Medicines that you take for other problems could cause or worsen depression. You may need to change them. DO NOT change or stop taking any of your medications without consulting your doctor.

People who are so severely depressed that they are unable to function, or who are suicidal and cannot be safely cared for in the community may need to be treated in a psychiatric hospital.

Most people benefit from antidepressant drug therapy, along with psychotherapy. As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.

MEDICATIONS FOR DEPRESSION

Drugs used to treat depression are called antidepressants.

• Selective serotonin re-uptake inhibitors (SSRIs) are the most commonly used antidepressants. Names include: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
• Serotonin norepinephrine reuptake inhibitors (SNRIs) are also commonly used. Names include desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta).
• Other medicines used to treat depression include: tricyclic antidepressants, bupropion (Wellbutrin), and monoamine oxidase inhibitors.
• People with psychotic symptoms, such as delusions or hallucinations, may need antipsychotic medications.

Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take medication for 4 - 9 months to get a full response and to prevent depression from coming back.

Some people who do not improve with routine dosages of antidepressants and talk therapy have what is called treatment-resistant depression. They are often prescribed higher (but still safe) doses of their antidepressants, or a combination of medications. Lithium and thyroid hormone supplements also may be added to help the antidepressants work better.

Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors.

An over-the-counter herb called St. John's wort may help some people with mild depression only. It can change the way other medicines work in your body, including antidepressants and birth control pills. Always talk to your doctor before trying this herb.

Note: Young adults ages 18 - 24 should be watched more closely for suicidal behavior, especially during the first few months after starting medications.

See also: Bipolar disorder

TALK THERAPY

People with depression benefit from some type of talk therapy and counseling. Talk therapy is a good place to talk about feelings and thoughts, and most importantly, learn ways to deal with them.

Types of talk therapy include:

• Cognitive behavioral therapy teaches depressed people ways of fighting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
• Psychotherapy can help someone with depression understand the issues that may be behind their behaviors, thoughts, and feelings.
• Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for a recommendation.

OTHER THERAPIES

Electroconvulsive therapy (ECT) may improve the mood of severely depressed or suicidal people who don't respond to other treatments. It may also help with depressed patients who have psychotic symptoms.

Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses that target affected areas of the brain. It is often thought to be a second-line treatment after ECT.

Use of light therapy for depressive symptoms may help in the winter months to restore a normal sleep cycle. However, by itself it is not an effective treatment for major depression.

For more information and resources, see depression support group.

The outcome with treatment is usually good, but not for everyone. Depression is a recurring problem for many people.

For people who have repeated episodes of depression, quick and ongoing treatment may be needed to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.

• Alcohol- and drug-related problems, as well as tobacco dependence are more likely in people with long-term depression
• Increased risk of problems with physical health and premature death due to medical illness
• Suicide (up to 15% of people with major depressive disorder die by suicide)

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, thoughts of harming yourself or others, or other suicide warning signs.

There are numbers you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

Call your doctor right away if:

• You hear voices that are not there.
• You have frequent crying spells with little or no provocation.
• Your depression is disrupting work, school, or family life.
• You think that your current medications are not working or are causing side effects. DO NOT change or stop any medications without consulting your doctor.
• You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.