What kinds of treatments work for depression?
The type of depression and its severity will determine the treatment plan. The majority of individuals with depression benefit from medication and psychotherapy. Medications can be prescribed by a health care professional or a psychiatrist to alleviate symptoms. Therefore, consulting a psychiatrist, psychologist, or other mental health expert can help many people with depression. Severe depression may require a visit to the hospital or enrolment in an outpatient treatment program until symptoms improve. Exercise can also be beneficial. If all else fails, a doctor might recommend brain stimulation procedures like electroconvulsive therapy or transcranial magnetic stimulation.
Medications
Antidepressants help improve mood and alleviate feelings of melancholy and hopelessness. Norepinephrine, serotonin and dopamine are the three main neurochemicals in the brain. Brain circuits that utilise these chemicals do not function effectively in depression, according to research. Antidepressants change the chemicals in the brain to improve the way the circuits work. It is imperative to consult a doctor about the possible side effects of each drug.
- Selective serotonin reuptake inhibitors (SSRI)
SSRIs are frequently prescribed by doctors. These medications are thought to be safer and have fewer negative side effects than other antidepressants. Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), and vilazodone (Viibryd) are a few known selective serotonin reuptake inhibitors (SSRIs).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs alter serotonin and norepinephrine-dependent brain circuits. Duloxetine (Cymbalta), veniafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezia), and levomilnacipran (Fetzima), fall under this category of medications.
- Atypical antidepressants
These antidepressants do not fall into any of the other antidepressant classifications. They include Bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivol XL), mirtazapine (Remeron), nefazodone, trazodone, and vortioxetine (Trintellix).
- Tricyclic antidepressants
These are older antidepressants, and are also known as cyclic antidepressants. Like SNRIs, they primarily affect norepinephrine and serotonin levels. They aid in the maintenance of serotonin and norepinephrine levels in the brain, which boosts the mood. These antidepressants which include imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin), and protriptyline (Vivactil), can be quite effective, but they have more severe side effects than newer antidepressants, hence they are not a first choice of treatment. Tricyclics are rarely administered unless an SSRI has failed to relieve symptoms. Nausea and drowsiness are common side effects of these medications.
- Monoamine oxidase inhibitors (MAOIs)
These were the first type of antidepressants. Because MAOIs, such as tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan), can have substantial adverse effects, they are normally recommended only when other medications have failed. Because of severe, and sometimes fatal, reactions with foods, such as certain types of cheese, pickles and wines, as well as some pharmaceuticals and herbal supplements, using MAOIs necessitates a restricted diet. It should be noted that MAOIs should never be taken together with SSRIs. Dry mouth, nausea, headaches, drowsiness, and difficulty sleeping are the most typical adverse effects of MAOIs.
- Other medications
Other medications, such as stimulants and anti-anxiety medications may be prescribed by a doctor. This is especially the case if the individual suffers from another mental or physical condition. Anti-anxiety or stimulant drugs, however, do not alleviate depression on their own. Antidepressants can also be used with other medications, such as those used to treat schizophrenia or bipolar disorder.
Other drugs can be combined with an antidepressant to boost its effectiveness. The doctor may suggest combining two antidepressants or adding mood stabilizers or antipsychotics to a treatment plan. For short-term use, anti-anxiety and stimulant drugs may be administered.
Psychotherapy
Psychotherapy is a broad term implying talking with a mental health expert about an individual’s depression and related difficulties in order to receive help. Talk therapy or psychological therapy are alternative names for psychotherapy. Depression can be treated using a variety of psychotherapies, including cognitive behavioural therapy and interpersonal therapy. Other forms of therapy may be suggested by a mental health practitioner. Psychotherapy can assist individuals in the following ways:
- Adapt to a crisis or other pressing issue.
- Replace unhealthy, negative thoughts and habits with healthy, positive ones.
- Examine relationships and experiences, as well as how the individual interacts with others.
- Improve problem-solving and coping skills.
- Identify the factors that contribute to depression and alter the habits that aggravate it.
- Regain a sense of fulfilment and control in life, as well as relief from depression symptoms like hopelessness and anger.
- Learn how to develop realistic life objectives.
- Using healthy practices, to improve the ability to tolerate and accept distress.
- Interpersonal Therapy
Interpersonal therapy is founded on the notion that depression is linked to interpersonal relationships. As a result, the purpose of this therapy is to assist an individual in improving relationship skills, such as communication and dispute resolution. Interpersonal therapy sessions are typically between 12 and 16 weeks long.
- Cognitive Behavioral Therapy
CBT is a type of talk therapy that aims to help break any negative thought or behaviour patterns that are causing or exacerbating depression. This type of therapy is typically short-term and focuses on current issues as well as the acquisition of new coping skills.
- Psychodynamic Therapy
Individuals will understand how depression may be linked to past events and experiences, unresolved conflicts, or unhealed wounds, throughout these therapy sessions. The therapist will assist in resolving these concerns so that individuals may move forward in life.
Alternative forms of therapy
Alternatives to face-to-face office appointments for depression therapy are available and may be a helpful option for some people. Therapy can be administered in a variety of ways, including as a computer software, online sessions, videos, or workbooks. A therapist can guide the programme, or it might be partially or completely self-administered. Before deciding on one of these formats, consult with a therapist to see if they are suited. It is important to note that smartphones and tablets with mobile health apps that provide support and general education about depression are not a replacement for seeing a doctor or therapist.
Other treatment options
Other procedures, known as brain stimulation therapies, may be recommended for some individuals:
- Electroconvulsive therapy (ECT)
Electrical currents are sent through the brain during ECT to alter the function and effect of neurotransmitters in the brain, which helps to alleviate depression. ECT is typically used for persons who do not respond positively to medication, or are unable to take antidepressants due to health concerns, or are at high risk of suicide.
- Transcranial magnetic stimulation (TMS)
For individuals who have not responded to antidepressants, TMS may be an option. TMS uses a treatment coil that is placed against the scalp to transmit brief magnetic pulses to nerve cells in the brain that are involved in mood regulation and depression.
- Vagus nerve stimulation
It is a brain stimulation procedure for those who have not responded to conventional therapies for depression. A pacemaker-like device the size of a stopwatch is implanted in the chest by a doctor. Its wires connect to the neck’s left vagus nerve. This nerve transmits information to and from the brain, and the device sends regular electrical impulses to it. According to studies, this procedure is effective and causes changes in the brain region associated with depression. However, changes in symptoms will be evident after 6 months or more.
Certain lifestyle adjustments can also aid in the lessening of depressive symptoms. Consuming a nutritious diet, exercising regularly, and getting adequate sleep are three of the most significant adjustments anyone can make.
Sources:
1. https://www.helpguide.org/articles/depression/depression-treatment.htm
2. https://www.verywellmind.com/treatments-for-depression-1065502
3. https://adaa.org/understanding-anxiety/depression/treatment-management
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181767/
5. https://my.clevelandclinic.org/health/treatments/9303-depression-alternative-therapies