Treating Depression
Treatment may involve the use of medicine, psychotherapy, or the use of both.
Severe depression usually requires hospital care and the use of drugs, such as olanzapine .
Up to 70% of depressed patients find relief from their symptoms with medicine. They can take 2 to 6 weeks to reach their maximum effectiveness. The medications include:
- Fluoxetine (eg, Prozac)
- Sertraline (eg, Zoloft)
- Paroxetine (eg, Paxil)
- Citalopram (eg, Celexa)
- Fluvoxamine (eg, Luvox)
- Escitalopram (eg, Lexapro)
***Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern-mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)-are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .
- Imipramine (eg, Tofranil)
- Doxepin (eg, Adapin, Sinequan)
- Clomipramine (eg, Anafranil)
- Nortriptyline (eg, Pamelor)
- Amitriptyline (eg, Elavil)
- Phenelzine (eg, Nardil)
- Tranylcypromine (eg, Parnate)
- Venlafaxine (eg, Effexor)
- Nefazodone (eg, Serzone)
- Mirtazapine (eg, Remeron)
- Bupropion (eg, Wellbutrin)
- Duloxetine (eg, Cymbalta)
Short-term (10 to 20 weeks) therapy can help some people. Psychotherapy is designed to help you:
- Cope with difficulties in relationships
- Change negative thinking and behavior patterns
- Resolve difficult feelings
ECT is the use of an electric stimulus to produce a generalized seizure. It may be used in people with severe or life-threatening depression. ECT is also used for people who cannot take or do not respond to medicine. It is considered a safe and effective procedure.
Regular exercise has been shown to relieve some of the symptoms. It should play a large role in the overall management of depression.
This therapy is done by sitting under special lights. It usually lasts about 30 minutes every morning.
St. John's wort is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate depression. Studies have shown that the herb is as effective as standard antidepressants and has fewer side effects. *¹
There is also recent evidence that DHEA, a dietary supplement, may help some people. DHEA is an ingredient in fish oil . Some experts disagree with these findings. Always discuss the use of dietary and herbal supplements with your doctor.
Research suggests that diets high in tryptophan, certain B vitamins , and fish oil may be helpful. They have shown promise in both relieving and preventing depression. Always discuss the use of such supplements with your doctor.
VNS is used as therapy for depression when multiple trials of medicine do not work. A pacemaker-like device stimulates the vagus nerve, in the neck.