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Treatment

Many treatment options are available for depression, including psychotherapy, medication, brain stimulation, self-care and complementary health approaches. How well treatment works depends on the type of depression and its severity.

Psychotherapy

Psychotherapy, support groups and psychoeducation about the illness are essential to treating depression:

  • Cognitive behavioral therapy (CBT) helps change the negative thinking and behavior associated with depression. The goal of this therapy is to recognize negative thoughts and to teach coping strategies.
  • Interpersonal therapy focuses on improving problems in personal relationships, which may be contributing to a person’s depression. The therapist teaches the person to evaluate their interactions and to improve how they relate to others.
  • Psychodynamic therapy, which is similar to psychoanalysis, is often more available than CBT and interpersonal therapy, but health care providers recommend it less often because there’s less data indicating that it works for depression.
  • Psychoeducation involves teaching people about their illness, how to treat it, and how to recognize signs of relapse. NAMI Peer-to-Peer is a recovery-focused educational program for adults living with mental illness who wish to establish and maintain wellness.
  • Family psychoeducation helps family members understand what their loved one is experiencing and reduces confusion. Psychoeducation can help the person with depression recover. NAMI Family-to-Family is an educational course for family, caregivers and friends of individuals living with mental illness.
  • Self-help and support groups for people with depression and their families are becoming more available. In support groups, people can share frustrations and successes, referrals to specialists, and community resources. They also share friendship, and hope for themselves, their loved ones and others in the group. NAMI sponsors two support groups. NAMI Connection Recovery Support Group is a weekly recovery support group for people living with mental illness, and NAMI Family Support Groups for family, friends and caregivers.

Medications

For some people, antidepressants can help reduce or control symptoms. Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to reach their full effect. Some people will have to try various doses or medications to find what works for them.

Selective serotonin reuptake inhibitors (SSRIs) act on serotonin, a brain chemical. They are the most common medications prescribed for depression. To improve mood, SSRIs increase the level of serotonin. Common side effects include sexual dysfunction and gastrointestinal problems.

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most common antidepressants. These medications increase the amounts of the brain chemicals serotonin and norepinephrine.

  • Venlafazine (Effexor)
  • Desvenlafazine (Pristiq)
  • Duloxetine (Cymbalta)

Norepinephrine-dopamine reuptake inhibitors (NDRIs) NDRIs increase the amounts of the brain chemicals dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes fewer (and different) side effects than other antidepressants. For some people, buproprion causes anxiety symptoms, but for others it is an effective treatment for anxiety.

Mirtazapine (Remeron) targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits. Mirtazapine is used less often than newer antidepressants (SSRIs, SNRIs, and buroprion) because it is associated with more weight gain, sedation and sleepiness. However, it appears to be less likely to result in insomnia, sexual side effects and nausea than the SSRIs and SNRIs.

  • Bupropion (Wellbutrin)
  • Mirtazapine (Remeron)

Second generation antipsychotics (SGAs), or “atypical antipsychotics,” are a group of medications used to treat schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental illness conditions. SGAs can be used for treatment-resistant depression.

  • Aripiprazole (Abilify)
  • Quetiapine (Seroquel)

Tricyclic antidepressants (TCAs) are older medications, seldom used today as first-line treatment for depression. They work similarly to SNRIs, but they have more side effects. They are sometimes used when other antidepressants have not worked. TCAs (and duloxetine) may be helpful with chronic pain as well.

  • Amitriptyline (Elavil)
  • Desipramine (Norpramin)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor, Avantyl)
  • Protriptyline (Vivactil)

Monoamine oxidase inhibitors (MAOIs) Less commonly used today, MAOIs work by inactivating enzymes in the brain, which break down serotonin, norephinephrine and dopamine, thus increasing the levels of these chemicals in the brain. They can never be used in combination with SSRI antidepressants. MAOIs can sometimes be effective for people who do not respond to other medications. MAOIs interact with other medications and food, which requires strict adherence to a particular diet.

  • Phenelzine (Nardil)
  • Isocarboxazid (Marplan)
  • Tranylcypromine Sulfate (Parnate)
  • Selegiline patch (Emsam)

Brain Stimulation Therapies

For some people, brain stimulation therapies may be effective:

  • Electroconvulsive Therapy (ECT). When medication and psychotherapy are not effective in treating severe depression or depression with psychosis, ECT can be highly effective. ECT involves transmitting short electrical impulses into the brain. Modern ECT, which is carried out under general anesthesia, does cause some side effects, including some memory loss, but it is much safer than methods used in the past.
  • Repetitive Transcranial Magnetic Stimulation (rTMS). rTMS is a type of brain stimulation that uses a magnet instead of an electrical current to activate the brain. It is a relatively new treatment for people whose depression has not responded to medication or psychotherapy.

Complementary and Alternative Medicine (CAM)

Relying solely on CAM methods is often not enough to treat depression, but they may be useful when combined with medication and psychotherapy. Examples of CAM used for depression include:

  • Folate. Some studies have shown that when people with depression also lack enough folate (also called folic acid or vitamin B9), they may not be receiving the full benefit from the antidepressants they take to treat the illness. These studies suggest that taking L-methylfolate (an active form of folate) can be useful as an additional treatment along with their other psychiatric medications.
  • Exercise. Studies show that aerobic exercise can help treat mild depression because it increases endorphins and stimulates the neurotransmitter norepinephrine, which can improve a person’s mood.
  • Massage therapy. Massage therapy is well known for its ability to lower cortisone levels, which contribute to stress, but it can also increase levels of serotonin and dopamine, which are neurotransmitters that stabilize a person’s mood.
  • Acupuncture. Acupuncture may help stimulate the release of certain mood-regulating brain chemicals, such as serotonin. While some research has shown that acupuncture is a useful addition to conventional care, many are still not sold on its effectiveness.
  • Guided imagery. Unlike meditation, guided imagery directs concentration to a specific image. Guided imagery can help with depression by actively combating negative thoughts and emotions and replacing them with positive imagery, thus boosting esteem and lowering stress levels.