Here at How to Get Rid of Things, we pride ourselves on helping people find ways to solve their own problems. However, depression is emphatically not a do-it-yourself kind of problem. Major depression is a serious and potentially life-threatening illness that must be treated as such. Depressed feelings can be triggered by events in your life and your own responses to them, but you can't beat depression simply by trying to cheer up. Odds are, the underlying causes of your depression reside in the tissues of your brain, or in attitudes and behaviors you may not even recognize in yourself. If you've been suffering from more than one of the symptoms in the list on the right for more than two weeks, you may be fighting depression, and it's important that you enlist the help of at least one person with a degree in medicine or psychology.
If you have questions or concerns about the various therapies a doctor or mental health professional might recommend if you do get a depression diagnosis, the next section offers a detailed overview of the most common treatments for depression. These treatments are often used in combinations of two or more, and you can expect a certain amount of trial and error as you and your doctor work together to find the right course of treatment for your depression. If you, like us, are full of the do-it-yourself spirit, there are many things you can try on your own to help your medical or psychological treatments along. Some ideas for supplementary self care can be found at the bottom of the page.
If you're having suicidal thoughts, stop reading this article and immediately talk to someone you trust, even if that person is a 911 operator or an emergency room doctor. You can also call the national suicide hotline at 1-800-784-2433 or 1-800-273-8255.
Options for Treating Depression
Check for medical causes; treat them if present. If you think you may be suffering from depression, a good first move is to visit a medical doctor, who can make a positive diagnosis and refer you to a psychiatrist or psychologist. A doctor can also determine whether the depression symptoms may have originated in some other, possibly undiagnosed physical ailment; sleep apnea, diabetes, thyroid disorders, and Parkinson's disease are just a few of the illnesses that can mimic or lead to depression. In women, premenstrual dysphoric disorder (PMDD) and the onset of menopause are other potential causes of depression. If your symptoms do have physical or hormonal roots, the underlying disorder must be treated to resolve the depression. In addition, certain drugs, including birth control and some heart medications, can have depression as a side effect. Your doctor will be able to assess whether one of your prescriptions is giving you the blues and either adjust your dosage or recommend an alternative.
Antidepressant medication is usually prescribed to help combat severe depression. In the brain, depression is associated with irregularities in neurotransmitters, which are chemicals that help neurons communicate with other cells. Most antidepressant drugs interact with one or more of the three neurotransmitters that have the greatest effect on mood—serotonin, norepinephrine, and dopamine—to correct an imbalance or deficiency that may be causing feelings of depression. Many different types of antidepressants are available, and one type may work better than another on your particular symptoms. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Celexa. Drugs in this class are effective for most people and usually cause less serious side effects than the other types of antidepressants: serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and so-called "atypical antidepressants" like Wellbutrin. No matter which antidepressant your doctor prescribes, you can expect it to take several weeks before you feel like your old self again. However, if you aren't noticing any improvement after about six weeks, or you experience severe side effects, check in with your doctor, who may recommend a change in your treatment. Never stop taking your medication without talking to your doctor first.
Psychotherapy is another cornerstone in the treatment of depression. Sometimes referred to as "talk therapy," psychotherapy is defined by regular meetings with a psychologist (or a psychologist and a group of other depression sufferers) to learn more about depression in general, and about your individual case in particular. Psychotherapy attempts to identify factors in a patient's life that may lie at the root of their depression, and focuses on teaching the patient how to avoid situations, attitudes, and behaviors that act as depression triggers. Many people find that simply having someone to talk to helps alleviate their depression, and some studies suggest that psychotherapy can be just as effective as antidepressant medication in treating mild depression. Psychotherapy is often short-term, lasting only several weeks following diagnosis, but can continue for much longer if the psychologist or patient thinks it necessary or helpful.
Electroconvulsive therapy (ECT) has regained legitimacy as a depression treatment in recent years. The electrical currents that pass through the brain during ECT cause an immediate seizure, and because doctors used to simply strap patients down and zap them without anesthesia, the procedure was long considered overly invasive, even barbaric. But these days, doctors administer the smallest effective amount of current while the patient is under the effects of a general anesthetic and a muscle relaxant. A seizure still occurs within the brain, triggering the desired (albeit mysterious) changes in brain chemistry, but without the patient having to actually convulse or even be aware of what's happening. ECT is usually recommended in a two-to-four-week course of three treatments a week, and is generally reserved for patients who don't get better on antidepressants, or whose depression is so severe that they are in danger of harming themselves. The procedure is safe and effective for most people, but it can cause temporary confusion or memory loss.
Brain stimulation is the newest and most experimental form of treatment for depression. Multiple types of brain stimulation are possible, but the two most common types are vagus nerve stimulation and deep brain stimulation. Of these, only vagus nerve stimulation has been approved by the FDA for treating major depression, and it has nevertheless remained controversial. Vagus nerve stimulation starts with a surgical procedure in which a pulse generator is implanted in a patient's chest, with a wire inside the body connecting the generator to the vagus nerve in the neck. After the surgery, the pulse generator delivers electrical pulses (go figure) to the vagus nerve, which passes them on to the brain, where they may affect neurotransmitters and gradually improve the patient's mood. Research has yielded contradictory results, however, and any type of brain stimulation should be considered only as a last-ditch therapy for depression that has proven untreatable by any other means.
Self Help for Depression
While none of the things in the list below would suffice as a substitute for professional help for depression, they are all important steps you can take to help yourself heal and prevent future depressive episodes—once your depression is already being controlled by medication, psychotherapy, or another of the treatments discussed above.
- Do as your doctor or mental health professional says. Take your medication as directed, even when you feel good, and attend any appointments you have for psychotherapy or medical checkups. If you're having trouble with your medication, talk to your doctor before trying to make any changes.
- Learn as much as you can about depression. Knowing how your illness works and why the treatments help can motivate you to stick with them.
- Stay healthy: eat well, exercise, allow yourself enough time for sleep, and just say no to drugs and alcohol.
- Keep your life as simple as possible by staying organized and on a schedule, making goals you can actually accomplish, and setting aside time to take care of yourself.
- Don't isolate yourself: spend time with friends and family, take a class, join a support group, or take up a social hobby.
- Pay attention to how you feel, and if you notice the signs of depression starting to reappear, get help as soon as possible. Like anything else, depression is easier to treat when treatment begins early on.