Treatment options
Talk therapy
There are many forms of psychotherapy, or "talk therapy," that can help a person with depression understand any underlying causes. Two common types of psychotherapies used in major depression are:
- Cognitive behavioral therapy - focuses on changing negative thinking and behavior that can lead to depression
- Interpersonal therapy - focuses on exploring issues in relationships with others to identify problems and positively change behaviors
Some people with depression may also benefit from couples therapy, family therapy or group therapy (sessions in which people with a similar illness work together with a trained therapist). There are many kinds of talk therapy; it may take a few tries to find the therapist or therapy that "fits," but that is okay, and is not unusual. The important thing is to find the treatment that will work best.
Antidepressants
It is believed that depression may be caused by an imbalance of chemicals found in the brain and body called neurotransmitters. Antidepressant drugs are most often grouped based on the way they work, although the newer medications tend to be grouped based on their relative effects on blocking the reuptake of different neurotransmitters in the brain and body, specifically norepinephrine (NE), serotonin (5-HT) and dopamine (DA).1
A large number of factors can influence the choice of an antidepressant. Selection should be based on safety, tolerability, co-existing medical and/or psychiatric conditions, cost, ease of administration, and an assessment of any drug-drug interactions.
Antidepressants usually take two to four weeks to start working.2 If little or no improvement is noted after four to eight weeks, the doctor may choose to change the dose of the medication or may add or substitute another antidepressant.1 Psychiatrists usually recommend that people with depression continue to take medication for (at least) five or more months after symptoms have improved to reduce the chances of their coming back. A healthcare professional should often check in with a person taking an antidepressant to see how he or she is responding to treatment. The doctor will check dosage and decide whether it is effective in treating all symptoms - emotional and physical. A healthcare professional will explain potential side effects, which may include nausea, dry mouth, sleepiness, decreased appetite and increased sweating. Any unexpected side effects should be reported immediately to a healthcare professional.
While a person has depression, there may be times when the symptoms become worse or the person has thoughts of suicide. Any unusual changes in behavior, including anxiety, agitation, panic, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or overexcitement and hyperactivity, should be reported to a physician immediately. If any of these changes are severe or occur suddenly, it could mean an increased risk of suicidal thinking or behavior. Also, be especially careful to report symptoms when starting any antidepressant therapy and whenever there is a change in dose.
Support groups
No one with depression has to feel alone. Support groups are places where people with depression and those who care about them can share their experiences, discuss coping skills and offer hope to one another.
Support groups also help people with depression follow their treatment plan and help them to understand that a mood disorder does not define who they are. In addition, support groups provide a forum for acceptance, understanding and self-discovery. But it is important to remember that support groups are not a substitute for professional care. Most support groups do not endorse or recommend the use of any specific treatment or medication. You can locate support groups near you by contacting any of the advocacy groups listed under Resources & Links
Health and Wellbeing
When a person has depression concentrating on improving health and wellbeing can also be helpful. Exercise and improved diet can help people feel better and in some cases looking to improve spirituality may also be beneficial.
References
- Blier P. Crosstalk between the norepinephrine and serotonin systems and its role in the antidepressant response. J Psychiatry Neurosci. 2001;26 Suppl:S3-10.
- Delgado P, Approaches to the Enhancement of Patient Adherence to Antidepressant Medication Treatment. J Clin Psychiatry 2000;61 (suppl2)