Depression: Medication and Treatment

How is major depression treated?

Although major depression can be a devastating illness, it is highly treatable. Between 80-90 percent of people diagnosed with major depression can be effectively treated and return to their usual daily activities and feelings. Many types of treatment are available, and the type chosen depends on the individual and the severity and patterns of his or her illness.

There are three well-established types of treatment for depression: medications, psychotherapy and electroconvulsive therapy (ECT). For some people who have a seasonal component to their depression, light therapy may be useful. These treatments may be used alone or in combination. Additionally, peer education and support can promote recovery. Attention to lifestyle, including diet, exercise and smoking cessation, can result in better health, including mental health.

NAMI’s 2009 survey of the public, caregivers and individuals with depression, Depression: Gaps and Guideposts, provides some personal perspectives on treatment for depression. Of the people who responded to the survey, medication and “talk therapy” are primary treatments but others are helpful.

In fact, research indicates that the combination of medication and psychotherapy are most effective for the treatment of depression. But the survey results indicate that other strategies, including exercise, prayer, music therapy, yoga, animal therapy and other practices all can play a role. What often works is a combination of treatments to fit a person and their lifestyle.

Psychotherapy

• Psychotherapy. There are several types of psychotherapy that have been shown to be effective for depression including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression can often be treated successfully with either of these therapies used alone. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.
• Cognitive behavioral therapy (CBT) helps to change the negative thinking and unsatisfying behavior associated with depression, while teaching people how to unlearn the behavioral patterns that contribute to their illness.
• Interpersonal therapy (IPT) focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person’s depression.

Medication

It often takes two to four weeks for antidepressants to start having an effect, and six to 12 weeks for antidepressants to have their full effect. The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neurotransmitters like serotonin, dopamine and norepinephrine can be corrected with antidepressants. Read more about medication.

Medications Approved for Depression

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depressive episodes. In situations where medication, psychotherapy and a combination of the two prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT may be considered. ECT may also be considered for those who for one reason or another cannot take antidepressant medications.

TMS

TMS is an outpatient intervention which could be an option for individuals diagnosed with major depression who have failed one trial of antidepressants at an adequate dose and duration. In clinical trials, individuals had been treated with an average of five medication treatment attempts, one of which was at an adequate dose and duration. TMS has not been thoroughly studied for people who have failed two or more adequate trials of antidepressants or for people who have not been on antidepressants. TMS is not indicated for individuals who have bipolar disorder, depression with psychosis or individuals with a high risk of suicide. Learn more...