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How is depression treated?

Depression treatment often incorporates anti-depressant medicine and psychotherapy. Psychotherapy alone, involving cognitive and behavioral awareness and change as well as interpersonal training, education, and family therapy, may effectively treat mild cases of mental depression. Untreated depression can worsen and become more resistant to treatment.

The newest class of anti-depressant medications increase the availability in the brain of serotonin, dopamine, and norepinephrine and include venlafaxine (trade name Effexor), nefazodone (trade name Serzone), bupropion (trade name Wellbutrin), mirtazapine (trade name Remeron), and trazodone (trade name Desyrel).

Anti-depressant medications classified as selective serotonin reuptake inhibitors (SSRIs) include escitalopram (trade name Lexapro), citalopram (trade name Celexa), fluoxetine (trade name Prozac), paroxetine (trade name Paxil), and sertraline (trade name Zoloft). These anti depression drugs allow the neurotransmitter serotonin to remain active longer at brain nerve terminals.

The tricyclic antidepressants (TCAs) appear to treat clinical depression as effectively as SSRIs by increasing the brain levels of serotonin and norepinephrine and include amitriptyline (trade name Elavil), desipramine (trade name Norpramin), imipramine (trade name Toframil), and nortriptyline (trade names Aventyl, Pamelor).

The older class of anti-depressants, known as monoamine oxidase inhibitors (MAOIs), increases brain levels of serotonin and norepinephrine to treat clinical depression but is associated with more severe side effects and requires tyramine-containing dietary restrictions. MAOIs include phenelzine (trade name Nardil) and tranylcypromine (trade name Parnate).

The herb St. John's wort treats mild to moderate depression symptoms more effectively than a placebo (inactive compound) but has not been scientifically evaluated against antidepressant drugs.

Clinical depression symptoms are improved in approximately half the people who take anti-depressant medication. Improvement may not be apparent for up to 8 weeks after the initiation of treatment, and depression medicine should be continued for at least 6 months after recovery from major depression to prevent relapse.

Bipolar disease is chronic and is most effectively treated continuously with mood-stabilizers and psychosocial therapy. Lithium is the standard manic depression treatment and the anticonvulsants valproate (trade name Depakote) and carbamazepine (trade name Tegretol) stabilize mania and depression in many people. Clozapine (trade name Clozaril) may stabilize mood in patients resistant to other mood stabilizers, and olanzapine (trade name Zyprexa) appears to effectively control mania and psychotic depression. Other medications, such as antidepressants or antipsychotics, can be added to treat episodes of mania or depression.

When depression symptoms are not alleviated by standard anti-depressant medicine and therapy, electroconvulsive therapy (ECT) may improve symptoms.

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