Maintenance Medications for Depression

Reviewed by W. Smith, MD, November 2005

Antidepressants are some of the best treatments we have for depression. But these drugs don't cure depression in the way that antibiotics cure infections. Instead, they can help ease the symptoms.

You will probably need to continue medication even after you feel better. The American Psychiatric Association recommends that people keep taking their medicine for four to five months after they recover. This helps reduce the risk of relapse.

Others may need medicine for even longer. Depression can sometimes be like any chronic illness, like diabetes or heart disease, and may need ongoing treatment. This is called maintenance treatment.

Here is a rundown of some of the most common medicines used to treat depression and prevent it from coming back.

Newer Antidepressants

In the past two decades, many new types of antidepressants have become available, each working in slightly different ways.

Selective serotonin reuptake inhibitors (SSRIs)

• affect the level of a chemical in your brain called serotonin.
• This class of antidepressants include Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline).
• Side effects are generally mild.
  They include stomach upset, sexual problems, insomnia, dizziness, weight change, and headaches.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

• affect levels of both serotonin and another brain chemical, norepinephrine.
• This class includes Cymblata (duloxetine) and Effexor (venlafaxine).
• Side effects are usually mild. They include upset stomach, sleep problems, sexual problems, headache, anxiety, and dizziness, and weakness.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

• affect norepinephrine and a different chemical in the brain, dopamine.
• This class of drugs includes Wellbutrin (bupropion).
• Side effects are usually mild, and include upset stomach, headache, sleep problems, and anxiety. Wellbutrin may be less likely to cause sexual side effects than other antidepressants.

Noradnergic and specific serotonergic antidepressants (NaSSAs)

• also affect serotonin and norepinephrine in your brain.
• This class of drugs includes Remeron (mirtazpine).
• Side effects are usually mild, and include upset stomach, sleep problems, anxiety, and dizziness.

Older Antidepressants

• Some of the first medicines used to treat depression were tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
• Both types affect the chemical balance in the brain.
• While these medicines can help, doctors don't use them as much anymore. They can have severe side effects and interact with other medicines and foods. However, they are still the right choice for some people with depression -- especially if newer antidepressants don't help.

Other Medicines

• Other drugs that are not actually antidepressants can also help. For instance, some people recovering from depression will benefit from drugs for anxiety or insomnia.

Finding the Right Depression Medicine for You

• Unfortunately, finding the right medicine and the right dose isn't always simple. People have very different reactions to these drugs.
• There's no way for your doctor to predict how well a medicine will work for you. You may even find that a medicine that used to help just doesn't anymore.

You may have to put up with some trial and error. While antidepressants begin to show significant effects within a few weeks, it can take several months before you feel the full effects of a new drug, so don't give up.

Over time, your doctor may want to increase or decrease the dose, depending on how you're doing.

If you've given a depression drug a chance and it still isn't helping, talk to your doctor. Your doctor may recommend that you try another antidepressant. With time, you should be able to find a medicine that helps.

Don't ever stop taking a medicine without your doctor's approval, even if you're feeling better. Stopping a medicine suddenly can trigger a relapse.

Your doctor will want you to check in every once in a while to see how you're doing. Take advantage of these appointments to talk about any issues you have with your medication.

Next: Coping with Side Effects

Talk Therapy During Your Recovery from Depression

Reviewed by Michael W. Smith, MD, November 2005

Talk therapy, or psychotherapy, is a key treatment for depression. You might get therapy along with medicine. Or you might use therapy alone. Some people keep getting therapy long after they recover, since it helps them stay well.

While there are many types of therapy, here are some of the most common.

• Cognitive Therapy, Behavioral Therapy, and Cognitive Behavioral Therapy
  ---- all focus on your own thoughts and behaviours.
  Without realizing it, you may react to situations in ways that perpetuate your depression.
  Your therapist will help you change these automatic responses.
  
  The approach is practical. Your therapist will help you focus on concrete changes to your behavior. He or she may assign "homework," which will help you try out new techniques.
  
  According to the American Psychiatric Association, many studies have shown the effectiveness of the approach. One 2005 study published in the Archives of General Psychiatry found that cognitive therapy worked as well as medicine in treating moderate to severe depression. Another study published in the same issue found that cognitive therapy may have more lasting effects than medicine. People who had cognitive therapy were less likely to relapse than those who used medicines
  .
• Interpersonal Therapy
  ---- focuses on how your relationships with other people play a role in your depression.
  Like cognitive behavioural therapy, it's often short-term. It focuses on practical issues. The American Psychiatric Association says that the benefits of interpersonal therapy are well established by many studies. For instance, one small 2001 study published in the American Journal of Psychiatry showed that interpersonal therapy significantly reduced the risk of postpartum depression, or depression after giving birth
  .
• Psychodynamic Therapy
  ---- is an older, traditional form of therapy.
  You and your therapist might look for the causes of depression in earlier traumas, especially during childhood. It's harder to study the effects of psychodynamic therapy because it can last for years. But some small studies have shown that it helps. For instance, one 2001 analysis published in the Clinical Psychology Review found that psychodynamic therapy was as effective as cognitive behavioral therapy
  .
• Group Therapy
  ---- is not a specific type of therapy.
  It can use any of the above approaches.
  Group therapy is a way of getting help along with other people who are also recovering from depression. Unlike a support group, group therapy is led by a professional.

Finding the Therapy That's Right for You

The key is to find a therapist whom you trust.

The specific type of therapy is less important. Besides, most therapists don't stick to a particular approach. Instead, they use a combination of different types.

Anyone can call himself a therapist. But most qualified therapists will be:

• Psychologists
• Social workers
• Psychiatrists
• Psychiatric nurses
• Counselors

If you're looking for a therapist, ask your doctor for a recommendation.

If there's a specific cause of your depression ï¿½?trauma, substance abuse, or a physical illness ï¿½?find a therapist who specializes in treating people in your position.

Many therapists ï¿½?psychologists, social workers, and counselors ï¿½?cannot prescribe medication. So if you take medicine, you will also need to see a doctor ï¿½?either your primary care doctor or a psychiatrist.

How Long Should Therapy Last?

The amount of time you stay in therapy depends on what you want, how well you respond to treatment, your insurance coverage, and your therapist's approach. Many therapists now do short-term therapy, which lasts for 10 to 20 weeks. You might focus on specific, attainable goals.

In general, experts say that you should continue with therapy for at least a few months after you feel better. This lowers the risk of relapse.

If you're at high risk of relapse, you might stick with therapy for even longer. This is called maintenance therapy. You might just make your appointments less frequent. For instance, you might go to therapy once a month instead of once a week. You just need to check in with your therapist occasionally. If paying for therapy is a problem, see if your therapist can lower his or her rate.

For people recovering from depression, maintenance therapy has advantages.

• You and your therapist can watch for any signs of depression, so you can stop it early.
• You can work through troubling issues in your life before they cause bigger problems.
• You might also learn more about the patterns in your life that lead to depression.

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Next: Your Daily Activity Planner
Original page:
http://www.webmd.com/content/Article/115/111745.htm

Daily Activity Planner for Depression Recovery

Reviewed by Michael W. Smith, MD , November 2005

Many people find that adding structure to the day can help with the symptoms of depression. So try to get on a schedule.

Below is a daily planner that you can use to map out your day.

But unlike most planners, it's also like a journal. It allows you to track your mood during different activities and different times of the day. You can also compare what you planned to do with what you actually did.

If you use this planner for a few weeks, you might discover patterns that you never noticed before. For instance, you might find that you feel worse at certain times of the day or during certain activities. It could also show what causes you to become preoccupied with anxious thoughts or worries.

Depression can make you feel out of control.
But once you start seeing patterns to your mood, you can anticipate the times when you might feel depressed. That way, you can prepare for them ï¿½?or avoid them altogether.

DIRECTIONS:

• In the first column, plan what you want to do tomorrow.
• Then, tomorrow night, fill out the remaining three columns
  .
• Did you do what you intended?
• How did you feel during this time?
• Did anything happen that might have affected your mood?
  .
• For instance, did you get in an argument with a friend?
• Did you start thinking about particular things that made you anxious?

	Fill out the night before	Fill out at the end of the day
	What you plan to do	What you actually did if it differs from what you planned	Your Mood During this Time on a scale of 1 (poor) to 5 (great)	Triggers, events, or thoughts that might have affected your mood
Early Morning (Wake-up until 10am)
Late Morning (10am-12pm)
Early Afternoon (12pm-3pm)
Late Afternoon (3pm-5pm)
Evening (5pm-8pm)
Night (8pm until bed)

Next: A Recovery Lifestyle

Benefits of Exercise in Recovery from Depression

Reviewed by Michael W. Smith, MD, November 2005

If you're just recovering from depression, you may still feel pretty exhausted. Putting on your sneakers and going to the gym could seem like the last thing you want to do. But the fact is that exercise is important for both your physical and mental health.

Many studies show that physical activity can help with recovery from depression. One such study showed that exercise -- three sessions of aerobic activity each week -- worked about as well as medication in reducing the symptoms of depression. In addition, the researchers found that after 10 months, people who exercised were much less likely to relapse than people who took medicine. The results were published in the journal Psychosomatic Medicine in 2000. A 2005 study in the American Journal of Preventive Medicine showed that moderate aerobic workouts, done three to five times weekly, cut mild to moderate depression symptoms nearly in half.

Here are some tips to starting off a new exercise routine.

• Start slow.
• Don't try to jump from a life of total inactivity right to marathon training! That will just leave you sore and demoralized. Instead, gradually work your way up.
• Start by exercising just for a short period of time -- a few minutes or more -- only on a few days of the week.
• Don't do more than that for a week or two. Slowly build up to exercising for half an hour or more, four days a week.
• Break it up.
• You don't have to get all of your physical activity in a single stretch or with one activity. Many people prefer doing smaller sessions of exercise during the day and varying the types of exercise.
• Three 15 minute walks are as good as one 45 minute walk.
• Pick something you enjoy.
• This advice may seem obvious. But a lot of people choose a sport not because they like it, but because they think that it will be good for them.
• If you treat exercise like a bitter medicine -- unpleasant but good for you -- you probably won't stick with it.
• Remember that there are a lot of activities to choose from, and they can be enjoyable: swimming in a local pool, using home fitness equipment in front of the TV, going for hikes, or taking a fun exercise class. Try different types of physical activity until you find one that you really like doing.
• Exercise with other people.
• Solo physical activity is sometimes hard to stick to - it makes it easier to decide not to do it at that moment. But if you have a plan to exercise with someone else, you might feel more committed. So seek out an exercise partner. Make a date to walk with a neighbour at a specific time, on specific days. Or start up a regular tennis game with a friend.
• Many people find that structured classes -- like aerobics or yoga -- also help them stick with a program.
• Get more everyday physical activity.
• Try adding a little extra physical activity whenever and wherever you can during your daily routine.
• Take the stairs instead of the elevator.
• Park a little further away from your workplace, so you can sneak in some extra walking.
• Stuff your remote control under a couch cushion and get up to change the channel.
• Over time, little changes to your behavior can add up to a big improvement in your health!