Depression is a common illness, affecting more than 17 million people in the US each year.
Although the exact cause of depression is not known most researchers believe it to be due to a chemical “imbalance” in the brain.
Antidepressant medications work to reestablish the balance of “neurotransmitter chemicals” in the brain.
Counselling plays a key role to help patients plan effective behavioral strategies to combat their depression.
Many providers of health care may help diagnose clinical depression: licensed mental-health therapists, family physicians, or other primary-care providers, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers.
If one of these professionals suspects that you have depression, you will undergo an extensive medical interview and physical examination. As part of this examination, you may be asked a series of questions from a standardized questionnaire or self-test to help assess your risk of depression and suicide.
Depression may be associated with a number of other medical conditions or can be a side effect of various medications. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of your symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed.
If your symptoms indicate that you have clinical depression, your health-care provider will strongly recommend treatment. Treatment may include supportive therapy, such as changes in lifestyle and behavior, psychotherapy, complementary therapies, and may often include medication. If your symptoms of depression are severe enough to warrant treatment with medication, you are most likely to feel better faster and for longer when medication treatment is combined with psychotherapy. Without treatment, your symptoms will last much longer and may never get better. In fact, they may get worse. With treatment, your chances of recovery are quite good.
Self-Care at Home
Once you are being treated for depression, you can make lifestyle changes and choices that will help you through the rough times and may prevent depression from returning:
•Try to identify and focus on activities that make you feel better. It is important to do things for yourself. Don't isolate yourself. Take part in activities even when you may not want to. Such activity may actually make you feel better.
•Talk with your friends and family and consider joining a support group. Communicating and discussing your feelings is an integral part of your treatment and will help with your recovery.
•Try to maintain a positive outlook. Having a good attitude can be beneficial.
•Regular exercise and proper diet are essential to good health. Exercise has been found to increase the levels of the body's own natural antidepressants called endorphins.
•Try to get enough rest and maintain a regular sleeping pattern.
•Avoid drinking alcohol or using any illicit substances.
Therapy frequently includes antidepressant medication and supportive care such as psychotherapy. Other less widely used therapies, such as electroconvulsive therapy, are used in severe cases.
Therapy may be provided by your health-care provider or by a specially trained mental-health professional.
•Psychiatrists are medical doctors who have completed specialized training in mental disorders.
•Psychologists are nonphysicians who have graduate (after college) and doctorate-level (PhD) training that includes experience in mental-health-care facilities.
•Psychotherapists may have a degree in medicine (psychiatry), psychology, social work, nursing, mental-health counseling, or couples and family therapy, as well as additional more specialized education or training.
Regardless of which treatment is used, psychotherapy, medication, or a combination, most people with depression can safely be treated in a series of office (outpatient) visits. Inpatient care (in the hospital) may be necessary for people with more serious symptoms and is required for those who are contemplating suicide or cannot care for themselves.
The major classes of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the atypical antidepressants.
SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses. These drugs are best known by their brand names.
TCAs are sometimes prescribed in severe cases of depression or when SSRI medications don't work. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Interestingly, premenopausal women tend to improve more and have less side effects when treated with SSRIs versus TCAs, while men tend to do better when their depression is treated with a TCA. Like the SSRIs, most of these are better known by their brand names. Examples include
•protriptyline (Vivactil), and
Atypical neuroleptic medications are increasingly being prescribed in addition to an antidepressant in people with unipolar depression who do not improve after receiving trials of different antidepressants and in addition to, or instead of, an antidepressant in people who suffer from bipolar disorder. Although clozapine (Clozaril) is often considered to be the first discovered atypical neuroleptic, the risk it carries for severe anemia and decrease in bone-marrow functioning generally disqualifies its use in depressed patients. Examples of other atypical neuroleptics include
•risperidone (Risperdal), and
Non-neuroleptic mood-stabilizer medications are also sometimes used with an antidepressant to treat people with unipolar depression who do not improve after receiving trials of different antidepressants and in addition to or instead of an antidepressant in those who suffer from bipolar disorder. Examples of non-neuroleptic mood stabilizers include:
•lithium (Lithium Carbonate, Lithium Citrate),
•divalproex sodium (Depakote),
•carbamazepine (Tegretol), and
Of the non-neuroleptic mood stabilizers, Lamictal seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant.
The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions with some medications and specific foods, the MAOIs may not be taken with many other types of medicines, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include
•phenelzine (Nardil) and
The atypical antidepressant medications work differently than the commonly used SSRIs. These medications might be prescribed when SSRIs have not worked.
One-half to two-thirds of people who take antidepressant medications get better.
•It may take anywhere from one to six weeks to start feeling better. Don't give up taking the medication if you don't feel better right away.
•Your health-care provider will see you again during this period to see if your body is tolerating the medication and if your symptoms are better. If they are not, he or she may adjust your dose or prescribe a different medication.
Even after you feel better, you should continue to take the medication for six to nine months.
•Stopping the medication too soon may cause your symptoms to return or to get worse.
•Some people need to take the medication for longer periods of time to keep the depression from returning.
Do not stop taking the medication without talking to your health-care provider.
•Stopping abruptly may cause serious withdrawal effects.
•If you and your health-care provider agree it is time to stop the medication, the dose usually will be slowly tapered to prevent these effects.
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