Stephen J. Schueler, M.D.

Depression Treatment

Treatment of depression depends on the severity of the symptoms. Depression is most successfully treated wit a combination of mental health counseling and medication. Selective serotonin reuptake inhibitors (SSRI), selective serotonin and norepinephrine uptake inhibitors (SSNRI) and tricyclic antidepressants are the most commonly prescribed medications to treat depression.

Those with severe depression that results in suicidal plans may require admission to the hospital for intensive treatment by a psychiatrist. In some cases, additional medication is necessary to treat hallucinations and delusions. Electroconvulsive therapy, or ECT, involves passing mild electrical current through the brain. Although the mechanism for this therapy is not understood, it can be a very effective treatment for severe depression. Additional treatment may include vagus nerve stimulation, which uses an implanted electrical device to stimulate the brain, and transcranial magnetic stimulation, which involves placing strong magnets against your scalp in order to produce an electrical current.

Treatment for depression may include:

Depression Drugs

Depression Lithium

Lithium is very effective in the treatment of depression in patients with a bipolar disorder. Exactly how lithium works is unclear.

Medications that contain lithium:

Lithium can cause kidney damage if the blood level gets too high. Routine lithium blood levels are important for all patients taking this medicine.

Depression SSNRI Drugs

The selective serotonin norepinephrine reuptake inhibitors (SSNRI) are a class of antidepressant medications that were developed after the selective serotonin reuptake inhibitors (SSRI). SSNRI medications inhibit both the reuptake of serotonin and norepinephrine in the synaptic space. This has the effect of increasing the concentration of both of these neurotransmitters, and ultimately, reducing depression.

Examples of SSNRI drugs include:

Depression SSRI Drugs

The selective serotonin reuptake inhibitors or SSRI's the most popular drugs for the treatment of depression. SSRIs increase the concentration of the chemical, serotonin, in the brain.

Selective serotonin reuptake inhibitors:

Selective serotonin reuptake inhibitors can also cause drug side effects, including:

Depression Tricyclics

Depression Psychotherapy

Psychotherapy for Depression
Psychotherapy includes a number of different counseling approaches. Some forms of depression respond to counseling as well as drug therapy, but without the risks of side effects present with drug treatment. There are three main forms of psychological therapy.

Interpersonal Therapy
This is a form of therapy that concentrates on interpersonal relationships. Treatment helps the patient to understand their feelings about their relationships and find ways to cope with them.

Cognitive Behavioral Therapy
This is a form of counseling that focuses on helping people recognize and change negative thinking and turn it into positive thoughts.

Psychodynamic Therapy
Therapy focuses on resolving deep internal conflicts that depressed people may have carried from childhood to adulthood.

Depression Questions For Doctor

The following are some important questions to ask before and after the treatment of depression.

Questions to ask before treatment:

  • What are my treatment options?
  • What are the risks associated with treatment?
  • Do I need to stay in the hospital?
    • How long will I be in the hospital?
  • What are the complications I should watch for?
  • How long will I be on medication?
  • What are the potential side effects of my medication?
  • Does my medication interact with nonprescription medicines or supplements?
  • Should I take my medication with food?

Questions to ask after treatment:
  • Do I need to change my diet?
  • Are there any medications or supplements I should avoid?
  • When can I resume my normal activities?
  • When can I return to work?
  • How often will I need to see my doctor for checkups?
  • What local support and other resources are available?

Depression Shock Therapy

Shock Therapy for Depression
Those with severe depression may not respond to medications. These patients may benefit from electroconvulsive therapy (ECT), which is also called shock therapy. During ECT, electrodes are placed on the patient's head, and an instrument is programmed to deliver a short burst of electricity to the brain. ECT triggers a short seizure, lasting about one minute.

ECT is performed under general anesthesia, in order to prevent pain and control prolonged seizures. Usually, a patient receives therapy 3 times a week, for 2 to 4 weeks. ECT improves symptoms in about 75 percent of patients who complete the full course of treatment.

The most common side effects of electroconvulsive therapy include:

  • Brief episodes of mild confusion:
    • May last several minutes to a few hours
    • Episodes of confusion may become longer after each additional treatment.
  • Temporary, mild memory loss:
    • May persist for a couple of months after treatment
    • Usually resolves
    • Permanent memory loss is unusual.

Additional side effects of electroconvulsive therapy include:

Depression Specialist

Physicians from the following specialties evaluate and treat depression:

Depression TMS

Transcranial magnetic stimulation or TMS is a new treatment that applies rapid magnetic pulses to the brain. The stimulation produces electrical current in the prefrontal cortex of the brain. The FDA has approved TMS (NeuroStar) for the treatment of major depression in those who have not responded to oral antidepressants.

TMS Features:

  • Treatments are delivered in the office setting while you sit in a special chair.
  • Treatments last for about 40 minutes and are done daily for 4 to 6 weeks.
  • Patients are awake through the process and there is no need for anesthesia.
  • Clinical studies of TMS show that it is effective in roughly 1 out of 4 who receive treatment.
  • Side effects are mild and include:

Continue to Depression Home Care

Last Updated: Jun 10, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Depression References
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  2. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003 Nov 10;163(20):2433-45. [14609780]
  3. Barrett B, Byford S, Knapp M. Evidence of cost-effective treatments for depression: a systematic review. J Affect Disord. 2005 Jan;84(1):1-13. [15620380]
  4. Neumeyer-Gromen A, Lampert T, Stark K, Kallischnigg G. Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials. Med Care. 2004 Dec;42(12):1211-21. [15550801]
  5. Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ. 2002 Nov 26;167(11):1253-60. [1245108]
  6. Wulsin LR. Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harv Rev Psychiatry. 2004 Mar-Apr;12(2):79-93. [15204803]
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