Treatment for Major Clinical Depression

Major depression is a chronic mental health condition that requires ongoing and long-term treatment. Treatment typically includes medications, usually a type of antidepressant, as well as psychotherapy. These traditional treatments may be supplemented with alternative therapies, such as acupuncture, and should be used along with self-management, good physical health practices, and social support. Treatment may be delivered on an outpatient basis or in a residential treatment facility.

Diagnosing and Treating Major Depression


Depression is a serious mental illness that does not get better without treatment. Although it is chronic, depression can be managed with the right treatment plan. The first step in managing this illness and feeling better is to get an accurate and professional diagnosis.

The diagnosis should be made or confirmed by a psychiatrist, and following the diagnosis, a treatment plan can be developed that includes medications, therapies, and other strategies. It is important for a patient to stick with treatment, to be consistent, and to communicate with doctors and therapists to see the best results.

Depression Medications – Antidepressants


Treatment plans for major depression are typically tailored to the needs of the individual patient, but medications called antidepressants are a part of treatment for most. Antidepressants work by altering the levels of certain brain chemicals, which may be off balance because of depression.

These drugs must be taken for a certain period of time before it can be determined if they are having the desired effect. It is very important to stick with an antidepressant for the recommended period of time before deciding if they work or not. Many patients need to try more than one antidepressant before settling on one that really works and has minimal side effects. There are several types of antidepressants that may be prescribed:

  • Selective serotonin reuptake inhibitors (SSRIs). Brand name drugs in the SSRI class include Prozac, Paxil, Lexapro, and Zoloft. An SSRI is often the first drug prescribed, because this type works well for a lot of people and causes fewer side effects. SSRIs act by increasing the amount of serotonin in the brain.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs act by increasing both serotonin and norepinephrine in the brain. Some examples of SNRI medications are Cymbalta and Effexor.
  • Tricyclic antidepressants. Tricyclics belong to an older class of drugs that are not used very often anymore. They work in a similar way to SNRIs but tend to cause more side effects. They may be used when other medications don’t work.
  • Monoamine oxidase inhibitors (MAOIs). This is another older class of antidepressants not used very often today. They cannot be used with SSRIs and interact dangerously with certain foods, drinks, herbal supplements, and other medications. MAOIs are only used when other antidepressants have no effect.
  • Atypical antidepressants. Some drugs that may be prescribed for depression don’t fit neatly into the other categories. These include Wellbutrin and a few others.

Risks and Side Effects of Antidepressants


Antidepressants can be very useful in treating depression, especially as part of an overall rehab or treatment program, but they also come with some risks and the potential for side effects. The side effects vary depending on the specific medication and the individual, and often subside after a few weeks of using the drug. Potential side effects are:

  • Nausea
  • Weight gain
  • Sexual dysfunction
  • Drowsiness or fatigue
  • Headaches
  • Diarrhea
  • Insomnia
  • Constipation
  • Dry mouth
  • Blurry vision
  • Agitation and anxiety
  • Dizziness

There are also some potentially serious risks of using antidepressants, including suicide. People under the age of 25 are at an increased risk of suicidal thoughts and behaviors during the first few weeks of taking a new antidepressant or changing doses. Some antidepressants may pose risks for fetuses and infants in women who are pregnant or breastfeeding. There is also a risk of experiencing withdrawal-like symptoms with abrupt cessation of antidepressants. Patients should never stop using an antidepressant without a doctor’s guidance.

Psychotherapy for Major Depression


For most patients being treated for depression, a combination of medication and psychotherapy provides the best long-term outcomes. Psychotherapy may take many forms, but a strategy called cognitive behavioral therapy, or CBT, is among the most common type used for patients with depression. Working with a therapist through CBT or another type of psychotherapy can help a person:

  • Recognize and change negative thought patterns
  • Change behaviors
  • Reduce depressive symptoms
  • Adjust to a traumatic or stressful event
  • Improve relationships by interacting better with other people
  • Regain a sense of control over one’s life
  • Set and achieve goals
  • Cope in more positive ways with stressful situations
  • Identify and avoid triggers for depression
  • Learn and use self-care strategies

In addition to traditional one-on-one therapy and CBT, patients with depression may benefit from some types of alternative therapies. These may include group therapy or participation in support groups, family or relationship therapy, art therapy, music therapy, animal therapy, or adventure therapy.

Inpatient and Outpatient Care for Depression


Most treatment for depression is done on an outpatient basis. A patient may visit with his or her doctor for prescriptions, with a therapist for weekly sessions, with a support group every week, or some combination of these treatment components. This is outpatient care, and it works for a lot of people.

Some patients, however, benefit from more intensive, round-the-clock care such as can be delivered in inpatient rehab. Severe episodes of depression, especially with psychotic symptoms, brief hospitalization may be required. For others, inpatient rehab or residential treatment can be a great way to get dedicated care over a longer period of time. Inpatient care allows an individual to focus on getting well and learning important strategies for coping with depression that can be used outside the clinical setting.

Brain Stimulation Therapies


When medications don’t help relieve the symptoms of depression, or they cause too many side effects and therapy isn’t enough, a doctor may suggest a brain stimulation therapy. These have been proven to be effective for some patients:

  • Electroconvulsive therapy (ECT). Short electrical impulses are sent into the brain to improve the functioning of neurotransmitters like serotonin. This kind of therapy is usually limited to patients who cannot use antidepressants or are at an increased risk for suicide. It may cause some memory loss and disorientation, but ECT is much safer now than it was in the past, and it is not painful.
  • Transcranial magnetic stimulation (TMS). This therapy is also a last resort option for treatment and involves sending magnetic impulses through the brain to stimulate nerves. TMS may not be as effective as ECT.
  • Vagus nerve stimulation (VNS). This therapy works by inserting a small device under the skin that sends electrical pulses to the vagus nerve, a major nerve running from the brain down to internal organs. VNS was originally used to treat epilepsy, but patients receiving the therapy had notably improved moods, so the therapy has since been approved for treating select patients with depression.

Alternative Treatments


Natural cures for depression can be misleading. There is no cure for depression, but some alternative therapies may be helpful for patients. These should never be used in place of traditional treatment, but can be used to aid those treatments. For instance, some people find relief with acupuncture or with certain herbal supplements, like St. John’s wort. It is important to discuss any alternative treatments with a doctor or psychiatrist, as there may be side effects or interactions with medications.

How to Combat Depression at Home – Self Care to Supplement Treatment


Self-care and management of depression is an important element of treatment. Self-care helps a patient maintain the progress made in therapy and cope with episodes of depression or stressful situations. Some self-care techniques can be taught in therapy and then used at home, such as meditation, mindfulness practice, breathing and relaxation techniques, and guided imagery.

Also important for self-care is managing physical health: eating a balanced and healthful diet, avoiding drugs and excessive alcohol, getting enough sleep, and exercising regularly. Social interaction is another important element of self-care. This means avoiding the urge to withdraw and to instead engage family and friends in social activities and conversation. Support from other people struggling with depression is also a useful tool for coping and managing symptoms.

Depression can at times seem like a challenge that is too much, that cannot be overcome, but treatment is effective and is proven to help patients feel better, reduce symptoms, and regain control over life. With the right mix of treatments that work for an individual patient, depression is a disease that can be managed over a lifetime. A treatment plan is most effective when the patient commits to it, is consistent with each element of the treatment plan, engages socially and relies on others for support, and uses self-care strategies at home to be proactive about symptoms and negative thoughts and behaviors.