How is depression treated?

Psychotherapy, which is known as psychological counselling, and medications are regarded as effective in most cases of depression. Medication may be prescribed by the psychiatrist or doctor to help relieve the symptoms. Keep in mind that a lot of people who suffer from depression will benefit from sessions with a mental health professional such as a psychologist or psychiatrist.

In some more severe cases, a hospital stay may be necessary or joining an outpatient program is advisable until the symptoms improve. The following are the treatment options for depression:

Medications

There are a number of types of medications, known as antidepressants, available for the treatment of depression, it is advised that the possible side effects be discussed with the prescribing doctor.

What are the side effects of antidepressants?

A very effective means of treatment for depression is the use of antidepressants. These can be used to treat both anxiety and depression. However, they do unfortunately come with some adverse side effects. These side effects include:

• Fatigue
• Weight loss
• Weight gain
• Insomnia
• Memory loss
• Loss of libido
• Nausea

How do antidepressants work?

Antidepressants such as SSRIs, the abbreviation for selective serotonin reuptake inhibitors, also known as happy pills or happy tablets, work through increasing the serotonin levels of the brain. Serotonin is one of the brain’s chemical messengers, also known as a neurotransmitter, and is responsible for carrying signals between the brain cells. Neurotransmitters basically allow for the brain to communicate and tell the body what to do. SSRIs stop the brain from reabsorbing the serotonin, or rather, block the reuptake of it, and therefore make it possible for more serotonin to be present in the brain, this helps improve the patient’s mood.

The list below are some antidepressants that are normally prescribed to treat depression:

• SSRIs (Selective serotonin reuptake inhibitors) – An SSRI is normally prescribed first by doctors. These kinds of medications tend to be safer to use as they have less side effects than others. Types of SSRIs include:
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Paroxetine (Paxil, Pexeva)
• SNRIs (Serotonin-norepinephrine reuptake inhibitors) – These types of medications help in easing symptoms of depression that include sadness and irritability. Types of these medications include:
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq, Khedezla)
• Venlafaxine (Effexor XR)
• Levomilnacipran (Fetzima)
• NDRIs (Norepinephrine-dopamine reuptake inhibitors) – These are a popular type of medication as they are not associated with any sexual side effects and are used to treat chronic pain and menopausal symptoms. The most common medication is Bupropion (Wellbutrin, Aplenzin, Forfivo XL).
• Atypical antidepressants – There are nerve cells that transmit signals in the brain using chemicals known as neurotransmitters, such as serotonin, norepinephrine and dopamine. Antidepressants are believed to change or alter these chemicals to improve their efficiency and help regulate someone’s mood. Atypical antidepressants do not fit into the same categories as other antidepressants and each has a unique effect and way of working. Mirtazapine (Remeron), trazodone, vilazodone (Viibryd) and vortioxetine (Brintellix) are some examples of these.
• Tricyclic antidepressants – These types of antidepressants are normally very effective in treating the symptoms of depression but have more severe side effects than others. Because of this, tricyclics are not normally prescribed unless an SSRI has first been tried. These include:
• Imipramine (Tofranil)
• Trimipramine (Surmontil)
• Doxepin
• Protriptyline (Vivactil)
• Amitriptyline
• Nortriptyline (Pamelor)
• MAOIs (Monoamine oxidase inhibitors) – These kinds of medications also have more serious side effects and are generally only prescribed once other antidepressants have been tried and deemed ineffective. These medications also require a very strict diet as they can be extremely dangerous when taken with certain foods and other medications. Dangerous interactions occur with some wines, pickles, birth control pills and decongestants. These types of medications cannot be combined with SSRIs. MAOIs include:
• Tranylcypromine (Parnate)
• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Selegiline (Emsam) – This is a newer kind of MAOI that comes in the form of a skin patch and causes fewer side effects than other forms of MAOIs.

Other medications 

It is possible to mix other medications with antidepressants that have been prescribed. In some cases, a doctor may prescribe the combination of two antidepressants such as antipsychotics and mood stabilisers. Stimulant medications and anti-anxiety medications are also able to be prescribed for short-term use. 

Finding the right medication for depression

Doctors can sometimes judge the efficacy of a medication and how it will work for the patient according to how a family member with depression may have responded to the same type of drug.

In other situations, the patient may have to try a variety of drugs and combinations thereof before finding the right kind of treatment. Patience is required from both the doctor and patient as the medications often need a number of weeks to achieve their full effect and show results, this is also the amount of time it will take for the side effects to become prominent if there are any.  

Risks of abruptly stopping antidepressant medication

It is advised that patients do not stop their medication without first talking to their doctor. Antidepressants have not been deemed addictive, however, in some cases, a physical dependence on them can occur.

Suddenly stopping one’s treatment or missing a number of doses can result in the symptoms of withdrawal or worsen depression. It is best to always work with a doctor to decrease or increase the dosage safely.

Pregnancy and antidepressants

If one happens to be pregnant or is breastfeeding, then some types of antidepressants may pose a risk for both the mother and baby. If a woman is diagnosed with depression, then it is best to speak to a doctor about medications that are safe for both herself and her baby preferably before falling pregnant or as soon she finds out that she has conceived.  

Increased suicide risk and antidepressants

Doctors say that most types of antidepressants are safe to take, however, all of them have warnings against taking them without extreme caution and care. There are some cases where patients under the age of 25 have experienced increased suicidal thoughts when taking prescribed antidepressants. This is particularly seen the in the first couple of weeks after the medication has been started or if the dosage has been changed.

Any patient who is taking antidepressants should be monitored for unusual behaviour, particularly in the first few weeks. Bear in mind, antidepressants are meant to reduce the risk of suicide and are usually effective in doing so over a period of time through improving the patient’s mood. That said, not all medication has the desired effect and often types and dosages need to be altered in order to find the best one to treat the person concerned.

Psychotherapy

This refers to the patient attending sessions with a mental health professional where they can discuss their symptoms and learn how to deal with them. This is normally done with the help and guidance of a psychologist or a psychiatrist.

Psychiatrists are trained medical professionals who are able to prescribe medications such as antidepressants as well as offer psychotherapy. Psychologists, on the other hand, offer psychotherapy exclusively. Psychotherapy refers to treating mental and emotional issues through the means of behavioural intervention. This is also known as psychological therapy or talk therapy.

There are a number of different types of psychotherapy available, these include interpersonal therapy and cognitive behavioural therapy. IPT, which is interpersonal therapy, is a kind of therapy that focuses on resolving interpersonal issues, as well as facilitating symptomatic recovery. It follows a time-limited approach that is highly structured, intended to be completed with 12 to 16 weeks.

Cognitive behavioural therapy is a kind of psychotherapy that involves challenging negative thought patterns in order to alter them and treat certain mood disorders.

Psychotherapy is able to assist patients in the following ways:

• Helping them to adjust to a difficult current crisis
• Identifying negative behaviours and beliefs and replacing these with positive ones
• Exploring experiences and relationships and then helping to create positive interactions on social and personal levels
• Finding more effective ways to solve problems and deal with current issues
• Identifying problems that are contributing to depression and changing behaviours that make the condition worse
• Teaching the patient to develop goals for their life
• Developing the ability to accept and tolerate distressing situations through practising healthier behaviours

Residential and hospital treatment

Some cases of depression are extremely serious and require a hospital stay in order for the patient to be closely monitored. This is sometimes needed when the patient is unable to care for themselves or is in danger of inflicting self-harm. This hospital stay will involve psychiatric care that helps the patient remain calm and not attempt to hurt themselves until their mood and psychological state has improved.

In other cases, the patient may only need partial hospitalisation or a day treatment program in order to get the help they need. These kinds of programs provide outpatient support as well as the counselling that is required to manage symptoms and get them and the patient’s mental health under control.

Other treatment options

In some cases, doctors may recommend the treatments listed below:

• ECT (Electroconvulsive Therapy) – This kind of treatment involves passing electrical currents through the patient’s brain. This procedure is performed under anaesthetic and is said to impact the ability of the neurotransmitters in the brain to allow for immediate relief of symptoms associated with even severe depression, this is done when other means of treatment are seen to be unsuccessful. The side effects are normally tolerable, a headache being the most common. Memory loss may also be one of the temporary side effects. Patients who typically undergo ECT do not respond to medications or cannot take antidepressants due to other health concerns.

• TMS (Transcranial Magnetic Stimulation) – This kind of treatment is often an option for patients who do not respond to antidepressant medications. During this procedure, the patient will sit in a recliner chair, and whilst the patient is awake, the doctor will place a treatment coil against their scalp. This coil will send brief pulses of magnetic frequencies to stimulate the nerve cells in the brain that are involved in depression and regulating mood. This treatment is usually done over a period of six weeks, five times a week.  

**My Med Memo: In the majority of cases, depression can be effectively treated. The earlier the treatment begins, the better the outcome. Always keep in mind that no two cases of depression are the same. There is no such thing as a ‘one-size-fits-all’ approach when it comes to treating depression. It often takes patience and trial and error to find the best treatment plan.

Alternative medicine

This is an unconventional means of treatment. These include complementary medications such as herbal supplements, acupuncture, nutritional therapy and even light-therapy. It is best not to replace conventional medications and prescriptions with unconventional ones.

In the case of depression, unconventional means of treatment cannot be viewed as medical care. It is best to always understand the benefits as well as the risks associated with alternative medicine options and speak to a doctor before exploring unconventional routes as many of these supplements can interact with prescription medications and have adverse effects.

Alternative supplements

Examples of alternative supplements that are often used for depression when following an alternative route include:

• St. John's wort – This is a herbal supplement that is yet to be approved as a means of treatment for depression in the U.S. by the FDA (Food and Drug Administration). However, it is a very popular treatment in Europe. Effective results are often seen in those who have a mild case of depression. This supplement has been known to interfere with several medications, and because of this, the use of it should be done with caution. Interferences with other medications include those used in chemotherapy, birth control pills, AIDS/HIV drugs, and drugs used to aid the body in not rejecting an organ transplant. The combination of St. John’s wort with antidepressant is also known to have various side effects.
• SAMe – This is a dietary supplement and is pronounced ‘sam-E’. It is a synthetic or artificial form of the chemical S-adenosylmethionine that is naturally found in every tissue in the body and is pronounced “es-uh-den-o-sul-muh-THIE-o-neen”. This chemical is a methyl donating compound circulating in the blood and provides methyl groups that help maintain metabolic reactions. A metabolic reaction is a chemical reaction that occurs in all living organisms and includes processes such as digestion and the transport of nutrients. A methyl group is known as a molecule containing one carbon atom that is surrounded by three atoms made of hydrogen. SAMe is also not approved by the FDA as a means of treatment for depression. This supplement requires more research to determine the positive effects of it as it has been known to trigger mania in some patients who have bipolar disorder.
• Omega-3 fatty acids – These are known as healthy fats that are found in flax oil, flaxseed, cold-water fish, walnuts and several other foods. These are considered to be safe, however, when taken in high doses these supplements have been known to adversely interact with other medications. The effect of Omega-3 fatty acids on depression is yet to be proven.

Dietary and nutritional products are not monitored and researched in the same way that conventional medications are. Therefore, their side effects and safety is not documented thoroughly. Because of this, it is best to always speak to the healthcare professional or doctor involved in the treatment of depression in order to ensure that all the risks have been taken into account for the specific case.

Mind and body connections

Some practitioners of alternative treatments for depression believe that the mind and the body need to be in harmony in order for the body to be healthy. Relying on these therapies as the only means of treatment is not generally advised in the treatment of depression. However, many of these treatments can often help conventional medications to work well and serve as a complementary form of treatment.

The following are examples of mind and body techniques that can be performed:

• Yoga, tai chi and other relaxation techniques
• Acupuncture
• Guided imagery – This is a mind-body intervention where a trained professional will generate and evoke certain mental images that are able to re-create or stimulate sensory perceptions of sounds, tastes, movements, and imagery that create a state of relaxation for the patient and help them to focus on their mental experience associated with certain senses.
• Meditation
• Light therapy – This kind of therapy is often used to treat SAD (seasonal affective disorder) through exposing the patient to artificial light by using light therapy boxes that contain a light brighter than natural light. This is said to help boost the patient’s mood and brain activity.
• Aerobic exercise
• Art or music therapy
• Massage therapy

 

Home and lifestyle means of treatment

It is not advised that depression be treated through lifestyle and home remedies as the sole means of treatments. However, it can complement professional and conventional means of treatment and help improve the experience of depression for the patient. The following are a set of lifestyle adjustment steps that can be done at home to assist with depression:

• Sticking to the treatment plan – It is advised that the patient does not skip their psychotherapy sessions or other appointments with their doctor/s. It is often the case when the patient is feeling better that they skip their medications. If this happens, their depression can often come back or they will go through withdrawal-like symptoms. When one is feeling better, it means that the medication is working, not that it should be stopped.
• Learning about depression – As a patient or loved one of a depression sufferer, educating yourself on the condition can motivate and empower you, giving you knowledge about treatment and what is to be expected. Encouragement from friends and family can also provide a strong base of support for the person concerned.
• Paying attention to the warning signs – It is advised that the patient, and in some cases, their loved ones, work with the psychologist or mental health professional to help identify the triggers of the symptoms of depression. If any adverse changes in symptoms are noticed, then it is best to discuss these with the doctor.
• Avoiding the use of recreational drugs and alcohol – In some situations, the symptoms of depression may appear to disappear when the patient is taking drugs or drinking alcohol. However, the symptoms will actually progress over time and, in turn, be harder to treat. Substance abuse should not be taken lightly and the patient should speak to their doctor if they suffer with it.
• Taking care of oneself – Eating healthy and nutritional foods, getting at least 30 minutes of physical exercise a day and getting enough sleep is important for both one’s mental and physical well-being. Consider swimming, gardening or jogging as exercise, as this can also help one to sleep better and have more energy during the day for other tasks. If sleeping tablets are needed, then the patient is advised to speak to their doctor.