In any given year, more than 10 percent of American adults have at least one episode of major depressive disorder (MDD), but fewer than 60 percent of them receive appropriate treatment. According to the Diagnostic and Statistical Manual of Mental Disorders, people have a major depressive episode if they experience items 1 or 2 in the list of symptoms below, plus at least four of the others, almost daily for at least two weeks, and these symptoms impair social, occupational, or other types of functioning:
1. Depressed mood with feelings of sadness, emptiness, and hopelessness (in children, irritability can be the main feature).
2. Apathy-loss of interest and pleasure in activities formerly enjoyed.
3. Sleep problems, such as insomnia or oversleeping.
4. Fatigue or decreased energy.
5. Noticeable changes in appetite and significant weight gain or loss when not dieting.
6. Inability to concentrate or think, or indecisiveness.
7. Physical symptoms of restlessness or being physically slowed down.
8. Feelings of guilt, worthlessness, and helplessness.
9. Recurrent thoughts of death or suicide, or a suicide attempt.
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 MentalHealth.gov 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.
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.
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, includingyour ability to participate actively in therapy.