Depression can be treated with medications and/or with counseling. Most people benefit from a combination of the two. Some studies have shown that antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone.
Medications include: tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. For persons with psychotic symptoms, such as delusions or hallucinations, antipsychotic medications may be needed.
Types of psychotherapy that have proven to be particularly effective for treating depression include interpersonal therapy, group therapy and cognitive/behavioral therapy. Antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone.
Electroconvulsive therapy (ECT) is a treatment that causes a central nervous systemseizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don't respond to other treatments.
Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain functioning in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may be effective in relieving depression.
As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements. It is important to maintain a healthy lifestyle, including: good nutrition, avoidance of alcohol and drugs (which make depression worse and may interfere with medications), regular exercise and sleep, and involvement in supportive interpersonal relationships.
Over the last decade, the use of herbal products has increased tremendously. Most consumers use herbal products for management of chronic conditions, such as psychiatry disorders, including anxiety and depression.
St. John's wort (hypericum) has a long history of use in Germany and has recently gained popularity as an adjunct antidepressant in the United States. Most of the German studies indicated a comparable wanted effect with use as tricyclic antidepressants, and better desired effects than placebo (sugar pill).
The National Institute of Mental Health and the National Center for Complementary and Alternative Medicine have recently sponsored the Hypericum Clinical Trial.
The multi-center, randomized, controlled study aims to compare 50 to 150 mg/day of sertraline (Zoloft), 900 to 1800 mg/day of St. John's wort, and placebo in 330 patients with major depression. The result of this large clinical trial will provide a better perspective of the role of St. John's wort in depression.
Side effects associated with the use of St. John's wort are usually mild and primarily include gastrointestinal symptoms and fatigue. Photosensitization is a common side effect, especially in light-sensitive individuals and/or with high dosage (1800 mg/day).
Fortunately, the effect is reversible within a few days of drug discontinuation. St. John's wort has been reported to interact with cyclosporine, warfarin (coumadin), and digoxin, with a decrease in concentration occurring with all the affected medications.
Close monitoring of drug levels and laboratory tests, such as INR, are advised if concurrent use is necessary. Contraindications to its use include pregnancy, lactation, and exposure to strong sunlight. Patients should tell their doctors about the use of herbal products.
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