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Understanding Depression -- Diagnosis and Treatment

Medication for Depression continued...

Because adolescents do not tolerate side effects well and tend to stop taking their medication, TCAs are not recommended for them as first-line treatments. In addition, heart rhythm problems have been seen in children and adolescents taking Desipramine, a TCA, so caution should be taken when this medication is prescribed to this population.

The third group of antidepressants, the monoamine oxidase inhibitors (MAOIs), like Parnate, Nardil, and the skin patch EMSAM, have also proved effective. MAOIs may sometimes work more quickly than the TCAs, but they require avoiding certain foods (such as aged meats and cheeses) and certain other medicines that can also affect serotonin or raise blood pressure. MAOIs are usually prescribed only if the SSRIs and the TCAs fail to bring improvement.

Lithium carbonate, which is a drug commonly used for manic depression, is also sometimes used to treat depression in combination with an antidepressant. Today, atypical antipsychotics have become the most widely prescribed class of medications that are added on to an antidepressant after an incomplete initial response. Two in particular, Seroquel XR and Abilify, are FDA-approved as add-on therapy, regardless of the presence or absence of psychosis (delusions or hallucinations). However, atypical antipsychotics can have many possible side effects, including weight gain, changes in blood sugar and cholesterol, sedation, and abnormal movements. 

Your health care provider can recommend the best medicine for you. 

 

Psychotherapy for Depression

Psychotherapy is an important part of treatment for depression. In cases of mild-to-moderate depression, psychotherapy may be used alone to relieve symptoms. More often, it is used in conjunction with medication to alleviate depression.

Commonly used forms of psychotherapy are cognitive, behavioral, and interpersonal therapies. 

  • Cognitive therapies challenge the negative thought patterns that accompany depressed moods and teach you new ways to think more positively. 
  • Behavior therapies concentrate on changing patterns of behavior. 
  • Interpersonal therapies help you examine how relationships affect your moods.

Other Treatments for Depression

Electroconvulsive Therapy (ECT)

ECT involves the application of an electric current through electrodes on the head. These are not felt by the patient, who is asleep under general anesthesia. Although doctors are still uncertain exactly how ECT works, it is thought that by producing a brief seizure, several treatments of ECT can bring about relief from depression. Its techniques have been refined in the past 20 years in order to minimize side effects, such as memory loss, and today ECT is considered to be as safe, or even safer, than many drugs used to treat depression and for some people, more effective. 

ECT is usually considered after a number of other options have been tried because it may require hospitalization and general anesthesia or if rapid results are vital, as with suicidal patients or those who refuse to eat or drink. However, ECT should not be thought of as a "last resort;" ECT is extremely effective and may work before other treatments have been tried and failed. 

WebMD Medical Reference

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