Treatment:

Depression can be treated in a variety of ways, particularly with medications and counseling. Most people benefit from a combination of the two treatments. Some studies have shown that antidepressant drug therapy combined with psychotherapy has better results than either therapy alone.

Medications include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. Although antidepressant medications can be very effective, some may not be appropriate for everyone. For example, in 2007, the FDA proposed that all antidepressant medicines should warn of the risk of suicidal behavior in young adults ages 18 - 24 years.

Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. People with psychotic symptoms, such as delusions or hallucinations, may need antipsychotic medications. The antipsychotic medication quetiapine has also been approved for treating episodes of depression in people with bipolar disorder.

Electroconvulsive therapy (ECT) is a treatment that causes a seizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don't respond to other treatments.

Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain function in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may be effective for relieving depression.

As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.

It is important to maintain a healthy lifestyle:

• Avoid alcohol and drugs (which make depression worse and may interfere with medications)
• Eat well-balanced meals
• Get regular exercise and sleep
• Seek supportive relationships

Many consumers try herbal products for depression. St. John's wort has a long history of use in Germany and has gained popularity as an herbal antidepressant in the United States. Most of the German studies indicated that St. John's wort was comparable to some antidepressants. However, a large study conducted by the National Center for Complementary and Alternative Medicine found that St. John's wort was NOT effective for treating major depression.

Because herbal products can have side effects, always tell your doctor if you are using them.

Support Groups:

For more information and resources, see depression support group.

Expectations (prognosis):

The outcome is usually good with treatment. Although most depressive episodes can be effectively treated with either medication, psychotherapy, or both, depression is a recurring problem for many people. For people who have experienced repeated episodes of depression, maintenance treatment may be needed to prevent future recurrences.

Complications:

• Suicide (up to 15% of people with major depressive disorder die by suicide)
• Increased risk of alcohol- and drug-related problems
• Increased risk of tobacco dependence
• Increased risk of problems with physical health and premature death due to medical illness

Calling your health care provider:

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.

Call your doctor right away if:

• You hear voices that are not there.
• You have frequent crying spells with little or no provocation.
• You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks.
• You think that one of your current medications may be making you feel depressed. DO NOT change or stop any medications without consulting your doctor.
• You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.