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Depression can be treated with psychotherapy or anti-depressant medications, or a combination of the two. While both work in most cases, drugs work faster. The two can also be combined.

Side effects of anti-depressants such as low sex drive can be remedied with other drugs.

Treatments are often determined by factors such as the doctor's training, your insurance, and your economic situation. There are steps to take to determine which therapy is best for you.

There are many sources of treatment. To maximize a diagnostic examination, it is helpful to know the questions you are likely to be asked.

There are separate considerations to think about before agreeing to treatment if you have Cancer or HIV/AIDS.

For information about what you can do about depression in addition to treatment, click here.

NOTE: If you have treatment resistant depression, the Mayo Clinic provides suggestions. Click here offsite link.

Treatments For Depression

Depression can be treated non-medically as well as medically.

On a non-medical basis, the following have been known to help:

Medical treatments available to treat depression include the following:

  • Psychotherapy with a psychiatrist, psychologist, social worker or therapist.
  • Short or long term treatment with anti-depressant medications.
  • A combination of psychotherapy and treatment with anti-depressant medications.
  • For patients who do not respond to treatment for depression, the FDA has approved a pacemaker-like device known as a Vagus Nerve Stimulator.

Anti-depressant medications can provide relatively quick symptom relief, though it can take trial and error to find a drug that works without unacceptable side effects. It can also take several weeks for the drugs to be effective. While psychologists and social workers cannot prescribe drugs, they are likely to have arrangements with doctors and/or psychiatrists who prescribe and monitor drug use for their patients.

Psychotherapy can provide an outlet for you to discuss some of the feelings you are having, as well as helping you to develop new or improved coping mechanisms. Therapy may be approached individually or with a partner/family member for support.

Your doctor will be able to discuss treatment options with you in much greater detail, taking into account any relevant factors as:

  • Other medical conditions you may have.
  • Your physical and psychological history.
  • Your lifestyle.
  • Your economic situation (including insurance.)

To help determine which treatment is best for you, see: How To Choose A Treatment For Depression That Is Best For You.

If An Anti-Depressant Causes Uncomfortably Low Sex Drive Or Impotence

One of the side effects of several anti-depressants is lowered sex drive or impotence.

One recommendation to counteract these effects is to take the pill early in the morning. It can help lower the rate of erectile dysfunction in the evening.

There are other drugs to help counteract the side effects such as BuSpar (buspirone) an anti-anxiety drug, and impotence drugs such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

An alternative is to switch to an anti-depressant less likely to have a similar effect such as bupropion (Wellbutrin) or nefazodone (Serzone).

How To Choose A Treatment For Depression That Is Best For You

In addition to self help such as exercise, the decision of whether to use talk therapy and/or drugs is often a matter of what doctor or other professional you see, together with insurance coverage and/or restrictions and your economic situation.

According to a survey by Consumer Reports in 2004:

  • Both talk therapy (13 sessions or more) and drug therapy are about equally effective. Drug therapy is the more prevalent mode. The combination of talk and drug seems to be the best overall.
  • Improvement with drug therapy happens more quickly than with talk therapy.
  • Care from primary care doctors instead of a specialist was effective for people with mild problems, but less so for people with severe ones.
  • Therapy was seen by patients as being just as effective when given by psychologists and clinical social workers as when given by psychiatrists.
  • Patients who did their own research and monitored their own care reported better results.
  • Therapy offers two advantages to drugs:
    • No side effects 
    • The prospect of a permanent solution since you learn long term strategies.

Consumer Reports suggests asking the professional who recommends treatment at least the following questions:

  • What is your understanding of this problem?
  • What kind of medical treatments would you recommend - and why? 
    • If you are recommending a medical treatment, is it addictive?
    • Is there a non-addictive medical treatment available?
  • What kind of non-medical treatments such as exercise would you recommend -- and why?
  • How long will it take to experience some relief of symptoms?
  • How long will I need to stay on medication and/or continue with talk therapy to get the maximum benefit?

If you choose drug therapy, Survivorship A to Z recommends that:

  • You read Drugs 101, particularly the information on how to choose a drug and how to live with a drug.
  • Consider also asking:
    • What was the determining factor or factors in your finding that I am clinically depressed?
    • What has research shown  about effectiveness of the drug you recommend with patients like me?
    • What has your experience been with other patients? How long has improvement lasted?
    • How often do you generally have to change drugs before finding one that helps?
    • As with drugs in general: are there alternative treaments I should try first?
  • Look at Consumer Reports' Best Buy Drugs for lower price drugs that may be comparably effective to brand name drugs. See: offsite link.

How To Locate A Provider For Treatment Of Depression

Any or all of the following sources may provide treatment or referral to an appropriate provider:

  • Your primary care physician or specialist. (If your primary care physician treats your depression, it is likely to be with drugs instead of talk therapy.)
  • Organizations of providers such as:
  • Therapists are available online using Skype and other computer-based connection methods to speak with patients anywhere.
    • You can find online therapists at such sites as offsite linkor offsite link
    • Private insurers do not generally pay for this type of therapy, but it is worth checking with your health insurer in any event.  Medicare does pay for this type of therapy in certain circumstances. The therapist should be able to advise you about this or call Medicare at 800-MEDICARE.
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors.
  • Health maintenance organizations.
  • Community mental health centers.
  • Hospital psychiatry departments and outpatient clinics.
  • University or medical school affiliated programs.
  • State hospital outpatient clinics.
  • Family service/social agencies.
  • Private clinics and facilities.
  • Employee assistance programs.

According to a survey done by Consumer Reports in 2004, people who got the name of a mental health therapist from a friend or family member had a better outcome than those who saw a therapist recommended by their employer or through an advertisement. People who were referred by their doctor or another mental health professional also got good results.

If you do not currently have a doctor, see: Choosing A Doctor. Also see: Choosing A Mental Health Provider.

How To Maximize Time With A Diagnosing Professional

Prepare for your interview by thinking about the following questions which you will be asked to help diagnose the situation and determine what to do about it:

  • What are your symptoms?
  • When did your symptoms start?
  • How long have they lasted?
  • How severe are they?
  • Have you had them before? If so, when? Were they treated? If so, with what?

If You Have Cancer

Some cancers and some cancer treatments increase the risk of depression. For example:

  • Studies have found that proteins called cytokines can cause depression. Cytokins are sometimes produced by tumors and sometimes produced by the immunological response to tumors.
  • Pancreatic and lung cancers can trigger depression-like symptoms.
  • Certain cancer treatments can induce depression. For example, hormonal medications such as Tamoxifen, some of the antitestosterone hormonal treatments for prostate cancer, and many chemotherapy agents.

Available treatments are described above.  Initial studies offsite linkindicate that light therapy may help. For information about additional steps you can take to help deal with depression, click here.

For more information about depression and cancer, see the National Institute of Mental Health's booklet by clicking here offsite link.

NOTE: When suffering from depression, bring it to the attention of all of your doctors. In addition to advice they may have (both medical and non-medical), they should know about your depression because it can affect adherence to whatever treatment they prescribe for your physical condition.

If You Have HIV/AIDS

Available treatments for depression are described above.

Before being treated for depression:

  • Talk with your doctor about being tested for low testosterone levels and/or hypo-or hyperthyroidism. Dr. Ross Slotten, a doctor in Chicago who treats a lot of patients with HIV/AIDS, suggests that both of these conditions be considered before being treated for depression. As quoted in the magazine, Positively Aware:  "Hypogonadism, or abnormally low testosterone levels, may cause fatigue, weight loss and depressed moods. For reasons that are unclear, impairment of testosterone production is common in HIV-infected men."
  • Consider reviewing your medications regime with your doctor or mental health care provider. A number of anti-HIV medications have so-called neuropsychiatric side effects. For example, efavirenz (Sustiva), AZT (Retrovir) and abacavir (Ziagen) can produce extreme fatigue, loss of energy, and depression. Stopping the medication generally resolves the problem if the symptoms are due to the drug.
  • Other, non-HIV medications which are often taken by people with HIV can also depress mood or induce depression like complaints.

For more information about depression and HIV,  see the National Institute of Mental Health's write up by clicking here offsite link.