What are my Treatment Options?

Depression is not a sign of weakness, and people with Major Depressive Disorder (MDD) can't just "pull themselves together" or "tough it out" and get better. Without proper treatment, the symptoms of depression can last for months, even years. Fortunately, there are many treatment options that can help most people feel better.

Effective treatments for MDD include a variety of medications, as well as three specific types of psychotherapy. The good news is that up to 80% of people with MDD can be helped with the right treatment.

MDD is often a chronic, relapsing illness. That means that once you've had one depressive episode, you may have more. Many people find that their depression gets better at some times, and worse at others. If a person gets treatment and appears to pretty well overcome their depression, later on it can appear and worsen for no apparent reason. This means that a recurrence of depression should NOT cause you to despair or to think of yourself as a "treatment failure." A recurrence of depression can be treated just as effectively as an initial episode of depression. What is important is that you get the help you need.

In fact, the skills that a person learns in dealing with the initial episode can be helpful in coping with setbacks and recurrences. Many people who have overcome more than one depressive episode find that while they still may have depressive episodes, they become much better at dealing with them. So even though their depression is not fully cured, it no longer controls their lives or the lives of those around them.

Medications
There are a variety of different classes of antidepressant medications used to treat MDD. Here’s a brief list:

Serotonin Selective Reuptake Inhibitors (SSRIs): People with depression are usually started on a low dose of these medications, and the dose is usually gradually increased. Most people notice some improvement from these medications within 3-8 weeks of their start date. These medications include: fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram and escitalopram.

Newer Antidepressants: These medications may be especially effective as "second-line" treatment in cases when a person has not responded that well to an SSRI. These medications include: venlafaxine XR, nefazodone, bupropion SR, mirtazapine, and reboxetine have been recently approved for the treatment of MDD.

Tricyclic Antidepressants (TCAs): These medications are mostly a doctor’s second or third-line choice for treating depression. Imipramine and clomipramine have demonstrated to be effective in the treatment of depression. In some cases there is also some evidence for the effectiveness of desipramine, doxepin, amitriptyline, and nortriptyline. Even though they are effective, doctors usually don't prescribe TCAs as a first option because of their side-effects.

Monoamine Oxidase Inhibitors (MAOIs): MAOIs including phenelzine, tranylcypromine and isocarboxazid are effective in treating depression. However, since MAOIs have side-effects, they are usually a doctor’s second or third-line choice for treatment.

Sometimes doctors will try a number of different of antidepressants before finding the most effective medication or combination of medications, and sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before people start to notice the full benefit.

How long do I have to be on the medication?
People often are tempted to stop taking their medication too soon. They may feel better and think they no longer need it, or they may think the medication isn't helping at all. It's important to keep taking medication until it has a chance to work. It's also important to know that side effects may appear long before you start to feel better. Once you start to feel better, it’s important to continue the medication for 4 to 9 months to prevent your depression from returning.

When it’s time for you to stop taking medication, some must be gradually decreased to give your body time to adjust to the change. Sometimes people can get withdrawal symptoms if they stop taking their medication all at once. It may be best for people with chronic or recurrent MDD to stay on medication indefinitely.

Are Antidepressant drugs addictive?
Antidepressant drugs are not considered to be addictive. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given.

BUT REMEMBER: Medications of any kind - prescribed, over-the counter, or borrowed - should never be mixed without consulting a doctor.

Psychotherapy
Psychotherapy for depression works at least as well as medication - and may be better than medication at preventing recurrences. A combination of medication and psychotherapy may be the most effective treatment for many people.

Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy helps you focus on changing your behavior, thinking, and mood. According to CBT theory our thoughts, moods and behaviors are all closely related. CBT therapists help patients change negative styles of thinking and behaving that are often associated with depression. These programs typically last between 10 to 20 weeks.

Interpersonal Therapy (IPT): Interpersonal Therapists focus on their patients relationships. According to IPT theory, regardless of what causes depression, depression is associated with loss, life changes and lack of close and supportive social relationships. The focus of therapy is to improve the patient's personal relationships by changing the patterns of behavior in those relationships. IPT programs also typically last between 10 to 20 weeks.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP): CBASP is a research-based psychotherapy that combines principles of CBT and IPT. CBASP was designed to help motivate patients to change their behavior and achieve their desired outcome in life. The emphasis is on helping people build new problem-solving and relationship skills. Research has shown that CBASP can be just as effective as medication treatment. Even more impressive is that in that study 85% of chronically depressed people who received a combination of CBASP and medication therapies responded to treatment and some of those who responded had been depressed for over 20 years!

Remember: More than 80% of people with MDD improve when they receive appropriate treatment.