Drugs or counseling? The biggest successes in most types of depression are typically obtained using a combination of both; in recent years, we've also had several studies indicating that this combo attack is more effective than either medication or psychotherapy alone. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy (ECT). Once you improve, counseling can be more effective. If you have mild to moderate depression, a combination of medications and a brief course of psychotherapy usually is effective. However, in one type of depression (Adjustment Disorder with Depression), it is psychotherapy that is primarily used to relieve symptoms; drugs are not generally called for, and when used, they are in the nature of a top-up to psychotherapy.



These drugs have become the first line of treatment for most types of depression. They appear to work by optimizing levels of the brain chemicals considered to be involved in depression. Antidepressants are usually taken in pill form, once or several times a day. Today, however, there are also controlled-release and extended-release versions available that can be taken less frequently. There are many classes of antidepressants. All are about equally effective against depression, though one person may respond better to one medication than another. Newer anti-depressants have improved the treatment of depression because they have fewer serious side-effects.


Inform your physician about any drugs you may be taking before an anti-depressant is prescribed. A number of other drugs interact poorly with depressants; they include alcohol, which can interfere with the way your body absorbs the medication. It typically takes two to three weeks to experience the effect of an anti-depressant. Initially, you may experience only side-effects (e.g., nausea, drowsiness, weight gain). But in most cases, the side-effects, improve or go away after about a week or two. It can take up to eight to 12 weeks before you feel the full effects of an anti-depressant, though you may feel some changes earlier. If your response to the drug isn’t satisfactory within 2 or 3 months, your doctor may suggest either adding another anti-depressant or replacing the first one with another from a different chemical family.

Anti-depressant treatment typically follows a two-stage approach. The initial treatment with medication helps relieve symptoms. Once symptoms ease, maintenance treatment typically continues for four to nine months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces your risk of a rapid relapse. If you've had two or more previous episodes of depression, your doctor may suggest even longer-term treatment with anti-depressants.


As with any medication, anti-depressants often cause side effects. However, most are temporary and will disappear as your body gets used to the medication. Let your doctor know about any side effects that interfee with daily functioning, or if they're especially bothersome.

The oldest type of anti-depressant could not be combined with certain foods and beverages (e.g., aged cheeses, wine) because this could bring on a sharp spike in blood pressure, known as a "hypertensive crisis". However, a new version of this type of anti-depressant is now available as a skin patch which works by releasing medication directly into the bloodstream. Those who are put on the lowest available dosage will not need to maintain the dietary restrictions that they would with all other drugs in this class. While the newest class of anti-depressants overall have less serious side-effects (headache, nausea, insomnia, agitation or a jittery feeling, and sexual difficulties), parents in particular should be aware that anti-depressants - including fluoxetine, which gained fame as well as notoriety as Prozac - may increase suicidal thinking in some persons, especially children and adolescents. All people being treated with them should be monitored closely for unusual changes in behavior. Recent research, however, seems to indicate that the benefits of such medication in the treatment of depression far outweigh the risks.

You should also be aware that your doctor may need to adjust the dosage or change the anti-depressant to achieve the best results with minimal side-effects. The safety of anti-depressant use in pregnancy is not completely understood. At least one of the newer drugs appears to be more likely to be associated with birth defects. Any woman who is nursing, pregnant, or plans to become pregnant should discuss taking anti-depressants with her gynecologist.

One thing more: Don't stop taking an anti-depressant suddenly; if you do, you may suffer withdrawal symptoms such as nausea, headache and dizziness.


In some cases, other medications such as anti-anxiety drugs and lithium may be used in combination with anti-depressants. These are generally not effective when taken alone for major depression. But low-dose lithium, for instance, can augment the effect of some types of anti-depressants in treating major depression. However, in treating another type of depression, bipolar disorder, lithium is indeed the drugs of choice.

If you can't take anti-depressants because they're contra-indicated due to another medical condition, your doctor may initially prescribe a stimulant (such as amphetamine). Stimulants are not usually effective when taken in conjunction with anti-depressants, but may be used under close monitoring in medically-ill patients with major depression. If a depressed person is also showing psychotic symptoms like delusions or hallucinations, anti-psychotic drugs may be used. The American Diabetes Association has warned, however, that certain anti-psychotic medications may increase the risk of diabetes, obesity and high blood pressure. Medications called "atypical anti-psychotics", which were initially developed for the treatment of psychotic disorders are sometimes also used to treat bipolar disorder.


Should you try herbal and dietary supplements? Not without speaking with your physician before you do. For one thing, you can't always be sure of what you're getting or if it's safe. Also, if you're already taking medications, herbal or dietary supplements may interfere with the way they work, or may cause dangerous interactions.

* Electro-Convulsive Therapy (ECT): "Shock Therapy", as it's called in popular parlance, remains a controversial procedure and still gets a lot of bad press. When it was first introduced in the 1930s, ECT could be painful and downright dangerous. But it's a different and safer procedure today, although it still does pose a risk of side-effects and complications, such as memory loss and confusion. The treatment involves using an electrical current to cause a brief convulsion in the depressed person. ECT is usually considered for those who don't respond to anti-depressants, who are at high risk of suicide or when there is some other need for urgent action such as a depressed person's refusal to eat. Medical scientists aren't sure how this therapy relieves the signs and symptoms of depression, but it is thought that the seizures cause changes in brain chemistry.

* Psychotherapy: The main thrust of counseling is on two areas: efforts to help the person change the negative patterns of thought and behavior that are linked with depression; and a focus on problems in the person's close relationships that may have fuelled or worsened the depression. Not just individual sessions, but in some cases marital counseling and /or family therapy may also be called for. In addition, stress management classes, run by a skilled professional or team of professionals, can help. The success of therapy lies in finding a therapist you are comfortable with, and also someone who's on top of the problem.

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