Depression: Treatment

The most common treatment for depression is a combination of antidepressant medications and psychotherapy. Other individuals seek treatment in complementary and alternative medicine. Antidepressant medications successfully elevate mood in 50% to 75% of people who use them as directed.

Antidepressant medications

Antidepressants successfully elevate mood in 50% to 75% of people who use them as directed. Although there are several different types of antidepressants, many antidepressants belong to one of the following three classes of medication:

• Selective serotonin reuptake inhibitors (SSRIs): This class of antidepressants works by selectively keeping increased levels of serotonin available in the brain. Although there is no evidence that any of the SSRIs are more effective than the older antidepressants, people who take SSRIs appear to experience fewer side effects. As a result, the SSRIs are often tried first and are very commonly prescribed.
• Serotonin norepinephrine reuptake inhibitors (SNRIs): This class of antidepressants works by selectively keeping increased levels of serotonin and norepinephrine available in the brain. There is no evidence that the SNRIs are more effective than older antidepressants. However, they appear to cause fewer side effects and as a result, they are often tried first and, like the SSRIs, are very commonly prescribed.
• Tricyclic antidepressants (TCAs): Prior to the introduction of the SSRIs, the TCAs were the treatment of choice. Because their effectiveness has been well studied, these medications are still frequently prescribed as either first-line or second-line medications.
• Monoamine oxidase inhibitors (MAOIs): Less commonly prescribed antidepressants, MAOIs require you to avoid a number of common foods containing a high content of the amino acid tyramine. MAOIs now tend to be prescribed only when other antidepressants are not effective.

See the chart for more information about other classes of antidepressants that are also available.

Regardless of the medication used, the selected antidepressant medication needs to be taken at an adequate dosage for an appropriate period of time. Because some antidepressants can cause unpleasant discontinuation symptoms if you stop using them abruptly, you should never stop taking your medication without first consulting your doctor.

Also, as depression tends to recur, antidepressants should be continued for at least 4 to 9 months after remission is obtained to prevent relapse. For people who have had recurrent depression, the doctor may recommend continuing antidepressant medications for a longer period of time.

Besides their own side effects, nearly all antidepressants have complicated interactions with other drugs, some of which can be life-threatening. Inform your physician of all medications you are taking, including any over-the-counter or alternative medications. You should also let your physician know if you are pregnant, breast-feeding, or trying to conceive.

Psychotherapy

Psychotherapy is another useful treatment option for depression. Psychotherapy may be used alone for mild to moderate depression, or in combination with medications for moderate to severe depression.

Forms of psychotherapy supported by evidence include cognitive-behavioral psychotherapy (CBT), interpersonal psychotherapy, psychodynamic psychotherapy, and problem-solving therapy. Psychotherapy is effective in both individual and group formats. Studies have shown that psychotherapy may have a physiological effect on the brain, easing symptoms of depression.

Other biological treatments

Individuals who suffer from seasonal affective disorder may benefit from bright light phototherapy.

Electroconvulsive therapy (ECT), a highly effective treatment, is usually reserved for the most severe cases of depression or in situations where other treatments do not work. ECT uses electrodes placed on the head to cause a controlled seizure. It is usually given 2 or 3 times a week, usually for a total of 6 to 12 treatments.

Complementary and alternative medicine

A wide range of complementary therapies and alternative medicines have been promoted for depression. Some have a modest amount of evidence to support them and should be studied further . These include:

• St. John's wort: An herbal medication that has shown some benefits in treating mild to moderate depression. St. John's wort has serious interactions with many medications, including some antidepressants. If you are using St. John's wort, tell your doctor and pharmacist.
• S-adenosyl methionine (SAMe): A substance found naturally in our liver and brain. SAMe may have some benefit for depression. However, further studies are needed before it can be recommended to treat depression.
• Omega-3 fatty acids: Found in foods and supplements, omega-3 fatty acids may help elevate mood when used in combination with antidepressants. But further research is needed before they can be recommended as a treatment for depression.
• Folate (folic acid): A B vitamin that can help improve the response to antidepressant medications. Taking 0.4 mg to 1.0 mg of folate daily is a low-risk way to improve general health and may help improve response to treatment.
• Acupuncture: Is part of traditional Chinese medicine and involves inserting acupuncture needles into the skin at specific points on the body. Further studies are needed before it can be recommended to treat depression.

In view of their current popularity, studies of other alternative therapeutic options are also needed. Remember to tell your doctor if you are using any alternative medicines.

The benefit of exercise has also been established in several studies, which show physical activity to be as beneficial as medication in easing depression. While the exact reason for this is not known, researchers in one study also found that people who exercised were statistically significantly less likely than those who took medication to relapse into depression.