The most common treatments for depression are antidepressant medications, depression-specific psychotherapy or, most effectively, a combination of the two. Other people also seek treatment in complementary and alternative medicine.
Antidepressants successfully improve mood for 60% to 80% of people who use them as directed. Although there are several different types of antidepressants, many (but not all) belong to one of the following 4 classes of medication:
- selective serotonin reuptake inhibitors (SSRIs): These antidepressants work by keeping increased levels of serotonin available in the brain. Although there is no evidence that SSRIs are more effective than the older antidepressants such as TCAs, people who take SSRIs appear to have less side effects. Therefore, SSRIs are often tried first and have become the most commonly prescribed class of antidepressant.
- selective serotonin and norepinephrine reuptake inhibitors (SNRIs): This class of antidepressants works by keeping increased levels of serotonin and norepinephrine available in the brain. SNRIs have not been shown to be more effective than the older antidepressants such as TCAs, but like SSRIs they have fewer side effects.
- tricyclic antidepressants (TCAs): Before the introduction of SSRIs, TCAs were the most commonly prescribed medication treatments. Because their effectiveness has been well studied, these medications are still used. However, they are now used less often because people experience more side effects.
- monoamine oxidase inhibitors (MAOIs): Less commonly prescribed, MAOIs require those taking them to avoid a number of common foods containing high amounts of the amino acid tyramine. MAOIs now tend to be prescribed only when people have already tried other antidepressants.
|Generic and trade names of specific antidepressants|
|Generic name||Trade name (note that generics are also available for many of these)|
|Selective serotonin reuptake inhibitors (SSRIs)|
|escitalopram||Cipralex®, Cipralex MELTZ|
|Norephinephrine-dopamine reuptake inhibitor (NDRI)||Bupropion||Wellbutrin SR, Wellbutrin XL|
|Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)|
|venlafaxine XR||Effexor XR®|
|Tricyclic antidepressants (TCAs)|
|Noradrenergic and specific serotoninergic antidepressant (NaSSAs)|
|Reversible Inhibitor of MAO-A Enzyme|
|quetiapine extended release||Seroquel XR®|
Regardless of the antidepressant medication selected, it needs to be taken at an adequate dosage for an appropriate period of time. On average, it takes 4 to 6 weeks to feel improvement in depressive symptoms. In many people it can take up to 8 weeks of antidepressant use before they have a complete response to the medication. Because some antidepressants can cause withdrawal-like symptoms (e.g., insomnia, nausea, vomiting, irritability, headache, diarrhea, dizziness), you should never stop taking your medication without first consulting your doctor.
Also, as depression tends to recur, antidepressants should be continued for 6 to 12 months after symptoms are gone (called remission) in order to reduce the chance of a relapse. For people who have had recurrent depression, the doctor may recommend continuing antidepressant medications for a longer period of time.
If people cannot tolerate an antidepressant medication or do not respond to one they are taking, it is reasonable to try a different antidepressant. Evidence supports that switching medications results in good response rates in most people.
In addition to side effects, many antidepressants have interactions with other medications, some of which can be life-threatening. Inform your doctor of all medications you are taking, including over-the-counter or natural health products. You should also let your doctor know if you are pregnant, breast-feeding, or trying to conceive.
Psychotherapy is useful in treating people with depression. For example, psychiatrists who prescribe antidepressants often also offer supportive therapy. The goal is to provide the patient with a supportive, nonjudgmental environment to maintain morale during the early stages of treatment.
More specific therapies, often used as alternatives or together with medications, include cognitive behavioural therapy and interpersonal therapy. Studies have shown that psychotherapy has an actual physiological effect on the brain, easing symptoms of depression.
|Cognitive-behavioural therapy||Cognitive-behavioural therapy helps patients identify and then alter false assumptions about the world and themselves that can lead to depression.|
|Interpersonal therapy||The goals of interpersonal therapy are improved communication skills within social and family interactions. Interpersonal therapy is most effective when major interpersonal issues are present.|
|Motivational interviewing||Motivational interviewing is most effective when depression and substance abuse are both present.|
Life therapy can be used if depression is present with seasonal pattern as a combination with antidepressant medication.
Electroconvulsive therapy (ECT)
ECT is another effective treatment for depression. When a patient receives ECT, an electrical current is applied to the brain to cause a seizure. The procedure is not painful and is performed by skilled doctors and nurses. A typical course of ECT is 6 to 12 treatments, with 2 to 3 treatments given per week. ECT is often reserved for patients who have not responded well to other treatments for depression.
Aside from ECT, other brain stimulation therapies include repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation.
Complementary and alternative medicine
A wide range of complementary therapies and alternative medicines have been promoted for depression. These include:
- dance and movement therapy
- herbal medicines (St. John’s wort, SAMe)
- massage therapy
- music therapy
- omega-3 fatty acids
- relaxation therapy
- sleep deprivation therapy
Although they are popular, it is difficult to comment on the effectiveness of these therapies for depression because of the 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 product St. John's wort can be viewed as effective to help with symptoms of mild-to-moderate depression.
Extracts from St. John's wort (also known by its Latin name Hypericum perforatum) have been used in folk medicine for many years for a wide variety of ailments, including depression. However, it tends to interact with many medications. You should consult your health care professional before starting to use it.
In view of their current popularity, more studies on complimentary and alternative medicine for the treatment of depression are needed. Evidence is limited at this time to support the majority of complimentary and alternative therapies.
Remember to inform your doctor if you are using any alternative medicines.