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First Steps for Treating Depression

by Wellness Letter  

If you are experiencing depression, speak with your primary health care provider, who can check to see if an underlying medical condition or medication is causing depressive symptoms. If depression is the main diagnosis, your health care provider can refer you to and coordinate care with a mental health professional.

In addition, professional associations (such as the American Psychological Asso­ciation), employee assistance programs, and the website are resources for finding a mental health professional.

Finding the right therapy

Treating depression often requires persis­tence. It may take a few tries to find the right type of therapy, which depends on the severity and frequency of your depression, overall health, and preferences.

In treating depression, health care pro­viders have three goals. The first is to relieve the symptoms of depression, the second is to restore the person’s ability to function socially and in the workplace, and the final goal is to reduce the likelihood of a recurrence.

When a person seeks treatment for a mood disorder, the first step is a complete evaluation, which includes a detailed psy­chiatric and medical history, as well as a mental status examination. Treatment can vary considerably, depending on the under­lying cause(s) of depression and on physical and mental factors as well as on the type and severity of the depression.

Trying psychotherapy

Like antidepressant medications, psychotherapy—sometimes called “talk therapy”—can relieve depression. For some, psychotherapy can be an effective alternative to drugs, with no physiological side effects; for other people, psychotherapy works well in combination with medications.

While psychotherapy usually requires more time than antidepressants, its positive effects may last longer than those from medication after cessation of treatment. Psychotherapy alone is often recommended as an initial treatment for some people with depression. For major depressive disorder, its effectiveness is similar to that of antide­pressants.

There are many approaches to treat­ment. Some focus on interpersonal experi­ence, present and past; some address trauma, loss, or destructive behaviors.

Cognitive behavioral therapy (CBT) is one of the best-studied forms of psycho­therapy for depression. In CBT, a therapist helps you learn to override negative think­ing patterns and behaviors so you can deal with challenges in a more positive way. A course of therapy typically lasts two to four months.

Combining treatments

Combination therapy (medication plus psychotherapy) has been shown in some studies to be more effective than either treatment alone. This option may be ben­eficial if single-therapy treatment pro­duces only partial results, if depression is chronic, or if the person is facing multiple challenges that are best treated by different means, such as medication for depressive symptoms and psychotherapy for job-related problems. Recent research suggests that combination therapy may prevent or delay recurrences.

Moreover, if you are really incapacitated, combining psychotherapy with antidepres­sants can improve the effectiveness of the psychotherapy. That’s because antidepres­sants can improve functioning, including your ability to participate actively in therapy.

The role of sleep

If you’re beginning treatment for depres­sion, it’s critical to also find ways to get a good night’s sleep. Try to get on a regular sleep schedule, waking up and going to bed at the same time every day—including weekends—as much as possible.

Sleep problems can be both a cause and an effect of depression. One of the best treat­ment options for frequent insomnia—just as for depression—is cognitive behavioral ther­apy; this therapy can help change thoughts and behaviors that interfere with good sleep. You can try our self-help measures for better sleep also.

Many popular sleep medications have depressive effects. While occasional short-term use can help with insomnia, long-term use can add to the problem of depression.

During the daytime, it’s important to maintain social contact and activities while being treated for depression. Friends and family can help support you and reduce social isolation and depression. You may have to make an extra effort to keep up social contacts, as depression can sap your motivation.

This article first appeared in the UC Berkeley Wellness Letter.