• Danielle Ibelema, MD

Treatment of Depression

Major depression is a clinical diagnosis that is characterized by sadness, emotional numbing, fatigue, and sleep changes.


Medication

Antidepressants are some of the most frequently prescribed medications in the U.S.

Antidepressants are medications that modulate the availability of neurotransmitters in the brain. Antidepressants usually take some time (4-6 weeks) to see an improvement in symptoms.


SSRI

Selective serotonin reuptake inhibitors (SSRIs) prevent ​the reuptake of serotonin which increases its availability in the brain. SSRIs are the most commonly prescribed antidepressants.


SSRIs include:


  • Prozac (fluoxetine)

  • Luvox (fluvoxamine)

  • Paxil (paroxetine)

  • Celexa (citalopram)

  • Lexapro (escitalopram)

  • Zoloft (sertraline)


SNRI

SNRIs are similar to SSRIs. Serotonin and norepinephrine reuptake inhibitors (SNRIs) inhibit the reuptake of two serotonin and norepinephrine.


SNRIs include:


  • Effexor (venlafaxine)

  • Cymbalta (duloxetine)

  • Fetzima (levomilnacipran)

  • Pristiq (desvenlafaxine)



Atypical Antidepressants


Atypical antidepressants don't fit into any of the other classes. Each atypical antidepressant influences different neurotransmitters in different ways. They are typically not used first-line, but may be prescribed if other classes of antidepressants have been ineffective or have caused side effects. They may also be prescribed as adjuncts to use in combination with other antidepressants.


Atypical antidepressants include:

  • Desyrel (trazodone)

  • Wellbutrin (bupropion)

  • Remeron (mirtazapine)

  • Trintellix (vortioxetine)


Psychotherapy

Psychotherapy may be done with couples, families, in a group setting or with one individual patient. There are different therapy modalities such as CBT, DBT, interpersonal psychotherapy, and psychodynamic therapy. Each modality is grounded by certain theories of psychology that guide a therapist's approach through the therapeutic process.


If you are considering starting therapy, it helps to ask about the therapists approach or the modality of therapy they use. Having an understanding of the framework that will used in your reflective process allows you to make an informed decision when choosing a therapist.


Psychotherapy is not quick fix as the the reflective process takes time. It's best to be in therapy for at least 12 weeks, but longer term therapy can be helpful.


ECT

ECT has received a negative portrayal in the media, but it can be safe and effective for those with severe depression. ECT has been in use since the 1940's, and despite all of the medical advancements in the interim, ECT continues to be used for a reason. It is effective.


ECT is an option for individuals with severe symptoms who have not responded to other treatments. During ECT a brief electrical stimulation of the brain while the patient is under anesthesia.