Treatments for (unipolar) depression

According to research, most people experience the greatest benefit from a combination of psychotherapy and antidepressant medications. The pharmacological component may not be necessary for those who are experiencing mild depression or situational depression that can be linked to a specific event. However, when depression is moderate or severe or recurrent, it is possible that “talk therapy” alone will not be as effective. In such cases, individuals who do not wish to take prescription medication may consider over-the-counter (OTC) alternatives. Keep reading below for a brief paragraph on complementary medicine.

Antidepressant medication

These medications have been widely studied and proven to help. They take 2-4 weeks to work, may cause side effects, and may pose serious risks to children, teens, and young adults (including suicidal ideation and suicide attempts). Ideally, any psychotropic drug should be prescribed after a complete evaluation by a psychiatrist, since medical doctors with a specialization in psychiatry are the most knowledgeable professionals when it comes to this type of medication. 

Most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Common side effects are nausea and vomiting, weight gain, digestive tract discomfort, sleepiness, and reduced sexual desire. To find the latest information about antidepressants, talk to your medical doctor and visit www.fda.gov.

Note: There is no “one-size-fits-all” antidepressant medication. You may need to try more than one antidepressant before you and your doctor find the one that works best with your symptoms and causes you the fewest and least bothersome side effects. 

Does Dr Maxwell prescribe medication? We get this question a number of times every year, so let’s clarify. In the state of Georgia (and most other states in the U.S.), the only professionals with the title of “doctor” who are allowed to prescribe any type of medication are medical doctors/physicians. The clinicians in the mental health field who have a PhD or a PsyD have the prefix of “Dr” because they hold academic doctoral degrees, not medical licenses.

Psychotherapy

Scientifically proven talk therapy approaches for depression include cognitive-behavioral therapy (CBT) and psychodynamic therapy. The effectiveness of these approaches for the treatment of depression has been proven in rigorous controlled studies. In my practice, I incorporate both approaches. 

CBT is known for its emphasis on practical, step-by-step tools that help modify dysfunctional thinking and behavior. It includes psychoeducational handouts, weekly action plans, weekly logs, and worksheets—all with the goal of helping you unlearn dysfunctional responses and learn new ways of reacting through repeated practice. In addition, for those who may need help with relaxation training, CBT can teach you various types of breathing and muscle-focused relaxation techniques.

Psychodynamic therapy recognizes the complexity of mental life and therefore addresses underlying psychological forces that may affect who you are. It is an approach that considers the relationship between past and present and helps you understand the why behind your thoughts, emotions, and behaviors, including the root of self-defeating patterns. This enhanced self-awareness is thought to be behind the fact that clients who receive psychodynamic therapy continue to improve after treatment ends.

Typically, psychotherapy for depression begins with more frequent sessions and then tapers in order to gradually end treatment. It may also be helpful to schedule monthly booster sessions for a couple of months (or for as long as you’d like) after your treatment is over.

Complementary medicine

St John’s Wort has been used for centuries for mental health conditions. Although it is a top-selling botanical product, the FDA has not approved its use as an OTC or prescription medicine for depression. It is important to keep in mind the following about this herb: the results of studies on the effectiveness for depression are mixed; long-term effects are not well known; interacts with many prescribed medications, limiting their effectiveness; can lead to a potentially life-threatening condition when mixed with prescribed antidepressants; may have dangerous side effects if taken by individuals with bipolar disorder or schizophrenia.

S-Adenosyl-L-Methionine (SAMe) is found naturally in the body. It has been studied primarily for depression, osteoarthritis, and liver diseases, with inconclusive results. Long-term safety is unknown. It remains under study but has not yet been proven safe or effective for routine use. SAMe may not be safe for people with bipolar disorder. It is also known to interact with some prescribed medications and other dietary supplements.

To get information on supplements, other complementary approaches, and research, visit the website for the National Center for Complementary and Integrative Health at https://nccih.nih.gov/health/depression.htm

What else can you do?

In addition to talking to a doctor and/or a psychotherapist, consider the following:

  • Be patient with yourself, with the medication, and with talk therapy
  • Take advantage of your support system (family members, friends, clergy, etc.)
  • Try gradual, aerobic exercise (“natural endorphins”), whether indoors or outside
  • If possible, spend time outside in nature and in the sun
  • Avoid alcohol and illicit drug use

If you are in a crisis

  • Call 911 or go to the nearest hospital emergency room
  • Call the Georgia Crisis & Access Line at 1-800-715-4225
  • Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)

Content based in part on the following two public domain sources:

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013
  • National Institute of Mental Health publications