How is depression treated?

• There are many ways to treat depression, depending on the severity and mental state. Treatments include medication, psychotherapy, electroconvulsive therapy (ECT), behavioral therapy, and newer forms of therapy such as nasal sprays, new drug classes, TMS technology, and behavioral modification.
• Self-treatment for depression can include regular exercise, quality sleep, choosing brain-boosting foods, practicing cognitive adjustments and mindfulness, talking to a trusted person, volunteering, and creating new routines that bring joy.
• Medication for depression includes several groups: SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), TCAs (Tricyclic Antidepressants), and MAOIs (Monoamine Oxidase Inhibitors).
• How do traditional and modern treatments for depression differ? Traditional treatments often use TCAs or MAOIs, which have broad but non-specific effects and significant side effects. Modern treatments focus on SSRIs or SNRIs, which have far fewer side effects than traditional treatments.

How is depression treated? This is a question many people worry about when they or someone they know is suffering from depression. Treatment depends on the severity of symptoms and mental state. Treatment options include medication, psychotherapy, electroconvulsive therapy (ECT), behavioral therapy, and newer treatments such as nasal sprays, new drug classes, TMS (Transcranial Magnetic Stimulation) technology, and treatments that combine medical technology with psychotherapy and behavioral therapy for longer-lasting results. But how does this differ from traditional methods of treating depression? This article has the answers.

How is depression treated?

If you're wondering how depression is treated, there are several effective ways to address the problem. For example, medication to balance neurotransmitters is combined with psychotherapy (CBT) to modify thoughts. Medication must be taken continuously as prescribed by a doctor and not stopped on your own. In addition, self-care including exercise, sufficient rest, and abstaining from alcohol are crucial for recovery. In severe cases, brain stimulation (TMS/ECT) may be used in conjunction with medication.

Self-Treatment Methods for Depression:

• Exercise regularly. Aim for 150 minutes per week of brisk walking or yoga to stimulate endorphins and repair brain cells.
• Get quality sleep. Go to bed and wake up at a consistent time for 7-9 hours a day to allow brain function to recover and maintain emotional stability.
• Choose brain-boosting foods. Focus on leafy green vegetables, fish, and nuts (Mediterranean style) to reduce inflammation in the body that affects mental health.
• Practice mindfulness and adjusting your thinking. Practice realistic thinking, manage negative thoughts, and live in the present to reduce accumulated anxiety.
• Connect with those around you. Talk and share your feelings with someone you trust or volunteer to reduce loneliness and increase self-worth.
• Create a new routine that brings smiles. Adjust your daily schedule and find activities that create laughter to stimulate positive energy.

Medication for Depression:

In addition to self-treatment, medication is another effective way to treat depression. However, you should never stop medication on your own. What medications are used to treat depression?

SSRIs (Selective Serotonin Reuptake Inhibitors)

These medications inhibit the reuptake of serotonin into nerve cells. This results in increased levels of this neurotransmitter in the brain, directly balancing mood and reducing symptoms of depression.

Advantages:

• High specificity: It directly inhibits serotonin reuptake, resulting in precise neurotransmitter balancing.
• Fewer overall side effects than older drug classes, such as tricyclics, making it better tolerated by most patients.
• Variety of drug options: Several drugs are available for doctors to choose from based on symptoms, such as fluoxetine, sertraline, or escalopram.
• Less drowsiness: Compared to other drug classes, this class of drugs generally has less impact on daily life.

Possible side effects:

• Nausea, vomiting, diarrhea, bloating, dry mouth, or loss of appetite.
• Nervous system and mood: Headache, insomnia, or unusual drowsiness; excessive sweating and restlessness.
• Sexual dysfunction: May result in decreased libido or impaired sexual response.
• Severe symptoms requiring immediate medical attention: Confusion, tremors, muscle spasms, unsteady gait, or if suicidal thoughts begin while taking this medication.
• If used with other drugs that increase serotonin levels (such as SNRIs or MAOIs), it may cause sweating, confusion, and rapid pulse. Which can be life-threatening.

SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

These drugs work by inhibiting the reuptake of two neurotransmitters: serotonin and norepinephrine. This results in increases of both substances at the junctions between nerve cells. Examples of drugs in this group include duloxetine, venlafaxine, as well as older drugs like amitriptyline and nortriptyline, which also affect other chemicals in the brain.

Advantages

• Broader action, suitable for patients who do not respond to drugs that act on only one substance.
• Pain relief: Many drugs in this group are effective in relieving chronic pain or neuropathic pain associated with depression.
• Mood and energy balance: Increased norepinephrine levels improve alertness and energy levels for activities.

Potential side effects

• Nausea, vomiting, abdominal discomfort, diarrhea, loss of appetite, headache, sweating, and decreased sexual performance.
• Dry mouth and throat.
• Constipation or blurred vision.
• May cause insomnia or unusual drowsiness. And restlessness.
• Severe symptoms requiring immediate medical attention include confusion, tremors, muscle spasms, unsteady gait, or suicidal thoughts occurring during treatment.
• Life-threatening condition (Serotonin Syndrome): If used with other medications that increase serotonin, such as SSRIs or MAOIs, it can cause confusion, excessive sweating, and severe physical changes.

Tricyclic Antidepressants (TCAs)

These are older, highly effective antidepressants that work by inhibiting the reuptake of serotonin and norepinephrine, increasing the levels of neurotransmitters in the brain. This helps improve mood and reduce anxiety. Common examples include Amitriptyline (often used for sleep aids/migraines), Nortriptyline (for nerve pain/smoking cessation), and Imipramine (for bedwetting).

Advantages:

• High efficacy: Often used as a primary treatment option when newer drugs like SSRIs are ineffective.
• Diverse uses: In addition to treating depression, they are used to treat chronic nerve pain, prevent migraines, and improve sleep.
• Cost-effective: As older drugs, they are often inexpensive and readily available in most hospitals.

Potential Side Effects:

• Dry mouth, dry throat, constipation, blurred vision, and difficulty urinating.
• Nervous system and blood pressure: Excessive drowsiness, dizziness, especially when standing up suddenly, and weight gain.
• Cardiac effects: May cause palpitations or adverse effects on the cardiovascular system. Overdosing can be life-threatening.
• Not commonly used as a first-line treatment. Because they have more side effects than newer drug classes, extreme caution is needed in patients with suicidal thoughts due to the danger of overdose.

MAOIs (Monoamine Oxidase Inhibitors)

MAOIs are among the first generation of antidepressants that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters. Inhibiting this enzyme results in increased levels of serotonin, norepinephrine, and dopamine in the brain, helping to balance mood in severe cases. They are often used as a "last resort" when other drug classes, such as SSRIs or SNRIs, have not responded.

Advantages

• High efficacy in difficult-to-treat cases. They are effective in treating severe depression or depression that does not respond to other newer antidepressants.
• Broad spectrum activity, covering three important neurotransmitters, including dopamine, which helps with motivation and feelings of pleasure.

Potential side effects

• Foods high in tyramine, such as aged cheeses, red wine, fermented foods, and processed meats, should be avoided because they can cause a rapid and life-threatening increase in blood pressure.
• Contraindications: Do not use in combination with other antidepressants, antihistamines, or certain cold medications. Because of the risk of Serotonin Syndrome (excess serotonin), which can be serious.
• Symptoms include dizziness, dry mouth, insomnia, or daytime drowsiness.
• Difficulty in use due to significant dietary and drug restrictions; therefore, strict adherence to a doctor's instructions is required.

What are some newer antidepressants?

• NaSSA drugs, such as Mirtazapine, directly increase norepinephrine and serotonin levels. Their notable uses include promoting sleep and stimulating appetite in patients with anorexia.
• NDRI drugs, such as Bupropion, inhibit the reuptake of norepinephrine and dopamine. They are often used to treat depression and also help reduce nicotine cravings in those trying to quit smoking.
• SARI drugs, such as Trazodone, work by inhibiting serotonin reuptake and blocking certain neurotransmitter receptors to reduce side effects and help balance mood.
• Newer serotonin modulators, such as Vortioxetine, work by both inhibiting reuptake and modulating the function of multiple serotonin receptors simultaneously, for improved therapeutic efficacy and reduced unwanted side effects.
• NMDA receptor antagonists, such as Esketamine nasal spray, act via the glutamate system to stimulate brain cell repair. These medications are often used in cases of drug-resistant depression and must be used only under the supervision of a doctor in a hospital.
• Neurosteroid modulators, such as Brexanolone, are specific medications that help balance GABA in the brain. They were developed specifically to treat postpartum depression.
• Melatonergic antidepressants, such as Agomelatine, mimic melatonin to normalize the sleep-wake cycle, while also adjusting dopamine and norepinephrine levels to improve mood.

How do traditional and modern treatments for depression differ?

Traditional Treatment:

• Often uses TCAs or MAOIs, which have broad but not specific acts.
• They have significant side effects, such as dry mouth, dry throat, constipation, palpitations, dizziness, and often cause drowsiness that interferes with daily life.
• With MAOIs, patients must be very careful about their diet to prevent harm.

Modern Treatment:

• Focuses on SSRIs or SNRIs, which specifically act on the serotonin or norepinephrine systems.
• Side effects are much fewer than traditional treatments, although nausea may occur initially, and drowsiness is less common. And treatment results are likely to be seen more quickly in the long term.
• Emphasis is placed on psychotherapy, such as CBT, from the beginning to modify thoughts and behaviors, which effectively reduces the chance of relapse.
• Nutrient levels are checked, and lifestyle adjustments are made to suit each individual's body to help restore brain function sustainably.
• Some individuals may experience anxiety or insomnia in the initial stages, so close communication with the doctor is necessary to adjust medication dosages appropriately.

Get screened for depression at Vibhavadi Hospital.

Early detection of depression can lead to timely improvement. If you feel sad, unhappy, or stressed, you can consult about depression at Vibhavadi Hospital. Doctors are ready to provide advice on solving depression problems, medication, and other treatment options to help you live your life and overcome obstacles with confidence.

Summary

Effective treatment for depression requires the use of medication to balance neurotransmitters, combined with psychotherapy (CBT) and lifestyle adjustments such as regular exercise, sufficient rest, and choosing brain-boosting foods to regenerate nerve cells. Current medications include newer groups like SSRIs/SNRIs, which are specific in their action and have fewer side effects, and older groups like TCAs/MAOIs, which are potent but require caution regarding diet and side effects.

Modern treatment approaches emphasize individualized care and integrated approaches to achieve faster results and minimize relapse. Crucially, continuous medication is essential for successful treatment. If you are struggling with depression or feeling hopeless, and it's impacting your daily life, you can consult Vibhavadi Hospital. Our doctors are ready to provide advice and treatment recommendations to help you feel confident and move towards a happier life.