Treatments for Depression
Numerous treatments for depression are available including:
Interpersonal Psychotherapy (IPT)
IPT is a 16-week, evidence-based therapy for acute major depression. Supported by over 30 years of research, it is effective in the treatment of mild to severe depressions and is compatible with taking antidepressants, if indicated. In IPT, you and your therapist focus on a current interpersonal stressor that is associated with the episode of depression. The goal of IPT is remission of depression by facilitating your mastery of the stressor. Interpersonal stressors commonly associated with an episode of major depression include grief, conflicts with others, and a life transition. IPT is offered as an individual therapy.
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that combines cognitive and behavioral interventions in the treatment of depression. The cognitive interventions help you to look at your thinking patterns so that you begin to change your reactions to the problems you face. This will help you to feel more realistically hopeful and to regain a more flexible, positive approach to the issues that you are struggling with. The behavioral interventions help you to activate yourself so that you can feel more productive, engage more effectively with others, and begin to experience pleasurable activities again. Like IPT, CBT can be combined with antidepressant medication, if indicated. CBT is offered as either a group treatment or as individual therapy.
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT is a new technique that blends mindfulness meditation and cognitive therapy techniques to lessen depression, particularly in individuals with recurrent episodes. MBCT is an active, empowering therapy that teaches new skills to individuals suffering depression. Cognitive therapy emphasizes trying to identify depressive thought distortions about the world such as viewing situations catastrophically when no disaster actually is threatening. Cognitive therapy trains the individual to answer back to this negative thought content. In MBCT, however, there is little emphasis on changing thought content, but rather on changing one’s relationship to one’s thoughts. Instead of thought content, MBCT is aimed at thought process. It features a “decentered” view of one’s thinking, allowing the individual to see that their thoughts are not facts, but merely mental events. Although obvious to many, for depressed individuals this can be an epiphany. In one MBCT exercise, individuals are taught to view their thoughts as if they are images moving across a video screen. Realizing they are just impermanent thoughts allows the individual to feel less agitated or depressed by them. In another example, when the depressed individual thinks, “I am a rotten person”, they are taught to recognize “I am having the thought I’m a rotten person” which allows them to differentiate themselves from the thought, so they do not have to accept the thought as true. Understanding that thoughts are not facts is a core concept of MBCT.
Dozens of medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression.
The various classes of these medications include the Tricyclic Antidepressants (TCAs), the Monoamine Oxidase Inhibitors (MAOIs), the Selective Serotonin Re-uptake Inhibitors (SSRIs), and others. Each class of antidepressants acts on different chemicals in the brain, and each medication has a distinct chemical structure. Despite these differences, these medications are all equally effective in treating depression. However, for reasons not yet well understood, they don’t all work the same for everyone. Your doctor will work closely with you to determine which medication might be best for you. If the first medication tried is ineffective or if it has problematic side effects, your doctor may recommend trying a different medication or a combination of medications.
Antidepressant medications need to be taken on a daily basis. Typically, response to an antidepressant takes four to six weeks. Once a response is achieved, medication should be continued for an additional nine to twelve months of feeling good. Stopping the medication sooner may result in a relapse back into the depression. For individuals with histories of several bouts of depression, ongoing treatment with medication may help prevent recurring episodes. It’s important that you don’t change your dosage or discontinue your medication without first talking to your doctor. A lot of people wonder if antidepressant medications are addictive; they are not.
Some people find that herbs and supplements are beneficial for mood symptoms. It’s important to know that herbs and supplements are not regulated by the FDA, and there is no guarantee that they are pure, safe, and effective. Very little is known regarding interactions with other similar products or with prescription or over-the-counter drugs, and their safety in pregnancy or with breastfeeding is unknown. If you are taking any herbs or supplements, please be sure to discuss this with your doctor.
Electroconvulsive Therapy or "ECT" is available for people suffering from particular behavioral and emotional disturbances, including some forms of depression, bipolar disorder, and schizophrenia. It is most often used in the treatment of severe depression that has not responded to medications and psychotherapy. At the UCSF Depression Center, this treatment is offered through a partnership between Langley Porter and the Ambulatory Services Center of UCSF Medical Center.