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Psychotherapy vs. drugs: Your prescription for easing depression

Prozac®, cognitive-behavioural therapy, Zoloft®, interpersonal therapy, Paxil®...these are just a handful of the dozens of options out there for treating depression. In fact, there are so many medication options and psychotherapy styles, finding the right approach may seem so daunting you just want to bury your head in the sand.

But at the heart of the question is whether medications, talk therapy, or some combination of the two is the right tactic for you.

With dozens of antidepressants available by prescription, medication is a popular treatment choice. While medications aren't a cure for depression, they can reduce or eliminate symptoms including sadness, sleep and appetite problems, concentration difficulties, and more.

Researchers don't know exactly how antidepressants work, but they do know that they alter the brain's chemistry by affecting neurotransmitters - the chemicals that nerve cells in the brain use to communicate. Depression is believed to be linked to low levels of the neurotransmitters serotonin, norepinephrine, and possibly dopamine, and different antidepressants work by affecting these neurotransmitters in different ways.

Just as there are different types of medications for depression, there are also different types of psychotherapy. Cognitive-behavioural therapy, which is considered to be one of the most effective forms of psychotherapy for depression, focuses on making you aware of your negative thought patterns and finding strategies that allow for better control over the negative feelings. Psychoanalysis involves examining memories and events from your childhood to help understand your current feelings and behaviour, while psychodynamic psychotherapy explores your unconscious thoughts. Other types of psychotherapy may involve family members and a variety of other techniques.

But don't be fooled into thinking that psychotherapy is all just talk. While there is much more research to be done, scientific evidence has shown that so-called talk therapy has an actual physiological impact on brain activity. Some researchers believe that this is because psychotherapy is a form of learning, which has been shown to create lasting changes on the brain.

One study compared images of the brains of people who had been treated for depression with the antidepressant and the brains of people who had been treated with cognitive-behavioural therapy. Both therapies relieved the symptoms of depression, and similar changes were found on the parts of the brain associated with depression.

So which option is for you? Because of their values and personal beliefs, some people may be resistant to one form of therapy or the other. Some may feel there's a stigma associated with requiring medication to deal with depression or may see it as a sign of weakness, while other people may not like the idea of hashing out personal issues with a psychotherapist.

Side effects are another issue. With some antidepressants associated with such side effects as nausea, changes in sleep pattern, low sex drive, and more, you may need to try out several different kinds in order to find one that you tolerate and find effective. While side effects tend to be most pronounced at the beginning of treatment and then ease, if you find them to be intolerable or they persist for a number of weeks, talk to your doctor or pharmacist. Your dosage may need to be changed or you may want to try another type of antidepressant.

Then there's the length of time before you can see results. Most people start to see results from antidepressants in 1 to 2 months. Generally, improvements occur faster with medications compared to psychotherapy alone.

Many people also find a combination of medication and psychotherapy to be most effective.

The fact of the matter is that when it comes to depression, there isn't one cure-all cookie cutter prescription that works on everyone. The aim of treating depression is to help restore your enjoyment and ability to function so you can live a normal life again, but, unlike other conditions that may have a standard course of treatment, here there is no one "right" way to make that happen with depression.

So talk to your doctor about which method will help bring you back to feeling your best.


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