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Diseases » Depression » Treatments

Treatments for Depression



Contents

Treatments for Depression:

Depression is very treatable. Perhaps the biggest obstacle to successful treatment is the shame, embarrassment, and/or stigma people with depression might feel. Overcoming preconceived notions of mental illness is often the biggest step many people with depression take to help themselves. It is often reassuring to know that depression is a common and very real medical condition with a variety of causes, including biological causes. If you think you may be experiencing symptoms of depression, it is important to visit a primary care provider so that your symptoms can be evaluated within the context of a full medical evaluation. Tests may also be ordered to ensure that your symptoms are not related to other conditions, such as hypothyroidism.

For the best outcome for your individual case of depression, your primary care provider may refer you to a qualified mental health care professional who is experienced in treating people with depression. These can include a psychiatrist or nurse practitioner who has specialized in mental health. In conjunction with this specialist, you will develop an individualized treatment plan that best fits your type and severity of depression, your goals, and your life style. The plan will also take into consideration your complete medical and family history and your response to prior treatments.

The overall treatment goal for people living with depression is to feel better and live normal, functional, and productive lives. The most effective treatment plans generally include a multifaceted approach and may include medications and psychotherapy.

Mild to moderate depression can often be successfully treated with psychotherapy, sometimes known as "talk therapy". In psychotherapy, a psychotherapist builds a relationship with a client, establishing trust and helping the client to address depression through such techniques as communication and behavior therapy. These techniques can help people to recognize and work through issues that are encouraging depression and can teach more effective ways of thinking and behaving to help change negative styles of thought and behavior. Other adjunctive treatments may include starting an exercise program. Exercise can help reduce feelings of depression by increasing the body's supply of endorphins, chemicals in the body that increase the feeling of well being.

For some cases, especially in more severe depression, psychotherapy combined with medication may be needed. After a complete evaluation, your health care professional will decide if medication is appropriate in your case and what medication or combination of medications will work best for you. Medications affect individuals differently and it may be necessary to adjust dosages or even change medications, depending on your response and reaction. Prescribed medications may include antidepressants. This class of drugs treats depression by helping to correct an imbalance in the brain of chemicals called neurotransmitters, including serotonin, norepinephrine, and dopamine. Neurotransmitters function within areas of the brain that regulate emotions and mood.

Commonly prescribed types of antidepressants include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), MAOIs (monoamine oxidase inhibitors), and tricyclics. Side effects can vary among these medications, but may include nausea, headache, insomnia, nervousness, sexual problems, drowsiness during the day, bladder problems, blurred vision, and dry mouth. Antidepressants are generally considered safe when taken as directed under medical supervision. However, some people, especially teenagers, may experience increased thoughts of suicide while taking antidepressants. It is very important to immediately notify your health care provider if you experiencing any side effects, especially thoughts of suicide, and that you take that these medications are taken exactly as directed. Also, ensure that all your health care providers, including the dentist, are aware of your medications.

A popular traditional herbal medication that has been touted to treat depression is St. John's Wort. This herbal supplement is available without a prescription in the U.S. However, it is essential to understand that just because a prescription is not needed to purchase a medication or supplement doesn't mean that it is safe or effective. St. John's Wort has been researched by the National Institutes of Health and was not found to be any more effective in treating major depression than a sugar pill. In addition, taking St. John's Wort can also seriously interfere with the effectiveness of other medications, so it is advised that people consult with their health care provider before taking this supplement.

In more rare situations in which medications and psychotherapy have not been effective, depression may be treated by electroconvulsive therapy (ECT). Also known as "shock therapy", ECT has come a long way from its early days. Today's ECT treatments have greatly improved and can be effective for severe depression that does not respond to other treatments.

Treatments for Depression

The list of treatments mentioned in various sources for Depression includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Depression: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Depression may include:

  • Various non-disease causes of down feelings:
    • Normal teenage behavior - all teenagers are somewhat moody but only about 4% are clinically depressed.
    • Normal child behavior - some children are sulky, but depression is relatively rare in children.
    • Grief - Down feelings from emotional loss or grief can be misdiagnosed as depression, but grief can also trigger depression.
  • more diagnoses...»

Hidden causes of Depression may be incorrectly diagnosed:

  • Depression may be directly related to a significant event in our lives such as losing a loved one, experiencing trauma, or battling a chronic illness. Other caused may involve:
  • Pre-menstrual and postnatal hormone changes
  • Hormone deficiencies
  • Alcoholism
  • more causes...»

Depression: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Depression:

Curable Types of Depression

Possibly curable types of Depression may include:

Depression: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Depression:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Depression include:

  • Amitriptyline - used in combination with chlordiazepoxide
  • Amitid - used in combination with chlordiazepoxide
  • Amitril - used in combination with chlordiazepoxide
  • Apo-Amitriptyline - used in combination with chlordiazepoxide
  • Alatrol - used in combination with chlordiazepoxide
  • Elavil - used in combination with chlordiazepoxide
  • Elavil Plus - used in combination with chlordiazepoxide
  • Emitrip - used in combination with chlordiazepoxide
  • Endep - used in combination with chlordiazepoxide
  • Enovil - used in combination with chlordiazepoxide
  • Etrafon-Plus - used in combination with chlordiazepoxide
  • Etrafon - used in combination with chlordiazepoxide
  • Etrafon-A - used in combination with chlordiazepoxide
  • Etrafon-D - used in combination with chlordiazepoxide
  • Etrafon-Forte - used in combination with chlordiazepoxide
  • Levate - used in combination with chlordiazepoxide
  • Novo-Triptyn - used in combination with chlordiazepoxide
  • PMS-Levazine - used in combination with chlordiazepoxide
  • SK-Amitriptyline - used in combination with chlordiazepoxide
  • Triavil - used in combination with chlordiazepoxide
  • Amoxapine
  • Asendin
  • Citalopram
  • Celexa
  • Desipramine
  • Apo-Desipramine
  • Deprexan
  • Norpramin
  • Pertofrane
  • Doxepin
  • Adapin
  • Sinequan
  • Triadapin
  • Zonalon
  • Fluoxetine
  • Alti-Fluoxetine
  • Apo-Fluoxetine
  • Gen-Fluoxetine
  • Med-Fluoxetine
  • Prozac
  • Prozac Weekly
  • Sarafem
  • Maprotiline
  • Ludiomil
  • Mirtazapine
  • Remeron
  • Remeron Sol Tab
  • Nefazodone
  • Lin-Nefazodone
  • Serzone
  • Serzone 5HT2
  • Nortriptyline
  • Aventyl
  • Pamelor
  • Paroxetine
  • Paxil
  • Paxil CD
  • Phenelzine
  • Nardil
  • Protriptyline
  • Sertraline
  • Zoloft
  • Apo-Sertraline
  • Gen-Sertraline
  • Novo-Sertraline
  • Thioridazine
  • Apo-Thioridazine
  • Mellaril
  • Mellaril-S
  • Millazine
  • Novo-Ridazine
  • PMS-Thioridazine
  • SK-Thioridazine
  • Trazodone
  • Desyrel
  • Alti-Trazodone
  • Apo-Trazodone
  • Desyrel Dividose
  • Novo-Trazodone
  • PMS-Trazodone
  • Trialodine
  • Venlafaxine
  • Effexor
  • Effexor XR
  • PMS-Amitriptyline
  • Anapsique
  • Tryptanol
  • Amitriptyline and Chlordiazepoxide
  • Limbitrol
  • Limbitrol DS
  • Amitriptyline and Perphenazine
  • Tiravil
  • Demolox
  • Novo-Desipramine
  • Nu-Desipramine
  • PMS-Desipramine
  • Marplan
  • Isocarboxazid
  • Vivactil
  • Temazepam
  • Apo-Temazepam
  • CO Temazepam
  • Gen-Temazepam
  • Novo-Temazepam
  • Nu-Temazepam
  • Ratio-Temazepam
  • Restoril
  • Trimipramine
  • Surmontil
  • Apo-Trimip
  • Novo-Tripramine
  • Nu-Trimipramine
  • Rhotrimine
  • Mianserin
  • Lumin
  • Tolvon
  • Aropax
  • GenRx Paroxetine
  • Oxetine
  • Paxtine
  • Reboxetine
  • Edromax
  • Saint John's Wort
  • St. John's Wort

Unlabeled Drugs and Medications to treat Depression:

Unlabelled alternative drug treatments for Depression include:

  • Clomipramine
  • Anafranil
  • Apo-Clomipramine
  • Novo-Clopamine
  • Maronil
  • Clonazepam
  • Apo-Clonazepam
  • Klonopin
  • Med-Klonazepam
  • Novo-Clonazepam
  • Rhoxal-Clonazepam
  • Rivotril
  • Fluoxetine - Seasonal Affective Disorder
  • Alti-Fluoxetine - Seasonal Affective Disorder
  • Apo-Fluoxetine - Seasonal Affective Disorder
  • Gen-Fluoxetine - Seasonal Affective Disorder
  • Med-Fluoxetine - Seasonal Affective Disorder
  • Prozac - Seasonal Affective Disorder
  • Prozac Weekly - Seasonal Affective Disorder
  • Sarafem - Seasonal Affective Disorder
  • Fluvoxamine
  • Apo-Fluvoxamine
  • Gen-Fluvoxamine
  • Luvox
  • Novo-Fluvoxamine
  • PMS-Fluvoxamine
  • Riva-Fluvoxamine
  • Methylphenidate
  • Concerta
  • Metadate CD and ER
  • PMS-Methylphenidate
  • Methylin ER
  • Ritalin
  • Ritalin-SR
  • Pramipexole
  • Mirapex
  • Selegiline
  • Apo-Selegiline
  • Carbex
  • Dom-Selegiline
  • Eldepryl
  • Med-Selegiline
  • Novo-Selegiline
  • PMS-Selegiline
  • Atomoxetine
  • Strattera
  • Dextroamphetamine
  • Dexedrine
  • Dextrostat

Latest treatments for Depression:

The following are some of the latest treatments for Depression:

Hospital statistics for Depression:

These medical statistics relate to hospitals, hospitalization and Depression:

  • average 15.2 hospital days per case in Canada 1999 (Centre for Chronic Disease Prevention and Control, Health Canada)
  • 80 per 100,000 population hospitalizations in Canada 1999 (Centre for Chronic Disease Prevention and Control, Health Canada)
  • 60 men per 100,000 population hospitalizations in Canada 1999 (Centre for Chronic Disease Prevention and Control, Health Canada)
  • 100 women per 100,000 population hospitalizations in Canada 1999 (Centre for Chronic Disease Prevention and Control, Health Canada)
  • 0.2% (25,852) of hospital consultant episodes were for depressive episodes in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Depression

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Depression:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Depression, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Depression:

The following medical news items are relevant to treatment of Depression:

Discussion of treatments for Depression:

Depression: NWHIC (Excerpt)

Depression is the most treatable of all mental illnesses. About 60 to 80 percent of depressed people can be treated successfully. Depending on the case, various kinds of therapies seem to work. Treatments such as psychotherapy and support groups help people deal with major changes in life. Several short-term (12-20 weeks) "talk" therapies have proven useful. One method helps patients recognize and change negative thinking patterns that have led to the depression. Another approach focuses on improving a patient’s relationships with people as a way to reduce depression and feelings of despair.

Antidepressant drugs can also help. These medications can improve mood, sleep, appetite, and concentration. There are several types of these drugs available. Drug therapies often take at least 4 to 12 weeks before there are real signs of progress and may need to be continued for 6 months or longer after symptoms disappear. (Source: excerpt from Depression: NWHIC)

Depression: NWHIC (Excerpt)

The first step to getting help is to overcome negative attitudes that stand in the way. The subject of mental illness still makes many people uncomfortable. Some feel that getting help is a sign of weakness. Many people mistakenly believe that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor, whether in private practice, a clinic, or a health maintenance organization, should decide if there are medical or drug-related reasons for the symptoms of depression. After a complete exam, the physician may refer the patient to a mental health specialist for further study and possible treatment. Be aware that some doctors may share some of the negative attitudes about depression and may not take the complaints seriously. Insist that your concerns be taken seriously or find a doctor who is willing to help.

If a depressed person refuses to go along with evaluation and treatment, relatives or friends can be reassuring. Explain how treatment will reduce symptoms and make the person feel better.

Don’t avoid seeking help because you are afraid of how much treatment might cost. Often, the problem can be solved with weeks -- not months or years -- of therapy or medication. Also, community mental health centers offer treatment based on a patient’s ability to pay. (Source: excerpt from Depression: NWHIC)

Let's Talk About Depression: NIMH (Excerpt)

Most people with depression can be helped with psychotherapy, medicine, or both together.

Short-term psychotherapy, means talking about feelings with a trained professional who can help you change the relationships, thoughts, or behaviors that contribute to depression.

Medication has been developed that effectively treats depression that is severe or disabling. Antidepressant medications are not "uppers" and are not addictive. Sometimes, several types may have to be tried before you and your doctor find the one that works best.

Treatment can help most depressed people start to feel better in just a few weeks. (Source: excerpt from Let's Talk About Depression: NIMH)

Let's Talk About Depression: NIMH (Excerpt)

Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help. (Source: excerpt from Let's Talk About Depression: NIMH)

Let's Talk About Depression: NIMH (Excerpt)

Talking through feelings with a good friend is often a helpful first step. Friendship, concern, and support can provide the encouragement to talk to a parent or other trusted adult about getting evaluated for depression. (Source: excerpt from Let's Talk About Depression: NIMH)

Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH (Excerpt)

Treatment for depressive disorders in children and adolescents often involves short-term psychotherapy, medication, or the combination, and targeted interventions involving the home or school environment. There remains, however, a pressing need for additional research on the effectiveness of psychosocial and pharmacological treatments for depression in youth. While data from adults indicate the need for maintenance treatment after episode recovery in order to prevent recurrences, the value of such treatment in children and adolescents has yet to be determined through research.

   Psychotherapy. Recent research shows that certain types of short-term psychotherapy, particularly cognitive-behavioral therapy (CBT), can help relieve depression in children and adolescents.1 ,28 ,29 CBT is based on the premise that people with depression have cognitive distortions in their views of themselves, the world, and the future. CBT, designed to be a time-limited therapy, focuses on changing these distortions. An NIMH-supported study that compared different types of psychotherapy for major depression in adolescents found that CBT led to remission in nearly 65 percent of cases, a higher rate than either supportive therapy or family therapy. CBT also resulted in a more rapid treatment response.30

Another specific psychotherapy, interpersonal therapy (IPT), focuses on working through disturbed personal relationships that may contribute to depression. IPT has not been well investigated in youth with depression; however, one controlled study found that IPT led to greater improvement than clinical contact alone.31

Continuing psychotherapy for several months after remission of symptoms may help patients and families consolidate the skills learned during the acute phase of depression, cope with the after-effects of the depression, effectively address environmental stressors, and understand how the young person's thoughts and behaviors could contribute to a relapse.1

   Medication. Research clearly demonstrates that antidepressant medications, especially when combined with psychotherapy, can be very effective treatments for depressive disorders in adults.32 Using medication to treat mental illness in children and adolescents, however, has caused controversy. Many doctors have been understandably reluctant to treat young people with psychotropic medications because, until fairly recently, little evidence was available about the safety and efficacy of these drugs in youth.

In the last few years, however, researchers have been able to conduct randomized, placebo-controlled studies with children and adolescents. Some of the newer antidepressant medications, specifically the selective serotonin reuptake inhibitors (SSRIs), have been shown to be safe and efficacious for the short-term treatment of severe and persistent depression in young people, although large scale studies in clinical populations are still needed. So far, there are two controlled studies showing efficacy of fluoxetine and paroxetine, respectively.33 ,34 It is important to note that available studies do not support the efficacy of tricyclic antidepressants (TCAs) for depression in youth.35 ,36

Medication as a first-line course of treatment should be considered for children and adolescents with severe symptoms that would prevent effective psychotherapy, those who are unable to undergo psychotherapy, those with psychosis, and those with chronic or recurrent episodes. Following remission of symptoms, continuation treatment with medication and/or psychotherapy for at least several months may be recommended by the psychiatrist, given the high risk of relapse and recurrence of depression. Discontinuation of medications, as appropriate, should be done gradually over 6 weeks or longer. (Source: excerpt from Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH)

Depression: NIMH (Excerpt)

Recent research suggests that brief psychotherapy (talk therapies that help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication. Efficacy studies show that late-life depression can be treated with psychotherapy.4 (Source: excerpt from Depression: NIMH)

Depression: NIMH (Excerpt)

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for depression.

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication.3 ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required.

Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications-chiefly the selective serotonin reuptake inhibitors (SSRIs)-the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects, page 13) may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust, and many can produce withdrawal symptoms if discontinued abruptly. For individuals with bipolar disorder and those with chronic or recurrent major depression, medication may have to be maintained indefinitely.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions. (Source: excerpt from Depression: NIMH)

Depression: NIMH (Excerpt)

Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome. (Source: excerpt from Depression: NIMH)

Depression Research: NIMH (Excerpt)

Electroconvulsive therapy (ECT) remains one of the most effective yet most stigmatized treatments for depression. Eighty to ninety percent of people with severe depression improve dramatically with ECT. ECT involves producing a seizure in the brain of a patient under general anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp. Repeated treatments are necessary to achieve the most complete antidepressant response. Memory loss and other cognitive problems are common, yet typically short-lived side effects of ECT. Although some people report lasting difficulties, modern advances in ECT technique have greatly reduced the side effects of this treatment compared to earlier decades. NIMH research on ECT has found that the dose of electricity applied and the placement of electrodes (unilateral or bilateral) can influence the degree of depression relief and the severity of side effects. (Source: excerpt from Depression Research: NIMH)

If You're Over 65 and Feeling Depressed Treatment Brings New Hope: NIMH (Excerpt)

One of the biggest obstacles to getting help for clinical depression can be a person's attitude. Many people think that depression will go away by itself, or that they're too old to get help, or that getting help is a sign of weakness or moral failing. Such views are simply wrong.

With treatment, even the most seriously depressed person can start to feel better, often in a matter of weeks, and return to a happier and more fulfilling life. Such an outcome is a common story, even when a person felt hopeless and helpless.

There are three major types of treatment for clinical depression: psychotherapy, medication, and, in some cases, other biological treatments. At times, these treatments may be used in combination.

Individuals respond differently to treatments. If after several weeks symptoms have not improved, the treatment plan should be reevaluated. Also, the procedures and possible side effects of all treatments should be fully discussed with the doctor.

Some people may find that mutual support groups are helpful when combined with other treatments.

Medication

There are many very effective medications, but the three types of drugs most often used in the past to treat depression are tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and lithium. Now, selective serotonin reuptake inhibitors (SSRIs) are also widely used. Lithium is very effective in the treatment of bipolar disorder and is also sometimes used to treat major depression.

  • All medications alter the action of brain chemicals to improve mood, sleep, appetite, energy levels, and concentration.

  • Different people may need different medications, and sometimes more than one medication is needed to treat clinical depression.

  • Improvement usually occurs within weeks.

Psychotherapy

Talking with a trained therapist can also be effective in treating certain depressions, particularly those that are less severe. Short-term therapies (usually 12-20 sessions) developed to treat depression focus on the specific symptoms of depression.

  • Cognitive therapy aims to help the patient recognize and change negative thinking patterns that contribute to depression.

  • Interpersonal therapy focuses on dealing more effectively with other people; improved relationships can reduce depressive symptoms.

Biological Treatments

Some depressions may respond best to electroconvulsive therapy. ECT is an effective treatment that is used in extremely severe cases of major depression when very rapid improvement is necessary, or when medications cannot be used or have not worked. Improved procedures make this treatment much safer than in previous years. During treatment, anesthesia and a muscle relaxant protect patients from physical harm and pain. (Source: excerpt from If You're Over 65 and Feeling Depressed Treatment Brings New Hope: NIMH)

Medications: NIMH (Excerpt)

Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not "uppers" or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed. (Source: excerpt from Medications: NIMH)

Medications: NIMH (Excerpt)

From the 1960s through the 1980s, tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin. Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment. Other antidepressants introduced during this period were monoamine oxidase inhibitors (MAOIs). MAOIs are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. This has deterred many clinicians and patients from using these effective medications, which are in fact quite safe when used as directed.

The past decade has seen the introduction of many new antidepressants that work as well as the older ones but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).

The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include venlafaxine (Effexor) and nefazadone (Serzone). (Source: excerpt from Medications: NIMH)

Medications: NIMH (Excerpt)

Other newer medications chemically unrelated to the other antidepressants are the sedating mirtazepine (Remeron) and the more activating bupropion (Wellbutrin). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.

Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants. (Source: excerpt from Medications: NIMH)

The Invisible Disease Depression: NIMH (Excerpt)

Antidepressant medications are widely used, effective treatments for depression. 6 Existing antidepressants influence the functioning of certain chemicals in the brain called neurotransmitters. The newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), tend to have fewer side effects than the older drugs, which include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). Although both generations of medications are effective in relieving depression, some people will respond to one type of drug, but not another. Other types of antidepressants are now in development.

Certain types of psychotherapy, specifically cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been found helpful for depression. Research indicates that mild to moderate depression often can be treated successfully with either therapy alone; however, severe depression appears more likely to respond to a combination of psychotherapy and medication. 7 More than 80 percent of people with depressive disorders improve when they receive appropriate treatment. 8

In situations where medication, psychotherapy, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis (e.g., hallucinations, delusional thinking) or suicidality, electroconvulsive therapy (ECT) may be considered. ECT is a highly effective treatment for severe depressive episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends. 9 (Source: excerpt from The Invisible Disease Depression: NIMH)

Depression A Serious but Treatable Illness - Age Page - Health Information: NIA (Excerpt)

Depression can be treated successfully. Depending on the case, different therapies seem to work. For instance, support groups help some people deal with major life changes that require new coping skills or social support. A doctor might suggest that an older person use a local senior center, volunteer service, or nutrition program. Several kinds of "talk" therapies are useful as well.

One method helps people change negative thinking patterns that might have led to depression. Another way works to improve a person's relationships with others in an effort to lessen feelings of despair.

Antidepressant drugs can also help. These medications can improve mood, sleep, appetite, and concentration. There are several types of antidepressants available. Some drugs can take 6 to 12 weeks before there are real signs of progress. Drugs may need to be used for 6 months or more after symptoms disappear.

Antidepressant drugs should be used with great care. This can help avoid unwanted side effects. Older people often take many drugs, and a doctor must know about all prescribed and over-the-counter medications being taken. The doctor should also be aware of any other physical problems. It is important to take antidepressant drugs in the proper dose and on the right schedule.

Electroconvulsive therapy (ECT) can also help. It is most often recommended when drug treatments can't be tolerated or there is an unacceptable delay in when drugs would become effective. ECT, which works quickly in most people, is given as a series of treatments over a few weeks. Like other antidepressant therapies, followup treatment with medication or occasional ECT is often needed to help prevent a return of depression. (Source: excerpt from Depression A Serious but Treatable Illness - Age Page - Health Information: NIA)

Book Excerpts: Treatment of Depression

Treatments of Depression: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Depression.

Fontanel depression: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If you detect a markedly depressed fontanel, take the infant’s vital signs, weigh him, and check for signs of shock — tachycardia, tachypnea, and cool, clammy skin. If these signs are present, insert an I.V. line and administer fluids. Have size-appropriate emergency equipment on hand. Anticipate oxygen administration. Monitor urine output by weighing wet diapers.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Major depression: Treatment
(Professional Guide to Diseases (Eighth Edition))

Depression is difficult to treat, especially in children, adolescents, elderly patients, and those with a history of chronic disease. The primary treatment methods are drug therapy and psychotherapy, particularly cognitive behavioral therapy.

Drug therapy includes tricyclic antidepressants (TCAs) such as amitriptyline, monoamine oxidase (MAO) inhibitors such as isocarboxazid, maprotiline, and trazodone, which has been available for 40 years. A newer class of drugs, the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, sertraline, bupropion, venlafaxine, and mirtazapine, are equally effective and have more tolerable adverse effect profiles.

TCAs, the most widely used class of antidepressant drugs, prevent the reuptake of norepinephrine or serotonin (or both) into the presynaptic nerve endings, resulting in increased synaptic concentrations of these neurotransmitters. They also cause a gradual loss in the number of beta-adrenergic receptors.

MAO inhibitors block the enzymatic degradation of norepinephrine and serotonin. These agents commonly are prescribed for patients with atypical depression (for example, depression marked by an increased appetite and need for sleep, rather than anorexia and insomnia) and for some patients who fail to respond to TCAs. MAO inhibitors are associated with a high risk of toxicity; patients treated with one of these drugs must be able to comply with the necessary dietary restrictions.

Maprotiline is a potent blocker of norepinephrine uptake, whereas trazodone is an SSRI. The mechanism of action of bupropion is unknown.

Electroconvulsive therapy (ECT) may be considered in particularly severe or drug-resistant depression. Six to 12 treatments are typically needed, although in many cases improvement is evident after only a few treatments. However, ECT has been associated with later short-term memory loss, heart arrhythmias, and seizure activity. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.

Short-term psychotherapy is also effective in treating major depression. Many psychiatrists believe that the best results are achieved with a combination of individual, family, or group psychotherapy and medication. After resolution of the acute episode, patients with a history of recurrent depression may be maintained on low doses of antidepressants as a preventive measure.

Depression may be experienced differently by members of different cultures. For instance, in some Asian cultures, there are more somatic manifestations of depression than overt psychologic signs or symptoms.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Fontanel depression: Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

If you detect a markedly depressed fontanel, take vital signs, weigh the infant, and check for signs of shock—tachycardia, tachypnea, and cool, clammy skin. If these signs are present, insert an I.V. line and administer fluids. Have size-appropriate emergency equipment on hand. Anticipate oxygen administration. Monitor urine output by weighing the wet diapers.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Depression, major: Treatment
(Handbook of Diseases)

Depression is difficult to treat, especially in children, adolescents, elderly patients, and those with a history of chronic disease. The primary treatment methods are drug therapy, electroconvulsive therapy (ECT), and psychotherapy.

Drug therapy

In depression, drug therapy includes tricyclic antidepressants (TCAs) such as amitriptyline, serotonin reuptake inhibitors such as fluoxetine, and monoamine oxidase (MAO) inhibitors, such as isocarboxazid, maprotiline, and trazodone.

❑ The most widely used class of antidepressant drugs, TCAs prevent the reuptake of norepinephrine or serotonin (or both) into the presynaptic nerve endings, resulting in increased synaptic concentrations of these neurotransmitters. They also cause a gradual loss in the number of beta-adrenergic receptors.

❑ After resolution of the acute episode, patients with a history of recurrent depression may be maintained on low doses of antidepressants as a preventive measure.

❑ Selective serotonin reuptake inhibitors, including fluoxetine, paroxetine, and sertraline, are increasingly becoming the drugs of choice. They are effective and produce fewer adverse effects than the TCAs; however, they’re associated with sleep and GI problems and alterations in sexual desire and function.

❑ MAO inhibitors block the enzymatic degradation of norepinephrine and serotonin. These agents are commonly prescribed for patients with atypical depression (for example, depression marked by an increased appetite and need for sleep, rather than anorexia and insomnia) and for some patients who fail to respond to TCAs.

MAO inhibitors are associated with a high risk of toxicity; patients treated with one of these drugs must be able to comply with the necessary dietary restrictions. Conservative doses of an MAO inhibitor may be combined with a TCA for patients refractory to either drug alone.

Maprotiline is a potent blocker of norepinephrine uptake, whereas trazodone is a selective serotonin uptake blocker. The mechanism of action of bupropion is unknown.

ECT

When a depressed patient is incapacitated, suicidal, or psychotically depressed, or when antidepressants are contraindicated or ineffective, ECT is commonly the treatment of choice. Six to 12 treatments usually are needed, although improvement is usually evident after only a few treatments. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.

Psychotherapy

Short-term psychotherapy is also effective in treating major depression. Many psychiatrists believe that the best results are achieved with a combination of individual, family, or group psychotherapy and medication. Therapeutic interventions focus on identifying the patient’s negative thoughts and interpretations and substituting adaptive responses.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Fontanel depression: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Monitor the infant's vital signs and level of consciousness.

▪ Monitor intake and output and watch for signs of worsening dehydration.

▪ Obtain serum electrolyte values to check for an increased or decreased sodium, chloride, or potassium level.

▪ If the infant has mild dehydration, provide small amounts of clear fluids frequently or provide an oral rehydration solution.

▪ If the infant can't ingest sufficient fluid, begin I.V. parenteral nutrition.

▪ If the patient has moderate to severe dehydration, provide rapid restoration of extracellular fluid volume to treat or prevent shock.

▪ Continue to administer I.V. solution with sodium bicarbonate added to combat acidosis. As renal function improves, administer I.V. potassium replacements.

▪ When the infant's fluid status stabilizes, begin to replace depleted fat and protein stores through diet.

▪ Obtain urinalysis for specific gravity and, possibly, blood tests to determine blood urea nitrogen and serum creatinine levels, osmolality, and acid-base status.

Patient teaching

▪ Explain all procedures and treatments to the infant's parents.

▪ Provide emotional support.

▪ Explain ways to prevent dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007


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