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It’s a more common question than you may think: What to do when depressed? Take heart. You’re not alone. Nearly 15 million Americans are depressed right now.
If you think you might be depressed, see your doctor. He or she can confirm your diagnosis and rule out any other underlying causes, such as a medical illness. The next step is to get help. You can feel better. There are many treatments available to help you.
Specialists Who Treat Depression
While your family doctor is probably your best bet for first identifying your depression, he or she may or may not be up to the task of providing treatment. Here is a rundown of the specialists who can provide you with the care you need:
- Psychiatrist: These physicians (MDs) specialize in the prevention, treatment and diagnosis of mental disorders. Psychiatrists are able to prescribe medications for depression. They also may treat patients with talk therapy or refer patients to psychologists, social workers, or other mental health professionals for talk therapy. They must be licensed to practice in the state in which they work. Psychiatrists also may be certified by the American Board of Psychiatry and Neurology.
- Psychologist: These specialists typically hold a doctorate degree (PhD, PsyD, or EdD) or master’s degree in psychology. Psychologists can diagnose depression using various tests, and they can treat the condition with talk therapy. In most states, they cannot prescribe drugs but often refer patients who need medication to psychiatrists, primary care doctors, or nurse practitioners. Psychologists must be licensed by their state and certified by the American Board of Professional Psychology.
- Psychiatric nurse: Psychiatric nurses are specialized nurses who treat people with depression and other mental health issues. They hold a degree in nursing, are licensed as registered nurses (RN), and have additional training in psychiatry. In some states, psychiatric nurses can prescribe medications, but usually only under a doctor’s supervision.
- Social worker: Social workers hold a master’s degree in social work and are trained in psychotherapy. Most states require them to be licensed or certified. Clinical social workers often work for hospitals or social services agencies. They help ensure that patients get access to the care they need. Like psychologists, social workers work closely with a psychiatrist, primary care doctor, or nurse practitioner if patients need medication along with talk therapy to treat their depression.
- Therapist: “Therapist” is a broad and non-specific term for professionals who provide support to families, groups, or individuals. Therapists may have some form of certification and licensure. Many but not all therapists are social workers, psychologists, or psychiatrists. However, there are therapists (such as certain mental health or addiction counselors) who do not have a master’s, doctorate, or MD degree but have completed shorter, specialized training programs. If you choose to see a therapist, it’s a good idea to ask about his or her training and experience in treating depression.
What To Do When Depressed: Do Medications Help?
Medications that are most often used to treat depression are thought to improve mood by adjusting levels of the brain chemicals (neurotransmitters) that contribute to feelings of depression.
While many different types of drugs are used to treat depression, the most common ones used for this condition are antidepressants. Because the different types of antidepressant drugs have similar effectiveness, which medication your doctor prescribes will largely depend on the side effects and how well you tolerate the drug.
Types of antidepressants include the following:
- Selective serotonin reuptake inhibitors (SSRIs): Among the newer antidepressant classes, SSRIs are widely considered to be the first choice for patients who receive antidepressants. They include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): Another relatively new class of antidepressant that may be just as effective as the SSRIs. Examples include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
- Reuptake inhibitors and receptor blockers: Two drugs in this class are FDA-approved to treat depression: trazodone (Desyrel) and nefazodone (Serzone). Nefazodone is rarely prescribed today because of its association with rare but serious liver problems.
- Other antidepressants: Newer antidepressants that work a little differently from those listed above include bupropion (Wellbutrin), Mirtazapine (Remeron), vilazodone (Viibryd), and vortioxetine (Brintellix).
- Tricyclic antidepressants (TCAs): Among the oldest antidepressants, this class includes imipramine (Tofranil), nortriptyline (Pamelor), desipramine (Norpramin), amitriptyline (Elavil), and clomipramine (Anafranil).
- Monoamine oxidase inhibitors (MAOIs): Also an older class of drugs and generally reserved for very treatment-resistant depression because of their multiple interactions with food and other drugs, MAOIs include tranylcypromine (Parnate), phenelzine (Nardil), isocarboxazid (Marplan), and selegiline (Emsam, which comes in a skin patch formulation).
What to Do When Depressed: Psychotherapy
Another important component of treatment for depression is to talk with a trained professional about the issues that may be causing or worsening your symptoms. It might sound simple, but talking can lift a lot of the emotional weight that you feel. Psychotherapy is available in one-on-one sessions, as part of a group, or in conjunction with your spouse or family.
- Cognitive behavioral therapy (CBT): People with depression are often plagued by negative thoughts. The idea behind CBT is that your thoughts can have a big impact on your mood. This treatment aims to identify and then change your negative perceptions to give you a more positive outlook. CBT starts with identifying the negative thoughts you have about yourself (“I’m a failure”), your environment (“Everyone hates me”) and your future (“I have nothing to look forward to”). Working closely with your therapist, you start to understand how certain negative beliefs have no basis in reality. Then, you reframe those false beliefs and replace them with more positive ones.
- Acceptance and Commitment Therapy (ACT): The primary goal of ACT therapy is to help individuals accept what is out of their personal control and to commit to actions that can improve and enrich their lives. Taking a somewhat different perspective about thoughts and feelings than CBT, ACT adopts the view that trying to change them can be counterproductive. A therapist using an ACT approach often uses mindfulness techniques, which teach recognition and acceptance of thoughts and feelings without judgment and without any attempt to change them. In doing so, negative thoughts and feelings can have less of an influence on one’s actions and wellbeing. Another component of ACT is to learn to focus on values and activities that bring meaning to one’s life.
- Concreteness training (CNT): An intriguing new form of psychotherapy, which uses many of the principles of CBT, is known as concreteness training, or CNT. The therapy involves teaching depressed people, who have a tendency toward negative abstract thinking and overgeneralization of negative thoughts, to think more concretely. For instance, the therapy involves teaching people to be more specific when thinking about individual problems, with the goal of keeping their problems in perspective and working on concrete solutions, rather than just worrying about them.
- Interpersonal therapy (IPT): Interpersonal therapy focuses on identifying the relationship issues that are driving your depression symptoms, particularly unresolved grief, relationship conflicts, transitions to a new role (such as from wife to wife and mother), and difficulty with interpersonal relationships. Then it helps you improve your communication and conflict resolution skills so that you are better equipped to handle issues that arise with your friends and family members.
- Psychodynamic therapy: Psychodynamic therapy is often a longer-term approach to treating depression. This treatment seeks to identify the roots of your depression by focusing on the behaviors and relationships that are making you unhappy and then developing new insights about how they affect you. You may go back as far as your early childhood, recalling events that you might have consciously forgotten but which are unconsciously driving your dark mood. By using techniques such as self-reflection and self-examination, your therapist can bring the painful memories and feelings that are haunting you to light and then try to work through them so you can learn how to live a healthier, happier life.
- Dialectical behavior therapy (DBT): DBT was primarily developed for people who struggle with a particularly severe form of personality disorder called borderline personality disorder, which includes profound feelings of emptiness, unstable interpersonal relationships, self-destructive behaviors, and suicidal tendencies. DBT emphasizes acceptance and change, and was influenced by psychological research and practice as well as by Buddhism.
For tips on dealing with depression, see these University Health News posts:
- “How to Stop Depression: What’s Good for the Body…“
- “8 Serotonin Deficiency Symptoms That You Can Identify Yourself“
- “How to Overcome Depression“
- “How to Fight Depression“
Originally published in April 2016 and updated.