What type of treatment for depression is appropriate depends on many factors, including the specific disorder causing the depression, the person’s and disease’s history, their age and their goals for treatment. Courses of treatment can be as varied as are people with depressive symptoms themselves.
The most common medications prescribed to treat depression today are Selective Serotonin Reuptake Inhibitors (SSRI) and their cousins, Serotonin-Norepinephrine Reuptake Inhibitors (SNRI). Serotonin and norepinephrine are both neurotransmitters, the chemicals in the brain that facilitate communication between brain cells. Both SSRIs and SNRIs work by increasing the amount of these chemicals available in the brain.
How effective these medications are is a matter of some debate. While some studies show them to be highly effective, others show very little or no effect. Effectiveness also varies from person to person and may depend on how severe the depression is in the first place.
SSRIs and SNRIs have several potential side effects. By far the most serious is that they apparently increase thoughts of suicide, suicide attempts and deaths by suicide in children and adolescents. It is not clear whether this is actually caused by the medication directly or whether severely depressed young people, as the medication begins to take effect but before they are back to a normal mood, gain the energy and motivation to kill themselves that was held back by the depressive symptoms before.
The most common side effects of antidepressants include dry mouth, weight changes and sexual side effects. Different people experience different side effects. Some of these effects will decrease with time and others may not, so it is always wise to tell your doctor of any side effects you experience.
Perhaps the most frustrating thing about antidepressant medication is that they take 4-6 weeks to build up in your system. Add to this the fact that different medications work or don’t work for different people, and the task of finding an appropriate medication can take a very long time. You might try one for six weeks, then switch, then switch again and again until finally finding one that works for you and getting some relief.
Psychotherapy has been shown to be effective in treating depression, and even more so when combined with antidepressant medication. There are numerous different types and “schools” of psychotherapy. Two of the most studied ones for depression are Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT).
CBT seeks to explore and change the negative thoughts that cause depressive symptoms. The therapist helps the depressed person identify so-called “distorted cognitions,” that is, beliefs or thoughts that are not based in fact. These might include things like, “I’m not worthwhile” or “Everybody is judging me.” The therapist and depressed person then work together to examine whether these statements are actually true, how these thoughts are triggered, and alternative ways of thinking.
In IPT, the person and therapist look closely at the depressed person’s interpersonal relationships and how they are or not effective in meeting the person’s needs. The depressed person explicitly works on improving their relationships and seeking out new ones where necessary, with the help of the therapist.
While CBT and IPT have many studies behind them, different forms of therapy can also be very effective. In fact, there are some studies that suggest that the type of therapy is less important than the relationship between the therapist and the depressed person and their ability to form an alliance to work together to combat the depression.
Electroconvulsive Therapy (ECT) is more commonly referred to as “electroshock.” Electricity is conducted directly into the brain of the depressed person to induce a seizure in hopes of relieving depressive symptoms. ECT is typically only used in cases of extremely severed depression where other treatment methods have not been effective.
While ECT can be quite effective, it can also have negative side effects such as permanent memory loss or cognitive deficits. These side effects are rare but of enough concern that ECT is often seen as a treatment of last resort.
There are a number of things that people can do for themselves to help manage their depression. Exercise is known to release endorphins in the brain that counteract the effects of depression. Many people with dysthymia, in particular, find that regular exercise can control their symptoms. Similarly, good nutrition, adequate intake of vitamins, and reduced consumption of processed sugars can also help with depression management.
Reducing caffeine intake is very useful to many people with depression, particularly if symptoms appear to be worse in the afternoons. The “crash” that occurs when morning coffee wears off can exacerbate depression.
There are a variety of natural, homeopathic and nutritional remedies that are purported to help with depression. The most common of these is St. John’s wort, a natural plant extract. Some studies suggest that St. John’s wort may be as effective as SSRI medications in treating Major Depressive Disorder, while others have found no such effect. St. John’s wort is not consider to be effective for dysthymia.