Is this information appropriate for me?

This information is appropriate for you if:

• Your healthcare professional * told you that you have depression (also called “major depressive disorder”).
• You are 18 years of age or older. This information comes from research done on adults.

* The term health care professional can refer to your family physician, psychiatrist, psychologist, another therapist, nurse, or physician assistant.

This information is not appropriate for you if:

• He is in the hospital because of his depression.
• She is a mother and her depression started shortly before or after giving birth.
• Your healthcare professional told you that you have any of the following conditions:
  • Seasonal affective disorder (symptoms of depression that occur only during winter, when there is less sunlight)
  • Dysthymia (mild depression almost every day, for a minimum of 2 years)
  • Bipolar depression (depression with sudden big mood swings)

This summary will answer the following questions:

• What is depression?
• What have researchers found when comparing antidepressants with psychotherapy (also called counseling) and other treatments for depression (exercise programs, acupuncture, and dietary supplements)?
• What should I ask my healthcare professional about treating my depression?

What is the source of this information?

This information comes from a research report funded by the Agency for Healthcare Research and Quality (AHRQ), a federal government agency.

The researchers reviewed 44 studies that compared antidepressants with other treatments for depression. The studies were published between January 1990 and January 2015. Health care professionals, researchers, experts, and the public provided their views on the report before publication.

Know your condition

What is depression?

Depression is a disease that affects the brain. Depression is not the same as feeling sad or discouraged for a few days. When you have depression, you can have symptoms almost every day. The person may be sad, lacking energy, or feeling tired most of the time. You may lose the desire to do things that you used to enjoy.

Also can:

• Have trouble thinking and paying attention
• Having trouble sleeping or sleeping too much
• Eating too little or too much
• Feeling hopeless, helpless, worthless, or guilty
• Avoid being with other people
• Having thoughts about your own death, injury, or suicide

Medical experts do not know what causes depression. It could be caused by changes in brain chemicals, life stress, or other factors. Depression also runs from generation to generation in certain families.

Depression is very common. In 2014, about 17.5 million adults (1 in 14 adults) in the United States had the type of depression that needs treatment.

Know your options

How do treatments for depression compare?

There are many ways to treat depression. You may have to try several treatments before you find one that works for you. Your healthcare professional may first suggest an antidepressant medicine or psychotherapy (also called counseling).

One of the types of psychotherapy is called cognitive-behavioral therapy. When the researchers compared it to antidepressants as the first treatment for depression, they found that:

• Cognitive-behavioral therapy is as effective as antidepressants in improving the symptoms of depression.

There are also two other types of psychotherapy (interpersonal therapy and psychodynamic therapy) that can be as effective as antidepressants, but more research is needed to know for sure.

Other treatments for depression include exercise programs, acupuncture, and dietary supplements (such as St. John’s wort and SAMe). These treatments can be as effective as antidepressants, but more research is needed to know for sure.

This summary will cover each of the treatments mentioned, their possible side effects, and what the researchers found. This summary can help you talk with your healthcare professional about which treatment, or combination of treatments, might be best for you.

What are antidepressant medications?

Antidepressants help improve the way the brain uses certain chemicals that control mood and stress. Examples of antidepressants are bupropion (Wellbutrin®), citalopram (Celexa®), fluoxetine, and venlafaxine.

Symptoms of depression improve in three out of five people who try antidepressants as their first treatment.

If you try an antidepressant, it will take you at least 8 weeks to know if it helps. If the antidepressant doesn’t help enough, you may need to try a different one. Some people need to try several antidepressants before finding one that will help them.

What are the possible side effects that antidepressants can cause?

The United States Food and Drug Administration (FDA) lists the following possible side effects of antidepressants.

• Nausea and vomiting
• Weight gain
• Much sleep
• Diarrhea
• Sexual problems
• Trouble sleeping

The more serious side effects are much less common. They include heart problems, a lack of sodium (salt) in the blood, and liver damage. Antidepressants can also cause a life-threatening reaction called “serotonin syndrome.” Serotonin syndrome can cause tremors, diarrhea, fever, seizures, and muscle stiffness.

What is psychotherapy?

Psychotherapy, or talk therapy, is a type of treatment where you speak with a trained therapist. You can meet alone or in a group with the therapist. Sessions are usually done once a week. If you try psychotherapy, you will need to go to at least eight sessions to see if it helps.

Talking to a therapist about issues that have to do with your depression can be upsetting. You may feel angry, nervous, or sad. Trying to resolve these feelings can help you get better. It is important to let your therapist know if psychotherapy upsets you or if symptoms of depression worsen.

Take a decision

What things should I think about?

You and your healthcare professional can decide what will be best to treat your depression. But first, your healthcare professional needs to know what you think about your depression and your treatment options.

Here are some things to consider. Talk about them with your healthcare professional.

• How does depression affect your daily life?
• What possible side effects of treatment are you concerned about?
• How much time can you spend on your treatment?
• How would your decision affect the cost of treatment?
• If you received treatment for depression before, what helped you?
• What treatment do you think is best for you?