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A Detailed Overview of the Treatments for Depression

Depression Treatment

There are a variety of treatment options for depression, and chances are you'll find one - or a combination - that works for you.

Research studies do not predict individual responses to any specific depression treatment. In other words, just because a treatment works for some (or even most) people, doesn't mean it will work for you. It's important to keep this in mind if you or a loved one are undergoing treatment for depression, as the first treatment or series of treatments may not be effective.

Depression is a complex illness. Most physicians practicing today believe that it is caused by a combination of biological (including genetic and bacterial), social, and psychological factors. A treatment approach that focuses solely on one of these factors is unlikely to be as beneficial as a treatment approach that includes both psychological and biological aspects (e.g., through psychotherapy and medication). In fact, the combination of psychotherapy and medication can provide the fastest and most powerful results.

Treating depression takes time. It usually takes up to 8 weeks for the medication to take effect. But not everyone feels better after taking the first medication prescribed. You may have to try two or three different medications before you find the one that works for you. The same could be true for psychotherapy as well - the first therapist may not be the one you end up working with. Most psychotherapeutic treatments for depression last 6 to 12 months, with weekly 50-minute sessions.

Psychotherapy for Depression

Today there are a number of effective psychosocial treatments for depression. Some types of psychotherapy have been researched more rigorously than others. Overall, however, the treatments listed below are helpful options. All are short-term therapies that can last between 10 and 20 sessions.
  • Cognitive-behavioral therapy (CBT) is the most popular and widely used therapy for depression. Hundreds of research studies have been conducted demonstrating their safety and effectiveness. CBT focuses on changing negative or distorted thoughts and behaviors that are perpetuating your depression. Your therapist will help you identify these thoughts (e.g., "I'm worthless", "I can't do anything right", "I'll never feel better", "This situation will never get better") and replace them with more realistic thoughts replace those that support your well-being and goals. CBT does not usually focus on the past, but on changing your thoughts, feelings, and behaviors now.
  • Interpersonal therapy (IPT) deals with an individual's social relationships and how these can be improved. It is believed that good, stable social support is essential to a person's overall well-being. When relationships falter, a person suffers directly from the negativity and unhealthiness of that relationship. Therapy seeks to improve a person's relationship skills, such as: communicating effectively, expressing feelings appropriately, and being properly assertive in personal and professional situations. Like CBT, IPT is usually performed on an individual basis, but can also be used in groups.
  • Behavioral Activation Therapy (BA) focuses on helping the individual change their behavior, which contributes to a change in their mood. You learn to recognize when you're starting to get depressed and to engage in activities that align with your desires and values ​​(which is crucial, since depression causes isolation, lethargy, and disinterest). These activities can include anything from spending time with loved ones to a yoga class. BA is pragmatic and helps you identify and achieve your goals. Recent research also suggests that BA can be effective in a group format.
  • Acceptance and Commitment Therapy (ACT) helps you focus on the present (instead of getting bogged down in the past or future); observing and accepting negative thoughts and feelings so you don't get stuck; to recognize what makes the most sense and is important to you; and to act on those values ​​so that you can build a rich, fulfilling life.
  • Problem- solving therapy (PST) helps people with depression learn to deal effectively with distressing problems in their daily lives. People with depression may view problems as a threat and believe they are unable to solve them. Your therapist will help you define the problem, find alternative realistic solutions, choose a helpful solution, and implement and evaluate that strategy.
  • Short-Term Psychodynamic Psychotherapy (STPP) focuses on interpersonal relationships and unconscious thoughts and feelings. The primary goal is to reduce your symptoms, and the secondary goal is to decrease your susceptibility to depression and increase your resilience. STPP is a family of treatments rooted in the theories of psychoanalysis, including drive psychology, ego psychology, object relations psychology, attachment theory, and self psychology. Research is currently underway to determine which individuals specifically benefit from STPP.
  • Family or couples therapy should be considered if your depression is directly affecting family dynamics or the health of important relationships. Such therapy focuses on the interpersonal relationships between family members and seeks to ensure that communication is clear and without duplicate (hidden) meanings. It also looks at the role that different family members play in making your depression worse. In addition, everyone is educated about depression.
Whatever treatment you choose, it's important to take a proactive approach. This includes voicing your concerns to your therapist and completing any daily or weekly tasks between therapy sessions. Therapy is an active collaboration between therapist and client.

Medication for Depression

Your doctor will choose your medication based on several factors, such as: B.: Your previous experiences with the drug (e.g. your reactions and side effects); co-occurring medical and psychological disorders (e.g. you also have an anxiety disorder); any other medications you are taking; personal preferences; short- and long-term side effects of the drug; overdose toxicity (if you are at risk of suicide); history of first-degree relatives who respond to the drug; and all financial constraints.

The most commonly prescribed medications for depression are antidepressants. Most antidepressants prescribed today are both safe and effective when taken as directed by your doctor or psychiatrist. Although antidepressants are often prescribed by primary care physicians or general practitioners in the United States, you should almost always see a psychiatrist for the best medication for depression.

Today, selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression — with Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Luvox (fluvoxamine) being the most commonly prescribed brands. SSRIs should not be prescribed in conjunction with monoamine oxidase inhibitors (MAOIs, an older class of drugs more popular in Europe than in the US). SSRIs work by increasing the amount of serotonin in the brain. Researchers aren't sure why increasing serotonin levels helps alleviate depression, but decades of studies suggest such drugs still help improve mood.

SSRIs were once thought to have fewer side effects than other antidepressants, but research over the past decade suggests otherwise. Although SSRIs appear to be safe, most people experience side effects such as nausea, diarrhea, restlessness, insomnia, or headaches while taking them. For most people, these initial side effects go away within 3 to 4 weeks.

Many people who take an SSRI complain of sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some people also experience tremors with SSRIs. Serotonin syndrome is a rare but serious neurological condition associated with SSRI use. It is characterized by high fever, seizures, and abnormal heart rhythms.

Long-term side effects of taking SSRIs for more than a year include trouble sleeping, sexual dysfunction, and weight gain.

The large, multi-clinic, government research study STAR*D found that people with depression who take medication often need to try different brands and be patient before finding one that works for them. The effects of medication are usually felt within 6 to 8 weeks of taking an antidepressant. But not everyone feels better with the first drug they try - and have to try several other drugs to find the one that works best for them.

Atypical antidepressants are often prescribed when a person has not improved on a usual SSRI. These drugs include nefazodone (Serzone), trazodone (Desyrel), and bupropion (Wellbutrin).

Your doctor may also prescribe an atypical antipsychotic to increase the effectiveness of your antidepressant. The FDA has approved the following atypical antipsychotics for "add-on treatment": aripiprazole (Abilify) in 2007; quetiapine XR (Seroquel XR) and olanzapine-fluoxetine (Symbyax) in 2009; and brexpiprazole (Rexulti) in 2015.

Other drugs used to increase the effectiveness of an antidepressant include the mood stabilizer lithium and thyroid hormones.

Ketamine is the newest treatment for severe forms of depression. In March 2019, the FDA approved a prescription nasal spray called esketamine (Spravato), a fast-acting ketamine-derived drug intended to be used in conjunction with an antidepressant for treatment-resistant depression. Spravato must be administered in a certified doctor's office or clinic, where patients must be monitored for at least 2 hours after receiving a dose. This is because Spravato has the potential for abuse and misuse, as well as an increased risk of sedation and dissociation. Results from esketamine studies have been mixed.

There are also clinics that offer ketamine intravenously. An initial series of ketamine infusion treatment sessions costs between $5,000 and $10,000, with regular refresher treatments required every month or two. This newer form of treatment is rarely covered by health insurance. Although apparently effective for many people who try it, treatment appears to be lifelong; moreover, the long-term effects of chronic ketamine treatments have not yet been studied.

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