What is the Best Treatment Option for Depression?

The best treatment option for depression must be tailored to the unique needs of the individual.  There are many kinds of depression and while treatment usually consists of medication, psychotherapy, or both, it’s important to understand a little bit about depression as a disorder. 

Consider these common forms of depression:

• Major depressive disorder (MDD).
• Persistent depressive disorder (PDD)
• Bipolar disorder
• Situational depression
• Seasonal affective disorder (SAD)
• Premenstrual dysphoric disorder
• Perinatal Depression (postpartum depression)
• Atypical depression

The Biological Aspects of Depression

Depression can be the result of a person’s genetic history, their early childhood experiences, general health, social and economic factors, as well as their biology. Depression can follow a traumatic life event, such as the death of a loved one, or it may arise seemingly out of nowhere. 

However, in many circumstances, there is commonality among the kinds of depression a person might experience based on the level of a person’s biology. The exact causes of depression are not completely known, but researchers believe that in some cases, depression results from changes in the way brain cells communicate with each other.

Our thoughts, emotions, and behaviors are formed from living circuits of brain tissue. Within these, the nerves rely on complex chemicals called neurotransmitters to signal each other. Correct signaling depends on just the right level of neurotransmitters. If something goes wrong with these levels of neurotransmitters, depression and other psychological issues are the result. Researchers also believe there are other factors influencing a person’s chances of developing depression, like hormones and a person’s genetic inheritance.

For most people who suffer from moderate to severe depression, antidepressant medications are effective at relieving the severity of depression symptoms, which is why they’re a good first-line treatment for depression.

Medical Approaches to Depression

A mental healthcare professional, such as a psychiatrist, can help evaluate whether you need medication, therapy, or both. Typically, the first-line treatment of moderate to severe depression includes a combination of psychotherapy and medication. Mild depression may sometimes be treated with monotherapy—medication or therapy alone.

Antidepressant Therapy

There are 60 known neurotransmitters, so finding the right antidepressant for a person’s depression may not happen on the first try. Antidepressant medications work by causing specific neurotransmitters to stay available to brain tissue longer, giving them more time to work.

This action is effective in treating depression, as people with depression or anxiety tend to eliminate neurotransmitters too rapidly from the brain tissues that need them. 

Most antidepressants developed in the past 25 years work to increase levels of serotonin, norepinephrine, or both. 

The following are two of the major types of antidepressant medications- 

Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are the most common first-line medications prescribed for major depression. SSRIs work by causing serotonin, a vital neurotransmitter, to stay in brain tissue longer than it otherwise would. This allows more serotonin to be available to nerves. Examples of SSRIs include:

• • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)

Selective Norepinephrine Reuptake Inhibitors (SNRIs). SNRIs operate primarily on the neurotransmitter norepinephrine, but they also affect serotonin. Examples of SNRIs include:

• • Venlafaxine (Effexor XR)
  • Levomilnacipran (Fetzima)
  • Desvenlafaxine (Pristiq)

Tricyclic antidepressants. These medications are an older type of antidepressant and work similarly to SSRIs and SNRIs, but tend to have more serious side effects. Examples of tricyclic antidepressants include:

• • Amitriptyline (Pamelor)
  • Imipramine (Tofranil)
  • Desipramine (Norpramin)

Atypical antidepressants. As the name suggests, these antidepressants work by other means that aren’t as clearly defined as those above. Popular medications of this class include: 

• • Bupropion (Wellbutrin) 
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)

Talking Therapy

Talking Therapy, sometimes called psychotherapy or counseling, involves meeting with a mental healthcare professional on a schedule to learn how to eliminate, reduce or control the symptoms of depression. This form of treatment is a great way to learn how to build more satisfying relationships, manage stress, and deal effectively with issues such as anxiety.

Most modern talking therapies take anywhere from 10 to 30 visits over the course of several months. Unlike older forms of therapy, such as psychoanalysis, modern therapy is focused on clear outcomes and is goal oriented toward problem-solving.

Therapy cannot “talk” someone out of purely biological depression, but for those people who lack a biological component to their depression, talking therapy is the best treatment option for depression.

Therapy can help a person:

• Pinpoint the issues that drive one’s depression and make necessary changes
• Identify and change habitual harmful thoughts, behaviors, and beliefs
• Adjust and adapt to a crisis
• Learn better ways of coping with stress
• Learn skills for defusing anger
• Learn to manage anxiety
• Develop better ways of relating to other people
• Gain control over their lives and improve their levels of satisfaction and happiness

Transcranial Magnetic Stimulation (TMS) for Depression

About one-third of all people with severe depression don’t receive relief from antidepressants alone, which makes therapy more challenging. Furthermore, depression may sometimes return, even after long periods of remission.

Fortunately, there’s a newer treatment for depression that provides long-lasting relief. Transcranial Magnetic Stimulation (TMS), is an FDA-approved, highly effective treatment for people with Major Depression Disorder, including medication-resistant depression and recurrent depression. TMS is also FDA-approved for the treatment of depression related obsessive-compulsive disorder (OCD).

TMS uses targeted magnetic fields to gently stimulate areas of the brain that are responsible for one’s mood. Multiple studies have shown that TMS gives relief from depression and other mental health conditions.

Other studies have demonstrated that TMS increases the effectiveness of antidepressant therapy and reduces the time it takes for them to deliver their maximum benefits. Timely relief is crucial, yet antidepressants alone can take four to six weeks before a person receives their maximum benefit. Studies have shown that TMS reduces this lag.

TMS has many advantages over traditional treatments:

• TMS works faster than any other treatment option
• TMS has superior results to the best traditional treatments
• TMS is safe and has no systemic side effects
• TMS requires no hospitalization
• TMS is convenient, with sessions lasting from 30 minutes to an hour
• TMS is FDA-approved for treating depression and other psychological issues

Other TMS facilities only provide TMS, but at NeuroSpa TMS®, we offer TMS Plus™, a unique and comprehensive suite of services that address every aspect of recovery from psychological disorders, including:

Cognitive Behavioral Therapy (CBT). CBT helps people understand how deeply established habitual patterns of thinking and responding to stress, depression and anxiety may be holding them back from the satisfying life they deserve.

Nutrition Counseling. Making healthy diet choices during TMS treatment is highly beneficial, as TMS therapy supports the brain as it builds healthier connections. Our nutrition counseling is provided by a registered dietitian who can help patients make lasting changes to their diet.

Blood Work. Our physicians determine if bloodwork is necessary to rule out issues like thyroid disorder or vitamin deficiency that are contributing to a patient’s depression.

Sleep Evaluation. As part of our comprehensive approach to mental healthcare, our physicians will determine if sleep apnea or insomnia are affecting a patient’s mental health.

Functional MRI Targeting. Functional MRI targeting allows our physicians to make any adjustments needed to the usual treatment areas to make sure patients get the best treatment possible.

NeuroSpa TMS® is pleased to be among the leading providers of TMS therapy in the country with the offering of TMS Plus™ and will continue to push the boundaries in order to make sure that all patients are provided with the safest most effective therapy possible. A better quality of life awaits you at NeuroSpa TMS®.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

American Psychological Association. (2017, July). What is Cognitive Behavioral Therapy? Clinical Practice Guideline for the treatment of Post-Traumatic Stress Disorder. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral. 

Brody, D. J., Pratt, L. A., & Hughes, J. P. (n.d.). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db303.htm. 

Clinical Practice Review for Major Depressive Disorder. Clinical Practice Review for Major Depressive Disorder | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/resources-professionals/practice-guidelines-mdd 

Mayo Foundation for Medical Education and Research. (2019, October 5). Serotonin and norepinephrine reuptake inhibitors (SNRIs). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970. 

Rupke, S., Blecke, D., & Renfrow, M. (2006, January 1). Cognitive Therapy for Depression. American Family Physician. https://www.aafp.org/afp/2006/0101/p83.html. 

Sukel, K. (2019, September 19). Neurotransmitters. Dana Foundation. https://dana.org/article/neurotransmitters/. Retrieved July 20th, 2021.

Swedish Council on Health Technology Assessment. (2004, March). Treatment of Depression: A Systematic Review [Internet]. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/28876724/. Retrieved July 20th, 2021

Symptoms of Depression Among Adults: United States, 2019, M. A., & Terlizzi, E. P. (2020, September 23). Symptoms of Depression Among Adults: United States, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db379.htm. 

Syvälahti, E. K. (1994, February). Biological aspects of depression. Acta psychiatrica Scandinavica. Supplementum. https://pubmed.ncbi.nlm.nih.gov/7914394/. 

Thase, M. E., Jindal, R., & Howland, R. H. (2002). Biological aspects of depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression (pp. 192–218). The Guilford Press.