How to Treat Depression
The vast majority of people with depression experience improved symptoms with treatment. So why, then, do only a fraction of patients seek help?
According to studies, 80 to 90 percent of people suffering from depression experience significant improvement when undergoing treatment, and almost all experience some control over symptoms. For people with severe depression, this treatment may comprise a combination of psychotherapy and medication, which helps many people but should never be the whole story. Therapy is an essential component to any treatment plan. Depression can alter the way people think, and therapy can help correct that, allow people to recognize distorted thinking patterns, and help them return to a more normal way of being.
Treating Depression with Medication
Antidepressants work slowly. Most patients see no benefit for the first 10 to 14 days. During that period, the onset of side effects like nausea, weight gain, insomnia, and other unpleasant symptoms tempt many people to stop taking the medication. But it’s important for patients to stick it out, and take a long-term view. After two weeks, irritability and daily crying spells typically fade. However, it may take another 8 to 10 weeks for a patient to realize the full benefit of an antidepressant. Therefore, medication should only be stopped under a physician’s supervision.
There are seven different classes of antidepressant medications, all of which work about equally well. When recommending the best treatment option for an individual patient, a doctor will typically weigh the prescription decision against tolerability, cost, and insurance coverage. 70 percent of people respond well to most antidepressants. If the first medication tried doesn’t work, most doctors recommend trying another class of medication. Some people will need an additional prescription, often called an “augmenting agent,” that works to boost the effects of the antidepressant. An augmenting agent can give the extra nudge needed to achieve full remission from symptoms.
Multiple studies have shown that a patient who stops taking her medication before nine months faces an increased risk of lapsing back into a full depression. However, after a year of consistent medication use, the risk of relapse drops to five percent. That said, 85 percent of people who experience one depressive episode will have more of them in their lifetimes. It comes down to brain wiring.
Treating Depression with Therapy
Two main types of therapy have proven effective in treating major depression: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT aims to restructure negative patterns of thinking. During CBT, a psychotherapist or therapist helps patients learn to recognize and change unhealthy or faulty cognition patterns, especially in times of stress. IPT for depression emphasizes the connections between symptoms and a patient’s interpersonal relationships. It is commonly recommended for children and adolescents with depression, but many adults use it to improve social functioning and personality issues.
In the rare cases where psychotherapy and medication do not help symptoms of depression, electroconvulsive therapy (ECT) may be a good option. In this treatment, the patient receives mild anesthesia and then electrical impulses are passed through the brain. This causes a short brain seizure. Often, ECT occurs several times a week, and may require medication alongside the treatment. After an initial course of ECT, many patients move to monthly treatments or personalized maintenance schedules.
Treating Depression with Lifestyle Changes
Patients with mild depression may experience improved symptoms with lifestyle adjustments that include the following:
- At least seven hours a night
- At least 30 minutes spent outdoors daily
- Light therapy for those who get depressed every autumn and winter
- Relaxation techniques like progressive muscle relaxation
- Regular testing of hormone levels
- Mindfulness, yoga, and meditation designed to focus on the moment and alleviate stress
- Daily exercise
- Music therapy
- Reduced carbohydrate intake
- A diet rich in omega-3 fatty acids and healthy fats
- Reduced caffeine, which can suppress serotonin levels in the brain
- A zero tolerance for stress
- Dietary supplement like saffron, B-vitamins, 5-HTP, L-Theanine, SAMe (S-adenosylmethionine) or St. John’s wort, taken with a physician’s approval
- Acupuncture treatments
Some medical professionals specializing in depression advise their patients to create a monthly chart with categories for sleep, exercise, sunshine, green time, nutrition, and stress in the left-hand margin. They then mark a daily check for each category successfully addressed each day. The goal is to earn at least three checks a day for the first month. Patients should simultaneously rate their anxiety every day on a scale of 1 to 10.
Journaling, or keeping a mood diary, helps some patients to highlight patterns of negative thinking, notice when good things happen, and stay motivated to make progress. Journal entries help remind some people that things do get better after a negative event. Writing once a week is a good initial goal, increasing frequency to once a day if the diary helps.
Experts in depression agree: No patient should struggle on his own with dark moods. People who surround themselves with a positive support network, who educate themselves about depression, and who seek out advice tend to respond best to treatment over the long haul.