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Major depression

  • Alternative Names

    Depression - major; Unipolar depression; Major depressive disorder


    Treatment

    In general, treatments for depression include:

    • Medications called antidepressants
    • Talk therapy, called psychotherapy

    If you have mild depression, you may only need one of these treatments. People with more severe depression usually need combination of both treatments. It takes time to feel better, but there are usually day-to-day improvements.

    If you are suicidal or extremely depressed and cannot function you may need to be treated in a psychiatric hospital.

    MEDICATIONS FOR DEPRESSION

    Drugs used to treat depression are called antidepressants. Common types of antidepressants include:

    • Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
    • Serotonin norepinephrine reuptake inhibitors (SNRIs), including desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta).

    Other medicines used to treat depression include:

    • Tricyclic antidepressants
    • Bupropion (Wellbutrin)
    • Monoamine oxidase inhibitors

    If you have delusions or hallucinations, your doctor may prescribe additional medications.

    WARNING: Children, adolescents, and young adults should be watched more closely for suicidal behavior, especially during the first few months after starting medications.

    If you do not feel better with antidepressants and talk therapy, you may have treatment-resistant depression. Your doctor will often prescribe higher (but still safe) doses of an antidepressant, or a combination of medications. Lithium and thyroid hormone supplements also may be added to help the antidepressants work better.

    St. John's wort is an herb sold without a prescription. It may help some people with mild depression. However, it can change the way other medicines work in your body, including antidepressants and birth control pills. Talk to your doctor before trying this herb.

    CHANGES IN MEDICATIONS

    Sometimes, medications that you take for another health problem can cause or worsen depression. Talk to your doctor about all the medicines you take. Your doctor may recommend changing your dose or switching to an alternative drug. Never stop taking your medications without first talkingt o your doctor.

    Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors.

    TALK THERAPY

    Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

    Types of talk therapy include:

    • Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how to become more aware of your symptoms and how to spot things that make your depression worse. You'll also be taught problem-solving skills.
    • Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.
    • Joining a support group of people who are sharing problems like yours can also help. Ask your therapist or doctor for a recommendation.

    OTHER TREATMENTS FOR DEPRESSION

    • Electroconvulsive therapy (ECT) is the single most effective treatment for severe depression and it is generally safe. ECT may improve mood in those with severe depression or suicidal thoughts who don't get better with other treatments. It may also help treat depression in those who have psychotic symptoms.
    • Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells in the brain that are believe to affect mood. There is some research to suggest that it can help relieve depression.
    • Light therapy may relieve depression symptoms in the winter time. However, it is usually not considered a first-line treatment.

    Support Groups

    You can often ease the stress of illness by joining a support group whose members share common experiences and problems.

    See: Depression support group


    Expectations (prognosis)

    Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take the medicine for 4 - 9 months to fully feel better and prevent the depression from returning.

    For people who have repeated episodes of depression, quick and ongoing treatment may be needed to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.


    Complications

    People who are depressed are more likely to use alcohol or illegal substances.

    Complications of depression also include:

    • Increased risk of physical health problems
    • Suicide

    Calling your health care provider

    If you have thoughts of suicide or harming yourself or others, immediate call your local emergency number (such as 911) or go to the hospital emergency room.

    You may also call a suicide hotline from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

    Call your doctor right away if:

    • You hear voices that are not there.
    • You have frequent crying spells with little or no reason.
    • Your depression is disrupting work, school, or family life.
    • You think that your current medications are not working or are causing side effects. Never change or stop any medications without consulting your doctor.