Depression Treatment: Your Options

Your treatment plan for depression will depend on what type you have and how severe it is. Some people get psychotherapy. They also might take antidepressants or follow other treatments. Exercise can help, too.

If that’s not enough, you have still more options. For example, your doctor may suggest brain stimulation techniques such as electroconvulsive therapy or transcranial magnetic stimulation.

If you have bipolar depression, your doctor may or may not prescribe antidepressants, depending on your symptoms and medical history. Mood- stabilizing drugs or certain antipsychotic meds also can help treat the condition.

Everyone is unique. You may need to try different drugs and at different dosages to find the best treatment for you. It also takes a while for an antidepressant to take full effect. You may meet with several doctors or therapists before you find the one you want to work with. Patience and openness will help put you on the path to feeling better.

Depression Drugs

Called antidepressants, these help lift your mood and ease the sadness and hopelessness you might feel. Work with your doctor to find the one that works best for you with the fewest side effects.

How Antidepressants Work

It’s all about the brain circuitry that helps manage your mood.

The three key chemicals are norepinephrine, serotonin, and dopamine. Research shows that in depression, brain circuits that use these chemicals don't work right. Antidepressants tweak the chemicals so that the circuits work better. That can help improve your mood, although researchers don’t understand exactly how.

How Long Will I Stay on Antidepressants?

Usually, your doctor will advise you to keep taking the meds for a while even after you start feeling better. That helps lower the chances that your symptoms will come back. How long you may need to stay on antidepressants will depend on your mix of symptoms, how much they improve, and whether you’ve had depression before.

What Are the Types of Antidepressants?

Tell your doctor if you’re taking any other meds, supplements, or herbs. They can interfere with antidepressants. The major types are:

SSRIs (selective serotonin reuptake inhibitors) are the most often prescribed type of antidepressant. They improve how brain circuits use serotonin. Examples include:

• Citalopram (Celexa ). You’ll usually take this as a pill once a day. As with all antidepressants, it can take a few weeks to work fully.
• Escitalopram (Lexapro)). You also take this daily. It causes side effects similar to that of other SSRIs, like nausea, headache, sexual side effects, and insomnia.
• Fluoxetine (Prozac). Prozac lasts in your system longer than most other antidepressants. So it may take several weeks for it to reach a steady level, and several weeks to leave your body once you stop the meds.
• Fluvoxamine (Luvox). This is more often prescribed for obsessive-compulsive disorder and social anxiety disorder.
• Paroxetine (Paxil). You can take this in tablet or liquid form, once a day.
• Sertraline (Zoloft). You can take this as a tablet or as a liquid you mix with water or juice.

SNRIs (serotonin and norepinephrine reuptake inhibitors) affect brain circuits that use both serotonin and norepinephrine. These SNRIs treat depression:

• Desvenlafaxine (Pristiq). This is a long-acting tablet you take once a day.
• Duloxetine (Cymbalta). You’ll usually take this capsule once or twice a day. It can take 1-4 weeks before the drug works fully. It causes similar side effects as several other antidepressants, like vomiting and nausea.
• Levomilnacipran (Fetzima). You take one long-action capsule a day.
• Venlafaxine (Effexor). You take this as a tablet or capsule with food, usually 2-3 times a day.

Atypical antidepressents also affect brain circuits, but work in different ways. Examples include:

• Mirtazapine (Remeron). This is usually taken at bedtime.
• Wellbutrin (Bupropion). This is taken once or twice a day depending on the formulation. It can help with smoking cessation but should not be used by people who have seizures or an eating disorder.

Tricyclic antidepressants (TCAs)

These are an older type of antidepressant. Sometimes they’re called cyclic antidepressants. Like SNRIs, these mainly affect levels of norepinephrine and serotonin and work well. But they can have more side effects than other drugs, so they’re usually not the first prescription choice.

They help keep up the levels of serotonin and norepinephrine in the brain, which in turn can improve your mood. These drugs can cause similar side effects, including nausea and drowsiness.

• Amitriptyline (Amitid, Elavil, Endep, Etrafon). You may take 1-4 tablets a day. It can take a few weeks to take full effect.
• Imipramine (Tofranil). You usually take one or more of this pill daily. You can expect it to take full effect in about 1-3 weeks.

MAOIs (monoamine oxidase inhibitors)

These were the first type of antidepressant. Today, you might try them if you don’t get relief from other depression drugs. You must avoid certain foods like cheese and aged meats, and certain medications (like decongestants or some cough syrups or certain prescription painkillers) that can interact dangerously with MAOIs.

Most common side effects from MAOIs are dry mouth, nausea, headaches, drowsiness, and trouble sleeping. Examples:

• Isocarboxazid ( Marplan ). Usually, you take 2-4 tablets a day. It could take 6 weeks or longer to take full effect. This drug can be habit-forming, so take it only as your doctor prescribed.
• Phenelzine ( Nardil ). You’ll usually take a tablet 3 times a day. It takes about a month to work fully. Your doctor may slowly lower your dose over time.
• Selegiline (Emsam). You can get this as a skin patch, which may cause fewer side effects than taking the drug by mouth.

When Are Other Medicines Used?

Your doctor may also put you on other medications, such as stimulants and anti- anxiety drugs. That’s especially likely if you have another mental or physical condition. But anti-anxiety medications or stimulants don’t treat depression by themselves.

Combining antidepressants with other meds, such as those used to treat schizophrenia or bipolar disorder, can also help.

What Is Psychotherapy's Role?

It’s also called talk therapy. You meet with a psychiatrist, psychologist, social worker, or other trained mental health professional. You will learn new ways to handle the challenges and mindset that depression can bring on.

If your depression is mild to moderate, psychotherapy may work as well as an antidepressant.

You can get talk therapy on your own, with your family, or in a group. Your doctor will help you find the best type for you.

Exercise is another good treatment for mild depression. In one review of studies on the topic, experts concluded that it works as well as drugs or psychotherapy in easing depression symptoms and keeping them at bay.

Different “doses” of exercise may work for different people. You may want to start working out for 45-60 minutes, 3-5 times a week. If that sounds like too much, remember that some is better than none. And you may still need medicine or psychotherapy to feel better.

Other Treatment Options

Electroconvulsive therapy can work for severe depression that doesn’t respond to other treatments. Also called electroshock therapy, it’s the best proven option for such people.

You’ll be given medicine to go to sleep while a doctor sends a brief and painless electric current through your scalp to your brain. This current induces a seizure. Electroshock therapy is safe.

Sometimes, doctors use electroconvulsive therapy when a person is a threat to themselves and others and it’s too dangerous to wait until medications take effect.

Transcranial magnetic stimulation (TMS) is used to treat major depression in adults who have already tried one antidepressant.

Your doctor places an electromagnetic coil over the side of your scalp. It creates a magnetic field that sends an electric current to stimulate nerve cells in the brain’s prefrontal cortex, which is one of the regions that controls mood.

TMS doesn’t work as well as electroshock therapy. It also differs in these ways:

• It uses a much smaller electric current.
• It targets a specific part of the brain.
• It doesn’t cause a seizure or loss of consciousness.
• You don’t need to be sedated.

You would get the procedure 4-5 times a week for up to 6 weeks. You won’t need to stay in a hospital.

Vagus nerve stimulation is a brain stimulation surgery for people whose depression has resisted other treatments.

A doctor implants a pacemaker-like device, which is the size of a stopwatch, in your chest. Its wires lead to the left vagus nerve in your neck. The device sends regular electrical impulses to this nerve, which relays information to and from the brain.

Studies suggest that this treatment can work well and triggers changes in the region of the brain linked to depression. But it can take 6 months or more for you to notice any improvements in your symptoms.

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