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Anxiety and Stress Disorders

What is the Treatment for Depression?

01/16/2001

Question:

My daughter`s boyfriend has moved into his college dorm and she only sees him a fraction of the time she used to. She is very stressed and depressed over this. Could medication help this?

Answer:

Large life changes can often trigger feelings of depression and hopelessness, particularly when they involve a large loss or change.

If these feelings are interfering with her ability to accomplish things she wants or needs to do (such as doing well in school, maintaining friendships and other social committments, eating and sleeping appropriately), and they have lasted for 2 weeks or more, most of the day, nearly every day, you may consider seeking help.

As with anxiety disorders, the treatments available for depression consist mainly of psychological treatments (psychotherapy) or physical treatments (medication).

Psychotherapy can actually consist of cognitive treatment (working with your thoughts), behavioral treatment (increasing positive behaviors and helping mental health by working on specific behaviors and coping skills), a combination of cognitive and behavioral (CBT), psychodynamic (focusing on internal conflicts and the unconscious), and a variety of other techniques.

There are several types of therapy with adolescents and young adults that are "empirically supported," which means that they have been found to be effective when compared to other types of psychotherapy and against a placebo.

These are almost all cognitive-behavioral programs, and include: Interpersonal Psychotherapy for Adolescents (based on work by Drs. Klerman and Weissman)--focused on the way in which our relationships with others can impact our emotional health, and steps we can take to have more control (and more positive feelings) in our interactions with others.

Coping with Depression (based on work by Dr. Lewinsohn)--this combines focusing on thoughts as well as behaviors, with emphasis on building coping skills and improving our interpersonal relationships with others. Includes activities such as increasing the amount of time spent with family and in enjoyable activities, as well as problem-solving skills.

Cognitive therapy (based on the work of Dr. Beck)--focuses largely on the ways in which our thoughts impact our mood, and teaches strategies for both identifying thoughts that trigger or maintain depressed moods and for overcoming these thoughts. These are just some examples of therapies available, and for which there is scientific support.

These therapy programs typically take 10-20 weeks, and are relatively short term in focus, although evidence gathered by the National Institute of Mental Health shows that they also help prevent against future depressive episodes.

Medication options are also quite numerous, although the available medical evidence suggests some commonly used medications may be less effective in children and adolescents than they are in adults (Werry & Aman, 1999).

The most commonly used medications for depression include the selective serotonin reuptake inhibitors (SSRIs; e.g., Prozac, Paxil, Zoloft), tricyclic antidepressants, and monoamine oxidase inhibitors. SSRIs are typically the first line of medical treatment, as they have fewer side effects and are relatively safe in overdose, compared to other available medical treatments.

These can only be prescribed by a medical health professional, preferably a psychiatrist or a general practitioner who is familiar with psychoactive medications. Medication choices always depend upon the individual`s symptoms, health history, other medications, and risk for suicide.

Also note, that many of these medications take 6-8 weeks before relieving symptoms, and medication must be taken consistently, typically for up to 1 year after resolution of symptoms. Abruptly starting or stopping medication can worsen symptoms and make later treatment more difficult.

Deciding which treatment option is best (medication, psychotherapy or both) is an individual choice, as there are pros and cons to each. Medications are quite effective, but are only effective as long as an individual takes them, and many individuals experience later depression upon discontinuation.

Psychotherapy may be more expensive in the short-term, particularly if you do not have insurance, but is as effective as medication in the short-term and even more so in the long-term.

Other things to consider include: how specific the symptoms are (if your daughter is currently only depressed about her relationship, psychotherapy may be a better option, as it can address her specific problem and give her techniques to deal with her feelings; if her depression is more global/severe medications may be a better choice).

Insurance/cost issues, and your own/your daughter`s comfort with the different treatment options are also important considerations--if you don`t believe you will be helped by an intervention, then you most likely won`t be!

There are also some wonderful books available for adolescents with depression.

You might consider looking for:
When Nothing Matters Anymore by Bev Cobain--written for teens experiencing depression.

Depression is the Pits, but I`m Getting Better by E. Jane Garland--written for teens experiencing depression.

It`s Nobody`s Fault by Harold Koplewicz (this is mainly for parents and addresses issues pertinent to younger children, but provides an excellent review of depression symptoms and current treatments)

Learned Optimism by M.E.P. Seligman--this is more of a self-help book, but is well written and has many examples relevant to both adolescents and adults; this gives a good overview of cognitive-behavioral types of therapy If you are interested in a treatment referral in your area, please contact us for further information.

For more information:

Go to the Anxiety and Stress Disorders health topic, where you can:

Response by:

Norman B Schmidt, PhD
Associate Professor
College of Social and Behavioral Sciences
The Ohio State University

Kathleen Kara Fitzpatrick, MA
Clinic Staff
College of Social and Behavioral Sciences
The Ohio State University