Major depressive disorder is a condition that affects roughly 6.7 percent of American adults, with an estimated 16.2 million individuals who annually experience an episode of depressive symptoms. Yet despite its widespread nature, depression is often not completely understood by the public, and treatment remains a mystery to many.
While we’re urged to help others cheer up when they’re feeling sad, a person with depression doesn’t respond effectively to sheer positivity. Separate from sadness, depression is a mental health issue that originates in the brain. You can’t make a depressed person happier, without digging deeper into what depression is and how it hurts people. For loved ones and relatives supporting someone with depression, this fact can be excruciating. Love and compassion can only go so far – at a certain point, it becomes critical to use the right combination of emotional support and psychiatric help to fight back against depressive disorders.
But with so many treatments on offer today, how is one to know what works and what doesn’t? The answer is that all viable methods for treating depression are effective in their own way, but cases of depression are always unique in how they respond to these treatments. There is only one way to find out what works. We will go over some of the most effective depression treatment options, in order of how they are typically prescribed.
Antidepressants are a class of psychoactive medication that manipulate the way the brain processes certain neurotransmitters, in hopes of better regulating a person’s mood and thoughts by increasing the availability of certain chemicals linked to happiness, depression, and mood management. The most popular of these drugs are SSRIs, because they are effective yet come with the least number of side effects, only affecting a single type of neurotransmitter in the brain (serotonin).
Other types of antidepressants exist, including SNRIs, TCAs, MAOIs, and many others. Within each type, different brands and formulations guarantee that, while one drug may not work for patient A, it might work very well for patient B, and the opposite is true with a different medication. When a person is diagnosed with a depressive disorder, antidepressants are often seen as first line treatment. However, they have their pros and cons.
Pros: Statistically effective, cost-effective, and time-efficient, antidepressants are a form of treatment with very little patient involvement, only requiring a regular pill intake. Because of the way they work, antidepressants (SSRIs) are not addictive.
Cons: It can take up to a month for an antidepressant to begin working, and it takes at least another month to safely taper off the drug if it doesn’t work as described. Because antidepressants target serotonin, they can have a broad number of potential side-effects, including rapid weight gain, mood swings, irritability, low sex drive, and more. These side-effects range from mild to severe, and often preclude treatment. This complicates finding the right pill to work with. In some cases, a patient may spend several months trying different antidepressants only to realize that none of them work well enough to continue taking the drug. This is known as treatment-resistant depression.
Psychotherapy (Talk Therapy)
Often prescribed in conjunction with medication, talk therapy can be effective in the treatment of depression if applied correctly, by a skilled therapist, in coordination with the patient. Different methods exist to help patients with different needs and circumstances, ranging from therapeutic methods that tackle negative thinking and promote affirmation as a way to combat it, to other forms of therapy that try to tackle interpersonal and relationship problems, family drama, or dig deep to discover events and patterns that help explain the onset of depression. There are both pros and cons.
Pros: Talk therapy is entirely non-invasive, and ‘side effects’ are rare. In most cases, talk therapy seamlessly meshes with other forms of depression treatment, often capitalizing on the improvements made by other treatments by helping a patient better cope with their condition, and promote the fostering of healthier coping mechanisms on the patient’s own time.
Cons: Talk therapy is not guaranteed to work and relies heavily on the quality of the relationship between the therapist and the patient. Furthermore, on its own, therapy is rarely effective for major depressive disorder. Many patients who struggle with severe depression are resilient to therapy without the help of medication or other treatments.
Brain stimulation consists of a series of invasive and non-invasive treatment methods that apply a form of energy to the nervous system, managing depressive symptoms by specifically targeting portions of the brain where depression develops and ‘resides’.
Common forms of brain stimulation include repetitive transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, and electroconvulsive therapy. Some of these treatments require the implanting or wearing of a pulse-emitting device, while others require a set number of sessions for the treatment to take effect.
Pros: especially effective in patients where other treatment methods have failed, brain stimulation is a relatively new frontier for depression treatment that tries to better understand how depression develops in the brain. In non-invasive cases, these treatments have no lasting side effects and have been shown to be highly effective.
Cons: invasive brain stimulation can be dangerous due to the risks surrounding surgery and the use of medical devices. However, non-invasive brain stimulation such as TMS don’t carry these risks.
These are ‘treatments’ that are not strictly approved, nor proven to work, but may help when used in conjunction with some of the other treatments above (except for St. John’s wort, which should never be taken alongside other antidepressants). Common forms of CAM for depression include the use of exercise, a greater focus on lifestyle and dietary improvements, supplementation, and the use of herbal medication to combat depression, including St. John’s wort, ginseng, and chamomile.
Pros: These treatments can be started on a patient’s own initiative and can be effective at a very low cost. Because they’re complementary, they also often don’t interfere with other forms of treatment (with some exceptions).
Cons: Natural doesn’t always mean safe. Many of these treatments, particularly the herbal ones, are not regulated by the FDA and do not need to stand up to heavy scrutiny. This lack of standards means varying degrees of effectiveness, as well as a degree of danger. While exercise and diet are, on the other hand, proven to be effective for depression, these lifestyle changes are difficult for depressed individuals to maintain, and otherwise require strict and expensive professional management. Nutrition is a very understudied subject, and thus prone to much confusion and misinformation.
Depression treatments come in all shapes and sizes, and most patients will want to try more than one. Even if a treatment happens not to work, it’s important not to give up hope. Not only are the treatments mentioned above continuously improving, but other treatments are being tested as we speak, promising more options in the future. As we continue to learn more about depression, so too will our treatment options greatly improve.