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An overview of treatment options

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression. Medication can relieve symptoms of depression, and it has become the first line of treatment for most types of the disorder.
Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.
Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for 6 to 12 months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment for at least 6 months greatly reduces your risk of a rapid relapse. If you've had three or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications

  • Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as nefazodone (Serzone), trazodone (Desyrel, Trialodine) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin, Zyban).
  • Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters but by a different mechanism than SSRIs. Doctors often prescribe them to treat moderate to severe depression. Among tricyclic antidepressants are amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil) and a combination of perphenazine and amitriptyline (Triavil, Etrafon). Tetracyclics include maprotiline (Ludiomil) and mirtazapine (Remeron).
  • Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.
  • Stimulants. If you're severely depressed, your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, DextroStat) or modafinil (Provigil) in addition to an antidepressant because most antidepressants are slow to work. After 1 to 4 weeks, your doctor may then switch you to just an antidepressant.
  • Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Epitol, Tegretol, Carbatrol) to treat bipolar depression. These medications provide relief 50 percent to 80 percent of the time. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

Most antidepressants have a similar level of effectiveness. However, a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication's side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you're lethargic, then a more energizing antidepressant may be more helpful.
Most antidepressants are slow to work. You may see a response in 2 weeks, but many people don't see a full benefit for 6 to 8 weeks. If your response to medication isn't resulting in satisfactory progress after 6 to 8 weeks, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.
In addition to medications, depression treatment may include:

Psychotherapy

There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.
The success of therapy depends on finding a doctor, psychiatrist or psychologist you're comfortable with. Both medications and psychotherapy can take 4 to 8 weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, may also help.

Electroconvulsive therapy

Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. In fact, it's the "gold standard" for treatment of severe depression.
In this therapy you receive a light general anesthesia and a muscle relaxant. An electrical current is passed through your brain for 1 to 3 seconds. The stimulus causes a controlled seizure, which typically lasts for 20 to 90 seconds. You wake up in 5 to 10 minutes and rest for about half an hour. Most people require 6 to 10 treatments.
Experts aren't sure how this therapy relieves symptoms of depression. The seizure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. A few people have some memory loss for several weeks. This therapy is usually used for people who don't respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can't take medications because of heart disease.

Light therapy

This therapy may help if you have seasonal affective disorder (SAD). This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.

Self-care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:

  • See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
  • Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
  • Don't become isolated. Try to participate in normal activities.
  • Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
  • Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.

 

This material is intended for informational purposes only and is not a substitute for the medical advice of your doctor or any other health care professional. Always consult with your physician if you are in any way concerned about your health.

© 2003 - 2005 SLPM Self-care Ltd.

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