What are the types of treatment for depression?

Depression can be treated through lifestyle changes and medical therapies, including:

Lifestyle changes

  • Stopping the use of alcohol and/or sedatives
  • Exercising regularly (stopping regular exercise can lead to depression)
  • Eating a healthy diet, particularly getting enough omega 3 fatty acids

Medication and other medical therapies

  • Switching current medications (such as antihypertensives, contraceptives, and steroids) to reduce side effects that may be causing depression
  • Diagnosing and treating other conditions known to cause depression (such as various endocrine disorders like hypothyroidism)
  • Counseling (psychotherapy: cognitive-behavior therapy, dialectic behavior therapy, interpersonal therapy, and others)
  • Light therapy (exposure to white fluorescent light to reduce symptoms of seasonal affective disorder)
  • Antidepressant medication
  • Brain stimulation therapies
    • Electroconvulsive therapy (controlled electrical discharge to induce seizure-like activity in the brain
    • Transcranial magnetic stimulation (TMS or rTMS) Vagal nerve stimulation

Combinations of therapy, adding quetiapine (Seroquel®), aripiprazole (Abilify®), buspirone (Buspar®), lurasidone (Latuda®), thyroid medication, lithium, L methylfolate (Deplin®), creatine, NSAIDS, and other anti-inflammatory medications

  • Hypericum (St. John's Wort) for a single episode of mild depression, S- adenyl methionine SAM-e) “alternative medication”

Ongoing research

  • Intravenous ketamine
  • Norepinephrine reuptake inhibitor
    • Reboxetine
  • Substances "P" antagonists
  • Vagal nerve stimulation
  • Deep brain stimulation
  • Transcranial magnetic stimulation (TMS or rTMS)
  • Intravenous ketamine
  • Scopolamine augmentation
  • Agomelatine, melatonin analog (not available in the US)
  • Ramelteon augmentation (Rozerem®)
  • S-mecamylamine, binding to the nicotinic receptor
  • Vortioxetine
  • Levominacipran
  • D-cycloserine
  • Moclobemide, a reversible monoamine oxidase inhibitor
  • Atomoxetine (Strattera®), whose indication is currently attention deficit disorder
  • New biomarkers that may predict treatment responses to different agents

What conditions can be treated with antidepressant medications?

Antidepressants can be used for the treatment of:

  • Major depression (symptoms of depression that persist for more than two weeks)
  • Panic disorder
  • Chronic pain
  • Bed wetting (enuresis)
  • Chronic(long-term) depression (dysthymia)
  • Migraine prevention
  • Chronic fatigue syndrome
  • Eating disorders
  • Anxiety, generalized
  • Obsessive compulsive disorder (SSRIs and clomipramine)

What are the types of antidepressants?

Selective serotonin reuptake inhibitors (SSRIs) include:

  • Fluoxetine (Prozac®)
  • Sertraline (Zoloft®)
  • Paroxetine (Paxil®or Pexeva®)
  • Fluvoxamine (Luvox®)
  • Citalopram (Celexa®)
  • Escitalopram (Lexapro®)

SSRIs have advantages over other antidepressants, including fewer side effects and effectiveness at lower dosages. They are also used in obsessive-compulsive disorder, along with clomipramine in the tricyclic group. Small doses are recommended to start for panic disorder. Generic versions are now available, reducing the expense. Side effects can include sexual dysfunction, nausea and diarrhea, and headache.

Selective norepinephrinereuptake inhibitors (SNRIs) include:

  • Venlafaxine (Effexor®); extended release desvenlafaxine (Pristiq®)
  • Duloxetine (Cymbalta®)
  • Vilazodone (Viibryd®)

Tricyclics (TCA) include:

  • Amitriptyline (Elavil®)
  • Amoxapine (Asendin®)
  • Clomipramine (Anafranil®) (for obsessive-compulsive disorder)
  • Desipramine (Norpramin®)
  • Doxepin (Sinequan®)
  • Imipramine (Tofranil®)
  • Nortriptyline (Pamelor®)
  • Protriptyline (Vivactil®)
  • Trimipramine (Surmontil®)

Tricyclics (TCA) can be helpful for reducing pain, providing weight gain, and improving sleep. They can cause dizziness, constipation, and urinary retention.

Other common antidepressants include:

  • Mirtazepine (Remeron®)
  • Trazodone (Desyrel®) ; extended release trazodone (Oleptro®)
  • Nefazodone (Serzone®)
  • Vilazodone (Viibryd®)
  • Bupropion (Wellbutrin®) two extended release forms
  • Venlafaxine (Effexor®); extended release desvenlafaxine (Pristiq®)
  • Duloxetine (Cymbalta®)
  • Monoamine oxidase inhibitors (MAOIs)
    • Tranylcypromine (Parnate®)
    • Phenelzine (Nardil®)
    • Isocarboxazid (Marplan®)
    • Selegiline (Emsam®) daily patch form

When MAOIs are prescribed for chronic depression, the patient must restrict foods that contain tyramine from his or her diet and avoid certain medications.