Treating Depression: What Psychiatrists and Psychologists Want You to Know
Treating depression is not a one-size-fits-all approach.
If you’ve ever dealt with depression, you know it affects more than just your mood or energy levels. You know how the symptoms can leak into your personal relationships, professional life, and overall health. Depression is a leading cause of disability in the American workforce and can lead to an estimated 20 days of lost workdays a year, according to the Centers for Disease Control and Prevention.
Simply tolerating symptoms of depression is a mistake. There are many different treatment options, from types of medication to therapy to adjunct lifestyle changes, and it’s important to find the right combination of approaches to help you.
In a 2016 study of more than 46,000 American adults, only 29 percent of those who screened positive for a type of depression actually received treatment. Not seeking help can have devastating consequences: over half of people who die by suicide each year were experiencing major depression. “Treatment of depression is hard work and necessary,” says Jennifer Hartstein, PsyD, a psychologist in New York City. “If you want to live your best life, don’t be afraid to ask for help.”
Common Treatments for Depression
The ideal treatment for major depressive disorder includes a combination of both talk therapy and medication, says Ben Michaelis, PhD, a psychologist in New York City.
Talk therapy, or psychotherapy, is one of the most common ways to treat depression. This is a trusting relationship between you and a mental health professional to explore problems, find alternative solutions or ways of thinking, and develop new coping strategies, according to the American Psychological Association.
Psychotherapy can be a powerful way to challenge negative thinking and develop resilience for challenges. “Depression really alters how we think,” says Dr. Hartstein. “We look at things through this very dark lens, and psychotherapy helps us challenge that.”
There are different types of psychotherapy, according to Susan Samuels, MD, a psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
Psychodynamic therapy is the most classic version, in which the patient and therapist dive into issues and analyze problematic feelings and behaviors.
Interpersonal therapy focuses specifically on a patient’s relationships with friends, family, and peers to build more positive interpersonal skills.
Cognitive behavioral therapy helps patients change dysfunctional or unproductive thought patterns, which may be the underlying cause of unhealthy or destructive behaviors.
While some professionals do specialize in particular methods, a blend of approaches is common. “Many therapists use pieces of all these different types of therapy in their office to address what it is that the person in front of them needs,” says Dr. Samuels. Learn more about the types of therapy here.
Medications that help treat depression include different categories of drugs such as SSRIs, SNRIs, tricyclic antidepressants, and MAOIs. These options work in different ways and affect people differently, so it may take a few tries to get the right fit. Here is more information on medication for treating depression.
And treatment for depression doesn’t just take place in a doctor’s office: Lifestyle changes are a key component to help alleviate depressive symptoms. “Thirty minutes of intense exercise multiple times a week goes head-to-head in studies with antidepressants for mild to moderate depression,” says Gail Saltz, MD, a psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Getting enough sleep and eating well are also contributing factors.
Treating Severe Depression
Doctors identify severe depression using the following criteria, according to Dr. Michaelis:
Inability to function well
Unable to work or hold a job
Unable to maintain healthy relationships
Not enjoying life
Using self-harming behaviors, including substance abuse
Having suicidal thoughts or attempting suicide
If medication, psychotherapy, and lifestyle changes have not been effective at treating depression, another strategy is electroconvulsive therapy, or ECT. This is when a quick electrical current stimulates a part of the brain while the patient is under general anesthesia. The procedure induces a controlled seizure that can change the brain chemistry to help treat depression, according to Dr. Samuels. (Learn more here about how ECT can help with depression.)
Depression can be tricky to treat, and there may be plenty of days where you feel like you’re taking one step forward and two steps back, but remember that consistent treatment yields the best results. “Stick with it,” encourages Dr. Hartstein. “The more you stick with it, the more skills you learn, the better you feel, the more set for life you are.”
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Treatment of depression is hard work and
necessary.
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If you want to live your best life,
don't be afraid to ask for help.
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[MUSIC]
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Talk therapy is very helpful in addressing
the negative thinking that comes with
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depression.
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Depression really alters how we think.
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We look at things in
a much more negative way.
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We look at things through
this very dark lens.
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And psychotherapy helps us
challenge those things.
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There are various different
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types of psychotherapy that include
things like psychodynamic psychotherapy,
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interpersonal psychotherapy,
cognitive behavioral therapy.
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And, truly, many therapists use pieces
of all these different types of
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therapy in their office to address what it
is that the person in front of them needs.
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Exercise is hugely affected for mood.
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Actually, it's found that 30
minutes of intense exercise,
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multiple times a week, goes head to
head in studies with antidepressants for
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mild to moderate depression.
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Sleeping well, eating well, those
are important things when you think about
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major depression.
The ideal treatment is a combination of
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medication and psychotherapy.
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That's been shown to be most effective for
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people that are suffering from depression.
The most commonly used
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antidepressant is probably the serotonin
selective reuptake inhibitor.
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There are also serotonin norepinephrine
reuptake inhibitors, which we use.
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Some older medications that we use
include tricyclic antidepressants and
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monoamine oxidase inhibitors.
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But they tend to have more side effects,
so we generally stick
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with the newer medications like the SSRIs.
Some work better for
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agitated depression.
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Some work better for typical depression.
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Some work better for atypical depression.
And I'm so grateful for medication
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because it's a very powerful intervention.
Depression is
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considered severe when the person is
not able to function in their life.
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They're not able to hold down a job.
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They're not able to have a relationship.
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They're not able to have friendships.
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They're really not able
to enjoy life in any way.
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Those are markers of severity,
as well as self-harming behaviors.
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When they're using alcohol or
drugs to harm themselves.
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As well as, of course,
suicidal thoughts or
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actually making a suicide attempt.
ECT,
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or electroconvulsive therapy,
is a form of treatment for
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depression in which a small,
very slight seizure is induced.
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That can change the brain chemistry
in a way that will be helpful
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to treat depression.
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And, oftentimes, this is a treatment
that is used if medications and
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therapy aren't working.
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And it tends to be incredibly effective.
Any sort of treatment for
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depression takes some time.
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Most medications that address the
serotonin issues that you have to help you
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feel better take four to
six weeks to kick in.
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And most therapy is gonna be up and down.
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Some days you're gonna feel great and
go to therapy and
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feel like I have nothing to talk about.
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And other days, you're gonna have so
much to talk about.
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Stick with it.
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The more you stick with it,
the more skills you learn,
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the better you feel,
the more set for life you are.
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[MUSIC]
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If you ever feel like you want to hurt or
kill yourself, call your doctor or
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nurse and tell them it's urgent.
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Call for an ambulance or 911.
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Go to your local emergency room, or
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call the National Suicide Prevention
Lifeline at 1-800-273-8255.
Depression. Bethesda, MD: National Institute of Mental Health. (Accessed on January 11, 2018 at https://www.nimh.nih.gov/health/topics/depression/index.shtml.)
Depression: what you need to know. Bethesda, MD: National Institute of Mental Health. (Accessed on February 9, 2018 at https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml.)
Major depression among adults. Bethesda, MD: National Institute of Mental Health. (Accessed on January 11, 2018 at https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml.)
Mental health and chronic diseases. Atlanta, GA: Centers for Disease Control and Prevention, 2012. (Accessed on February 9, 2018 at https://www.cdc.gov/workplacehealthpromotion/tools-resources/pdfs/issue-brief-no-2-mental-health-and-chronic-disease.pdf.)
Olfson M, Blanco C, Marcus SC. Treatment of adult depression in the United States. JAMA Intern Med. 2016;176(10):1482-91.
Suicide facts and figures. New York, NY: American Foundation for Suicide Prevention. (Accessed on February 9, 2018 at https://www.theovernight.org/index.cfm?fuseaction=cms.page&id=1034.)
Understanding psychotherapy. Washington, DC: American Psychological Association. (Accessed on February 9, 2018 at http://www.apa.org/helpcenter/understanding-psychotherapy.aspx.)