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Treatment of Depression

Even severe cases of depression can be treated successfully, and earlier initiation of treatment is associated with more effective outcomes. Treatment can comprise, most commonly, psychotherapy, pharmacotherapy, or a combination of both.

Pharmacotherapy

Antidepressant medications primarily affect neurotransmitters, particularly serotonin and norepinephrine, although some also affect dopamine.

SSRIs and SNRIs. Some of the most commonly prescribed selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, sertraline, escitalopram, paroxetine, and citalopram, many of which are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) include venlafaxine and duloxetine.

SSRIs and SNRIs generally are associated with fewer adverse effects than older antidepressant medications, and such events typically diminish or cease with continued use. Adverse sexual effects that some patients experience with SSRIs and SNRIs may be managed by adjusting the dosage or switching to another medication.

Bupropion affects dopamine and typically is associated with similar adverse effects as SSRIs and SNRIs, but it is less likely to cause sexual adverse effects.

Tricyclic antidepressants. Tricyclics are an older type of antidepressant medication that are not widely used currently, primarily because the potential adverse events associated with them are more serious. Tricyclics include imipramine and nortriptyline.

MAOIs. Monoamine oxidase inhibitors (MAOIs), the oldest class of antidepressant medications, can be effective in cases of “atypical” depression (eg, patients experiencing increased appetite and hypersomnia rather than decreased appetite and sleep). However, use of MAOIs requires restriction of certain types of foods and beverages and avoidance of some types of medications, due primarily to the risk of dangerous increases in blood pressure. MAOIs should not be used with SSRIs due to drug-drug interactions that can produce a serious condition called “serotonin syndrome.”

Psychotherapy. Various types of psychotherapy are available for the treatment of depression, particularly the mild to moderate forms of the disorder. The following are 2 of the most frequently employed types of psychotherapy:

  • Through cognitive-behavioral therapy (CBT), patients learn to restructure negative thought patterns and to interpret their environment and interactions with others in a positive and realistic way. CBT may also assist patients in recognizing factors that may contribute to depression and in changing behaviors that may make depression worse.
  • Interpersonal therapy (IPT) guides patients in understanding and reshaping troubled relationships that may cause or exacerbate their depression.

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