What Happens in Depression Treatment?

Depression is a serious illness, and there’s no single way to treat it. Different people are affected differently by the condition. But if you need help, there are certain things to expect from treatment.

How Treatment Starts

If you think you’re depressed, see a doctor. That could be your primary care physician or a specialist in mental health.

They’ll start by asking you some questions about how you’re feeling. These are designed to help figure out whether you have the symptoms of depression, another mental health condition, or whether your problem might have a physical cause. For instance, you might be asked to give a blood sample so doctors can look for signs of thyroid problems, which also can cause depression.

If your doctor thinks you’re depressed, your first treatment will depend on what the doctor thinks is going on.

  • Your doctor may prescribe an antidepressant. These are medications designed to relieve the symptoms of depression by adjusting how certain chemicals in your brain affect brain circuits that control your mood.
  • Your doctor might refer you to a mental health specialist. That could be a psychiatrist, psychologist, or some other type of counselor. They would talk with you about your problems and feelings, and figure out how to address them. This is psychotherapy or “talk therapy.”
  • Most likely, your treatment will involve some combination of the two.

Antidepressants

Antidepressants can help you feel better. Scientists believe they work by helping brain circuits that regulate mood work more efficiently. The most common types of antidepressants work by increasing levels of serotonin in the brain. Serotonin helps transmit messages from one area of the brain area to another. If you’re given antidepressants, it may take 2 to 4 weeks for the medication to start producing a noticeable effect. Your doctor will most likely want you to take a drug for at least several months, maybe up to a year.

Doctors typically start with medications called selective serotonin reuptake inhibitors (SSRIs) because they have the fewest side effects. Still, with any antidepressant, you could experience:

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The FDA warns that anyone taking antidepressants should be watched closely, particularly in the first few weeks. Children, teenagers, and young adults might have more negative thoughts, possibly even suicidal thoughts or behaviors while taking antidepressants.

You may need to try a few different antidepressants before you find one that works well for you. You might have side effects during the first few weeks of taking an antidepressant. These usually get better. If you’ve given it a few months and it doesn’t seem to help, or if your side effects are making it hard for you to take it, go back to your doctor. She might recommend a different drug. But don’t stop taking your medication on your own. That can cause more problems. When it’s time to stop, your doctor will slowly reduce your dose to let your body readjust.

Psychotherapy

This involves sitting down with a mental health professional who can help you better understand your thoughts, feelings, and emotions. Together, you’ll try to figure out what helps you feel better.

Psychotherapy can help you figure out why you feel the way you do and how to manage difficult emotions better. It might help you to overcome certain fears, or change behaviors that aren’t helping you manage your feelings.

Sessions take place on a regular schedule, maybe once or twice a week depending on what you need. The sessions are meant to be neutral, nonjudgmental, and confidential. While your medications take time to work, a mental health professional can:

  • Show you how your thoughts, emotions, and behavior affect your condition
  • Help you manage stress
  • Offer ways to improve your dealings with other people
  • Help you spot early signs of a problem and get help
  • Help you confront and overcome fears that aren’t helping you

This type of therapy can take months or more than a year, depending on how serious your depression is. But some patients feel better in a matter of weeks. You and your therapist will decide when you’ve made enough progress to stop.

You may need to try a few different therapists to find one you are comfortable sharing your feelings with.

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Electroconvulsive Therapy

If your depression is severe enough, and drugs and psychotherapy aren’t helping, your doctor might recommend electroconvulsive therapy, or ECT. This involves sending a small, painless electric current through your brain while you’re asleep under general anesthesia, which causes a brief seizure that can relieve the symptoms of depression.

ECT is also known as electroshock therapy. It has a controversial history but is now considered an effective treatment for depression.

Modern ECT is performed in a series of sessions (either inpatient or outpatient) over up to 4 weeks. You’ll be given anesthesia to make you sleep, and you won’t feel the current or the seizure. But it has some side effects. They can include headaches, nausea, confusion, disorientation, and memory loss, which can last for several months. If your doctor is recommending ECT, be sure to talk about the pros and cons before agreeing.

Other Forms of Brain Stimulation

Besides ECT, other technologies have been developed in recent years. They treat depression by stimulating areas of the brain that are believed to control mood. They’re used when other depression treatments haven’t worked.

  • Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved procedure that uses a magnetic coil to stimulate specific brain areas over a series of treatments lasting several weeks.  Patients are wide awake and feel no pain or discomfort. 
  • Vagal nerve stimulation (VNS) is an operation that puts a device under the collarbone and then attaches a thin wire to the vague nerve in your neck. The device sends signals to regions of the brain that affect mood. 
  • Deep brain stimulation (DBS) is an experimental procedure that puts thin electrodes deep within the brain to directly stimulate to areas that handle emotions.

What Else You Can Do

No matter what your treatment includes, your doctor may also suggest you do some things your own, such get more exercise, eat better, and lose weight. All of these can help your mood.

It’s also important that you get enough sleep. If you’re having problems sleeping, let your doctor know. It may also help to cut back on caffeine and alcohol.

Your doctor may also suggest you join a support group. They can put you in touch with people who are facing the same thing. They may be able to offer you advice and fellowship when you hit a rough patch.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on January 20, 2017

Sources

SOURCES:

National Institute of Mental Health.

Center for Substance Abuse Treatment: “Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery.”

Anxiety and Depression Association of America: “Depression.”

The Mayo Clinic: “Depression (major depressive disorder).”

Armstrong, C. American Family Physician, May 2011.

Depression and Bipolar Support Alliance.

National Alliance on Mental Illness: “Depression.”

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