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What are the types of treatment for depression?
A physician can treat depression by prescribing any number of lifestyle
changes and medical therapies, including:
Lifestyle changes
- Stopping the intake of alcohol and/or sedatives
- Exercising regularly
- Eating a healthy diet (supplemental vitamin B complex)
Medical therapies
- Switching current medications (such as antihypertensives,
contraceptives, and steroids) to reduce side effects that may be causing
depression
- Diagnosing and treating other conditions known to cause
depression (such as hypothyroidism)
- Counseling (psychotherapy: cognitive-behavioral, interpersonal,
and other forms)
- Light therapy (exposure to white fluorescent light to reduce
symptoms of seasonal affective disorder)
- Antidepressant medication
- Electroconvulsive therapy (controlled electrical discharge to
induce seizure-like activity in the brain)
- Combinations of therapy
- Hypericum (St. Johns Wort) for mild single depression
Ongoing research
- Norepinephrine Reuptake Inhibitor
—Reboxetine
- Substances "P" antagonists
- Vagal nerve stimulation
- Deep brain stimulation
What conditions can be treated with antidepressant medications?
Antidepressants can be used for the treatment of:
- Major depression (symptoms of depression that persist for more
than two weeks)
- Panic disorder
- Chronic pain
- Bed wetting (enuresis)
- Chronic depression (dysthymia)
- Migraines
- Chronic fatigue syndrome
How effective are antidepressants in the treatment of depression?
All antidepressant medications are effective in treating depression.
Antidepressants have been shown to be 60 to 70 percent effective for treating
depression. The effectiveness of individual types of antidepressants can vary
from patient to patient.
How are antidepressant medications prescribed?
Antidepressants are chosen based on:
- Any medical illnesses that are present
- Side effects from previous treatments with antidepressants or
concern over side effects that may occur
- Effectiveness of medication in other family members
- Medications being taken for other conditions
- Effectiveness of a medication in controlling a past episode of
depression
- The presence of another psychiatric disorder (such as panic disorder)
What are the types of antidepressants?
Selective Serotonin Reuptake Inhibitors include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Selective serotonin reuptake inhibitors (SSRIs) have advantages over
other antidepressants including fewer side effects and effectiveness at lower
dosages. However, they are more expensive and can cause sexual dysfunction,
nausea and diarrhea, and headache.
Tricyclics include:
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Clomipramine (Anafranil) (for obsessive-compulsive disorder)
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Tricyclics (TCA) are less expensive and can be helpful for reducing pain,
providing weight gain, and improving sleep. They can cause dizziness,
constipation, and urinary retention.
Other common antidepressants include:
- Mirtazepine (Remeron)
- Trazodone (Desyrel)
- Nefazodone (Serzone)
- Bupropion (Wellbutrin)
- Venlafaxine (Effexor)
- Monoamine oxidase inhibitors (MAOIs)
—Tranylcypromine (Parnate)
—Phenelzine (Nardil)
—Isocarboxazid (Marplan)
When MAOIs are prescribed for chronic depression, the patient must restrict
tyramine-containing foods from his or her diet and avoid certain medications.
How soon does an antidepressant begin working and how long do I need to take
it?
Some symptoms may begin to improve after a few days. More significant
improvement should occur after 2 to 3 weeks of treatment. In elderly patients,
symptoms may take up to 12 weeks to improve.
The length of time you need to continue use of the medication depends on a
number of factors, including your age, the severity of your depression, and
whether you have suffered from depression in the past.
Generally, if this depression is your first episode, you should stay on the
medication for 1 year. If you have had two episodes of depression, your doctor
may recommend that you continue the medication for 2 to 5 years. Persons who
have had three or more episodes of depression generally need to take medication
for life to prevent depression from recurring (maintenance medication).
How can I know when to stop my medication?
Fifty to 85 percent of patients who have had one episode of major depression
will go on to have a second episode, usually within 2 to 3 years. Lifelong
maintenance through the use of medication may prevent depression from recurring.
Maintenance medication is recommended when the person has had:
- Three or more episodes of major depression
- Two episodes of major depression plus a family history for
depression (unipolar or bipolar manic depression)
- History of recurrence within 1 year after effective medication
has been stopped
- Early onset of depression (first episode before age 20)
- Two episodes, both severe and sudden
If you plan to stop your medication, the medication needs to be tapered off
slowly over months rather than stopped abruptly. However, abrupt discontinuation
may be required in cases of medical emergency.
Where can I learn more?
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
(703) 524-7600
www.nami.org
National Mental Health Association
2001 N. Beauregard Street, 12th Floor
(703) 684-7722
www.nmha.org
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