What Is Depression? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Which Types of Talk Therapy Work Best for Depression?

The Society of Clinical Psychology rates several types of psychotherapy as highly effective treatments for depression:

• Behavioral Activation Therapy The aim of this type of therapy is to reverse the downward spiral of depression by encouraging you to seek out experiences and activities that give you joy.
• Cognitive Behavioral Therapy (CBT) CBT focuses on changing specific negative thought patterns so that you are able to better respond to challenging and stressful situations.
• Interpersonal Therapy This very structured, time-limited form of therapy focuses on identifying and improving problematic personal relationships and circumstances directly related to your current depressive mood.
• Problem-Solving Therapy This therapy is a form of CBT that teaches take-charge skills that help you solve real-life problems and stressors, big and small, that contribute to depression.
• Self-Management or Self-Control Therapy This type of behavioral therapy trains you to lessen your negative reactions to events and reduce your self-punishing behaviors and thoughts.

What Are the Different Antidepressants and How Do They Work?

The most commonly prescribed antidepressants cause changes in brain chemistry that affect how neurons communicate. Exactly how this improves mood remains somewhat of a mystery, but the fact that they do often work is well-established. If you’re thinking about trying antidepressants, talk to your doctor about whether these treatments could be right for you.

• SSRIs (Selective Serotonin Reuptake Inhibitors) This category of drug includes fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) and targets serotonin, a neurotransmitter that helps control mood, appetite, and sleep.
• SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) SNRIs include drugs like duloxetine (Cymbalta), desvenlafaxine (Pristiq), and venlafaxine (Effexor XR), which block the reabsorption of both serotonin and another neurotransmitter, norepinephrine.
• NDRIs (Norepinephrine-Dopamine Reuptake Inhibitors) This class of medications includes bupropion.
• TCAs (Tricyclic Antidepressants) TCAs include such drugs as imipramine (Tofranil) and nortriptyline (Pamelor). These drugs were among the earliest antidepressants to come on the market. These days, doctors generally only turn to them when treatment with SSRIs, SNRIs, and NDRIs has failed.
• MAOIs (Monoamine Oxidase Inhibitors) MAOIs, including phenelzine (Nardil) and isocarboxazid (Marplan), were the first antidepressants developed. They’re rarely used today, in part because people who take them require careful monitoring to prevent negative interactions with certain foods and other medications.

All antidepressants can have side effects, but some may be more problematic than others. You may need to try several different medications, or a combination, guided by your doctor, before you find what works best for you.

In addition, it may take some patience before you see results. The full benefits of the drugs may not be realized until you’ve taken them for as long as three months, according to the the STAR*D trial, the largest, longest study on antidepressant treatment, which ended in 2006.

Sometimes, other medications may be added to your regimen, depending on the form of depression, severity of your symptoms, and your response to other therapies. These might include a mood stabilizer, such as lithium (sold under several brand names) or valproic acid (Depakene, Depakote). If symptoms of psychosis (having delusions or seeing or hearing voices that are not real, for example) are present, a doctor may prescribe an antipsychotic medication, such as haloperidol (Haldol), risperidone (Risperdal), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa).

Some experts believe that using an antipsychotic in combination with an antidepressant may be more effective for depressive disorders than antidepressants alone, according to a review published in Shanghai Archives of Psychiatry.

Learn More About Depression Treatment

Lifestyle Changes for Depression

Lifestyle changes, such as making art, journaling, exercising more, and practicing yoga or mindfulness, can also alleviate depression and the stress that can heighten it. Alternative treatments like massage, acupuncture, and light therapy may also help.

Diet changes, too, can uplift your mood by reducing inflammation and helping to ensure your brain gets the nutrients it needs to function at its best.

One small randomized controlled study, published October 9, 2019, in the journal PLoS One, found that self-reported symptoms of depression dropped significantly in just three weeks in young adults who changed from a highly processed, high-carbohydrate diet to a Mediterranean diet focused on vegetables, whole grains, lean proteins, unsweetened dairy, nuts and seeds, olive oil, and the spices turmeric and cinnamon. In contrast, the depression scores didn’t budge in a control group of people who didn’t change their diet.

Should You Worry About Antidepressant Withdrawal?

No, but it’s easy to see why some people might think so, because of a medical condition called antidepressant discontinuation syndrome (ADS), which can occur if you abruptly stop taking medication rather than tapering off as is generally advised. ADS is marked by a wide range of responses, including but not limited to flu-like symptoms, insomnia, worsening mood, and stomach distress, according to a report published March 11, 2019, in Psychiatric Times.

Current estimates are that up to 40 percent of patients who’ve taken an antidepressant for at least a month will experience ADS symptoms if they abruptly stop their medication instead of lowering their dose gradually, according to a study published December 2018 in The American Journal of Psychiatry. (Conversely, more than 60 percent of patients who stop taking an SSRI will have no significant symptoms.) Tapering under the care of a doctor can prevent ADS by allowing the brain to adjust to changes in neurotransmitter levels.

More to the point, while you should slowly stop your antidepressant with the help of your doctor, antidepressants do not cause dependence and withdrawal like other substances. Unlike substances that are known to cause addiction, such as alcohol, opioids, and barbiturates, people don’t crave antidepressants. You don’t get “high” from them, and they aren’t intentionally or compulsively overused. Serious reactions like the seizures and agitation that can follow sudden withdrawal from addictive substances are “unheard of when these antidepressants are tapered gradually,” note the authors of the Psychiatric Times report.

What Is Treatment Resistant Depression and Is There Any Help for It?

If you’ve tried at least two different antidepressants and your depression hasn’t improved, you may be diagnosed with treatment-resistant depression (TRD). TRD is a serious condition that has been highly associated with suicidal ideation and suicide attempts. Thirty percent of people with TRD attempt suicide in their lifetime, more than double the rate of their treatment-responsive peers, according to a review published in April 2018 in the Journal of Affective Disorders. It is not, however, a hopeless condition. A number of alternative treatment approaches are available, including:

• Esketamine A nasal spray marketed under the name Spravato, esketamine won FDA approval on March 5, 2019, as a new treatment for TRD. It is derived from ketamine, a veterinary anesthetic best known as the street drug “Special K.” Because of safety concerns, Spravato must be administered in a medical office and should be taken along with an oral antidepressant.
• Electroconvulsive Therapy (ECT) ECT is the modern-day version of electroshock therapy. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. According to the APA, ECT rapidly provides substantial improvement in approximately 80 percent of patients with severe, uncomplicated major depression. Like any medical procedure, ECT is associated with side effects — most commonly, issues with memory. In most cases, this is short-term; however, some people can experience permanent gaps in memory, per the APA. Nevertheless, current ECT has far fewer side effects than electroshock therapy of the past.
• Transcranial Magnetic Stimulation (TMS) TMS uses rapidly alternating magnetic fields to change activity in specific areas of the brain. Although researchers don’t fully understand how exactly TMS affects the brain, it appears to influence how the brain is operating and, in turn, improve mood and decrease depressive symptoms, according to Mayo Clinic.
• Vagus Nerve Stimulation This therapy involves implanting a tiny device in the chest that provides regular mild electrical pulses to the longest of the nerves that arise from the brain. A study published on August 21, 2018, in the Journal of Clinical Psychiatry involving nearly 600 patients with TRD found that vagus nerve stimulation significantly improved quality of life for many patients.
• Psychedelic Drugs While not yet FDA approved, microdosing with psychedelic drugs to produce a more positive mood in people with chronic depression is the focus of a flurry of research worldwide, including at the Johns Hopkins Center for Psychedelic and Consciousness Research. The possibilities appear vast and promising. For example, one of the latest Johns Hopkins studies, published March 1, 2019, in The American Journal of Drug and Alcohol Abuse, found that a synthetic form of a psychedelic derived from the venom of certain toads provided fast-acting relief from depression and anxiety. However, according to a July 2022 position statement from the APA, there’s not enough evidence yet to endorse the use of psychedelics for the treatment of any mental health condition except during approved investigational studies, and more research is needed in this field.

Prevention of Depression

If you’re wondering how to prevent depression, unfortunately there’s no surefire way. But according to Mayo Clinic, these steps could help:

• If you suspect you have depression, get professional help early on to keep it from getting worse.
• Lean on your family or friends for support.
• Consider long-term treatment to prevent your depressive symptoms from coming back even after you feel better.

Try your best to curb stress in your life.