How is depression treated?
The two most common treatments for depression are psychotherapy and antidepressant medications. However, other options are also available, including electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and alternative therapies like biofeedback.
Psychotherapy. Psychotherapy is sometimes called “talk therapy.” It is used to treat mild and moderate forms of depression. A licensed mental health professional helps people with depression focus on behaviors, emotions, and ideas that contribute to depression. They also help the depressed person identify and understand life problems that contribute to their illness in order to enable them to regain a sense of control. Psychotherapists help patients learn coping techniques and problem-solving skills. Psychotherapy can be done on an individual or group basis and can include spouses and family members. It is most often the first line of treatment for depression.
Medicines. Medicines are commonly used to treat depression. Your family doctor can prescribe the medications or refer you to a psychiatrist. Currently, five different types of medications are approved to treat depression. These are:
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), and fluoxetine (Prozac®)
- Serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine (Effexor®) and duloxetine (Cymbalta®)
- Tricyclic antidepressants (TCAs), such as nortriptyline (Pamelor®), amitriptyline (Elavil®), and imipramine (Tofranil®)
- Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil®), and tranylcypromine (Parnate®)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as bupropion (Wellbutrin®)
- Non-competitive N-methyl-D-aspartate receptor antagonist, called esketamine (Ketanest®, Spravato®)
The type of drug initially prescribed for you will depend on your symptoms, the presence of other medical conditions, other medicines you are currently taking, the cost of the prescribed treatments, and potential side effects.
Electroconvulsive therapy (ECT). Electroconvulsive therapy is a procedure that uses a brief application of electric current to the scalp to produce a seizure in the patient. It is believed that ECT results in the release of chemicals in the brain that aid in reversing the symptoms of depression. It is used for severe forms of depression, suicidal patients, and for other mental illnesses. ECT is performed while the patient is asleep under general anesthesia.
Transcranial magnetic stimulation (TMS). Transcranial magnetic stimulation uses magnetic energy to help control mood. The treatment consists of the use of a magnetic device that creates an electric current. When the device is pressed against the scalp near the forehead, the electric current causes nerve cells in that area of the brain to send impulses that triggers a chemical reaction that, over time, helps relieve symptoms of depression. TMS is approved for the treatment of severe depression in patients who have not been helped by at least one antidepressant medication.
Vagus nerve stimulation (VNS). Traditionally used for epilepsy, this treatment uses electrical pulses to stimulate the vagus nerve, a nerve thought to affect the area of the brain that controls depression. A tiny pacemaker-like device implanted in the chest sends electrical pulses to an electrode in the neck to stimulate the nerve and provide symptom relief. VNS is only approved for patients with treatment-resistant depression. The specific Food and Drug Administration approval is for patients with chronic (ongoing) or recurring depression in whom at least four other antidepressant treatment methods have been tried and failed to relieve symptoms of depression.
Alternative treatments. Alternative treatments, by providing forms of relaxation and relief from stress, have a place in healing and general health and well-being. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others. In general, alternative therapies by themselves are effective for mild, but not more severe, forms of depression.
What is the typical approach to treating depression?
The earlier treatment is started, the more effective it is. Antidepressant medications, psychotherapy or a combination of both are the usual first steps in treating depression.
The good news is that are many options available to treat depression. Don’t be discouraged if you start taking an antidepressant and it doesn’t appear to be working. Antidepressant therapy can take 4 to 8 weeks or longer before becoming fully effective. If the initial dose of antidepressant is not fully effective, your doctor may increase the dose of the drug, change to a different antidepressant drug, add a second antidepressant to your drug regimen, or try other drugs that are sometimes used to treat other conditions but have been shown to be useful in patients with depression (such as anti-anxiety medications, anti-psychotics, or mood stabilizers).
Other treatment options, such as psychotherapy and alternative treatments, can also be part of the initial treatment for mild to moderate depression. ECT, TMS, and VNS are reserved for more severe forms of depression.