Depression - major; Unipolar depression; Major depressive disorder
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:
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.
For more information and resources, see depression support group.
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.
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:
Moore DP, Jefferson JW. Mood disorders. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 74.
US Preventive Services Task Force.
Conway MW, Miller MN. Mood disorders. In: Rakel P, Bope ET, eds. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa:Saunders Elsevier;2008:chap 281.
American Psychiatric Association.
Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.