Depression Treatment: Your Options

Your treatment plan for depression will depend on the type you have and how severe it is. Some people get psychotherapy. Others also take antidepressants or get other treatments. Exercise can also be part of the plan.

If those don't give you enough relief, there are more options. For instance, your doctor may suggest brain stimulation techniques such as electroconvulsive therapy (also called ECT or electroshock therapy), transcranial magnetic stimulation, or vagus nerve stimulation.

If you have bipolar depression, your doctor may prescribe different types of medicines, such as mood-stabilizing drugs or certain antipsychotic medicines, instead of antidepressants.

Everyone is different. It may take some trial and error to find the treatment plan that works best for you. It also takes time for an antidepressant to have its full effect. You may meet with several doctors or therapists before you find the one you want to work with.

Be patient and tell your doctor how you’re doing. Your openness will help him find solutions, so you feel better ASAP.

What Are Depression Drugs?

These medicines, called “antidepressants,” lift your mood and ease the sadness and hopelessness you feel. You’ll work with your doctor to find the one that works best for you with the fewest side effects.

For in-depth information, see WebMD's Depression Medicines.

How Do Antidepressants Work?

It’s all about the brain circuitry that’s involved in managing your mood.

Three key chemicals are norepinephrine, serotonin, and dopamine. Research shows that in depression, brain circuits that use these chemicals don't work properly. Antidepressants can help these brain circuits work better by tweaking the chemicals that run through them. That can help improve mood, although the exact way they work is still not fully understood.

What Are the Types of Antidepressants?

The major types are:

SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed type of antidepressant. They can make brain circuits that use serotonin work better. Examples include:

SNRIs (serotonin and norepinephrine reuptake inhibitors) affect brain circuits that use both serotonin and norepinephrine. These SNRIs treat depression:

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Tricyclic antidepressants (TCAs) are an older type of depression medication. They mainly affect levels of norepinephrine and serotonin. They are effective, but because they can have more side effects than other drugs, doctors typically don’t prescribe them first.

MAOIs (monoamine oxidase inhibitors) are also an older type of antidepressant. They tend to work best in people who don’t get relief from other depression drugs. If you take one, you must avoid certain foods like cheese and aged meats, and certain medications (like decongestants or some cough syrups or prescription painkillers) that can have a dangerous interaction with MAOIs. For this reason, doctors usually don’t prescribe these drugs first. Examples:

When Are Other Medicines Used?

Doctors sometimes prescribe other medications, such as stimulants and anti-anxiety drugs, as well as an antidepressant. This is especially likely for people who have another mental or physical condition. But anti-anxiety medications or stimulants don’t treat depression on their own.

Other medicines, such as those used to treat schizophrenia or bipolar disorder, can also help when added to an antidepressant.

What Is Psychotherapy's Role?

Psychotherapy is “talk therapy,” where you meet with a psychiatrist, psychologist, social worker, or other trained mental health professional. You will learn new ways to handle challenges and change ways of thinking that depression affects.

It’s a key part of depression treatment for many people. In people with mild to moderate depression, it may work as well as an antidepressant.

There are different kinds of psychotherapy. You may go on your own, with your family, or in a group. Your doctor will help you find the best type of psychotherapy for you.

For in-depth information, see WebMD's Psychotherapy for Depression.

Exercise to Curb Depression

You already know that working out is good for your heart, muscles, and bones. Research shows that it’s also an effective treatment for mild depression. In one review of studies on the topic, experts concluded that it works as well as medicine or psychotherapy.

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Each of those studies was different. Some lasted for a few months. Some assigned depressed people to specific exercise plans to do on their own or in a group. The result: Exercise eased depression symptoms and helped to keep them at bay.

When you’re depressed, you may not have the energy to be active. Or you may find it hard to keep it up. Just remember, it does help.

Although there is no “dose” that is proven to work for everyone, you may want to start with 3-5 sessions a week that last for 45 minutes to an hour each. If that sounds like a lot, work up to it. Some is better than none.

You may also need to take medicine or get psychotherapy. That’s OK. Being active still helps.

If you’re not active now, ask your doctor for their advice on what activities are best for you and how often you should work out to see benefits.

When Is Electroconvulsive Therapy Recommended?

Electroconvulsive therapy (electroshock therapy, or ECT) is used to treat severe depression that doesn’t respond to other treatments.

During ECT, you’ll be given medicine to go to sleep while a doctor sends a brief and painless electric current through your scalp to your brain. This current induces a seizure. ECT is both safe and effective at treating depression.

Doctors might also use ECT if a depressed person poses a threat to themselves or others and it is dangerous to wait until medications take effect.

For in-depth information, see WebMD's Electroconvulsive Therapy (ECT) for Depression.

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What Is the Transcranial Magnetic Stimulation (TMS) Device for Treating Depression?

This device treats major depression in adults who have already tried one antidepressant.

It’s an electromagnetic coil. The doctor places it over the scalp along one side of the head. It creates a magnetic field that sends an electric current to stimulate nerve cells in the brain’s prefrontal cortex, which is one of the regions that controls mood.

TMS differs from ECT in these ways.

  • It uses a much smaller electric current than ECT.
  • It targets a specific part of the brain.
  • It doesn’t cause a seizure or loss of consciousness.
  • You don’t need to be sedated for the procedure.

You would get TMS four or five times each week for up to 6 weeks. It’s an outpatient procedure, which means you don’t stay in a hospital.

TMS is safe and it works, but it has not been shown to be as effective as ECT.

For in-depth information, see WebMD's Brain Stimulation for Depression, High-Tech Treatments for Depression, and Therapies for Treatment-Resistant Depression.

What Is Vagus Nerve Stimulation (VNS) for Depression?

Vagus nerve stimulation (VNS) is a brain stimulation technique for people who haven’t been helped by other depression treatments.

A doctor implants a pacemaker-like device, which is the size of a stopwatch, in your chest. Its wires lead to the left vagus nerve in your neck. The device sends regular electrical impulses to this nerve, which relays information to and from the brain.

For in-depth information, see WebMD's Vagus Nerve Stimulation for Depression.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on May 15, 2015

Sources

SOURCES:

National Institute of Mental Health: "What is Depression?" "Brain Stimulation Therapies."

FDA: "The Lowdown on Depression."

Mental Health America: Mpower: "Facts about Depression and Suicide."

Depression and Bipolar Support Alliance: "Psychotherapy: How it works and how it can help."

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depression, 2000.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R. Bipolar II, Rodale Books, 2006.

George, M. Archives of General Psychiatry, May 2010.

Connolly, K. Journal of Clinical Psychiatry, April 2012.

UptoDate.com: “Patient Information: Depression Treatment Options for Adults (Beyond the Basics.”

Blumenthal, J. ACSM’s Health & Fitness Journal, July-August 2012.

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