Depression Treatment

If you are depressed, you must seek the treatment you need to lead the fulfilling life you deserve. This page discusses the process of finding a mental health specialist and explains the types of psychotherapy that are available today. If your depression is mild, psychotherapy alone may be enough to help you recover. If your depression is moderate to severe, you may be prescribed with antidepressants, which are also discussed on this page.

While receiving treatment from mental health professionals is an essential part of managing your depression, you can complement your treatment with beneficial lifestyle changes. On this page, you will also learn about the various lifestyle improvements you can make to better manage your depression and enhance your life further.

Finding a Mental Health Specialist

If you suspect you are depressed, you must seek treatment right away. The first step towards treatment is finding a mental health specialist. (1) When searching for the right therapist, it’s a good idea to start with referrals. These referrals can come from trusted family and friends, a primary care doctor, or even mental health organizations. (1)

If cost is an issue, you want to make sure that the therapist you choose accepts your insurance. If you find that the therapist you choose doesn’t accept your insurance, you can ask your insurance provider for a list of therapists who do accept your insurance. (2) If cost is still an issue, you may search for community mental health clinics that offer therapy on a sliding scale for payment. (1)

Your connection with your mental health specialist is very important. You may have to contact more than one therapist before finding one you feel comfortable with. The right therapist will be a caring and supportive partner in your depression treatment and recovery. (1) To ensure you make the right decision, you can interview your potential therapist by phone or in person to learn about the type of therapy he or she practices and discuss your treatment goals. (2) Some good questions to ask are:

What education and training do you have?
How long have you been practicing?
What are your areas of expertise (e.g. children, teens, or adults)?
What experience do you have helping people with my problems or issues?
What are your treatment approaches and have they been effective for people like me?
How long are your sessions?

(2)

Types of Therapy

Psychotherapy / “Talk Therapy”

Psychotherapy, or “talk therapy”, teaches you strategies for dealing with unhealthy thoughts so you can manage your depression symptoms and function at your best. (3) Psychotherapy is an extremely effective treatment for depression because it gives you the skills and insight you need to help prevent depression from coming back. (1) The strategies and skills you learn in psychotherapy are lifelong tools you can use to manage depression and minimize symptoms.

Psychotherapy may be combined with medications, depending on the severity of your depression. (3) If your therapist thinks you will benefit from medication, he or she may prescribe you with antidepressants. If you are prescribed with antidepressants, please know that you have absolutely nothing to be ashamed of. Taking medication for depression is like taking medication for any other illness (e.g. diabetes, high blood pressure, arthritis, etc.). If you have any concerns or questions about your medication, you may discuss them with your therapist.

There is no “one-size-fits-all” approach to psychotherapy. The type of psychotherapy you receive depends on your needs. (3) Be sure to communicate with your therapist about what aspects of your therapy do or do not work. Your therapist may be able to make adjustments to your treatment or refer you to another therapist whose treatment would benefit you more.

The most common depression treatment methods include:

Cognitive Behavioral Therapy
Interpersonal Therapy
Psychodynamic Therapy
Dialectical Therapy

Often, a blended approach is used. (1)

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is based on the idea that thoughts trigger feelings. (4) During CBT, a therapist helps to identify the thoughts you have that trigger depressed feelings. (2) Figure 1 shows an example of a successful man who thinks he’s a failure despite his success. The thought that triggers his depressed feelings is “I am a failure.” A therapist helps identify these distorted and unhelpful thinking patterns. (3)

Figure 1. Thoughts Trigger Feelings

Once your therapist is aware of your thoughts, he or she can help you replace your negative attitudes with positive attitudes. (5) During CBT, your therapist works with you to reveal more accurate information to counter your negative thoughts with a more realistic picture of your present and future. (2) Unlike the grim picture you paint when you’re depressed, CBT helps you see a more realistic and hopeful picture. CBT helps you restructure your negative thought patterns so you can see your life in a more positive and realistic way. (3)

During CBT, your therapist will work with you to improve your problem-solving and coping skills. (2) On the “What is Depression?” page, you learned that depression causes you to see many challenges and the thought of overcoming those challenges is overwhelming. For this reason, the problem-solving and coping skills you develop from CBT are a very important part of your recovery.

CBT also helps you change behaviors that may be making your depression worse. (3) For instance, on the “What is Depression?” page you learned that depression causes you to lose interest in activities and hobbies you once enjoyed. As a result, you begin to avoid these activities, which leads you to feel even more depressed. Your therapist will work with you to break this cycle, promoting a gradual increase in your participation in pleasurable activities. (2) Once again, you will enjoy participating in the activities you loved before you became depressed.

Your therapist may assign daily or weekly exercises to help you apply your new skills in the real world. (5) It’s important to apply the skills you develop in therapy throughout your daily life to ward off depression. If you follow through on the exercises, you are likely to see significant improvement. (5)

People with less severe cases of depression can improve significantly with CBT alone. For those with moderate to severe depression, the best results are achieved when CBT and medication are used in combination. (2) Of course, everyone is unique. Your therapist will discuss your treatment options with you. If you have any questions or concerns about taking medication, you can discuss them with their therapist.

Interpersonal Therapy

Interpersonal Therapy was developed to address the interpersonal issues that seem most important to the start or continuation of a person’s depressive symptoms. (2) On the “Causes of Depression” page, you learned that conflicts with family, friends, and coworkers can contribute to a person’s depression. IPT addresses these conflicts within a patient’s relationships and looks at how he or she relates to people—including family, friends, coworkers, and even strangers. (5)

On the “Causes of Depression” page, you also learned that life changes and the loss of a loved one can contribute to a person’s depression. IPT addresses these situations as well. Issues worked through during IPT sessions include unresolved grief over the loss of a relationship or life changes and transitions that affect relationships. (2)

Through IPT, a therapist effectively treats your depression by helping you to:

Improve communication patterns and ways of dealing with others.
Change behavior that can cause conflict.
Identify triggers of troubling emotions.
Express appropriate emotions in a healthy way.

(3)

By improving the ways you communicate, behave, and express emotions in your interpersonal relationships, you minimize the conflict in your life. By identifying triggers of troubling emotions, you can learn to avoid those triggers. As a result, you’re less likely to have depressive symptoms.

IPT can be used in combination with medication, which is especially helpful for people who have experienced multiple episodes of depression. (2) Again, your therapist will discuss your options with you. Don’t hesitate to ask any questions or raise any concerns you have regarding medication.

Psychodynamic Therapy

During Psychodynamic Therapy, your therapist has you engage in a significant amount of self-examination and reflection on the past. (5) This helps you learn how your past influences the way you think and act. You gain greater self-awareness and understanding about your own actions. (3) You will learn what has motivated you to think and act the way you do.

Your therapist will also help you identify troublesome relationship patterns in your life and understand where they come from. (5) For example, if you have always let people take advantage of you, manipulate you, or verbally abuse you, your therapist will help you understand why you allow others to treat you in such a way. Hopefully, your understanding will help you realize you deserve to be treated better.

When you learn about your influences and motivations, you are less likely to criticize or judge yourself too harshly as some people tend to do. The therapy helps to remove guilt or self-blame so you can move forward with your life. (5) You will be able to leave the past behind, live in the present, and look forward to the future.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavior Therapy is treatment for individuals with severe depression and associated suicidal thoughts. (6) This type of therapy combines Cognitive Behavioral Therapy with two other techniques:

Dialectics – engaging in discussion or dialog to explore and resolve issues
Mindfulness – becoming more aware of and present in the moment

(2)

Patients participating in DBT take part in both individual and group sessions:

Individual sessions. During these sessions, the patient and therapist discuss issues from the previous week with the goal of improving specific life skills. Issues discussed are prioritized as follows:

1. Self-injurious behaviors

2. Behaviors that interfere with therapy

3. Quality of life issues

4. Life improvement goals

Group sessions. During these sessions, several DBT patients meet to practice different life skills in a safe, controlled environment. These skills include recognizing and controlling emotions, tolerating distress, or staying mindful.

(2)

Group Therapy

Group Therapy is another option for those seeking treatment for depression. Group therapy sessions, which last about an hour or two each week, involve one or more psychologists who lead a group of between five and 15 patients. (7) Participants immediately see they aren’t alone with their struggles.

Listening to peers going through the same struggles can validate your experiences and help build self-esteem. (1) It is comforting for participants to know there are people out there who understand what they are experiencing. You may get tips from someone going through similar challenges or someone who has already overcome those challenges. (1) Learning from others can help you to better manage or overcome your own struggles. In addition, the psychologist(s) leading the group can teach you proven strategies for managing certain problems. (7) It always helps to have a professional opinion too.

To find groups that would be a good fit, you can ask your physician and your individual psychologist. You can also call local hospitals and medical centers, which often sponsor support groups. (7) There are always people willing to help and provide support.

Antidepressant Medication

While therapy alone may be sufficient for people with mild depression, other people may need to combine antidepressants with therapy. In cases of moderate and severe depression, medications are often essential and even life-saving. (2) Depending on state laws, primary care physicians or psychologists may be able to prescribe antidepressants. However, it is highly recommended that you see a psychiatrist because he or she is more familiar with the various types of antidepressants, the latest research on antidepressants, and any safety concerns associated with antidepressants. (8)

After an initial consultation, the doctor prescribes what he or she believes is the best antidepressant for you. The doctor will schedule regular follow-up visits with you so your progress can be assessed. These follow-up visits are very important because they enable the doctor to remain aware of your mental health. You should also be able to contact your doctor between appointments if necessary.

When taking antidepressants, please keep the following recommendations in mind:

Follow instructions. Don’t skip or alter your dosage. Don’t stop taking the medication until advised by your doctor. Stopping medication early could cause a relapse and/or serious withdrawal symptoms.
Beware of mixing medications. It can be dangerous to take antidepressants with painkillers and/or antihistamines (found in many over-the- counter cold and allergy medicines and sleep aids). Always talk to your doctor or pharmacist before combining medications.
Advise the doctor of physical and emotional changes. If your depression worsens or suicidal thoughts occur, contact your doctor or therapist immediately. See your doctor regularly to discuss progress.
Be patient and don’t give up. You may have to try more than one medication to find what is best for you. It can take up to four to six weeks for antidepressants to reach full effect. Again, make sure your doctor is aware of your progress so changes can be made if and when necessary.

(8)

If you take medication for depression, you shouldn’t ignore other treatments. The various types of therapy discussed on this page in addition to lifestyle changes can help to speed recovery from depression and provide skills to help prevent a recurrence. (1)

Lifestyle Changes

Sleep

Getting adequate sleep each night is an important part of your recovery from depression. (9) If you’re not getting adequate sleep, you’re more likely to be irritable, moody, sad, and of course, tired. (10) Notice that the effects of lack of sleep are similar to some of the symptoms of depression you learned about on the “What is Depression?” page. If you have trouble falling asleep, try listening to some relaxing music, reading a book, or having a warm bath before bed.

Exercise

Exercise releases chemicals in your body that alleviate symptoms of depression. In fact, the effects of regular exercise are similar to the effects of antidepressants for two reasons:

Exercise boosts serotonin and triggers the growth of new brain cells and connections, just like antidepressants do. (10)
When you exercise, your body releases norepinephrine and endorphins, chemicals that trigger positive feelings in the body. (11)

If you recall from the “Causes of Depression” page, serotonin and norepinephrine are neurotransmitters that must be present at adequate levels for you to think in healthy ways. If you are deficient in these chemicals, exercise can raise their levels and improve your mood. The endorphins released from exercise improve your mood.

Reduce Stress

It’s important to find ways to minimize the amount of stress in your life as much as possible. Too much stress exacerbates depression and increases the likelihood that you will become depressed again. (10) Some methods you can use to reduce stress in your life are:

Get enough sleep. Sleep is the most important natural stress reducer.
Exercise. Physical activity reduces the impact of stress.
Pace yourself. Take regular breaks throughout your day. It’s important for you to take time to revitalize and refresh. Go for a walk. Have your partner or children help out with household duties. Delegate tasks at work when possible.
Set realistic expectations for yourself and others. If you set expectations that are too high for yourself and others, you set yourself up for disappointment and aggravation. Do not over-commit yourself. It’s okay to say “no” if you feel overwhelmed. Remember, we’re all human.
Practice positive self-talk. Never demean yourself. Rather than putting yourself down, think about your great qualities. If there are things you don’t like about yourself, work on changing or improving them and realize you’re a work in progress. Your masterpiece is yet to be created.
Practice positive thinking. Remaining positive is not easy, especially if you’re depressed. However, the more you practice positivity, the easier it will become. We all have disappointments but there are always lessons to be learned. Sometimes things don’t turn out as we plan, but life can steer us towards better plans than we imagined. Remember, life can bring nice surprises when you least expect them.

(9) & (12)

Social Support

Although depression tends to make you want to withdraw and cut yourself off from the world, you have to fight the urge to isolate yourself. Social isolation typically worsens depression. (11) The more isolated you become, the more depressed you will get and the harder it will be for you to come out of your shell. You have to break the cycle.

Do not shut out the supportive people in your life, especially since support systems have proven beneficial for maintaining mental health and protecting against depression. (9) The keyword here is “support”. The best source of support for you comes from caring, sympathetic, and non-judgmental people who can challenge your negative thinking and offer you the support and encouragement you need. (9)

Now that you know how important it is to build and maintain relationships with supportive people, you can start by reaching out to the supportive family members and good friends you have. If you don’t have supportive people in your life right now, don’t be discouraged and don’t give up on meeting people that can offer you the support you need. Here are some options to consider:

Find groups of supportive people who have struggles similar to your own.
Find groups that share your interests. Meetup.com is a great website where you can search for local groups that share your interests.
Check the recreation centers of your town or nearby towns to see if they have activities or teams you’d like to join.
Volunteer. Volunteering is a wonderful way to get social support and help others while also helping yourself. (10)
Find groups that share your interests on social networking sites. While socializing online is an option, don’t forget to balance online communication with face-to-face connections. (9)

Nutrition

Symptoms of depression can be influenced by your dietary habits. You should limit or avoid consuming the following foods and beverages because of the negative impacts they have on your nervous system and your brain.

Processed foods
Sodium-rich foods
Alcohol
Caffeine
Hydrogenated oils
Artificial sweeteners
Refined sugars

(11)

To help prevent or alleviate your symptoms of depression, your diet should include nutrients that are essential for a healthy mind and body. Scientists have linked deficiencies in the following nutrients to symptoms of depression.

Amino acids
Iodine
Iron
Calcium
Magnesium
Omega-3 fatty acids
Selenium
Vitamin B complex
Folic Acid
Folate
Vitamin D
Zinc

(9) & (11)

If you have difficulty including adequate amounts of nutrients in your diet, you may benefit from dietary supplements. However, you must remember that they too can have side effects and drug or food interactions. (10) It is important to discuss any dietary supplements with your doctor before you begin taking them. Your doctor can advise you about the major benefits and risks of dietary supplements or connect you with the right information so you can make a safe treatment decision. (13)

Relaxation Techniques

While some people are simply not interested in meditation or yoga, these two relaxation techniques have proven to be beneficial for depression sufferers. In addition to helping to relieve symptoms of depression, relaxation techniques may also reduce stress and boost feelings of joy and well-being. (10)

Mindfulness Meditation

Mindfulness meditation is a form of meditation that is becoming increasingly popular. In order to understand how mindfulness meditation helps those with depression, it is important to first understand what mindfulness meditation is. This relaxation technique consists of:

Focusing on the present moment. Focusing on your breathing or some other sensation or an object in your surroundings.
Observing without judgment. Observing your own thoughts and experiences as they occur without judgment. For instance, acknowledging the source of your stress without attaching too much meaning to it or dwelling on it.
Letting your thoughts fade away. Acknowledging and naming your thoughts and feelings but then letting them fade away. In other words, allowing your thoughts and feelings to flow over you.

(9)

When you practice mindfulness meditation, you don’t focus on the flow of negative thoughts that tend to enter your mind when you are depressed. The thoughts may come but instead of dwelling on them and allowing them to drag you down to the depths of despair, you let the thoughts float away like a balloon that a child sets free into the sky.

Mindfulness meditation has been found to be so beneficial that it is incorporated into a new kind of therapy called Mindfulness-Based Cognitive Therapy (MBCT), which combines cognitive behavioral therapy with mindfulness meditation to help people who suffer repeated bouts of depression. (14) It is likely that MBCT will become increasingly popular but in the meantime, you can practice mindfulness meditation on your own to capture some of its benefits.

Yoga

Yoga is a form of exercise that can be an especially helpful part of your depression treatment plan because it combines meditation and adds in a physical component, both of which are very helpful in combating depression. (15) In addition, studies have shown that practicing yoga reduces stress and depression and improves energy, sleep quality, and well-being. (4) Just by practicing yoga, you implement four lifestyle changes that strengthen you in your battle against depression: exercise, meditation, stress reduction, and improved sleep! While yoga may be difficult, the benefits you experience may outweigh the difficulty.

Summary

If you are depressed, you must seek treatment right away. The faster you obtain treatment, the sooner you will recover and enjoy life again. This page covered how to find a mental health specialist and provided information about the various types of psychotherapies that are available. In some cases of depression, psychotherapy may be enough to help patients recover but in other cases, antidepressants may be combined with psychotherapy. You must always be honest with your therapist about any physical and emotional changes you experience so your therapist can provide you with the best treatment possible. Don’t give up! It takes time and patience to find the optimal treatment but if you stick with it, your life will improve dramatically!

You can complement the treatment you receive from mental health professionals with beneficial lifestyle changes to speed your recovery from depression and prevent recurrence. Some great methods you can use to reduce stress and minimize your depressive symptoms are to get adequate sleep each night, exercise regularly and/or practice meditation and/or yoga. In addition, you can limit or avoid foods and beverages that negatively impact your mental health and try to increase your intake of nutrients that are beneficial for you. While you are busy implementing these lifestyle changes, don’t forget to maintain contact with the supportive people in your life because they can help you overcome your depression.