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An Overview of Depression Treatment Options

Depression can be treated effectively with antidepressant medications and psychological therapies. Research suggests that antidepressant medications and psychotherapy are equally effective for treating mild to moderate cases of depression. For more severe cases, medications are clearly superior. Electroconvulsive therapy (ECT) is the most effective treatment for depression with psychotic symptoms or when depression is life threatening.

Antidepressant Medications
There are different classes of antidepressant medications and each type has different side effects. Fortunately, all classes of antidepressants are effective. The patient and doctor just have to find the one that works best for the individual. In fact, 60 to 70% of depressed patients who are given an antidepressant recover from their depression in three to six weeks, provided that the dose is sufficient and that the patients take their medication each day as prescribed.

The goal of treatment is complete relief of depressive symptoms, not just partial relief. Patients should be open with their doctors about how they feel after they begin taking an antidepressant. If they feel better after three to six weeks, but their symptoms are still present, the doctor will likely increase the dose of the antidepressant that they are taking. If they cannot tolerate a higher dose, the doctor will likely switch to another medication. If one?s symptoms are no better or worse after three or four weeks, the doctor should suggest that the patient try a different antidepressant.

Issues to Discuss With Your Doctor

  1. Patients should spend time talking with their doctors about which type of drug will work best for their particular depressive symptoms.

  2. Patients should ask about the side effects that they might experience while they are taking the drug.

  3. They should find out what type of monitoring will be necessary to ensure that they are using the drugs safely.

  4. They should find out how long they are expected to take the drug.

There are a number of effective psychotherapies that have been developed specifically to treat depression, including cognitive-behavioral therapy, interpersonal psychotherapy, and short-term or focused psychodynamic psychotherapy. Clinical trials show that these approaches are equally effective as antidepressant medications for patients with mild to moderate depressive symptoms. Basically, these therapies target one or more aspects of a patient?s thoughts, feelings, or personal interactions that bring on and sustain an episode of depression. Patients should avoid therapies that seem open-ended or that have poorly defined goals. More information about specific types of pscyhotherapies can be found in the Psychotherapy section of the Mental Health Center.

ECT (Electroconvulsive Therapy)
ECT involves the deliberate induction of a brain seizure by passing a small electrical current through the brain. This treatment is recommended for patients with severe, chronic depression, medication resistant depression, catatonia, or serious medical problems. ECT has a success rate of over 80% and can produce a rapid remission of symptoms within one to three weeks. However, ECT cannot prevent a relapse. Patients who have completed a course of ECT are prescribed antidepressant medication, or they receive ECT once a month to prevent recurrence. ECT is performed on an inpatient or outpatient basis and requires general anesthesia. Overall, modern ECT is considered general safe, but there is a varying degree of risk of memory loss and confusion. The memory loss varies from person to person. Some individuals lose only memories surrounding each ECT treatment, while others lose entire chunks of memories of significant past life events. This side effect should be thoroughly discussed with your doctor before proceeding with ECT treatment.

Treatment Resistant Depression
If two adequate antidepressant regimens fail to help an individual, he/she is considered to have treatment resistant depression and should see a psychiatrist immediately.

Treating Relapses
Once depression is under control, patients should continue taking their antidepressant medications at the same dose for nine to twelve months to prevent a relapse. After a second depressive episode, the doctor may prescribe an antidepressant for as long as two years. Patients who have had three or more episodes of depression have a very high risk of recurrence. These patients may need to take an antidepressant for an indefinite period (possibly for life) to decrease the chance of future depressive episodes.

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Last reviewed: By John M. Grohol, Psy.D. on 29 Mar 2015
    Published on PsychCentral.com. All rights reserved.