• Lifestyle changes
• Complementary and alternative medicine

Non-Drug Therapies

The following non-drug therapies used in addition to medications help relieve depressive symptoms.

Psychotherapy

Common types of psychotherapy include:

• Cognitive therapy
  Cognitive therapy helps people become aware of and change their unhealthy thinking patterns. The therapy uses guided self-discovery (personal analysis to understand oneself) and imaging (using thought to create mental experiences).
• Behavior therapy
  Behavior therapy uses basic learning techniques to help people change their undesirable behaviors. The therapy uses a system of rewards, reinforcements of positive behavior, and desensitization (confronting the cause of the problem).
• Cognitive-behavior therapy
  Cognitive-behavior therapy combines features of both cognitive and behavior therapies to help people identify and change their unhealthy thoughts, and develop healthier behaviors. Techniques used include journal keeping, homework assignments, role playing, and desensitization.
• Interpersonal therapy
  Interpersonal therapy is designed to improve people skills and relationships.
• Play therapy
  Play therapy is used with children who are not yet able to express their emotions or feelings in words. Children engage in activities, such as playing with dolls or toys.
• Psychoanalysis
  Psychoanalysis attempts to discover unconscious mental processes that influence a person's feelings and behaviors. The techniques used include free association (people say whatever comes to mind without censorship), interpretation, and dream analysis. Psychoanalysis is based on the work of Sigmund Freud.

Electroconvulsive therapy

Scientists believe that ECT results in chemical changes in a person's brain activity, which reduces the symptoms of severe depression. A course of treatments of ECT over several weeks is typical. Maintenance treatments of psychotherapy, antidepressants, and perhaps occasional ECT are usually needed.

Light therapy

• Light box (people stay within a set distance from a box that produces very bright light)
• Desk lamp (a light box made to resemble a desk lamp)
• Light visor (a portable light that is worn on the head and hangs over the eyes)
• Dawn simulator (a light that simulates sunrise by gradually makes a dark room lighter over time)

Support groups

The following organizations are good resources for information on depression:

• American Psychological Association
• American Psychiatric Association
• Depression and Bipolar Support Alliance

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Medications

Many people with depression are helped when their treatment includes antidepressants. Most antidepressants work by making brain chemicals called neurotransmitters (serotonin, norepinephrine, and dopamine) more available to the brain. Scientists believe that higher levels of neurotransmitters improve the transmission of nerve impulses, which elevates a person's mood and behavior.

Antidepressants take 3 to 4 weeks (or longer) to start working fully. A doctor may have a person try more than one antidepressant before determining which antidepressant or combination of medications does the best job of relieving the person's symptoms with the fewest side effects.

Most people take antidepressants for at least 4 to 9 months to prevent a recurrence of their depression. Antidepressants should be taken regularly, according to the guidelines established by a doctor. People with chronic major depression may have to take antidepressants indefinitely.

It's important for people to be under medical supervision while taking antidepressants. People should ask their doctor or pharmacist in advance for possible drug side effects or interactions. A doctor should be notified if any severe reactions occur. When discontinuing an antidepressant, the dosage must be decreased gradually to avoid withdrawal symptoms.

In 2007, the Food and Drug Administration (FDA) proposed that all antidepressant medicines should warn of the risk of suicidal behavior in young adults between 18 to 24 years old.

The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) increase the level of serotonin in the brain by blocking reuptake (reabsorption) of this neurotransmitter. SSRIs typically have fewer side effects than other antidepressants. Examples include:

• citalopram (brand name: Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac)
• fluvoxamine (Luvox)
• paroxetine (Paxil, Pexeva)
• sertraline (Zoloft)

Tricyclic antidepressants

The tricyclic antidepressants (TCAs) are older antidepressants that increase the levels of both serotonin and norepinephrine in the brain by blocking the reabsorption of these two neurotransmitters. TCAs have more side effects and are usually only prescribed for people who do not respond to the newer antidepressants. Examples include:

• amitriptyline (Elavil)
• amoxapine
• clomipramine (Anafranil)
• desipramine (Norpramin)
• doxepin (Adapin)
• imipramine (Tofranil)
• nortriptyline (Aventyl, Pamelor)
• protriptyline (Vivactil)
• trimipramine (Surmontil)

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) increase the levels of norepinephrine, serotonin, and dopamine in the brain by preventing the enzyme monoamine oxidase from metabolizing these three neutotransmitters. MAOIs are not used as often, because they have dangerous interactions with many other types of medications (such as decongestants) and some foods that are high in tyramine (such as aged cheeses, cured meats, and wines). Examples include:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)

Norepinephrine and dopamine reuptake inhibitors

Norepinephrine and dopamine reuptake inhibitors (NDRIs) increase the levels of norepinephrine and dopamine in the brain by inhibiting the reabsorption of these two neurotransmitters. Example:

• bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)

Wellbutrin is not recommended for people with, or at risk for, a seizure disorder.

Serotonin and norepinephrine reuptake inhibitors

Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase the levels of serotonin and norepinephrine in the brain but have fewer side effects than the tricyclic antidepressants. Examples include:

• duloxetine (Cymbalta)
• venlafaxine (Effexor)

Tetracyclic antidepressants

Tetracyclic antidepressants increase the levels of norepinephrine and serotonin in the brain by preventing nerve cell receptors called alpha-2 receptors from binding with these two neurotransmitters. Example:

• mirtazpine (Remeron)

Combined reuptake inhibitors and receptor blockers

Combined reuptake inhibitors and receptor blockers increase the levels of serotonin and norepinephrine in the brain by inhibiting the reabsorption of these two neurotransmitters and by blocking nerve cell receptors. Examples include:

• bupropion
• trazodone

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Lifestyle Changes

In addition to psychotherapy and medications to treat depression, the following lifestyle changes help people cope in their everyday lives:

• Avoid alcohol and illegal drugs.
• Eat well-balanced meals.
• Engage in enjoyable activities even when depressed.
• Exercise regularly.
• Interact with family and friends or join a support group.
• Maintain a regular sleep routine.
• Set realistic goals and expectations.

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Complementary and Alternative Medicine

Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.

The following nontraditional therapies help treat depression. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a physician before trying them.

DHEA

Omega-3 fatty acids

Melatonin

Relaxation techniques

• Acupuncture
  Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
• Biofeedback
  Biofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns.
• Deep breathing
  Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
• Qi gong
  Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
• RESPeRATE Blood Pressure Lowering Device
  RESPeRATE is an FDA-approved portable electronic device that helps relieve stress naturally by helping people to master the technique of paced breathing.
• Yoga
  Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.

St. John's Wort