Depression is incredibly common — if you were to line a 100 random people up, chances are than at least 10 of them will either have been depressed in the past or currently be suffering from depression. Feeling sad, angry, demotivated, low, worthless, and pessimistic are all symptoms characteristic of depression, and they may very well lead to you to believe that "nothing can even get better". Despite that, treatment can't just work for you, it can work quite fast, too.
Medications: How antidepressants work and what options are available
Antidepressants will be a key part of the treatment of moderate to severe depression in most cases. Though their mechanism of action is rather complex, their basic aim is to relieve the symptoms of depression by restoring your brain chemistry to a healthier state. Once you feel better, continuing antidepressant therapy has the goal of preventing your depression from coming back.
The most commonly used antidepressants are:
- Tricyclic antidepressants (TCAs) — These have been on the market the longest amount of time, but their use is unfortunately often accompanied by more side effects.
- Selective serotonin reuptake inhibitors (SSRIs) — Newer than TCAs, SSRIs are the most commonly prescribed kind of antidepressant today. Familiar names like Zoloft and Prozac fall into this category.
- Selective serotonin noradrenaline reuptake inhibitors (SSNRIs) work similarly to SSRIs, and include Cymbalta and Effexor.
In addition, there are monoamine oxidase (MAO) inhibitors, which aren't typically chosen as the initial option, selective noradrenaline reuptake inhibitors, Wellbutrin, alpha-2 blockers, selective noradrenaline/dopamine reuptake inhibitors, melatonin receptor agonists, and serotonin 5-HT2C receptor antagonists.
Your treating doctor will consider medical history, symptoms, potential side effects, and other factors as they decide which antidepressant is likely to work best for an individual patient.
One piece of research showed that escitalopram (Lexapro), paroxetine (Seroxat), sertraline (Zoloft), agomelatine, and mirtazapine were more likely than other antidepressants to be both effective and well-tolerated, however, so you may well end up with one of these.
Talk therapy: An important option in the treatment of depression
Psychotherapy, less intimidatingly called talk therapy or even counseling, might not change your physical brain chemistry, but it plays a key role in the treatment of depression.
Cognitive behavioral therapy is designed to help you recognize where your thoughts aren't working in your interest and where they may be wrong, to allow you to start over with a healthier way of thinking. Now, I know that sounds pretty awful when put that way, but I've done CBT myself and it worked well for me. The great thing about CBT is that it often allows great progress to be made within a short period of time, within eight sessions over eight weeks.
Other forms of therapy include interpersonal therapy, problem-solving therapy, and psychodynamic therapy. Interpersonal therapy targets your relationships — with anyone from parents to children, from your partner to your friends and coworkers. Psychodynamic therapy focuses on the past to help you move forward, while problem-solving therapy may be right for no-nonsense people who want a practical approach.
The good news? While many depressed people do indeed recover by choosing either therapy or antidepressants, you can absolutely combine the two if your doctor recommends it. That way, your brain chemistry and your mind are both receiving treatment, giving you the best chance of recovering from depression.
Electroconvulsive therapy: What? Blast from the past?
If you're anything like me, you'll have seen electroconvulsive therapy presented on TV shows in horrendous, torture-like, ways, and you've perhaps heard personal horror stories from those who went through it in the past, as well. ECT has more recently once again been explored, however, and it can be a very viable option for people whose depression hasn't lifted with therapy and antidepressants. Now conducted on an outpatient basis with respect for the individual, ECT is no longer the scary treatment it once was.
Lifestyle changes to improve symptoms of depression
For people with mild depression, lifestyle changes may be enough to get them back on the road. For others, who do need therapy, antidepressants, or both, proactive steps you take to change your life can still have a positive impact. Changes often suggested include:
- Regular exercise — research has shown that people who are physically active on a regular basis are less likely to become depressed in the first place, as well as that working out reduces the symptoms of depression. It's not currently clear how much exercise you need to do to enjoy some symptom relief, but as one paper said, " clearly any exercise is better than no exercise".
- A different diet may help those who have gotten into the habit of eating junk foods of poor quality, as not getting adequate vitamins and minerals can affect the neurotransmitters that play such an important role in depression as well. Research suggests that cutting out sugary foods and alcohol is particularly important. A diet rich in fruits and vegetables is beneficial for everyone.
- Better sleep hygiene — because people who are sleep deprived are much more likely to be depressed. If a relaxing bedtime routine and regular sleep and wakeup times do not help you get to sleep and stay asleep through the night, please let your doctor know.
- A social support network is of key importance both as you recover from depression and to prevent relapse. Other depressed people understand what you are going through like no-one else, so group therapy or support groups for depressed people, online or offline, can really help.
- Eliminating the things that are making you depressed from your life may be another step. Depression certainly doesn't always set in after a particular trigger or situation that is making you stressed and unhappy, but it can. In some cases, trying to work out what will really give you purpose and fulffilment in life can make a big difference.
Alternative treatments for depression
You may also be interested in what the realm of alternative medicine has to offer you as you seek to recover from depression. In this case, it's important to note that you should discuss any herbal treatments you're keen on trying with your doctor before you take the plunge. That is because herbs can have side effects and interact with other medications, including antidepressants, just like conventional medications can.
- St John's Wort is a popular alternative treatment for depression. Sold as a supplement in the US, it is easy to come by — and there is plenty of research to support the idea that it really does help treat depression, sometimes as well as an antidepressant. Because it isn't as predictable as antidepressants, however, and because it doesn't always work, it's not a good idea to start taking St John's Wort on your own instead of seeing a doctor about depression. You should also always ask your healthcare provider before taking it alongside an antidepressant.
- Music therapy may offer some symptom relief in people with depression, research suggests.
- Omega-3 fatty acids, as a dietary supplement, may help you improve your mood if used alongside other treatments.
- Relaxation training may also help you feel a little better.
There is, on the other hand, currently no solid scientific evidence that other often-suggested treatments for depression — acupuncture, inositol, or SAMe — actually work.
The bottom line
Depression can be treated, but one size does not fit all. To give yourself the best possible chance of recovering as soon as possible, work with a competent doctor; your family doctor is a perfectly OK first point of call, and they can refer you to a psychologist, psychiatrist, or other specialist when necessary. You should feel absolutely free to ask about the pros and cons of your suggested treatment or treatments, and once you start treatment, it's also important to let your doctor know how you are getting on. It may take a while to find the right antidepressant, kind of therapy, or other treatment, but once you do, you should start noticing improvements very soon.