Medically reviewed by Susan Vachon, PA-C on January 10, 2022
If you’ve got depression, you’ll need a treatment plan to help you feel like yourself again. Luckily, there are many options to consider.
While all of the following are valuable treatments for depression, keep in mind that you’ll need help from a doctor to determine what’s best for you. Together, you and your medical provider can devise a depression treatment plan to help you overcome your symptoms. Usually, it will combine several of these options. It may take a little trial and error, but eventually, most people find a mixture of treatments that works for them.
Medications are an important step in treating depression. That’s because depression is often caused by an imbalance of neurotransmitters in the brain. Neurotransmitters are chemicals that help different parts of the brain communicate. In particular, depression is linked to lower levels of three neurotransmitters: serotonin, dopamine, and norepinephrine. The goal of medications is to help rebalance these neurotransmitter levels.
There are many different types of antidepressant medications available. However, they can be broken into five main classes:
- Selective serotonin reuptake inhibitors (SSRIs) – These work by increasing levels of serotonin in the brain.
- Serotonin and noradrenaline reuptake inhibitors (SNRIs) – These work by blocking the reabsorption of serotonin and norepinephrine so your brain can reuse them.
- Tricyclic antidepressants – These work by blocking the reabsorption of serotonin and norepinephrine so your brain can reuse them. These are often used as second-line treatment if use of SSRI’s or SSNI’s do not work.
- Monoamine oxidase inhibitors – These work by inhibiting an enzyme called monoamine that typically removes norepinephrine, dopamine, and serotonin from the brain. These are less prescribed these days, as they have more side effects.
- Norepinephrine and dopamine reuptake inhibitors (NDRIs) – These work by blocking the reabsorption of norepinephrine and dopamine so your brain can reuse them. The only NDRI on the US market is Wellbutrin, which can also be used to help quit smoking.
Finding the right medication
Since there are so many medication options, you may have to try a few out before you can find the one that works best for you. Every person is different, meaning their body may react differently to each medication.
Generally, your medical provider will prescribe a drug based on your symptoms, any other medical conditions, and any other medications you’re currently taking. Cost and potential side effects are also important factors.
It may take several weeks before you know if a medication is working or not. During this time, your body will be adjusting to the meds, so you may experience side effects. If these don’t go away after four to eight weeks, or you don’t see any improvement in your depression, your medical provider may switch you to another medication.
Risks of abruptly stopping a medication
If you start to feel better after being on medication for a while, you may think you no longer need it. You may be tempted to stop taking your meds altogether. However, this may be a bad idea.
While you’re on antidepressants, your body gets used to the increased levels of serotonin, dopamine, or norepinephrine. Stopping these medicines abruptly may mean your body is suddenly faced with lower neurotransmitter levels than it’s used to. This may cause you to feel certain physical and emotional symptoms as your body tries to cope.
You may notice symptoms as soon as three days after stopping your dose. These may feel similar to what your depression was like before you started the meds, or they could be even worse. You may develop headaches, nausea, nightmares, dizziness, muscle spasms, and more.
Luckily, these symptoms are temporary. They will likely only last a few weeks. However, because they’re quite severe and could lead to a relapse of your illness, it’s best to avoid stopping your medication abruptly. Instead, your medical provider will likely recommend tapering off your dose to give your body time to adjust to the absence of the medication.
Antidepressants and pregnancy
Antidepressants are a safe option for most people during pregnancy. Your doctor will likely recommend SSRIs, SNRIs, tricyclic antidepressants, or NDRIs, as they are the safest options. Luckily, the risk of birth defects or other complications is extremely low when a mother is on antidepressants.
Antidepressants and increased suicide risk
If you’re taking an SSRI, you may notice that it comes with a black box warning about suicidal ideation. There is a very low risk of suicidal thoughts when starting most antidepressant medications. This risk is highest in the first 2 weeks of use. It is very important to talk to your medical provider should you experience any thoughts of suicide or worsening mood symptoms during your treatment. If you are acutely feeling suicidal call the National Suicide Prevention Lifeline.
Psychotherapy is a very common treatment for depression, and it’s often used in conjunction with medication. It can help you understand how your behaviors, emotions, and ideas are contributing to your depression. It may also help you uncover the triggers that have led to your depression.
Therapy can come in many forms. The most common is individual therapy, where you work one-on-one with a therapist to tackle your issues. However, you may also benefit from group therapy, where you get to talk with others experiencing the same problems as you.
If your depression stems from your relationships, you’ll likely need some couple or family therapy. These sessions bring in your loved ones so you can talk through your issues in a safe space.
There are a few main approaches to therapy. Your therapist will decide which route to take after meeting with you for the first time. One option is psychodynamic therapy. This is when your therapist helps you find unresolved, unconscious conflicts that might be causing your depression.
Interpersonal therapy is another method. In this type of therapy, you will work on your communication skills in an effort to improve your self-esteem. Finally, there is cognitive-behavioral therapy. This therapy helps you identify negative patterns of thought so you can establish healthier ways of thinking.
Alternate formats for therapy
Traditional therapy works for many people, but it isn’t your only option. There are several alternative therapies that can be just as effective in your depression treatment plan.
For example, you might try art or music therapy. In these sessions, you’ll meet with a qualified therapist that guides you through a creative experience. In art therapy, you might paint an abstract picture to help express your mood. In music therapy, you might listen to calming sounds to help yourself feel better.
Research shows that these types of approaches can work. One study found that adding music therapy to standard depression treatment made it far more effective than standard treatment alone.
Hospital and residential treatment
If you’re having severe or life-threatening symptoms, you may require hospitalization and residential treatment. It’s just like being hospitalized for any other serious medical condition.
In these settings, you’ll receive 24-hour medical supervision to make sure you don’t harm yourself or others. You’ll be in a safe space where you can take your time to recover. You won’t have to worry about the stress of everyday life or any other problems.
During this time, you can also test out a medication regimen to see what works best for you. Being hospitalized makes it easier to try out new treatments, as you’ll be monitored for side effects.
Residential treatment can last from a few days to a few weeks. Often, it depends on how much your condition improves. During this time, you’ll likely have a lot of group therapy sessions to learn how to cope with depression, medication side effects, and stress.
Other treatment options
There are a few other things you can try for your depression, especially if therapy and medications don’t work. One such thing is electroconvulsive therapy. This is when your medical provider uses small electrical pulses to cause a controlled seizure. Don’t worry – you’ll be asleep for this part.
When you wake up, you won’t have any memory of the event. You will have to return for a total of six to 12 treatments for it to be effective. This treatment is thought to work by helping to stimulate neurons and neurotransmitters in the brain.
Another option may be repetitive transcranial magnetic stimulation (rTMS). It uses magnetic pulses to stimulate your brain, boosting nerve cell activity. You might also consider vagus nerve stimulation, which uses electrical pulses to stimulate the large nerve running from your brain to your stomach.
There are always new depression treatments on the horizon. Before these are released to the public, they must go through clinical trials. This is a multi-year process where potential medications are tested on various groups of people. If the results are positive, the drug can eventually be approved by the FDA.
You may be able to join a clinical trial if you meet the demographic requirements. Many current clinical trials are looking for participants with treatment-resistant depression. To join a study, you can check with the National Institute of Mental Health or the Anxiety & Depression Association of America for opportunities in your area.
Lifestyle and home remedies
While getting medical help for your depression is crucial, there are plenty of home remedies you can try to alleviate your symptoms. For example, you’ll probably want to avoid using alcohol or recreational drugs. This can often exacerbate your symptoms, especially if you’re testing out medication.
Eating healthy and exercising regularly are key to controlling depression. In particular, experts recommend a diet filled with leafy green vegetables, fruits, and lean proteins like fish. These provide your brain with the nutrients it needs to stay healthy. Getting in at least 30 minutes of cardio several times a week is also good at helping with the production of endorphins, a feel-good neurotransmitter.
You may also try ways to balance your mindfulness. Activities like yoga and meditation can help you reset your mind and body.
Western countries aren’t the only places that experience depression, so you may want to experiment with treatments from other parts of the world. Acupuncture is a traditional Chinese medicine where needles are inserted into specific locations under your skin. It’s believed that these punctures can help rebalance your body’s energy flow.
Supplements might also help with your depression. These aren’t as effective as medications and shouldn’t be substituted for them. But they can be a part of your depression treatment plan.
St. John’s wort is said to help with depressive symptoms, but it can’t be taken alongside other antidepressants. You may also try omega-3 fatty acids, which you can find naturally in fish or in pill form.
Coping and support
Coping with depression is tough, but you don’t have to do it alone. Ask your loved ones for support through your journey. They can provide you with a shoulder to cry on and maybe even help you with chores around the house. Whatever you do, don’t self-isolate, as you need interaction with others to facilitate your recovery.
Don’t have enough friends or family to support you? Try researching support groups in your area. Chances are, your community has a depression group that meets regularly and can offer tips and an open ear for your problems. You can also look online if you can’t find anything in person.
There are other things you can try as well. You might want to structure your day to make it easier to manage. Make sure you sleep, eat, and work at the same time to provide a sense of routine. Tasks lists can feel wonderful when you start checking off completed items.
Finally, be sure to make time for your self-improvement. Read self-help books to learn ways to continue improving. It may also help to keep a journal of your thoughts so you can record your feelings and emotions for the day.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes.