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OVERVIEW

Depression can be treated with varying degrees of success. Keep in mind that no two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best. Visit NIMH Find Help for Mental Illnesses if you are unsure of where to start. If you suspect that you may be depressed and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated.

Your doctor needs to rule out medical conditions that may contribute to depression or medical conditions that mimic depression.  Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or underactive thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression. The more medications you are taking, the greater the risk for drug interactions.

The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms other brain stimulation therapies may need to be explored.

LIFESTYLE CHANGES

EXERCISE—Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.

SOCIAL SUPPORT—Strong social networks reduce isolation, a key risk factor for depression. Keep in regular

contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself. Try to spend time with other people and confide in a trusted friend or relative. Don’t isolate yourself, and let others help you. You may want to consider establishing a “code word” with close associates to indicate that you are in the midst of a serious depression episode (e.g., "I’m code blue!"). Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

 

NUTRITION—Eating well is important for both your physical and mental health. The dietary intake pattern of the general population in many countries reflects that they are often deficient in many nutrients, especially essential vitamins, minerals, and omega-3 fatty acids. Studies have indicated that daily supplements of vital nutrients are often effective in reducing patients' symptoms. Supplements containing amino acids have also been found to reduce symptoms, as they are converted to neurotransmitters which in turn alleviate depression and other mental health problems. On the basis of accumulating scientific evidence, an effective therapeutic intervention is emerging, namely nutritional supplement/treatment. These may be appropriate for controlling and to some extent, preventing depression, bipolar disorder, schizophrenia, eating disorders and anxiety disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), autism, and addiction.

contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself. Try to spend time with other people and confide in a trusted friend or relative. Don’t isolate yourself, and let others help you. You may want to consider establishing a “code word” with close associates to indicate that you are in the midst of a serious depression episode (e.g., "I’m code blue!"). Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

 

NUTRITION—Eating well is important for both your physical and mental health. The dietary intake pattern of the general population in many countries reflects that they are often

 

LIFESTYLE CHANGES

EXERCISE—Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.

SOCIAL SUPPORTStrong social networks reduce isolation, a key risk factor for depression. Keep in regular

contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself. Try to spend time with other people and confide in a trusted friend or relative. Don’t isolate yourself, and let others help you. You may want to consider establishing a “code word” with close associates to indicate that you are in the midst of a serious depression episode (e.g., "I’m code blue!"). Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

 

NUTRITION—Eating well is important for both your physical and mental health. The dietary intake pattern of the general population in many countries reflects that they are often deficient in many nutrients, especially essential vitamins, minerals, and omega-3 fatty acids. Studies have indicated that daily supplements of vital nutrients are often effective in reducing patients' symptoms. Supplements containing amino acids have also been found to reduce symptoms, as they are converted to neurotransmitters which in turn alleviate depression and other mental health problems. On the basis of accumulating scientific evidence, an effective therapeutic intervention is emerging, namely nutritional supplement/treatment. These may be appropriate for controlling and to some extent, preventing depression, bipolar disorder, schizophrenia, eating disorders and anxiety disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), autism, and addiction.

SUNLIGHT EXPOSURE—We’re used to hearing about how too much of the sun’s warm rays can be harmful to your skin. But did you know the right balance can have lots of mood-lifting benefits?

Sunlight and darkness trigger the release of hormones in your brain. Exposure to sunlight is thought to increase the brain’s release of a hormone called serotonin. Serotonin is associated with boosting mood and helping a person feel calm and focused. At night, darker lighting triggers the brain to make another hormone called melatonin. This hormone is responsible for helping you sleep.

Without enough sun exposure, your serotonin levels can dip. Low levels of serotonin are associated with a higher risk of major depression with seasonal pattern (formerly known as seasonal affective disorder or SAD).

SLEEP—Sleep has a strong effect on mood. When you don't get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you're getting enough sleep each night. Very few people do well on less than seven hours a night. Aim for somewhere between seven to nine hours each night.

STRESS REDUCTION—Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Take the aspects of your life that stress you out, such as work overload or unsupportive relationships, and find ways to minimize their impact.

 

MEDICATIONS

Depression medication may be the most advertised treatment for depression, but that doesn’t mean it is the most effective. Depression is not just about a chemical imbalance in the brain. Medication may help relieve some of the symptoms of moderate and severe depression, but it doesn’t cure the underlying problem, and it’s usually not a long-term solution. Antidepressant medications also come with side effects and safety concerns, and withdrawal needs to be carefully managed by a physician.  If you're considering whether antidepressant medication is right for you, learning all the facts can help you make an informed decision.

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

But, antidepressants take time—usually 2 to 4 weeks—to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

WARNING: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

KETAMINE—Ketamine has been tested as a rapid-acting antidepressant for treatment-resistant depression in bipolar disorder, and major depressive disorder. Ketamine's antidepressant effect has a short duration of action. Meta-analyses have shown overwhelming clinical evidence to support the acute efficacy of ketamine in severely unwell populations, but lack consensus on optimal dosing and the effect of long-term treatment. Currently, ketamine is not approved for the treatment of depression, and so this is an off-label use. As of June 2017, esketamine, the S(+) enantiomer of ketamine, is in Phase III clinical trials for intranasal treatment of depression. To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.

 

ST. JOHN'S WORT—Although this is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

PSYCHOTHERAPIES

There are many types of therapy available (also called “talk therapy” or, in a less specific form, counseling) that can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: What You Need to Know.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy

can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

 
 
 

BRAIN STIMULATION THERAPIES

ELECTROCONVULSIVE THERAPY (ECT): If medications do not reduce the symptoms of depression  ETC may be an option to explore. Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

ECT, as currently administered, is not painful. Patient is

put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

ECT can provide relief for people with severe depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention for people who have not been able to feel better with other treatments.

ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. 

TRANSCRANIAL MAGNETIC STIMULATION (TMS): Is gaining ground as a therapy for treatment-resistant depression

In 2008, the Food and Drug Administration (FDA) approved TMS as a treatment for people with major depression who have failed to respond to at least one antidepressant. Initially, the agency approved just one TMS device, called NeuroStar, made by the company Neuronetics. In 2013, the FDA approved a second device, manufactured by Brainsway.

TMS has become a promising treatment alternative for the estimated 30 percent to 50 percent of people with depression who don't respond sufficiently to antidepressant medications. While TMS shows promise, it's certainly no miracle cure. Some of the patients who responded positively to TMS have experienced remissions lasting months or even years, but follow-up booster sessions every few weeks or months may help prevent a relapse.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

Brain Stimulation Implants are showing great promise for helping people with severe depression. Known as deep brain stimulation (DBS), electrodes are implanted in Area 25 below the crown of the head and is powered by a battery implanted in the chest. In a small sample of 28 people, about a third experienced full remission, half had a measurable, noticeable reduction in stress. Research indicates that “if you get better, you stay better” with sustained improvement. (see the study in the American Journal of Psychiatry)

 

From The New York Times:

Brain Stimulation Shows Promise in Treating Severe Depression

Years ago, more than two dozen patients received an electrical implant to counter their depression. They’re still feeling better, a new study finds.

https://www.nytimes.com/2019/10/04/health/deep-brain-stimulation-depression.html

CLINICAL TRIALS

Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of their clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.

To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.

THE CHALLENGE

Sticking to your treatment plan is one of the most important things you can do. It’s easy to get discouraged in the first few weeks of treatment. You may not want to continue. All types of treatment can take a few months before you notice a difference. It’s also easy to feel like you’re doing much better and stop treatment all together. Never stop treatment without consulting your doctor first.

You should feel comfortable talking to your therapist. If you don’t, try switching to a new one. You may have to meet with several therapists before you find the one that’s right for you.

You should also talk to your therapist about your feelings toward your therapy sessions and your overall treatment plan. This allows them to work with you and make changes if your treatment plan isn’t working.

Finding the right treatment is often a trial-and-error process. If one doesn’t work, it’s good to move on. If two or more months have gone by and you’ve stuck to a treatment but don’t feel any relief from the depression, it’s likely not working for you. You should experience relief from depression within three months of starting a medication.

Talk to your doctor immediately if:

•  your depression doesn’t improve after several months of treatment

•  your symptoms have improved, but you still don’t feel like you

•  your symptoms get worse

These are signs that your treatment plan isn’t working for you. A medication switch might be all that it takes. There are a number of different classes of antidepressants. There are SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), tricyclics and tetracyclics. Newer antidepressant medicines that affect many different serotonin receptors in the brain include vilazodone (Viibryd) and vortioxetine (Trintellix, formerly called Brintellix). Some antidepressants are thought to affect the brain chemicals dopamine and norepinephrine through unique mechanisms, and are often combined with other antidepressants in order to take advantage of their combined effects such as bupropion (Wellbutrin) or mirtazepine (Remeron). Another older class of antidepressants, called MAO inhibitors affect a special enzyme inside brain cells that can increase the functioning of several different neurotransmitters. Sometimes, switching from one class of antidepressant to another can make a difference.

In other cases, your doctor might try adding a new medicine to the antidepressant you're already using. This can be especially helpful if your current drug is partly helping, but not completely relieving your symptoms.  One option is to add a second antidepressant from a different class. This is called combination therapy. Another approach is called augmentation therapy: adding a medicine not typically used to treat depression, like lithium, an anticonvulsant, or an antipsychotic. Aripiprazole (Abilify), brexipipzole (Rexulti) or quetiapine (Seroquel XR) are FDA approved as add-on therapies to an antidepressant for treatment-resistant depression. Olanzapine-Fluoxetine (Symbyax) is a combination drug that contains the active ingredients in fluoxetine (Prozac) and olanzapine (Zyprexa) together in one tablet and is approved for the acute treatment of treatment-resistant depression. Another approach is called augmentation therapy: adding a medicine not typically used to treat depression. One drawback to this approach is that the more medicines you take, the greater potential for side effects.

Life with depression is hard, but treatment-resistant depression can be especially brutal. When one treatment after another doesn't help, you can lose hope that you'll ever feel better. Arriving at the right treatment for depression can take time. Don't give up and accept the symptoms of depression. Remember, the longer a depression goes on, the harder it may be to treat. Go back to your doctor and see if there's something else you can try.

 

TREATMENT CENTERS

Good depression treatment centers generally include a holistic therapy set-up that provides a diet and exercise plan, counseling sessions, talk therapy sessions, recommended medications, motivation tapes, and other materials. Visiting a depression treatment center is a completely voluntary process that requires deep commitment from both the patient as well as the treatment center. While some treatment centers for depression are privately-run, others are managed by non-profit/charitable organizations. In addition, there are day treatment centers as well as residential treatment centers for depression to suit the needs of individuals.

Noted below are the top ten treatment centers for depression treatment in America, which are run by private organizations:


1. The Center for Counseling and Health Resources—Washington

2. Sierra Tucson Depression Treatment Center—Arizona
3. Walden Behavioral Care—Massachusetts
4. Bayridge Anxiety and Depression Treatment Center—Ontario
5. Connecticut Anxiety and Depression Treatment Center—Connecticut

6. Youth Care Residential Treatment Center—Utah

7. Anxiety and Depression Treatment Center—California

8. Skyland Trail—Atlanta
9. Sunset Malibu’s Depression Treatment Center—California

Top ten depression treatment centers run by or affiliated with university hospitals:

1. Harvard—Massachusetts General Hospital (Department of Psychiatry)

2. The Johns Hopkins Hospital (John Hopkins Mood Disorders Center)
3. Harvard—McLean Hospital
4. University of Pennsylvania (Department of Psychiatry)

5. Stanford University (Depression Research Clinic and Bipolar Disorders Clinic)

6. University of Michigan Depression Center
7. University of Colorado Denver Depression Center
8. University of Louisville Depression Center

9. The University of California San Francisco Depression Center

10. Columbia University (Columbia Psychiatry)

For a list of treatment centers by state, visit:  https://www.psychologytoday.com/us/treatment-rehab

 

The treatments for depression are quite varied. Visit our blog for further information.