Early treatment may keep the depression from becoming more severe or chronic. Many types of psychotherapies and medications are available.
Psychotherapy for Depression
Popular types of psychotherapies include:
- Behaviour therapy (focuses on current behaviour)
- Cognitive therapy (focuses on thoughts and beliefs)
- Interpersonal therapy (focuses on current relationships)
Therapists try to understand an individual's personal and social relationships that may have caused or contributed to the depression. Depression, in turn, may make these relationships more difficult. A therapist can help an individual understand his or her illness and the relationship between depression and conflicts within a person's life.
Depression usually responds best to a treatment of both therapy and medicine.
Depression can result when individuals constantly scold themselves, expect to fail, make inaccurate assessments of what others think of them, and have negative attitudes toward the world. Psychotherapy helps many people replace negative beliefs and thought patterns with more positive ones.
In many instances, psychotherapy is combined with prescription medication. This treatment will help patients during their therapy and is very important when depression has caused a loss of work or has affected daily activities. Since medication may require several weeks to be effective, electro-convulsive shock therapy may be used when there is a high risk of suicide. Electroshocks have been viewed negatively by the media, but they are still useful in select individuals.
Medications for Depression
It takes two to six weeks for most antidepressant medications to have their full effect (in some cases, eight to ten weeks may be required), although side effects from the drug may begin immediately. The time before the drug becomes effective varies with the drug and with the individual. Antidepressants may have to be taken regularly for months, even years, for gains to continue. A full course of treatment should be taken in order to avoid relapse.
Your doctor may have you try several medications to determine which works best for you. And recent research has shown increased effectiveness in the treatment of depression when drugs from two classes of antidepressants are used together. The major types of medication used to treat depression include:
Over the past 20 to 30 years, many new antidepressant drugs have become available. They act primarily by increasing the availability of individual neurotransmitters, such as norepinephrine, serotonin, or dopamine. These medications are safer in overdose situations (they're less likely to be fatal if someone takes more than the prescribed dose) than their older counterparts, and their side effects (diarrhea, digestive problems, stimulation, insomnia, weight loss) tend to be fewer, better tolerated, and more likely to fade than those of earlier antidepressants.
One of the first of these newer antidepressants to hit the market was fluoxetine (Prozac), which belongs to a type, or class, of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Other SSRIs include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft). SSRIs have become the most commonly prescribed antidepressant medications.
Other newer antidepressants that affect specific neurotransmitters are the serotonin and norepinephrine reuptake inhibitors (SNRIs), which include duloxetine (Cymbalta) and venlafaxine (Effexor), and the norepinephrine and dopamine reuptake inhibitor (NDRI) bupropion (Wellbutrin).
From the 1960s through the 1980s, the tricyclics were the first-choice medication for the treatment of depression. Although they have been replaced by the SSRIs as the typical first-line drug treatment, they are still prescribed today for more severe cases of major depression. The side effects commonly caused by tricyclic antidepressants include weight gain, drowsiness, and constipation, which tend to be less acceptable to patients than the side effects caused by the newer antidepressants.
Monoamine oxidase inhibitors:
Monoamine oxidase inhibitors (MAOIs), an older class of antidepressants, are sometimes prescribed for those who do not respond to SSRIs or tricyclic antidepressants. MAOIs may also be prescribed for individuals who have bipolar disorder (also known as manic-depressive illness), generalized anxiety and phobic disorders, and panic attacks.
One problem with the MAOIs is that they may lead to unpredictable and occasionally serious interactions with some foods and other medications. Individuals taking MAOIs must follow a special diet, avoiding tyramine (an amino acid); otherwise, they may experience a dangerous rise in blood pressure. Tyramine is present in many foods, including fermented cheese, liver, lima beans, red wines, and beverages containing caffeine and chocolate.
Lithium has long been prescribed for people who have bipolar disorder (also known as manic-depressive illness), which is discussed next. Lithium, however, is also prescribed for a small number of people who suffer from depression without mania. The people most likely to respond to lithium therapy are depressed individuals whose family members have manic-depression or whose depression is recurrent rather than constant.
Lithium acts without causing sedation (drowsiness), but it requires a period of use before it becomes effective and must be used cautiously, since the difference between a safe, effective dose and a toxic one is relatively small.
Medication and therapy are not the only treatments for depression. On the next page, we will explore some alternative therapies for depression.
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