Professional Help for Depression

Getting help for depression

When you’re depressed, it can feel like you’ll never get out from under its shadow. However, depression responds very well to treatment. With professional help and support, most depressed people experience a significant reduction in their symptoms. But finding the right treatment strategy for you isn’t always easy. There is no one therapy, pill, or treatment that works for everyone. And even when you find the winning treatment combination, feeling better takes time. It’s important to be patient, work closely with your therapist or doctor, and follow through with treatment. If you stay the course, you’ll be rewarded with a new lease on life and sense of well-being.

The importance of a diagnosis

Before you can be treated for depression, you need to get a diagnosis that confirms that depression is indeed the problem. Although it may look and feel like depression, that doesn’t necessarily mean the problem is psychological. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated. That’s why it’s important to see a doctor if you’re feeling depressed. Your doctor can screen for drugs and diseases that could be causing your symptoms.

When it comes to a depressed mood, illnesses involving the heart, the brain, the immune system, and the endocrine system are among the possible culprits. Hypothyroidism, or low thyroid, is a particularly common mood buster, especially in women. Prescription drugs that can cause depression as a side effect include antibiotics, sleeping pills, heart and blood pressure medications, steroids, and birth control pills.

The diagnostic exam

A good diagnostic evaluation will include an interview about your symptoms, a physical exam, and lab tests. The doctor will also ask you questions about your medical history, the medications and supplements you’re taking, and what’s going on in your life. The information you provide affects the accuracy of the diagnosis, so answer as honestly and openly as possible. Since substance abuse can also cause depression or make it worse, be sure to tell your doctor about your drinking habits or any drug use.

Treating depression

If your doctor determines that there are no health problems causing your depression, then it’s time to explore your treatment options. This is best done with the help of a mental health specialist, rather than your primary care doctor. While primary care doctors can prescribe antidepressants, depression is not their area of expertise and they aren’t likely to be up on the latest research or cutting-edge treatments. A better option is to work with a psychiatrist or a psychologist with advanced training and extensive experience treating depression.

While psychiatrists are the only mental health specialists who can prescribe medication, keep in mind that they may not be trained in talk therapy. If you’d like to pursue talk therapy, also consider psychologists, licensed counselors, and social workers.

Finding a treatment provider

Treating depression takes time and throughout the process you’ll be working hand-in-hand with your doctor or therapist, so finding the right health care provider is important. To find a good therapist, start by asking around. Get recommendations from friends and family members, or ask your doctor for a referral. It’s a good idea to check credentials—just remember that they aren’t everything. It’s more important to find a health care provider that you connect with. Make sure you feel comfortable opening up to this person.

Developing a treatment plan

Once you’ve found a therapist or psychiatrist you click with, you will work together on a personalized treatment plan. The most common treatment approach for depression involves some type of talk therapy, antidepressant medication, or a combination of the two. 

While your doctor may suggest taking an antidepressant, medication is by no means the only way to feel better. In fact, research shows that talk therapy is equally effective. Even if you decide that medication is right for you, it’s a good idea to pursue therapy as well. Studies show that for depression treatment, a combination of medication and therapy works better than medication alone.  

Antidepressant medication

Several types of medication are used in the treatment of depression, including the SSRIs (selective serotonin reuptake inhibitors), tricyclic antidepressants, MAOIs (monoamine oxidase inhibitors), and atypical antidepressants. SSRIs such as Prozac and Zoloft and the newer atypical antidepressants such as Wellbutrin and Effexor are usually preferred over the tricyclics and the MAOIs because their side effects are less severe.

While antidepressants can help moderate to severe depression, they are not a cure for everyone. Nearly one out of three people don't respond to antidepressants and others are unable to tolerate the side effects. Relapse rates are also high when the drug treatment is stopped. Medication may be useful in the short term—especially when depression is severe—but it only addresses symptoms, not the underlying issues and causes of the depression. That’s where therapy comes in.

Talk therapy for depression

As a treatment for depression, talk therapy is designed to relieve your symptoms and teach you more positive and effective ways of thinking and behaving. coping and looking at the world. Talk therapy can help you get to the root of your depression, learn how to cope with negative emotions, and develop better problem-solving skills. Ultimately, the aim of talk therapy is to give you the tools you need to overcome depression. Many different types of therapy are used to treat depression, but the most widely-used approaches are cognitive behavioral therapy, psychodynamic therapy, and interpersonal therapy.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) focuses on how your thoughts affect your feelings. According to the National Alliance on Mental Illness, this brief form of therapy is just as effective as antidepressants at treating depression and more effective at preventing relapse. The idea behind cognitive behavioral therapy is that our thoughts and attitude affect our mood, not the other way around. When it comes to depression, negative ways of looking at yourself, the world, and the things that happen to you trigger and fuel feelings of self-loathing and hopelessness.

According to cognitive behavioral therapy, in order to transform these depressed feelings, you have to tackle your negative thoughts. But spotting them isn’t always easy, since they’re often part of a lifelong pattern of thinking. In fact, you may not be consciously aware of negative thoughts—even as they’re flitting through your head and bringing you down. In cognitive behavioral therapy, you’ll work with the therapist to uncover them and put them to the “reality test.” More often than not, you’ll find that your negative thoughts are irrational and distorted—and the truth is not so bleak.

Challenging and changing negative ways of thinking takes practice, and not just in your therapy sessions. Your therapist will give you homework assignments to practice more positive ways of thinking and behaving, such as:

• Thought stopping - Noticing when irrational, self-defeating thoughts are occurring and putting a mental stop sign on them.
• Automatic thought record – Keeping a log of automatic negative thoughts, including the situations that triggered them, what you thought, and how it made you feel. Then you come up with challenges to the truth of the negative thoughts and other more positive ways of looking at the situation.

With time, cognitive behavioral therapy will teach you how to stop negative thoughts before they can spiral out of control. You’ll also learn to replace them—and the ineffective or self-destructive behaviors that stem from them—with healthier ways of thinking and acting.

Psychodynamic therapy

Psychodynamic psychotherapy is the modern version of classic Freudian psychoanalysis. In psychodynamic therapy, the focus is on understanding your personality more fully: your desires, motives, hidden conflicts, and fears. In particular, psychodynamic psychotherapy examines how your past—including past relationships, your upbringing, and early life experiences—is tied to your problems in the present.

The goal of psychodynamic therapy is to uncover unresolved issues and the unconscious compromises you’ve made in order to avoid dealing with them. According to psychodynamic theory, these compromises, or defense mechanisms, may help you avoid the pain of the original problem, but they lead to problems of their own—such as depression. In order to overcome depression, you must bring your unconscious defense mechanisms into conscious awareness, and then find new ways of dealing with your fears.

Interpersonal therapy

Interpersonal psychotherapy (IPT) is a short-term, structured approach that is used to treat a wide range of issues, including depression. The focus in interpersonal psychotherapy is on your relationships. In therapy, you’ll evaluate your romantic, work, family, and social relationships, with an eye for recurring problems and difficulties. The goal is to learn better coping skills for dealing with interpersonal strife and strengthen your current relationships as a result.

Since positive, healthy relationships and a solid support system provide a formidable buffer against depression, interpersonal psychotherapy is a good option for depression treatment. In addition to relationship issues, interpersonal therapy also addresses other things that can trigger depression or fuel it, including grief and loss issues, struggles with major life changes (such as a divorce or retirement), and conflict over social roles and expectations.

Other therapies for depression

Therapy for depression doesn’t always require an individual focus. Group therapy is helpful if you’re feeling alone in your struggle with depression. It can be very therapeutic to share your experience with others who know exactly what you’re going through. Family therapy or couples therapy are good choices if your depression is causing problems at home. Marriage and family therapy can teach you and your loved ones how to deal with the depression, solve relationship issues, and communicate clearly and with compassion.

Alternative and complementary treatments

In addition to talk therapy and antidepressant medications, there are a number of alternative and complementary treatments that can help you feel better.

Exercise

Exercise can be a huge mood booster. In fact, many studies have shown that regular exercise is at least as effective, if not more so, than antidepressant treatment for depression. What’s more, while depression often returns once medication is stopped, exercise can prevent this relapse. Researchers have found that exercising for as little as 60 minutes three times a week can lift the symptoms of depression. Daily exercise sessions of thirty minutes or more are even more effective. Brisk walking is one easy and inexpensive way to get active, but the type of exercise doesn’t matter, so long as you get your body moving. The key is to choose an activity that you enjoy and will stick with long-term.

Most people can safely start exercising on their own. But if you have health problems or you’re pregnant, significantly overweight, or over the age of 40, it’s a good idea to check with your doctor first.

Meditation

When practiced regularly, meditation can both relieve depression and prevent its recurrence. Meditation is also a powerful way to relieve stress and evoke a state of deep relaxation and release. There are many types of meditation, but all involve focusing your attention and awareness—whether on a word, a sound, a symbol, or your own breathing or bodily sensations.

When it comes to depression, research shows that mindfulness meditation is particularly beneficial. The focus of mindfulness meditation is on the present moment—whatever you’re experiencing in the here-and-now. Mindfulness meditation teaches you to be aware of your emotions as they fluctuate from moment-to-moment. With practice, you learn to let them come and go without judging, battling, or reacting to them. By teaching you how to remain in the present moment, rather than obsessing about the past or worrying about the future, mindfulness meditation breaks depression’s negative cycle of self-criticism, rumination, and fear.

Light therapy

While light therapy has long been the treatment of choice for seasonal affective disorder, also known as “winter depression,” new research suggests that it also helps treat cases of mild to moderate depression that aren’t seasonally influenced. Additionally, light therapy appears to boost the effectiveness of antidepressants.

Light therapy for depression involves daily morning sessions in front of a special light box designed to mimic natural sunlight. Typical sessions range from 30 minutes to 2 hours. Dawn simulation boxes—which gradually brighten to wake you naturally from sleep—are another option. It is believed that light therapy works by inhibiting the production of melanin, a brain chemical that can depress mood and cause sleepiness. 

Natural and herbal supplements for depression

While research is still ongoing, a number of nutritional and herbal supplements have shown promise as alternative treatments for depression. Keep in mind that even natural and herbal supplements can have side effects and drug or food interactions, so check with your doctor first before you start using them.

• St. John's Wort – Studies have shown that St. John’s Wort is effective in the treatment of mild to moderate depression. The herbal preparation is available over-the-counter. However, St. John's Wort can interfere with certain prescription drugs including antidepressants, birth control pills, AIDS medications, and drugs to prevent the rejection of organ transplants. You should never take St. John’s Wort and an SSRI antidepressant medication at the same time.
• B vitamins – Research has shown that B vitamins, particularly folic acid and B-12, play a role in regulating mood and keeping depression at bay. To increase your B-12 vitamin intake, pop a daily multivitamin or eat more meat, chicken, cheese, and eggs. To get more folic acid, add citrus fruit, leafy greens, and legumes. 
• SAMe – SAMe (S-adenosyl-methionine) is an important amino acid believed to boost serotonin and dopamine levels. SAMe works faster than St. John's Wort, enhances the effectiveness of traditional antidepressants, and is available as an over-the-counter supplement.
• 5-HTP – 5-HTP (5-hydroxytryptophan) is a chemical made from the amino acid tryptophan. The body naturally converts tryptophan into 5-HTP and then uses the 5-HTP to make serotonin. 5-HTP supplements are believed to increase serotonin levels in the brain.
• Omega-3 fatty acids – Omega-3 fatty acids are believed to play an important role in brain function and stabilizing mood. Supplements are available in the form of fish oil and flaxseed oil pills. If you'd like to get more omega-3 in your diet, you can eat more fish, walnuts, soybeans, and tofu.
• Chromium picolinate – Several studies have shown that chromium picolinate is a beneficial supplement for atypical depression, a common subtype of depression characterized by oversleeping, overeating, and weight gain. It can significantly reduce carbohydrate cravings, and can also reduce mood swings and boost energy.

Treatment-resistant depression

If you have treatment-resistant depression that does not respond to therapy, medication, and other interventions, there are several treatments that work by stimulating the brain. These treatments carry risks, so they are only pursued in cases of severe depression that haven't responded to anything else.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is sometimes used for individuals at a high risk for suicide or who don't respond to antidepressant medication or other types of therapy. In ECT, the patient is put under anesthesia and administered an electric shock that triggers a seizure. Six to twelve treatments are typically given over the course several weeks. It isn't known why ECT alleviates depression, but one theory is that it works by triggering a massive release of neurotransmitters.

The most common side effects of ECT are temporary memory loss and confusion. However, some cases of permanent amnesia have been reported. As Harvard Medical School notes, ECT is the most effective treatment for severe depression, providing relief to approximately 80% to 90% of patients.  But because of its side effects and risks, it is recommended only in extreme cases.

Other options for treatment-resistant depression

Repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation are two newer alternatives to ECT for treatment-resistant depression. Like ECT, both treatments work by delivering magnetic or electrical impulses to the brain. But while they show promise for severe depression, studies into their safety and efficacy are still ongoing.

• Repetitive transcranial magnetic stimulation (rTMS) – In rTMS, the brain is stimulated through strong magnets strong magnets placed on the scalp. Treatment is administered daily for at least 10 sessions. The procedure is painless, non-invasive, and doesn't require anesthesia. rTMS does not appear to be as effective as ECT. However, unlike ECT, rTMS doesn’t cause memory loss or other cognitive problems.
• Vagus nerve stimulation – Vagus nerve stimulation is another new brain stimulation treatment that can be used for people with chronic, recurring depression. A device called a pulse generator is surgically implanted in the chest. The pulse generator then sends electrical signals to the vagus nerve, which is connected to several mood-regulating parts of the brain. The device is left in the body permanently.

 

Related links for depression diagnosis and treatment

Depression diagnosis

Diagnosis of Clinical Depression – Learn how depression is diagnosed. Includes a list of diagnostic criteria. (All About Depression)

Depression Due to a Medical Condition – Covers the health conditions and illnesses that can cause depression symptoms. (Fairview Health Services)
Finding a therapist for depression treatment
Choosing a Therapist – Advice on what to look for when choosing a therapist, including their credentials, orientation, proximity, and values. (Psychology Today)

How to Find Help Through Psychotherapy – Introduction to psychotherapy, including its effectiveness and how to find a good therapist. (American Psychological Association)

Depression treatment

Getting the Treatment You Need – Covers how to set goals for recovery, treatment options, and seeing eye-to-eye with your healthcare provider. (Depression and Bipolar Support Alliance)

The Art of Avoiding Depression – Examines skills and knowledge you'll need to prevent depression, and compares the long-term effects of psychotherapy and medication. (Psychology Today)

Staying Well Once Your Depression is Treated – Learn about maintenance treatment options for keeping depression from recurring, including ongoing therapy or drug treatment. (Harvard Medical School's Consumer Health Information)

Psychotherapy for depression

How Psychotherapy Helps People Recover from Depression – This question-and-answer fact sheet discusses depression with a focus on how psychotherapy can help a depressed person recover. (American Psychological Association)

Healing Emotional Disorders - An Alternative Approach – Addresses how trauma in early life—rather than genes or disease—can be the source of many psychiatric disorders, and how this changes approaches to treatment. (Jeanne Segal, PhD)

Alternative and complementary treatment for depression

Depression and anxiety: Exercise eases symptoms – Learn about exercise’s benefits as a treatment for both anxiety and depression. (Mayo Clinic)

Finding Happiness: Cajole Your Brain to Lean to the Left – Reprint from a New York Times article on how mindfulness meditation combats depression. (Steve Shealy, PhD)

Mindfulness Based Cognitive Therapy and the prevention of relapse in depression – Overview of mindfulness meditation as a treatment for depression. (University of Oxford Centre for Suicide Research)

Natural and herbal supplements for depression

Herbs and Supplements for Depression – Browse through fact sheets on various natural and herbal supplements for depression, including St. John’s Wort, SAMe, Omega-3 fatty acids, and the B vitamins. (University of Maryland Medical Center)

Melinda Smith, M.A. contributed to this article. Reviewed by Jeanne Segal, Ph.D. Last modified on: 11/19/07.