An Overview of the Treatments for Depression

Depression is treatable and most people see improvements in their symptoms with psychotherapy, medication, or a combination of the two. That said, what works for one person might not necessarily work for another.

It's important to talk to your physician and or healthcare provider about which options may be most effective for you. To help with that discussion, here is an overview of the most commonly used treatments for depression.

Psychotherapy

Psychotherapy is often referred to as "talk therapy." There are various approaches to psychotherapy. Many therapists specialize in a particular type of therapy to treat depression, but sometimes they pull from multiple approaches to create a more individualized therapy that is based on your specific treatment needs. 

Since many types of psychotherapy are available, one study set out to discover which ones are most effective for depression. Researchers found that all of the following provide good results.

Interpersonal Therapy

Interpersonal therapy is based on the idea that depression can be related to our relationships. Therefore, the goal of this type of therapy is to help you improve your relationship skills, such as becoming a better communicator and learning how to resolve conflict. Interpersonal therapy sessions are relatively short in duration, usually lasting between 12 and 16 weeks.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy designed to help you change any negative thought or behavior patterns that may be contributing to or worsening your depression. This therapy is also generally short-term and focuses on your current problems and learning new coping skills. 

Social Skills Training

Social skills training teaches you how to interact with others more effectively so you can have healthy relationships. The goal is to improve your communication skills and learn how to build a strong social network with others, such as by creating relationships based on honesty and respect. 

Psychodynamic Therapy

Psychodynamic therapy is the type of therapy often portrayed in movies or pop culture. During these therapy sessions, you learn how your depression may be related to past experiences, unresolved conflicts, or unhealed wounds. The therapist will help you address these issues so you can move forward in your life. 

Supportive Counseling

Supportive counseling is less structured than some of the other therapies and mainly involves listening to you share whatever is on your mind. You are invited to talk about any issues you want and the therapist works with you to show understanding and support.

Behavioral Activation

Behavioral activation teaches you how to set goals and include more pleasant activities in your lifestyle. The goal of this therapy is to avoid isolation and increase the positive interactions you have with your environment. By getting active and engaging in more pleasurable activities, your symptoms of depression may be reduced.

Problem-Solving Therapy

Problem-solving therapy aims to define your most pressing issues, then guides you to come up with multiple ways to overcome them. The therapist helps you evaluate all of your options and choose the best solution for you.

Family or Couples Therapy

Family or couples therapy may be considered when depression affects others in the household. This involves looking at each of your roles and expectations. This type of therapy also involves educating your loved ones about depression and how it affects you.

Medication

There are many different medications that can help reduce the symptoms of depression. Here are some classes of medication that are commonly used. 

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are the most-prescribed medications for depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), and Luvox (fluvoxamine) are commonly prescribed brand names.

SSRIs have been found helpful for both severe and non-severe depression. They also tend to have fewer side effects compared to other antidepressant types.

Note that SSRIs should not be prescribed together with some monoamine oxidase inhibitors (MAOIs). This is due to the potential for a dangerously high serotonin buildup, which can cause serotonin syndrome. 

Serotonin and Norepinephrine Reuptake Inhibitors

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer type of antidepressant that work similarly to SSRIs. The main difference is that they also block the body's reuptake of norepinephrine, another neurotransmitter involved in mood.

Common medications in this class are Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (deslavenfaxine). Like with SSRIs, the Food and Drug Administration indicates that SNRIs should not be taken with MAOIs, and care should be followed if you have liver or kidney issues or narrow-angle glaucoma.

Norepinephrine and Dopamine Reuptake Inhibitors

Norepinephrine and dopamine reuptake inhibitors (NDRIs) can help with depression by blocking both norepinephrine and dopamine transporters. NDRI medications include Focalin (dexmethylphenidate), Ritalin (methylphenidate), and Wellbutrin (bupropion).

Wellbutrin is sometimes preferred because it is less likely to have the sexual side effects that are common in the other antidepressants. Plus, the side effects that are common this medication, which can include headache, trouble sleeping, and dizziness, generally go away within one to two weeks.

Tricyclic Antidepressants 

Tricyclic antidepressants (TCAs) were among the first antidepressants developed. Research shows that tricyclics are just as effective as SSRIs for treating chronic depression and dysthymia, also known as persistent depressive disorder.

Drugs that fall into this category include Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline). Tricyclic antidepressants have more side effects than newer options but can be more effective for certain patients.

Monoamine Oxidase Inhibitors 

Monoamine oxidase inhibitors (MAOIs) are another older type of antidepressant. Like tricyclics, MAOIs are not generally a first-choice treatment, but they can sometimes be helpful for more difficult-to-treat depression. MAOIs include Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine).

If you are taking an MAOI, you will have to follow certain dietary restrictions to prevent a reaction that can cause high blood pressure. You will also have to be careful about interactions with certain other medications.

Newer Medication Options 

Sold under the brand name Spravato, esketamine was FDA approved in March 2019 and is authorized for adults with treatment-resistant depression, meaning that other medication options have not worked.

Esketamine is a nasal spray that works within 20 to 40 minutes, compared to the weeks or months that it takes for other medications to help you start feeling better. However, there are some risks associated with this drug.

For example, esketamine is a variant of the hallucinogenic drug ketamine and may cause sedation and out-of-body experiences. For this reason, you can only receive the drug at a certified location and will be monitored for several hours after taking it. Esketamine must also be prescribed along with an oral antidepressant.

Procedures

Some depression treatment options are more invasive in nature. There are three that are used most often when a patient is not responding to other forms of treatment.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) involves using a form of electrical stimulation to the brain to create seizures. It works by changing the brain's chemistry and environment. You are under general anesthesia when the doctor performs ECT, so you don't remember the treatment session.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is another form of brain stimulation. However, TMS is less invasive than ECT and works by placing a small device on the skull to stimulate the brain's neurons. This changes their activity, thus decreasing feelings of depression.

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) also sends electrical pulses to the brain, this time through the vagus nerve. Yet, one difference between VNS and the other two options is that this often involves implanting a device in the chest. 

Self-Help Strategies

Some self-help activities have also been found useful along with medication and therapy for easing depression. Self-help methods for the treatment of depression may also be helpful for someone who is unable to access professional resources or has mild symptoms. These strategies include the following.

Support Groups

Support groups allow you to talk to other people who can relate to the issues and symptoms you are experiencing with your depression. Many people report that being a part of these groups helps them realize that they're not alone and provides ideas and resources for feeling better.

Online Resources

There are also many websites, chat rooms, and online programs that help people with depression. The benefit of this option is that help is available to you at all times of the day and night. Simply go online and the information and support is there.

Self-Help Books

Self-help books can teach many of the same skills that people gain in therapy. The drawback is that this option requires that you be able to apply the information to your own life. Many self-help books are available for free through local libraries. You can also find them in online bookstores, giving you the ability to see which ones have the highest reviews.

Lifestyle Changes

Making certain lifestyle changes can also help you reduce your feelings of depression. Three of the most important changes you can make include eating a healthy diet, getting regular physical exercise, and getting enough sleep.