Deciding on a Treatment
Finding the right treatment is not like choosing wallpaper. You’re not looking for what works best for your personality, but rather depending on the recommendation of your doctor who can customize your treatment depending on the severity, type, and triggers of your depression.
For some, lifestyle changes like exercise and relaxation may be all that’s recommended. Others may benefit from talk therapy. Still more may require lifestyle changes in combination with therapy and/or medication.
Here’s a breakdown of various types of psychotherapy:
Cognitive Behavior Therapy (CBT)
Once you’re feeling a little better or begin practicing lifestyle strategies like exercise or relaxation or start medication, your doctor may recommend cognitive behavior therapy (CBT). It’s not appropriate for everyone, but often people have long-established patterns of thinking that are dysfunctional and nonproductive. “As long as those patterns persist, they can interfere with your ability to get better,” says Halaris. Let’s say your mom criticizes you, and you feel bad about it. Your automatic response to her criticism is that you’re no good. Therapy helps you understand your feelings about the criticism, and let go of the automatic response by replacing it with a positive one like ‘I have an excellent career.’ Therapy usually lasts once weekly for three to four months.
Interpersonal therapy (IPT) is based on the idea that improving your communication skills and patterns, as well as the way you relate to others, can help your depression. Your therapist will focus on issues concerning your relationships such as disputes with friends or family, divorce, or work conflicts, and find better ways to help you deal with them. IPT analyzes how you interact with people and if your interactions cause problems, how to correct them, and how to change those behaviors. Your therapist may help you explore the triggers that influence your depression such as grief, loss, or transition. Therapy usually takes place weekly for two to four months. A maintenance phase is often recommended with monthly follow-up visits.
Psychodynamic therapy focuses on gaining insight about how your emotions affect your behaviors. Therapists and patients work very closely to find problematic patterns and help you understand and correct them. This type of therapy may be used along with CBT or IPT. Research published by the American Psychological Association found this therapy grows more powerful after treatment ends, meaning patients later discover even more meaning from their past therapy once it’s ended. These therapies can last several months to many years.
Medication and Therapy
In addition to therapy, “medications are the cornerstone of treatment for depression,” says Halaris. There are a number of antidepressant medications on the market; the most common are Selective Serotonin Reuptake Inhibitors (SSRIs), which work by increasing serotonin, a neurotransmitter in the brain.
Other classes of medications include:
- Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Sometimes, doctors will prescribe other psychiatric medications in addition to antidepressants.
Through trial and error, you can find the right combination of therapy and medication to ease your depression. Work closely with your doctor until your symptoms improve and your depression is managed.
“The brain of the psychiatrist is like a computer into which you feed data, and the computer needs to do a data integration at a very high speed and come up with the best match as far as choice of medication,” says Halaris.
Most medications take four to six weeks before you notice an affect. You may be on medication for six months, a year, or longer. It is important to discontinue antidepressant medication gradually under the supervision of your doctor since abruptly stopping an antidepressant can have serious physical and emotional withdrawal effects. If you’ve had several episodes of moderate to severe depression, you may need to remain on medication longer or indefinitely.