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Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented. People with depression are often seen first by their family doctor or general practitioner. In milder cases, family doctors can assess and treat you as an outpatient with medication, counseling or both. They may refer you to other community resources (e.g., counseling services, drop-in centers).

Basically, the first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional. The doctor or mental health professional will then conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide.

Next, in deciding the best plan for treatment, the doctor will consider the severity of your illness, events that may have triggered its onset, and if applicable, previous treatments you have undergone. Treatments for depression include psychosocial treatments (e.g., psychotherapy, psycho-education) and biological treatments (e.g., medications, brain intervention therapies). These treatments may be used individually or in combination. It is very helpful for a person’s partner or family to learn about the disorder, either through reading materials, attending a family support and education group or talking with a mental health care provider.

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1. PSYCHOTHERAPY

Psychotherapy is often used along with medication to treat depression. Psychotherapy is a general term used to describe a form of treatment that is based on “talking work” done with a therapist. The aim is to relieve distress by discussing and expressing feelings, to help change attitudes, behavior and habits that may be unhelpful, and to promote more constructive and adaptive ways of coping. Successful psychotherapy depends on a supportive, comfortable relationship with a trusted therapist. Psychiatrists, social workers, psychologists and other mental health providers are trained in various models of psychotherapy, and work in hospitals, clinics and private practice.

Actually, there are many different treatment models of psychotherapy for individuals. Short-term models usually last up to 16 weeks. These therapies include interpersonal therapy (IPT), cognitive-behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT). They are structured and focus on current rather than childhood issues, and the therapist takes an active role in guiding the discussions. Bottom line, research has found these therapies to be very effective in treating depression.

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2. MEDICATION

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have discovered that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work. The newest and most popular types of antidepressant medications are called “Selective Serotonin Reuptake Inhibitors (SSRIs)”. SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).

SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclic named for their chemical structure and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. However, medications affect everyone differently where no one-size-fits-all approach to medication exists. People taking MAOIs, for instance, must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high levels of the chemical tyramine, which is found in many cheeses, wines and pickles, and some medications including decongestants. MAOIs interact with tyramine in such a way that may cause a sharp increase in blood pressure, which could lead to a stroke. Therefore, a doctor should give a patient taking an MAOI a complete list of prohibited foods, medicines and substances.