Thursday, March 31, 2011

Treatments for Depression

The good news about depression is that you have a number of excellent treatments to choose from. More than 80% of people who get treatment for depression say that it helps them feel better.
Here's a rundown of some of the most common approaches. Many people use a mix. For instance, you might try medicine and therapy at the same time. Some studies show that using both together is better than using either one alone.

Talk Therapy for Depression

Talking with a trained therapist is one of the best treatments for depression. Many studies show that it helps. Some people choose to be in therapy for several months to work on a few key issues. Other people prefer to stay in therapy for years, gradually working through larger problems. The choice is up to you. Here are some common types of therapy.
  • Cognitive behavioral therapy helps you see how behaviors -- and the way you think about things -- play a role in your depression. Your therapist will help you change some of these unhealthy patterns.
  • Interpersonal therapy focuses on your relationships with other people and how they affect you. Your therapist will also help you identify and change unhealthy behaviors.
  • Problem solving therapy focuses on the specific problems you currently face, and on helping you find solutions to those problems.

Antidepressant Medicines

Medicines are the other key treatment for depression. If one antidepressant doesn't work well, you might try another drug of the same class or a different class of depression medicines. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression. There are now dozens of antidepressants that your health care provider can choose from. They include:
  • Selective serotonin reuptake inhibitors (SSRIs). These common medicines include Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline). Side effects are generally mild. They include stomach upset, sexual problems, insomnia, dizziness, weight change, and headaches.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer type of antidepressant. This class includes Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (desvenlafaxine). Side effects include upset stomach, insomnia, sexual problems, anxiety, dizziness, and fatigue.
  • Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were some of the first medicines used to treat depression. TCAs include amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Side effects of include stomach upset, dizziness, dry mouth, changes in blood pressure, changes in blood sugar levels, and nausea. MAOIs can cause serious interactions with other medications and certain foods. While they work well, these drugs aren't typically used for initial treatment.
  • Other medications: Bupropion (Wellbutrin, Aplenzin) is different than other antidepressants and only weakly affects the brain chemicals that other antidepressants influence. Side effects are usually mild, includi All antidepressants carry a boxed warning about increased risks of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old. Depression and other psychiatric problems are also linked to increased risk of suicide. All patients started on antidepressant medication should be monitored closely.
    Other medicines may be prescribed in addition to antidepressants, particularly in treatment resistant depression. Here are examples of medicines that may be used to augment as an add-on to antidepressant treatment.
  • Antipsychotic medications like Abilify and Seroquel can be used as an add-on to antidepressant treatment. Symbyax, a combination of the antipsychotic drug Zyprexa and an SSRI (fluoxetine), is approved for treatment-resistant depression.
  • Your doctor may recommend or prescribe other medications or supplements not FDA approved for use in depression.
Working with your doctor, you can weigh the risks and benefits of treatment and optimize the use of medication that best relieves your symptoms.

ECT (Electroconvulsive Therapy) for Depression

This is a safe and effective treatment for people with depression that is resistant to medication. It's typically used on people who haven't been helped by medicines or therapy.
In ECT, your doctor will use electric charges to create a controlled seizure. These seizures seem to affect the chemical balance and functioning of the brain. It may sound scary. But during the procedure, you receive anesthesia and a muscle relaxant, so you won't feel anything.
ECT tends to work very quickly. It also works well -- about 80%-90% of people who receive it show improvement. The most common side effect is temporary memory loss.
You might have up to 12 sessions over a few weeks. Some people get "maintenance" therapy with ECT to prevent depression from returning.

Vagus Nerve Stimulation (VNS) for Depression

Vagus Nerve Stimulation (VNS) is a new option for people with severe, treatment-resistant depression. Approved by the FDA in 2005, it's used only on people who haven't been helped by at least four antidepressants.
VNS involves implanting a small electrical generator in your chest, like a pacemaker. The device is attached with wires to the vagus nerve, which runs from the neck into the brain. Once implanted, the device sends electrical pulses to the vagus nerve every few seconds. The pulses are then delivered via the vagus nerve to the area of the brain thought to regulate mood. The electrical charges may change the balance of chemicals in your brain and relieve depression.
The device must be implanted by a surgeon, but patients can usually go home the same day.
  • ng upset stomach, headache, insomnia, and anxiety. Bupropion may be less likely to cause sexual side effects than other antidepressants. Mirtazapine (Remeron) is usually taken at bedtime. Side effects are usually mild and include sleepiness, weight gain, elevated triglycerides, and dizziness. Trazodone (Desyrel) is usually taken with food to reduce chance for stomach upset. Other side effects include drowsiness, dizziness, constipation, dry mouth, and blurry vision.
ranscranial magnetic stimulation is a new nondrug approach that's been approved for treatment-resistant depression. Unlike VNS and ECT, it uses a magnetic field to induce a much smaller electric current in a specific part of the brain without causing a seizure or loss of consciousness.  TMS is used to treat milder depression and works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis.
Patients undergoing TMS must be treated four or five times a week for four weeks.

Alternative Treatments for Depression

Some people use herbs, supplements, and other alternative therapies for depression. However, none of these approaches has been proven to work. Herbs and supplements -- like St. John's wort -- can have side effects and cause interactions with other medicines. Never start taking an herb or supplement without talking to your doctor first.
Other alternative treatments -- like acupuncture, hypnosis, and meditation -- may help some people with their symptoms. Since they have few risks, you might want to try them, provided that your health care provider says it's OK.

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