Your 10 top questions about treatment for depression
Depression hurts, but treatments exist. We asked the experts about medication, therapy and other strategies for healing.
Depression is among the most common mental health conditions. But for most people, it’s entirely treatable. The American Psychiatric Association states that nearly 100% of patients experience at least some relief from symptoms, and 80% to 90% experience significant improvement.
Mild to moderate depression tends to respond well to therapy alone, while more severe cases usually require medication. A recent American Journal of Psychiatry study showed that combining the 2 treatments was often most effective for patients who failed to manage their depression with either treatment alone.
If you’ve just been diagnosed with depression, you likely have questions. So we spoke with the experts to find your answers. (And if you're on medication, be sure to bring the Optum Perks prescription discount card with you to the pharmacy. You could save up to 80%.)
1. What are the most common medications used for depression, and how do they work?
Prozac® and Zoloft® are the medications you may have already heard of. These are selective serotonin reuptake inhibitors (SSRIs), the most prescribed class of medication for the treatment of depression. Common SSRIs include (click each drug name to access instant coupons):
As the name suggests, SSRIs increase levels of serotonin. This is a neurotransmitter, or brain chemical, that helps regulate mood, says Joy Alonzo, PharmD. She’s a clinical assistant professor of pharmacy practice at the Texas A&M Health Rangel College of Pharmacy in College Station.
A second class of antidepressant you may encounter is called serotonin and norepinephrine reuptake inhibitors (SNRIs). In addition to serotonin, these target the neurotransmitter norepinephrine. SNRIs may help relieve chronic pain, which makes them effective for patients who develop depression as a result of physical suffering. Examples of SNRIs include:
Other medications used for depression include:
- trazodone (Desyrel®)
- mirtazapine (Remeron®)
- bupropion hydrochloride (Wellbutrin®)
- aripiprazole (Abilify®)
These medications are generally used to target specific cases. Trazodone and mirtazapine, for instance, have sedating effects, meaning they make you sleepy. This can be useful if your depression is keeping you awake. Trazodone and mirtazapine may each be used on their own or prescribed alongside other medication to help with sleep.
Bupropion has an added benefit of helping people quit smoking, while aripiprazole is considered an antipsychotic medication. It’s usually used in combination with a more traditional antidepressant, such as an SSRI.
Alonzo says an older class of antidepressants, called tricyclics, are effective but aren’t often a first choice among doctors. They come with too many negative side effects. Examples of tricyclic antidepressants include:
2. How quickly do depression medications work?
SSRIs can take 4 to 6 weeks to fully kick in. But you may notice smaller improvements, such as more energy or less intense negative emotions, earlier.
SNRIs work a little faster. You’ll usually feel the full effect in 3 to 6 weeks. Trazodone and mirtazapine work right away for sleep, but they take 2 to 4 weeks for depression relief. Bupropion may take longer, maybe 6 to 8 weeks for full effect, and aripiprazole usually starts working within 72 hours.
Tricyclics, which are less commonly used, usually start working in a couple of weeks. They often reach full effect after about a month.
3. How will I know my medication is working?
“SSRIs are very effective, but you’ve got to have faith and give it some time,” says Alonzo. “It’s more the absence of feeling poorly at first versus feeling well.”
Your doctor should schedule a checkup with you within the first month or so of treatment to see how you’re doing. Hopefully you’ll find yourself better able to deal with stress. You should also be sleeping better as your depression improves.
If 4 to 6 weeks go by and you still aren’t feeling significant improvement, tell your doctor. You may need to have your medication adjusted. Do not abruptly stop taking your antidepressant medication. It’s important to taper the dose down to avoid symptoms of withdrawal.
Learn more about how to resolve serious sleep problems with our guide: “The Safest Way to Cure Insomnia.”
4. Are there side effects?
Yes, but they’re usually mild. With SSRIs and SNRIs, some patients report headaches, dry mouth, sleep trouble, sexual problems (inability to orgasm or poor sex drive) and more. Nausea and stomach upset are also common, but they tend to fade quickly. Bupropion can cause many of these same issues, but it is less likely to impact sexual function.
Each medication comes with its own side effects, so you should talk to your doctor about what to expect with your specific prescription. Mirtazapine increases appetite and can cause weight gain. (In some patients this is a good thing, since depression sometimes causes people to lose their appetite.)
Aripiprazole can cause headaches and nausea and may make you tired. Tricyclics can cause dizziness, constipation, dry mouth, urinary retention and heart complications in patients with pre-existing heart conditions.
5. I’ve heard about a new antidepressant medication that is sprayed into your nose. What’s that?
You’re talking about esketamine (Spravato®). It’s a nasal spray designed to be combined with other antidepressant medications such as Zoloft while waiting for the full effect. It can be prescribed for severe or treatment-resistant depression.
Esketamine is made from ketamine, an anesthetic. Unlike other antidepressants, this one is thought to work by triggering the production of a neurotransmitter called glutamate, which tells the brain to create new connections between brain cells. This can lead to greater optimism and more positive behavior.
Esketamine can be very expensive. And one added challenge is that treatment can cause hallucinations that can last up to 2 hours. For that reason, it can be used only in a medical setting, says Alonzo.
6. Speaking of cost, are most antidepressants affordable?
Absolutely. Many antidepressants, including SSRIs and SNRIs, cost less than $10 a month in generic form. And they’re typically covered by most insurance.
Optum Perks can help make any prescription medication more affordable. Just download our discount card and show it to your pharmacist.
7. Is medication always required?
Not at all. “Mild to moderate cases of depression can often be managed with talk therapy alone,” says LaToya Gaines, PsyD, a clinical psychologist based in New York City. She describes therapy as a one-sided relationship that gives patients a safe space to talk through problems and learn coping strategies. “We say it’s one-sided because the therapist is there to support you,” she says. “One-hundred percent of everything that takes place in therapy is for your benefit.”
8. Does it matter which therapist I choose?
Yes. With any condition, finding a therapist that you can really open up to can have a big impact on the outcome, says Gaines. Questions to ask:
- Do you feel comfortable with this person?
- Does the atmosphere feel safe and welcoming?
- Is there a good vibe between the two of you?
If the answer to any of these questions is no, then you should probably try somebody else.
9. What else can I do to help improve my symptoms?
Exercise has been shown to improve symptoms of milder depression. In some cases, it may be just as effective as medication. Experts credit endorphins, the soothing chemicals that increase during exercise. Endorphins can soothe pain, reduce stress and improve sleep.
Meditation and other mindfulness techniques can ease depression, too. They teach self-compassion and help create distance between you and your stressful thoughts.
10. How long will I need to be in treatment for depression?
It’s different for everyone, says Alonzo. Some people need help their whole lives. But if the treatment is effective and you’re feeling positive, you might be able to wean off after 6 to 18 months, she says. Therapy makes this process easier, since it can help you notice and cope with parts of your life that trigger the depression.
If you do decide to end treatment, it’s important to not suddenly quit your medication. This can lead to unpleasant withdrawal symptoms. Instead, talk to your doctor about creating an exit plan, says Alonzo. With the help of a prescriber and a therapist, you have very high odds of beating depression and leading the life you want.
Download our app and you can look up coupons on your phone while waiting in line at the pharmacy.