Depression

Before we look for ways to manage your depression, we want to get to know you. Having a thorough understanding of your symptoms, traumas, personal history and health history helps us know what kinds of treatment might be most effective.

Your provider will ask you several questions about your symptoms, including when they started and how often you have them. They may also do tests to see if there are any underlying health conditions causing your symptoms.

Types of this condition

Not all depression is the same. There are different types of depression, and your treatment options will depend on the type you have. Some types include:

• Clinical depression.
• Dysthymia (persistent depressive disorder).
• Bipolar disorder.
• Seasonal affective disorder (seasonal depression).
• Adjustment disorder.
• Premenstrual dysmorphic disorder (PMDD).
• Prenatal depression.
• Postpartum depression.
• Atypical depression.
• Depressive disorder due to another medical condition like heart disease, Parkinson’s disease or cancer.

What to expect at your first visit

It’s normal to feel nervous when you come in for your first appointment. Talking about depression can make you feel raw and vulnerable. That’s why we want to get to know you first. We’ll go at a pace that’s comfortable for you.

We usually don’t get too in-depth at your first visit. We’ll ask you questions about your history of depression and how you’re feeling now. This first appointment is a way for us to get to know each other before diving into treatment.

Meet Our Depression Care Team

When you choose Cleveland Clinic, you’ll see a carefully selected team of specialists. Your team might include:

• Psychiatrists (doctors with mental health expertise who can prescribe and monitor your medications).
• Advanced practice providers (medical providers, such as nurse practitioners and physician assistants, who can prescribe and monitor your medications).
• Psychologists  (experts in talk therapy).
• Social workers (therapists trained in navigating the connections between your mental, physical, economic and social well-being).

Our team will work with your primary care physician (PCP) to design a treatment plan that matches your needs. We’ll stay in close contact with them during your treatment and give them updates about your progress.

We value your privacy and your right to confidentiality. That’s why we’ll never share things discussed during your therapy sessions.

Getting depression treatment is a personal decision — and one that you’re in control of. We’ll discuss your options with you in detail. But it’s up to you to decide your next step.

Treatment depends on many things, including what type of depression you have, your response to behavioral health treatments in the past, and your own personal goals and expectations. You might get one treatment or a combination of treatments.

Psychotherapy

Psychotherapy involves talking with a provider during a therapy session. The goal is to help you identify unhealthy patterns and find ways to change or reframe them. There are many different types of psychotherapy, but the most common is cognitive behavioral therapy. Depending on your needs, you might go to therapy for a few weeks, several months or years. Many people find that regular therapy is a good way to manage depression and maintain a healthy outlook on life.

Antidepressant medication

Sometimes, our specialists use prescription medications to treat depression. Antidepressants treat your symptoms, while psychotherapy treats the cause. That’s why many providers recommend a combination of these approaches. There are several types of antidepressants, including:

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin/norepinephrine reuptake inhibitors (SNRIs).
• Serotonin modulators.
• Atypical antidepressants.
• Tricyclic antidepressants (TCAs).
• Monoamine oxidase inhibitors (MAOIs).

Relaxation training

Learning how to truly relax is about taking a moment to pause and dial down the stress in your life. Our therapists can help you do that. They can teach you how to relieve tension in your muscles and use deep breathing exercises to calm anxiety. They can also help you practice mindfulness, which means enjoying and being present in the moment instead of worrying about what lies ahead.

Intensive Outpatient Program (IOP)

If you need additional help, you might want to check out our Intensive Outpatient Program (IOP). This could be a good option if you have depression but are still able to get through the day without much trouble. The goal of our IOP is to reduce depression symptoms and help you regain confidence as an active member of your family and community.

Our IOP usually lasts four to six weeks. You’ll typically attend four days a week, for three and a half hours each day. In addition to individualized care, you’ll also participate in group therapy where you can talk with others who are going through similar things.

Brain stimulation therapy

In severe cases of depression, brain stimulation therapy can influence or change the activity in your brain. Brain stimulation therapy isn’t one of the first things we try for depression, but it can be very effective when depression medications aren’t working.

Types of brain stimulation therapy include:

• Electroconvulsive therapy (ECT).
• Transcranial magnetic stimulation (TMS).
• Vagus nerve stimulation (VNS).

Advanced therapies

Our specialists are always researching the newest methods to treat depression. Using the medications ketamine, esketamine and some psychedelic drugs, like LSD, in a controlled and closely monitored setting can sometimes help treat depression. Your provider will let you know if you qualify to participate in a clinical trial for an advanced therapy. It’s important to know that using an advanced therapy may result in a longer hospital stay.

Therapy for treatment-resistant depression

If at least two antidepressants haven’t helped manage your condition, you may have treatment-resistant depression. Our specialists can help with this, too. Your provider may refer you to a psychiatrist, who’ll go over your medical and mental health history. Then they’ll work to find a treatment strategy that’s right for you. Your treatment plan may include:

• Giving the antidepressant you’re taking a little more time to work.
• Increasing the dose of your current antidepressant medication.
• Adding a different class of antidepressant or other types of medications (lithium, Lamictal® and atypical antipsychotics) which augment the response to treatment.
• Recommending that you see a psychologist for psychotherapy.
• Referring you for brain stimulation therapy, such as TMS, or advanced therapies, like esketamine or ketamine.

If these strategies don’t work, your provider will talk with you about trying different medications or treatments.

Follow-Up Care

Depression is a condition you manage. Symptoms can wax and wane over the course of your lifetime. Our specialists will help you decide what long-term maintenance looks like for you. You may want to check in with us every few months. Or you might prefer to see us regularly, even when symptoms ease up.

Like treatment, the best follow-up plan depends on a lot of things, including the severity and frequency of your symptoms and how depression affects your daily life.

Taking the Next Step

When you’re depressed, everything feels like a chore. We understand that picking up the phone or going online to make an appointment can feel overwhelming at best and debilitating at worst. But if you can take that first step, we’ll walk beside you on the rest of your journey. Life is full of ups and downs. But when you spend more time in the valley than you do on the mountaintop — or even at ground level — it’s time to seek care. You deserve to enjoy life and feel connected to those around you. Our Cleveland Clinic specialists are here to help you do that, and so much more.