Treatment for depression can involve several strategies. Most studies indicate that a combination of psychotherapy and antidepressant medication is the most effective treatment for major depressive disorder. Either medication or psychotherapy alone is effective in treating patients with mild depression.

What medications are used to treat depression?

There are several groups of antidepressants that are used to treat depression:

• Selective serotonin reuptake inhibitor (SSRI) drugs work by increasing levels of serotonin in the brain. These commonly used medications include Zoloft, Prozac, Paxil, Lexapro, etc.
• Serotonin-norepinephrine reuptake inhibitor (SNRI) drugs increase levels of serotonin and norepinephrine in the brain. These commonly used medications include Effexor, Cymbalta, Pristiq, etc.
• Tricyclic or cyclic, antidepressants (TCA) are less commonly used today. Introduced in the late 1950s, they act on approximately five different neurotransmitter pathways to achieve their effects. These drugs are a good choice for patients who are resistant to other antidepressant medications. They include Nortriptyline, Amitriptyline, Clomipramine, etc.
• Monoamine oxidase inhibitors (MAOI) mediations inhibit the activity of one or both monoamine oxidase enzymes. Introduced in the 1950s as the first drugs to treat depression, they are rarely used today.

What types of psychotherapy are used to treat depression?

Cognitive Behavioral Therapy (CBT) – Short Term Therapy
The goal of cognitive behavioral therapy is to change patterns of thinking or behaviors associated with people’s difficulties, resulting in improving the way they feel. CBT works by changing people’s attitudes, behaviors, and how they deal with emotional problems by focusing on their thoughts, images, beliefs, and attitudes. Most studies have found that cognitive-behavioral therapy is as effective as medication in treating major depressive disorder.

Interpersonal Therapy – Short Term Therapy
Interpersonal therapy, developed by Gerald Klerman, focuses on one or two of a patient’s current interpersonal problems. During the course of treatment, therapy may address a patient’s defense mechanisms, internal conflicts, lack of assertiveness, limited social skills, or distorted thinking.

Supportive Psychotherapy – Short to Long Term Therapy
This is a type of psychotherapy that integrates various components of psychodynamic, CBT, and interpersonal psychotherapy. It helps to improve symptoms and to maintain, restore, or improve self-esteem, ego functions, and adaptive skills.

Psychodynamic Psychotherapy – Short to Long Term
The goal of this psychotherapy is to study the psychological forces that underlie human behavior, feelings, and emotions and how they might relate to early experiences. Psychodynamic psychotherapy works to uncover repressed childhood experiences that are thought to explain an individual’s current difficulties.

Psychoanalytic Psychotherapy – Long Term Therapy
The goal of psychoanalytic psychotherapy is to effect a change in an individual’s personality or character, such as improving interpersonal trust, capacity for intimacy, coping mechanisms, the capacity to grieve, and the ability to experience a wide range of emotions. Treatment may continue for several years.

Family Therapy – Short Term Therapy
Family therapy is not generally viewed as primary therapy for the treatment of major depressive disorder. However, family therapy will be considered if the depression jeopardizes the functioning of a patient’s marriage or family, or if the depression is promoted or maintained by the family situation.

Are some patients resistant to treatment?

A certain number of patients may have treatment-resistant depression, meaning they do not get better with medication and therapy. For these patients, treatments including transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT) can help.