Depression can almost always be helped. Here, I will summarize the treatment approaches that have been shown to be the most effective for treating depression. These are cognitive behavioral therapy (CBT) and medication. Research that suggests that cognitive therapy and behavior activation (combined, known as CBT) are two of the most effective methods for helping people get better and stay better. Although I describe cognitive and behavioral approaches separately here, you can learn to use them simultaneously.
People who take medication alone are at greater risk for future relapse compared to people who combine medication with cognitive and behavioral interventions. If you have been prescribed medication for your depression, CBT can help you minimize the likelihood that you will get depressed again once you get better and stop taking your medication.
The following sections describe each type of intervention for depression.
When we are depressed, we tend to notice and remember the negative aspects of our experiences more readily than we do the positive or neutral aspects. We also are more likely to interpret events in our lives with a negative bias when we are depressed. When we are not depressed, we tend to interpret events with a positive bias. For example, suppose you invite three people to join you for lunch, and all agree to come. If you are depressed, you will tend to focus on the one person who didn’t come and maybe even conclude, “No one likes me.” If you are not depressed, you are more likely to think, “Most people like me.” The one who couldn’t come to lunch might’ve had other plans, but they missed out on a good time.
Cognitive therapy teaches people to identify, test, and change negative, or unhelpful, thoughts by reviewing all the information in their lives, positive, neutral, and negative. Your therapist will teach you how to think in more adaptive ways to reduce your depression. As you might imagine, cognitive therapy will show you how to make changes in your thinking that will help you feel better.
If you track your activities and feelings of depression, you may discover that when you’re depressed, you are less active. For this reason, and important part of recovering from depression is to increase the number of activities that you do each day. Even more important than just the number of activities are the types and quality of activities that we do. In general, we get the biggest mood boost from activities that bring us pleasure and a sense of accomplishment, that lead to approaching rather than avoiding life’s challenges, and that are connected to what we value most. Each of us needs to discover the right personal mix of these different types of activities to improve our mood. Your therapist can help you discover the right mix for you.
Although medication can sometimes help depression, not everyone who is depressed will benefit from it. Your therapist or another healthcare provider may recommend a consultation with the psychiatrist or another physician who can evaluate whether or not your medication might be helpful for you. Some people worry about the effects of antidepressant medication. Some of the most common concerns are addressed here.
How do I know if medication will help?
There can be a trial-and-error process to prescribing antidepressants. Currently, there are dozens of antidepressants available, so you and your physician can’t know with certainty if an antidepressant will work for you until you’ve taken one for a few weeks. Different antidepressant medications may be prescribed, depending on the particular symptoms you have and the specific effect you and your physician want to achieve. If the first prescription does not produce beneficial effects, your physician may ask you to try others to see if the desired effect can be obtained.
Unlike many other medications, antidepressants take 2 to 4 weeks to reach their beneficial effect. Because you may not respond positively to the initial medication prescribed for you, it may take eight weeks or longer to achieve therapeutic levels of the right antidepressant.
One drawback to antidepressant is that many have annoying side effects, especially when a person first begins to take them. The side effects may include dry mouth, drowsiness, and weight changes, although these effects diminish or disappear after the medication is taken for a period of time.
If you have been stuck in depression for a long time, or if your depression is quite severe, it makes sense to try to find things that will help you feel better. If medication is something that helps you, then it can be worthwhile to add it to your plan to feel better. Taking medication doesn’t mean you’re crazy. You can discuss with your physician any concerns you have about medications, and also ask how long you might need to take them.
How long will I need to take antidepressant medication?
Once you and your physician find an effective antidepressant, you will probably take it for up to one or two years; although some people benefit from taking antidepressant medication longer. You and your physician can discuss how long you should take medication. In any case, when your physician recommends that you decrease antidepressant medication, she or he will want you to decrease them gradually and systematically. It is important for you to follow your physicians directions for taking and stopping antidepressant medications. Sometimes medication needs to be increased and decreased slowly to achieve the desired effects and to minimize side effects.
Some treatments for depression emphasize the importance of improving close relationships. Family and friends can provide positive support and help you recover from depression. You can use the strategies taught but your therapist to make your relationships better. If you are in an abusive relationship or in a relationship with someone who criticizes you constantly, it can be harder to recover from depression. Couple therapy and family therapy can help you improve relationship conditions that may be fueling your depression.
Information presented here is adapted from Greenberger, D., & Padesky, C. A. (2016). Mind over mood: Change how you feel by changing the way you think.