What Treatments are Available for Depression?

DISCLAIMER:

This post includes general information and should not be construed as medical advice intended to diagnose or treat your specific symptoms. This content is solely informational. If you live in the Dallas-Ft. Worth area and would like to be assessed by a Prestonwood Health psychiatrist, please visit our website at www.prestonwoodhealth.com to request an appointment.

What treatments are available for depression?

Many options are available for the treatment of depressive symptoms, including medications (sometimes referred to as pharmacotherapy or psychopharmacology), psychotherapy (also called counseling or therapy), lifestyle changes, and brain stimulation therapies (sometimes referred to as neuromodulation or interventional psychiatry). Treatments that may be recommended depend on many different factors, including your specific symptoms, your previous treatment history, your psychiatric diagnoses, and current medical problems.

Pharmacotherapy

Medications that are effective in the treatment of depression are known as antidepressants. Many different types of antidepressants are used clinically. Most of them, however, have largely similar effects on the brain, similar side effects, and similar efficacy -- in fact, there is no evidence to suggest that any particular antidepressant is "superior" or "the best" in the treatment of depression. Instead, factors like the cost of a medication, your previous experiences with specific medications, and your current symptoms help your doctor choose a medication.

All of the antidepressants increase the activity of a group of chemicals called monoamines in the brain. The monoamines include serotonin, norepinephrine, and dopamine. The antidepressants are grouped into different classes depending on the specific effects that they have on the different monoamines. Commonly used antidepressants include:

• Serotonin-selective reuptake inhibitors (SSRIs) - these medications increase the activity of serotonin in the brain by slowing down your brain's ability to recycle serotonin. The SSRIs include medications like fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil).

• Serotonin/norepinephrine reptake inhibitors (SNRIs) - these medications increase the activity of both serotonin and norepinephrine in the brain by slowing down your brain's ability to recycle these chemicals. The SNRIs include medications like venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).

• Serotonin modulators - these medications are very similar to SSRIs but also interact with serotonin receptors. Clinically, however, they are largely indistinguishable from the SSRIs. These medications include vortioxetine (Trintillex) and vilazodone (Viibryd).

• Tricyclic antidepressants (TCAs) - the TCAs include many medications with slightly different effects on the brain. Some TCAs function like SSRIs and some function like SNRIs. However, TCAs also interact with other receptors in the brain and body, causing many more side effects than newer medications like the SSRIs and SNRIs. The TCAs include medications like amitriptyline (Elavil), nortriptyline (Pamelor), clomipramine (Anafranil), and doxepin (Sinequan).

• Monoamine oxidase inhibitors (MAOIs) - the MAOIs are the oldest antidepressants still in clinical use, though they are used rarely because of the potential for significant side effects. These medications include tranylcypromine (Parnate), phenelzine (Nardil), and selegiline (Emsam)

Many other medications are sometimes used in the treatment of depression, including mirtazapine (Remeron), bupropion (Wellbutrin), lithium, aripiprazole (Abilify), and brexpiprazole (Rexulti), among others.

Psychotherapy

Psychotherapy involves speaking with a trained professional about your problems and symptoms. Many different professionals work as therapists, including licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), psychologists (PhDs and PsyDs), and psychiatrists (MDs and DOs). By talking about what's on your mind, working to understand where feelings are coming from, and incorporating lifestyle changes specific to your symptoms, psychotherapy can improve your symptoms and help you cope with challenges in your life.

Many types of psychotherapy are used in the treatment of depression and other psychiatric conditions. Nearly all types of psychotherapy have been shown to be effective; while all forms of psychotherapy share the same general principles, individual forms of psychotherapy tend to emphasize different concepts and utilize different approaches to address challenges. Individual therapists typically specialize in specific types of psychotherapy, and you may find a particular approach more helpful for you. Different types of psychotherapy are often broadly divided into two categories:

• Manualized therapies - manualized therapies -- named because they often include manuals for therapists and patients to follow -- are often problem-focused and emphasize improving specific symptoms quickly. These therapies often include "homework," and your therapist may provide specific interventions or tips for you to try between sessions. Manualized therapies are generally time-limited and designed to take place over the course of 6-12 months. Common manualized therapies include cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT).

• Expressive therapies - expressive therapies take a very different approach than manualized therapies. These approaches to therapy are often broader, do not follow a schedule or specific structure, and focus on what's on your mind in the moment to make better sense of your symptoms and potential problems in your life. Expressive psychotherapy varies widely in how long a course of therapy lasts: a course of therapy may last months or years. Common expressive therapies include psychodynamic psychotherapy, interpersonal psychotherapy, and psychoanalysis.

Brain stimulation therapies

Brain stimulation therapies include treatments that directly change the electrical activity in the brain. Brain stimulation therapies often fall under the umbrella of interventional psychiatry and typically take place in specialized treatment settings, sometimes in a hospital. These treatments are typically reserved for people who have severe symptoms or whose symptoms have not improved with multiple medication trials and psychotherapy. Brain stimulation therapies used in clinical practice include:

• Repetitive transcranial magnetic stimulation (rTMS) - rTMS utilizes a small magnet to stimulate specific areas of the brain thought to be involved in the development of depressive symptoms. There are many different forms of rTMS, but the principle of the treatment is the same. rTMS has few side effects but is also associated with the lowest rates of response.

• Transcranial direct current stimulation (tDCS) - tDCS utilizes a small amount of electrical current, supplied by small electrodes placed on the head, to change the activity of specific areas of the brain thought to be involved in the development of depressive symptoms. tDCS is very similar to rTMS but utilizes electric rather than magnetic current to change brain activity. In the United States, tDCS is not a commonly utilized treatment.

• Electroconvulsive therapy (ECT) - ECT involves passing a small amount of electrical current to the brain to cause a seizure. The procedure is performed under general anesthesia and typically occurs in a hospital setting. ECT has the greatest response rates but also the greatest side effect burden.

• Magnetic seizure therapy (MST) - MST is similar to ECT but utilizes a magnetic rather than electrical stimulus to cause a seizure. MST is currently an investigational treatment -- phase III clinical trials are currently occurring in the United States and Canada.

Want to talk with someone about your symptoms?

If you would like to speak with someone about treating your depressive symptoms, click here to request an appointment with one of Prestonwood Health's board-certified psychiatrists. After a thorough evaluation, we will talk with you about your treatment options to begin your return to wellness. You may also e-mail us or call us at 214-810-1898.