Treating Depression as a Persistent Illness
Because major depression has both a physical and environmental component, i.e., brain chemistry and early life experiences, treatment is likely to be lifelong. Most doctors will prescribe both medication and counseling for depression. This combination – of SSRIs, SNRIs, sedatives and/or tricyclics, and psychotherapy – can be ongoing, and depressed patients are always advised to keep taking prescribed medications until a doctor says they can stop. This includes young people, who may experience more – or more significant – adverse effects from depression medications.
Any medication – prescription, over-the-counter, even herbal – puts a person at risk of side effects. When medications are very complex in their operation, as is the case with prescription drugs, the risk is even greater. In addition, not all depressed individuals have the same response to a prescribed medication, some require more of a medication than others do, and some victims of depression also have health issues that prevent use of certain medications. As a result, finding a depression medication that works best can be a long, complicated, and very delicate procedure.
Antidepressants are the standard of treatment, and usually the first thing your doctor will prescribe. However, it’s important to remember that only about a third of depression sufferers find relief after taking their first course of antidepressants. The other two-thirds may have to experiment for weeks, or months, to find an antidepressant that works for them, their lifestyle, and their health situation.
Combination Medicinal Therapy
At least 20 percent will find that they need more than one medication – i.e., an antidepressant and a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinphrine reuptake inhibitors (SNRI). Either one works well with Bupropion. Aripiprazole, an atypical antipsychotic, works well with depression sufferers taking SSRIs. A second choice, though less well understood, is mirtazapine, which helps deal with depression symptoms like loss of appetite and insomnia.
Commonly used to treat bipolar disorder, lithium (a mineral) has also shown itself to be useful in treating depression in some individuals. However, it can build up in the blood and cause unfortunate health side effects, so depressed individuals will need to have frequent, regular blood tests to check for lithium accumulations in blood serum.
L-Triiodothyronine, or T3
T3 is sometimes used in combination therapy with tricyclic antidepressants (TCAs) like Amitriptyline, Amoxapine, Desipramine, Doxepin, Imipramine, and Nortriptyline. It also works well with Monoamine oxidase inhibitors (MAOIs), or first-generation antidepressants. Many doctors believe that T3 is excellent at speeding up response to treatment, and less effective in helping depressed individuals achieve remission.
D-amphetamine and methylphenidate, Dexedrine and Ritalin are occasionally used to treat depression, either by themselves or in combination with other drugs. Their benefits are most effective in achieving a rapid response among individuals who are recovering from a stroke or who have chronic medical conditions that limit their affect.
Other Depression Treatments
When medications don’t resolve depression, doctors may recommend psychotherapy, cognitive behavioral therapy, and even electroconvulsive therapy, or ECT, also known simply as shock therapy. These, in addition to medication, may be the only way to resolve what psychiatrists refer to as “treatment resistant depression”.
CONVERGE Consortium Nature (2015)