Understanding Depression Treatment

You may wonder, “what comes next” after a diagnosis of depression. Fortunately, there are many high-quality treatments available for depression! The experience of depression is very difficult, but therapy with a trained professional can help you reduce your symptoms and suffering, reconnect with the people and activities you miss, and develop skills for keeping mentally healthy. Many people who access an empirically supported treatment for depression go on to recover and return to their normal lives.

What does “empirically supported treatment” mean?

An empirically supported treatment – also called evidence based treatment – refers to a treatment that has been tested in several rigorous research studies conducted by scientists and medical professionals. Clinical research studies might include:

– Initial work looking at whether a new course of treatment helps a small group of people.

– Larger studies looking at how the treatment compares to other treatments, or to no treatment, with a more diverse group of people.

– The gold standard, Randomized Controlled Trials, where a large group of people are randomly assigned to receive the new treatment or not. Random assignment means that other factors, such as personality or how long ago the trauma was, should be spread out between the two groups. If the people who receive the treatment become healthier than the people who don’t receive the treatment, we can be confident that the new treatment is the reason why they improved.

All of the treatments described in the following section are empirically supported treatments, which means they have been tested in several large research studies with many different types of people, from young adults to the elderly, married and single, and men and women. The below treatments work well across all these different groups.

The American Psychological Association (United States) and the National Institute for Health and Clinical Excellence (NICE; United Kingdom) released guidelines for treating depression based on all the available research so far. Here are the treatments that are currently strongly recommended as the best options.

Cognitive Therapy, or Cognitive Behavioral Therapy (CBT): Cognitive behavioral therapy (CBT) are a group of therapies focused on the relationships between the ways we think, feel, and act. Accordingly, CBT for depression focuses on helping patients understand how certain thoughts and actions affect emotions, like intense sadness or depression. Patients with depression may have thoughts that they are not loved or wanted, or that they are worthless. In terms of behaviors, patients with depression may withdraw from the world around them, or neglect important tasks like their health and hygiene. Patients may also stop doing pleasurable or enjoyable activities. The goal of CBT is to help patients change thoughts and behaviors in ways that will help reduce depression. CBT often happens in a therapist’s office, but patients are often expected to do between-session “homework” to bring about lasting change. The treatment typically consists of 12 to 20 face-to-face sessions, wherein a depressed patient meets on a weekly basis with a qualified cognitive-behavioral therapist. However, this form of treatment can also be done successfully via remote technology (online; mobile apps), with little involvement from a therapist.

Interpersonal Psychotherapy (IPT): Interpersonal psychotherapy is a type of treatment for depression that helps patients understand how relationships in their lives affect their mood and behaviors. With the help of a qualified psychotherapist, patients begin to evaluate their relationship patterns and their capacity for intimacy. Further, patients may learn how recent interpersonal changes (e.g., being let go at work; losing a loved one) are impacting their mood, and ways to successfully cope with these changes. The treatment typically consists of 12 to 20 face-to-face sessions, wherein the patient meets with the therapist on a weekly basis.

Anti-Depressant Medications (ADMs): Certain medicines, called anti-depressant medications (ADMs), have research evidence indicating they reduce symptoms of depression. There are several different anti-depressant medications including Prozac, Zoloft, Paxil, Celexa, Cymbalta, and Effexor. Anti-depressant medications may work by changing the chemicals in the brain that affect emotions, like intense sadness or depression. The goals of ADMs are to relief symptoms of depression and improve patients’ quality of life. ADMs are often prescribed by a family physician or psychiatrist and can be obtained from a pharmacy. Pharmacists may provide patients with education on how the anti-depressant medications work, as well as on common side effects. Depressed patients are typically prescribed anti-depressant medications for 16 weeks, but the majority of patients stay on these treatments for longer. The dosage may be small in the beginning of treatment but is gradually increased each week to a maximum daily dose. The physician or psychiatrist may then decrease the dosage if patients had difficulty with side effects. Common side effects included feeling tired and experiencing reduced sexual functioning, problems sleeping, sweating, and headaches.

In addition to the above treatments, the American Psychological Association, the National Institute for Health and Clinical Excellence, and other organizations suggest the following therapies are promising, and researchers are currently exploring how well they work in different settings with different populations: Behavior Therapy, Supportive or client-centered psychotherapy, and Short-Term Psychodynamic Psychotherapy.

References and further reading