Treatment for Depression

Get Help Immediately: Call the National Suicide Prevention Lifeline (800) 273-8255 or 911, or go to the nearest hospital if you start thinking about hurting yourself or somebody else or if you hear strange voices that nobody else seems to hear.

Call a doctor if:

• You cry a lot for no reason.
• Your depression is starting to affect your school, your work, or your family life.
• If you think you are feeling depressed because of the medications you are taking – DO NOT stop taking them or start changing them without consulting with a doctor first.
• You think you drink too much or a loved one has told you that you drink too much, you feel guilty about how much you drink, or the first thing that you drink in the mornings is alcohol.

Depression and Suicide

Depression makes it more likely a person will hurt themselves or commit suicide. Feelings of hopelessness can make suicide seem like a way to escape the emotional pain they are feeling. All threats of suicide, including thoughts of death and self harm, suicidal thoughts and behaviors, should be taken seriously.

In the United States alone, suicide ranks as the 11th leading cause of death, with it ranking 2nd in the cause of deaths among teens and 3rd in people aged 15 to 24 years. Although depression is more often diagnosed in women, the highest risk of suicide is in men older than 75 years old and more men die from suicide than do women. This is because men are more likely to use a more lethal method such as firearms while women tend to take an overdose of medications.

People who are at high risk of committing suicide are the elderly, men, those who have a diagnosis of major depression or who have other serious illnesses, and those who have made previous suicide attempts. People who lack social support (such as family and friends), who own a gun or have a gun in the house, and who are a widow or divorcee are also more likely to commit suicide.

Warning Signs of Suicide include the following:

• Talking about harming or killing one’s self.
• Being preoccupied with death and dying.
• Reckless behavior or having a death wish.
• Talking about strong feelings of hopelessness and feeling trapped.
• Calling people to say their goodbyes.
• Putting affairs in order or making a will.
• A sudden change of behavior from being very depressed to appearing calm and happy.

If you think a family member or a friend is thinking of or considering suicide, express your concern and immediately seek help. Call the National Suicide Prevention Lifeline (800) 273-8255, call 911 or contact your doctor or local hospital emergency room. People sometimes think that talking to the person about suicide will make it more likely for them to act but the opposite is actually true.

For a diagnosis of depression, treatment options generally involve antidepressant medication or psychotherapy, or a combination of the two. It is important to understand that treatment of depression takes time to work and patience is needed. More than one medication may have to be tried to determine the most effective and appropriate for a particular person. The dosages may also have to be adjusted to achieve an optimal effect with the fewest side effects. In general, treatment is changed if a person does not respond adequately or respond as expected within 6 to 8 weeks after starting the treatment. If there has been a satisfactory response, treatment is continued for 4 to 9 months for the first major depression episode. A longer course of medications is beneficial in people with recurrence of depressive symptoms.

Medications

Antidepressants can help relieve the feelings of sadness and improve your mood. Doctors take into consideration your age, other medical conditions, and medication side effects in choosing the appropriate medication.

Research has shown that three neurotransmitters or chemical messengers in the brain are involved in depression: norepinephrine, serotonin, and dopamine. Antidepressants work by re-establishing a normal balance of these chemicals in the brain. All of these medications take 4-6 weeks to show their full effects and sometimes longer. There are several types of antidepressants, which include the following:

Selective serotonin reuptake inhibitors (SSRIs)

These are generally the first-line of antidepressants and work by increasing the amount of serotonin in the brain. Drugs in this class include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa). fluvoxamine (Luvox) and escitalopram (Lexapro). They have relatively few side effects but might include nausea, diarrhea, agitation, insomnia, nervousness, sexual problems or dysfunction, and headaches.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

These work by increasing the availability of norepinephrine and serotonin in the brain. Venlafaxine (Effexor) and duloxetine (Cymbalta) are the most commonly used SNRI’s. They may be especially effective in people who have not responded well to other drugs. Side effects are similar to SSRIs but may also cause increased sweating and high blood pressure.

Tricyclic antidepressants (TCAs)

These medications affect the amounts of norepinephrine and serotonin in the brain. These also tend to have more side effects than the other classes of antidepressants, and are thus not usually used first. Drugs in this class include imipramine (Tofranil), amitriptyline (Elavil), desipramine (Norpramin, nortriptyline (Pamelor) and clomipramine (Anafranil). Side effects may include dry mouth, constipation, increased heart rate, blurred vision, memory problems, sedation, increased appetite, low blood pressure, dizziness, and sexual problems.

Monoamine oxidase inhibitors (MAOIs)

These are used in patients who do not respond to other treatments. They were the first drugs used to treat depression and are sometimes used in treating other mental disorders. These drugs block an enzyme that breaks down neurochmicals. Drugs in this class include phenelzine (Nardil) and tranlcypromine (Parnate). People who take these medications must avoid certain foods like cheese, beer, wine, soy sauce and other foods because of possible interactions with this class of medications. Side effects include insomnia, weight gain, low blood pressure, sexual problems or dysfunction. Serotonin syndrome is a life threatening side effect of MAOIs which is characterized by a rapid onset of hypertension, elevated temperature (hyperthermia), rapid heart rate (tachycardia), and shock.

Antidepressants should not be abruptly discontinued. Doing so can cause discontinuation syndrome, characterized by physical symptoms like nausea, body aches, flu-like symptoms, anxiety, and irritability. Abrupt discontinuation of MAOI can cause agitation, irritability, and delirium. Abruptly stopping a TCA can also lead to irritability, agitation, and arrhythmias or abnormal heart rhythms. If your doctor decides to stop your medication he or she will decrease the dose slowly. Do not stop your medication without talking to your doctor first.

Other Medications

Occasionally, doctors also prescribe other medications like anti-anxiety medications and stimulants, especially if the patient has another mental or physical disorder.

The extract from an herb called St John’s wort (Hypericum perforatum) is currently being used in Europe and the United States to treat mild to moderate depression. It may be effective in mild to moderate depression but its long term side effects are not known and it is not approved for use by the US Food and Drug Administration. The composition of herbal products varies widely and is not regulated by the FDA so it is difficult to know how much to take. It is important to tell your doctor if you do decide to take it as it can interact with other medications and should not be used in combination with other antidepressants.

List of medications used to treat depression

Psychotherapy

Psychotherapy helps people with depressive symptoms by teaching them to develop appropriate coping strategies to help them in dealing with everyday stressors, improve social skills and increase self-confidence. Psychotherapy can be very effective in treating depression especially when used in combination with medication.

There are several types of psychotherapy including cognitive therapy, behavioral therapy, and cognitive behavioral therapy. These focus on how behaviors and thought processes contribute to depression, and patients learn new ways to react to situations. Other type of therapy include:

Interpersonal therapy which focuses on how relationships affect depression. Patients learn to identify unhealthy behaviors and change them.

Psychodynamic therapy which focuses on the causes of depression, such as childhood traumas.

Individual counseling which is a one-on-one session with a professional therapist who educates the patient on depression and understanding their condition. Specific stressors and triggering factors are identified. Strategies for handling stress and preventing the worsening or recurrence of depression are also taught.

Family counseling involves all family members because the whole family also becomes affected with the diagnosis of depression. The family helped to understand their loved one’s condition and the warning signs of any problems. This has been shown to be effective in improving a patient’s lifestyle and medication compliance.

Group counseling where patients with depression have the chance to meet and interact with other people with the same diagnosis. Each person can share his or her own experiences, which can be an effective way of learning new ways to think and cope with depression.

Electroconvulsive Therapy

Sometimes medications and psychotherapy fail to relieve a person’s depression despite everyone’s best efforts. Electroconvulsive therapy (ECT) may be used when the depression does not respond to other kinds of therapy or when a person cannot tolerate anti-depressant medication. It is also very effective in giving quick relief of severely depressed or suicidal patients. ECT works by giving a carefully controlled electrical current to the brain through electrodes on the scalp leading to a brief seizure in the brain.

Before administering an ECT treatment, a muscle relaxant and general anesthesia are given to the patient. Careful monitoring during the treatment is done during the procedure. It may cause some temporary side effects, such as confusion, memory loss, and disorientation. Elevated blood pressure and irregular heartbeat have also been observed, usually in patients with preexisting heart conditions. ECT can be safe and effective for selected patients despite its negative depiction in the media.

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) involves a surgically implanted device in the armpit which sends electrical impulses to the fibers of the vagus nerve in the neck to stimulate the brain. This has been approved by the FDA for adult patients with chronic or recurrent depression.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has also been approved by the FDA and involves noninvasively creating a magnetic field to induce a smaller electric current in a specific part of the brain without causing seizures or loss of consciousness. This may be used in patients who have failed two or more medical treatments.

Hospitalization

If a depressed person is at risk of committing suicide, admission to a hospital is necessary for close monitoring and to ensure safety. Other reasons for hospitalization include severe depressive symptoms, psychotic depression, inability to take care of one’s self and worsening medical illness because of depression.

Other Treatments

Lifestyle changes and alternative therapies also have some efficacy in treating depression. examples include acupuncture, chiropractic treatments, guided imagery, hypnosis, yoga, aromatherapy, herbal remedies and supplements (eg, St John's wort, vitamins B12 and D, folate), and massage.