Treating Depression

Depression is an illness, and it can be treated successfully. Learn about medications, talk therapy and other treatments that may be used.

A first step in escaping from the fog of depression is recognizing that it is not part of who you are. Depression is an illness like high blood pressure, asthma and other medical problems, and it can be treated successfully. With proper treatment and support, you could feel better in a matter of weeks.

For treatment to work, you need help from an experienced doctor, one who can recommend treatments that are likely to work for your form of depression. A doctor may prescribe medications and/or refer you for psychotherapy or other treatments.

Antidepressant medications
There are many medications that are used to treat depression. Experts think they work by altering the levels of brain chemicals that affect mood. Antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs).These are the most commonly prescribed antidepressants. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). Common side effects include nausea, insomnia, restlessness, dry mouth and decreased sex drive. SSRI side effects are usually mild, and most of them will go away within a few weeks.
  • Atypical antidepressants such as bupropion (Wellbutrin), venlafaxine (Effexor) and duloxetine (Cymbalta).The side effects of these drugs vary. They may include nausea, fatigue, weight gain, nervousness, dry mouth and blurred vision.
  • Tricyclic antidepressants such as amitriptyline or desipramine. Tricyclics are an older class of drugs, and they are more likely than SSRIs to cause side effects such as drowsiness, dry mouth and constipation. They may be tried if other antidepressants don't work.
  • Monoamine oxidase inhibitors (MAOIs). These older medications are rarely prescribed because of the risk of serious interactions with other drugs and certain foods.

Important things to keep in mind:

  • Antidepressants need time to work. It may be as long as 12 weeks after you start taking an antidepressant before you feel better.
  • People respond differently to antidepressants. Don't be discouraged if one medication doesn't work for you. Your doctor can change the dose or prescribe a different medication.
  • Antidepressants often work best when combined with psychotherapy. Therapy can sometimes get to the root of the problems that contributed to your depression.
  • Do not suddenly stop taking an antidepressant. This can cause unpleasant symptoms, including a return of depression. When you are ready to quit, your doctor can work with you to slowly taper the dose.

NOTE: Anyone being treated with antidepressants, especially people being treated for depression, should be watched closely for worsening depression and for suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed (either increased or decreased). Discuss any concerns with your doctor. Call 9-1-1 right away if you or anyone is having thoughts of suicide or death.

NOTE: SSRI antidepressants, such as sertraline, citalopram and paroxetine, may slightly raise the risk of congenital heart defects if taken during the first trimester of pregnancy. Discuss the benefits and risks of antidepressants with your doctor if you are pregnant or plan to get pregnant. Do not stop taking these medications without first talking to your doctor.

Psychotherapy
Psychotherapy involves talking with a mental health professional. It could be a psychiatrist, social worker, psychologist or counselor. Therapists can help depressed people gain insights about themselves and make positive changes in their behavior and feelings.

There are many types of psychotherapy to choose from. Two that are commonly used to treat depression are cognitive-behavioral therapy and interpersonal therapy.

  • Cognitive-behavioral therapy can help identify and correct negative thought patterns. This can improve a person's outlook and sense of self-worth.
  • Interpersonal therapy looks at the relationships that may be at the root of depression.

Psychotherapy can often help relieve symptoms of depression. In general, people with severe depression respond best to a combination of psychotherapy and medication.

Transcranial magnetic stimulation (TMS)
Transcranial magnetic stimulation is a treatment that stimulates the brain by delivering strong, focused magnetic pulses. It was approved in 2008 to treat major depression in adults who have not responded to standard treatments. TMS has fewer side effects than most other treatments for depression. Scalp pain and headache are the most common.

Electroconvulsive therapy (ECT)
During ECT, a mild electric shock is applied to the brain while the person is asleep under anesthesia. ECT is a highly successful treatment for people with severe depression who can't take medications. It may also be life-saving for those at high risk for suicide. Side effects may include short-term memory loss and confusion.

Light therapy
People with severe seasonal affective disorder (SAD) often need bright light treatment (phototherapy). For this treatment, a person sits in front of a special light box each morning for half an hour or longer. The light box emits bright white light that is about 10 times stronger than regular lights. Side effects are uncommon but may include headaches or eyestrain.