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Psychotherapy and Medications
A variety of antidepressant medications and psychotherapies can be used to treat depressive illnesses. Some people do well with psychotherapy, some with antidepressants. Some do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems. Depending on your diagnosis and severity of symptoms, you may be prescribed medication and/or treated with one of the several forms of psychotherapy that have proven effective for depression. It is important to note that most people can be successfully treated for depression on an outpatient basis. On rare occasions, electroconvulsive therapy (ECT ) is useful, particularly for individuals whose depression is severe or life-threatening or who cannot take antidepressant medication. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. Antidepressant Medications Three groups of antidepressant medications have been used to treat depressive illnesses: tricyclics monoamine oxidase inhibitors (MAOIs), and lithium. Lithium is the treatment of choice for manic-depressive illness and some forms of recurring, major depression. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes the dosage must be increased to be effective. There are now two new classes of antidepressants which are neither tricyclics nor MAOIs, and which generally lack the side effects associated with these two traditional classes of drugs. The first of these is fluoxetine, a serotonin re-uptake inhibitor; the other is bupropion, believed to act on the dopaminergic system. Patients often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. In cases of manic-depressive illness and chronic major depression, medication may have to become part of everyday life to avoid disabling symptoms. Antidepressant drugs are not habit-forming, so you need not be concerned about that. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly. If you're taking MAO inhibitors, you will have to avoid certain foods, such as cheeses, wines, and pickles. Be sure you get a complete list of foods you should not eat from your doctor and always carry it with you. Other forms of antidepressants require no food restrictions. Never mix medications of any kind -- prescribed, over-the-counter, or borrowed -- without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug that you are taking antidepressants. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Some drugs, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Antianxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they should not be taken alone for a depressive illness. Sleeping pills and stimulants, such as amphetamines, are also inappropriate. Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related. Side Effects Antidepressants may cause mild and usually temporary side effects in some people. Typically these are annoying? but not serious. However, unusual side effects or those that interfere with functioning should be reported to your doctor. The most common side effects usually associated with tricyclic antidepressants and ways to deal with them, are:
Psychotherapies There are many forms of psychotherapy used to help depressed individuals, including some short-term (10-20 weeks) therapies. "Talking" therapies help patients gain insight into and resolve their problems through verbal"give and-take" with the therapist. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to their depression. Two of the short-term psychotherapies that research has shown helpful for some forms of depression are Interpersonal and Cognitive/Behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive Behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression. Psychodynamic therapies, sometimes used to treat depression focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood. In general, the severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with psychotherapy for the best outcome. NIMH Publication  
RECOMMENDED READING FROM THE PSYSTORE:   Cognitive Therapy of Depression
by Aaron T. Beck, A. John Rush, Brian F. Shaw (Contributor), Gary Emery (Contributor) Our Price: $27.00 "Aaron T. Beck's "Depression" is regarded as a classic. Its emphasis is on the diagnosis and treatment of depression, including manic depression (bipolar disorder), and other affective (mood) disorders. This book has value to academic libraries, mental health professionals and students, as well as people who are interested in the study of depression and mood disorders." -- Amazon.com User Review For a selection of books on this topic, visit the Psystore.
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