Depression: treatment

The most common treatment for depression is a combination of antidepressant medications and psychotherapy. Other individuals seek treatment in complementary and alternative medicine.

Antidepressant medications

Antidepressants successfully elevate mood in 60% to 80% of people who use them as directed. Although there are several different types of antidepressants, many antidepressants belong to one of the following three classes of medication:

• Selective serotonin reuptake inhibitors (SSRIs): This class of antidepressants works by selectively keeping increased levels of serotonin available in the brain. Although there is no evidence that any of the SSRIs are more effective than the older antidepressants, individuals who take SSRIs appear to experience fewer side effects. As a result, the SSRIs are often tried first and have become the most commonly prescribed class of antidepressant.
• Tricyclic antidepressants (TCAs): Prior to the introduction of the SSRIs, the TCAs were the treatment of choice. Because their effectiveness has been well studied, these medications are still frequently prescribed as either first-line or second-line medications.
• Monoamine oxidase inhibitors (MAOIs): Less commonly prescribed antidepressants, MAOIs require the avoidance of a number of common foods containing a high content of the amino acid tyramine. MAOIs now tend to be prescribed only when other antidepressants are not effective.

Regardless of the medication used, the selected antidepressant medication needs to be taken at an adequate dosage for an appropriate period of time. Because some antidepressants can cause withdrawal-like symptoms if you stop using them abruptly, you should never go off your medication without first consulting your doctor.

Also, as depression tends to recur, antidepressants should be continued for one year in order to prevent rapid relapse. For those individuals who have had recurrent depression, the doctor may recommend continuing antidepressant medications for a longer period of time.

Besides their own side effects, nearly all antidepressants have complicated interactions with other drugs, some of which can be life threatening. Inform your physician of all drugs you are taking, including any over-the-counter or alternative medications. You should also let your physician know if you are pregnant, breast-feeding, or trying to conceive.

Psychotherapy

Many physicians believe that some type of psychotherapy is useful in treating depressed patients. For example, psychiatrists who prescribe antidepressants often also provide supportive therapy. The intent is to provide the patient with a supportive, nonjudgmental environment in order to maintain morale during the early stages of treatment.

More specific therapies, often used as alternatives or together with medications, include cognitive therapy, interpersonal therapy, behavioral therapy, and psychodynamic psychotherapy. Studies have shown that psychotherapy may have an actual physiological effect on the brain, easing symptoms of depression.

Other biological treatments

Individuals who suffer from seasonal affective disorder may benefit from bright light phototherapy. Electroconvulsive therapy (ECT), a highly effective but controversial treatment, is usually now reserved for the most severe cases of depression or in situations where other treatments do not work.

Complementary and alternative medicine

A wide range of complementary therapies and alternative medicines have been promoted for depression. These include:

• acupuncture
• aromatherapy
• dance and movement therapy
• exercise
• herbal medicines
• homeopathy
• massage therapy
• music therapy
• relaxation therapy

Although they are popular, it is difficult to comment on the effectiveness of some of these therapies for depression because of the very limited published evidence. To further complicate matters, the available data is often difficult to interpret, due to such issues as small sample size, uncertainty of diagnosis, lack of adequate outcome measures, and the personal belief of the investigator in the treatment being studied. As a result, one recent review in this area has concluded that, based on the available evidence, only exercise and the herbal medicine St. John's wort could be viewed as effective symptomatic treatments for mild to moderate depression. And for moderate depression, the jury is still out, since other well-designed studies have found St. John's wort to be no more effective than a placebo (a sugar pill containing no active medication). Little rigorous scientific evidence exists regarding the effectiveness of the other complementary and alternative medicines.

St. John's wort as a treatment for depression is particularly intriguing. Extracts from this plant (also known by its Latin name Hypericum perforatum) have been used in folk medicine for many years and for a wide variety of ailments, including depression. It is particularly popular in Germany, where it is the most widely used antidepressant in that country and where it is licensed as a prescribed medication. A recent comparative study between St. John's wort and standard antidepressants found that St. John's wort seems to be at least as safe as conventional antidepressants, but further studies addressing effectiveness, tolerance, and safety are required. For example, a recent report has suggested St. John's wort may cause cataracts in people who are exposed to bright light and sunshine. In view of their current popularity, studies of other alternative therapeutic options are also needed. Remember to inform your doctor if you are using any alternative medicines.

The benefit of exercise has also been established in several studies, which show physical activity to be as beneficial as medication in easing depression. While the exact reason for this is not known, researchers in one study also found that people who exercised were statistically significantly less likely than those who took medication to relapse into depression.