Depression - Treatment Overview

Treatment Overview

Initial treatment

Treatment of depression may include antidepressant medication, professional counseling such as cognitive-behavioral therapy, or a combination of the two.

• Professional counseling may be all that you need for mild to moderate depression.⁷
• If your early symptoms are severe, your initial treatment most likely will include both antidepressants and professional counseling.
• Hospitalization may be necessary if you show warning signs of suicide, such as thoughts or plans about harming yourself or another person, detachment from reality (psychosis), or excessive use of alcohol or drugs.

Depression can lead to suicide. The warning signs of suicide change with age.

• Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
• Warning signs of suicide in adults may include alcohol or substance abuse, recent job loss, or divorce.
• Warning signs of suicide in older adults may include the recent death of a partner or diagnosis of a life-limiting illness.

Depression usually can be successfully treated with medication, professional counseling, or a combination of the two. However, it sometimes takes several attempts to find the medication and type of counseling that work best for you. You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. You and your health professional will work together to find the right treatment.

If you think you may have depression, take a short quiz to evaluate your symptoms:

Interactive Tool: Are You Depressed?

Should I take medications to treat depression?

Should I take antidepressants during pregnancy?

If you have recently given birth, learning how to manage postpartum depression may help you recover more quickly.

How can I manage postpartum depression?

In rare cases, electroconvulsive therapy (ECT) may be an initial treatment choice for people who cannot take antidepressants, who have not responded to other treatments, or whose depression is severe and includes symptoms of psychosis, suicidal behavior, or an inability to eat.⁸ ECT involves an electric stimulation to the head which causes a brief seizure. This is thought to relieve depression by altering brain chemicals known as neurotransmitters.

Ongoing treatment

At least half of those who have one depression episode will have a recurrence of symptoms (relapse). Continuing to take antidepressant medicine after recovery reduces your risk of a relapse.⁹ Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.

Ongoing treatment for depression also includes:

• Eating a balanced diet.
• Avoiding alcohol.
• Getting exercise.
• Getting quality sleep.

It may also be helpful for you to obtain social support from family and friends.

If you have another illness along with depression, you need to continue treatment for your other illness. It is possible for other mood disorders such as anxiety and anxiety disorders, psychosis, or mania to accompany depression. For more information, see the topics Generalized Anxiety Disorder, Social Anxiety Disorder, and Bipolar Disorder.

Treatment if the condition gets worse

If your depression gets worse while you are receiving professional counseling alone, medication can be added to your treatment.

• Evidence shows that adding medications to counseling for severe depression works better than counseling alone.⁹
• If you have recurrent depression, you may need to take antidepressant medications for the rest of your life.

If your depression gets worse while you are already taking medications and receiving professional counseling, different or additional medications may be tried.

Electroconvulsive therapy (ECT) has been shown to be an effective treatment for severe depression or depression that has not been helped by other treatment.^{9, 8} ECT involves an electric stimulation to the head that causes a brief seizure. This is thought to relieve depression by altering brain chemicals known as neurotransmitters. ECT will need to be followed with medications and counseling, because relapse of symptoms is common.¹⁰

If your symptoms of depression get worse, it is essential to work with your health professional to find effective treatment. Major depression may be a risk factor for developing heart problems such as coronary artery disease or heart attack.¹¹ However, the greatest danger from depression is suicide. Up to 15% of people with depression die by suicide.³

The warning signs of suicide change with age.

• Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
• Warning signs of suicide in adults may include alcohol or substance abuse, recent job loss, or divorce.
• Warning signs of suicide in older adults may include the recent death of a partner or diagnosis of a life-limiting illness.

What To Think About

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed. The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

Should I take antidepressants during pregnancy?

Anyone can develop depression regardless of age, race, or social status. As many as 1 out of every 10 people who visit a doctor has depression, but it goes unrecognized or undertreated in about half of those cases.² If left untreated, depression can lead to poor quality of life and higher risk of suicide.

Less than one-third of people with depression seek professional treatment.¹² Even when treatment is sought, health professionals sometimes attribute the vague symptoms of depression to other illnesses. You may not realize you are depressed, or you may be embarrassed to seek treatment. However, it is important to seek treatment as soon as you suspect that you or someone you love is depressed. The sooner you seek treatment, the better your chance for a quick and full recovery. Preventing recurrence of depression is also important.

Depression is not normal at any age, and treatment is important.

• Depression is often underdiagnosed in children and older adults. In children and adolescents, depression might be mistaken for hormonal "moodiness." For more information, see Depression in Children and Teens.
• Older adults may think it is normal to experience feelings of depression along with aging. Early treatment of depression in older adults can delay nursing home placement. The risk of death associated with depression increases significantly during the first year an older adult enters a nursing home.³

Family involvement and support in the treatment of depression can be very important, especially for children, teens, and older adults. Sometimes parents of depressed children and teens may also be diagnosed with depression and need treatment. Sometimes one or both parents can be depressed first and this can lead to their children also being diagnosed with depression.

If you have recently given birth, learning how to manage postpartum depression early on may help you recover more quickly and prevent a prolonged or serious problem with postpartum depression.

How can I manage postpartum depression?