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Major Depressive Disorder
(Depression)

Depression Information

Feeling sad or down can be a big problem, and unfortunately, it is also a common problem. These feelings of depression can affect how you handle life problems and how you are able to handle simple tasks such as the energy and motivation to eat, sleep, perform at school or work, and may even affect your ability to make decisions or concentrate. As with most mood disorders, depression is a spectrum disorder. This means that some people may feel the symptoms of being sad or down for a few hours or days, whereas others might struggle with these symptoms for weeks or longer.

Major depressive disorder, often called depression, is a psychiatric disorder that is defined by the diagnostic and statistical manual of mental health (DSM-V). You must experience at least five of the following symptoms for at least two weeks duration. In addition, at least one of the symptoms must be depressed mood or loss of interest in activities that were enjoyable.

  • Depressed mood

  • Loss of interest or pleasure in activities that were enjoyable prior to onset of depression

  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day

  • Decrease in thought processes

  • Decrease in physical activities/movements

  • Loss of energy or little energy

  • Feelings of worthlessness

  • Guilt

  • Problems with concentration and focus

  • Thoughts of death or wanting to die 

Depression Treatment

Treatment for depression symptoms typically involves medications, education, and development of skills to help with symptoms of feeling sad, down, or depressed. Providers often involved in the treatment of major depression are family medicine providers and mental health providers such as physician assistants, nurse practitioners, psychiatrists, and mental health therapists. 

Medications

  • Selective serotonin reuptake inhibitors (SSRIs). This class of drugs help depression by allowing more of the neurotransmitter serotonin to be available for neuron use. They are overall safe drugs and some in this class are used even during pregnancy. Typical SSRIs include:  citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), vortioxetine (Trintellix), and vilazodone (Viibryd).

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs). This class of drugs help depression by allowing more of the neurotransmitters norepinephrine and serotonin  to be available for neuron use. Typical SNRIs include: duloxetine (Cymbalta), venlafaxine (Effexor XR), and desvenlafaxine (Pristiq).

  • Norepinephrine and dopamine reuptake inhibitors (NDRIs). These drugs help depression by allowing more of the neurotransmitters norepinephrine and dopamine  to be available for neuron use. Typical NDRIs include: bupropion (Wellbutrin XL).

  • Atypical antidepressants. These types of antidepressant medications have more than one specific mechanism of action. These include: mirtazapine (Remeron) and trazodone (though it does share many SSRI properties).

  • Tricyclic antidepressants. This class of drugs work in several ways to achieve their effects. They work to increase the levels of serotonin and norepinephrine available for neuron use. Typical tricyclic antidepressants include: imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline (Elavil), and doxepin.

  • Monoamine oxidase inhibitors (MAOIs). MAOIs — These mmay be prescribed when other drugs haven't worked, but because of their potential for serious side effects, they are not generally used. If you are using MAOIs, you are required to follow a strict diet because of dangerous  interactions with foods, medications, and supplements. 

  • Stimulants. These are FDA controlled medications that are comprised of methylphenidate or amphetamine. Although they can help depression symptoms, they are highly regulated drugs due to their abuse potential. These medications work by allowing more of the neurotransmitters norepinephrine and dopamine to be available for neuron use.

  • Other medications. Other medications are sometimes needed in addition to the above commonly prescribed drugs. Sometimes drugs are combined or other medications such as mood stabilizers or antipsychotics are used. 

Therapy

 

Counseling therapy can help improve depression symptoms by helping you develop skills to more effectively deal with the thoughts and feelings you are having. These therapies consist of:

  • Cognitive behavioral therapy. This type of therapy will help you cope better with depression by teaching skills specific to management of organization, patterns of thinking, and behavioral patterns. 

  • Family therapy. Because many people with depression encounter loved ones, family members, and spouses who are unfamiliar with depression, this therapy can help them overcome the stress associated with living with someone who struggles with depressive symptoms. 

  • Music therapy. This therapy utilizes music to help relax an individual to enhance their mood. Music therapy activates  cognitive, motor, and speech centers in the brain to help improve overall functioning.

  • Talk therapy. This type of therapy employs a variety of techniques to help a person better deal with thoughts and behaviors.

  • Interpersonal therapy. IPT is a type of therapy that focus on personal relationships and how you feel. It is a short-term, intensive therapy.

  • Integrative therapy. This therapy approach takes aspects from different therapy types to create a personal therapy to best treat the presenting problem.

Treatment Resistant Modalities

 

If you go through therapy and several medications without significant improvement of your symptoms related to your depression, your provider may suggest treatments reserved for people who don’t respond to traditional approaches. The good news is that most people will respond positively with medication and counseling therapy management. Treatment of depression in people that don’t respond to traditional methods  include:

 

  • Electroconvulsive therapy (ECT)

  • Trans Magnetic Stimulation (TMS)

  • Vagus Nerve Stimulation (VNS)

  • Esketamine Treatments

Depression Resources

  1. Depression Definition and DSM-5 Diagnostic Criteria

  2. Bipolar Disorder News – Pendulum.org

  3. Depression and How Therapy Can Help

  4. Depression Screening

  5. Depression and Bipolar Support Alliance (DBSA)

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