Depression is a highly treatable condition. For treatment to work, you need help from an experienced provider, one who knows which medications are most effective for your form of depression.
A first step is a psychiatric evaluation. A physical exam and possibly laboratory tests also may be done to help find out if an undiagnosed medical problem may be related to your depression.
Many factors affect how well medications will work, such as your weight, health and metabolism. Medication can take three to six weeks before you feel better. If one form of medication doesn't work, your provider may try another, change the dose or prescribe a combination of medications.
 Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
Medications
Tricyclics and selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for people whose symptoms include fatigue, feelings of hopelessness, helplessness and excessive guilt, inability to feel pleasure, and loss of appetite with weight loss as a result.
SSRIs are usually preferred because of their low risk of side effects. These side effects generally go away, but the sexual problems do not. Side effects may include:
- Headache
- Tremor
- Nervousness
- Trouble concentrating
- Nausea
- Diarrhea
- Dry mouth
- Changes in weight or hunger
- Weakness
- Increased sweating
- Sleeping problems
- Sexual problems
Monoamine oxidase inhibitors (MAOIs) may be given to people whose depressions are marked by increased hunger, excessive sleepiness, anxiety, and phobic and obsessive-compulsive symptoms. These medications also may be prescribed for people who have not done well with other antidepressants. Because of the high risk for interacting with certain foods and other medications, MAOIs are generally not the first drug a doctor may try.
Lithium is used for people with bipolar illness. The drug also is prescribed for people suffering from recurrent depression without mania, or highs experienced in bipolar I.
Lamictal® (lamotrigine) is another medication used to treat bipolar disorder and was approved by the FDA for maintenance treatment for bipolar. Clinical studies have shown that lamotrigine works well in reducing how often depressive episodes strike. It also is used in people with depression.
Psychotherapy
In some cases, psychotherapy alone can help fight depression. Psychotherapy involves talking with a licensed professional who will help patients gain insights about themselves in order to make positive changes in their feelings, behavior and lives. Studies have shown that in some cases, psychotherapy can work as well as medication in relieving symptoms of depression, although results take longer to achieve. In general, psychiatrists agree that severely depressed patients respond best to a combination of medication and psychotherapy. However, be sure to see a doctor no matter what. It may be difficult for you on your own to determine how severe your depression is.
Electroconvulsive therapy (ECT)
This therapy uses an electric shock to affect the same transmitter chemicals in the brain that are corrected by medications. Although the use of ECT has decreased in recent years, it is still used to treat people who cannot take medications because of other health problems or who have not done well with medication. According to the American Psychiatric Association, ECT can be a life-saving treatment that is considered when other therapies have failed or when a person might kill themselves.
Light therapy
People with seasonal affective disorder are often treated with sessions of light generated by a special light box.
Coming out of the darkness
A first step in stepping out of the fog of depression is recognizing that it's not part of who you are. It is a real condition just like high blood pressure, asthma and many other medical problems that can be treated by a qualified health professional. Thanks to huge advances, medications are better and more effective than ever before. Support from caring people and others with depression is readily available. With help, you usually can feel better in a matter of weeks and can ward off future episodes.
This article was reviewed and updated June 2007.
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