Some of the newer antidepressant drugs, however, appear to have particularly robust effects on both the norepinephrine and serotonin systems. These medications seem to be very promising, especially for the more severe and chronic cases of depression. (Psychiatrists and other mental health professionals, rather than family practitioners, see such cases most frequently.) Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima) are four of these dual-action compounds. Effexor is a serotonin reuptake inhibitor that, at lower doses, shares many of the safety and low side-effect characteristics of the SSRIs. At higher doses, this drug appears to block the reuptake of norepinephrine. Thus, venlafaxine is an SNRI, a serotonin and norepinephrine reuptake inhibitor. Cymbalta and Pristiq tend to act as equally powerful serotonin reuptake inhibitors and norepinephrine reuptake inhibitors regardless of the dose, Fetzima even more so. They are, therefore, also SNRIs.

Explore options if it doesn't work well. If you have bothersome side effects or no significant improvement in your symptoms after four weeks, talk to your doctor about changing the dose, trying a different antidepressant (switching), or adding a second antidepressant or another medication (augmentation). A medication combination may work better for you than a single antidepressant.


Depression, also known as clinical or major depression, is a mood disorder that will affect one in eight Canadians at some point in their lives. It changes the way people feel, leaving them with mental and physical symptoms for long periods of time. It can look quite different from person to person. Depression can be triggered by a life event such as the loss of a job, the end of a relationship or the loss of a loved one, or other life stresses like a major deadline, moving to a new city or having a baby. Sometimes it seems not to be triggered by anything at all. One of the most important things to remember about depression is that people who have it can’t just “snap out of it” or make it go away. It’s a real illness, and the leading cause of suicide.
While you can’t force yourself to have fun or experience pleasure, you can push yourself to do things, even when you don’t feel like it. You might be surprised at how much better you feel once you’re out in the world. Even if your depression doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.
By working with a therapist or thinking strategically about the tactics you want to try, you can integrate them and execute several at once. For example, therapist Asta Klimaite often asks her clients to incrementally increase their exercise by using different methods and routes to reach her office. Her tactic also helps them develop a sense of accomplishing simple goals. They start by taking a different route to her office and using whatever mode of transportation they like. She then challenges them to ride a bike or walk to her office. Before they even start therapy, they are already working on their mental health.
Depression, also known as clinical or major depression, is a mood disorder that will affect one in eight Canadians at some point in their lives. It changes the way people feel, leaving them with mental and physical symptoms for long periods of time. It can look quite different from person to person. Depression can be triggered by a life event such as the loss of a job, the end of a relationship or the loss of a loved one, or other life stresses like a major deadline, moving to a new city or having a baby. Sometimes it seems not to be triggered by anything at all. One of the most important things to remember about depression is that people who have it can’t just “snap out of it” or make it go away. It’s a real illness, and the leading cause of suicide.

Mahableshwarkar AR, Jacobsen PL, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, parallel group study comparing the efficacy and safety of 2 doses of vortioxetine in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-02.
Just as there are many different experiences of anxiety and depression, there are a variety of options for treatments and coping techniques to help manage symptoms.  The recommendations in this section take an integrative mental health approach, which incorporates health-promoting lifestyle changes; evidence-based holistic therapies and healing practices; and mainstream interventions, including psychosocial therapies and the judicious use of prescription medication. We cover each of these areas in detail--click the links or see the menu on the left for more information. 
Bear in mind that while effective treatment for anxiety or depression need not be a long-term commitment, it is likely to require regular, ongoing appointments at least in the short-term (e.g., 6-12 months). Therefore, it is critical to find a professional you trust and with whom you feel comfortable speaking about your symptoms. It is equally important to make sure that you find a clinician that you can afford. Before making the commitment for ongoing care, you may want to meet with a couple of providers to get a feel for therapeutic styles/approaches and their treatment recommendations; you can then use this information to determine which path forward feels best to you.
But with all three of these treatments, there is the promise of alternative medications to treat depression that might help people feel better — sometimes faster — and hopefully with fewer troubling side effects. No one treatment is right for everyone (that’s why we made our iPhone app called Start, to help people figure out if their antidepressant works), so better research into safe alternatives is important.
It helps to try to think about the last two weeks, rather than just when you felt very anxious or stressed. Also remember that this test is just one part of an assessment of whether anxiety might be a problem for you. There’s more to it, like getting feedback from people who know you well, and looking at how long anxiety’s been a problem for you and how it impacts on your life.
Everyone experiences a range of emotions over the course of days and weeks, typically varying based on events and circumstances. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings ebb and flow. They respond to input and changes. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be cheered, comforted or consoled. People who recover from depression often welcome the ability to feel normal sadness again, to have a “bad day,” as opposed to a leaden weight on their minds and souls every single day. More
Despite major advances in drugs and medical treatments, maintaining a healthy diet, being physically active, and not smoking are still the best approaches to preventing heart disease. In this Special Health Report, Healthy Eating for a Healthy Heart, find out how improving your diet lowers your risk for heart disease in many ways, including helping to lower high cholesterol, blood pressure, and blood sugar and insulin levels, as well as preventing obesity and improving the function of your heart and blood vessels. Fortunately, a heart-healthy diet is relatively easy to define, and you don’t have to give up great-tasting food.

Anxiety disorders are the most common type of mental disorder. 50-60% of migraine patients will suffer from an anxiety disorder. Most anxiety disorders involve chronic worry or fear and avoiding things that trigger these feelings. In panic disorder, the patient has recurrent, unexpected feelings of intense fear or terror that seem to come from out of the blue. The heart starts beating rapidly and breathing becomes strained. Other symptoms may involve sweating, fear of dying, or losing control. Although attacks don’t last very long and are not dangerous, many people develop significant anxiety between attacks and come to fear normal body sensations.

Mirtazapine (Remeron), another antidepressant, is a tetracyclic compound (four-ring chemical structure). It works at somewhat different biochemical sites and in different ways than the other medications. It affects serotonin but at a postsynaptic site (after the connection between nerve cells). It also increases histamine levels, which can cause drowsiness. For this reason, patients take mirtazapine at bedtime; physicians often prescribe mirtazapine for people who have trouble falling asleep. Like the SNRIs, it also works by increasing levels in the norepinephrine system. Other than causing sedation, this medication has side effects that are similar to those of the SSRIs.


Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. They include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Wellbutrin, Aplenzin, Forfivo XL). Bupropion is one of the few antidepressants not frequently associated with sexual side effects.
Self-help approaches to treating depression are best thought of as adjuncts or additions to professionally prescribed treatments. Don't delay treating your depression professionally, or attempt to treat your depression solely on your own. Instead, seek a professional diagnosis at the earliest opportunity. Early diagnosis of depression is critical. The sooner your depression has been properly diagnosed and treated, the sooner you will have a good chance of recovering. Many people think that their low mood is temporary and will resolve by itself. While some depressions are temporary and relatively mild conditions, others really aren't. Delaying treatment in such cases allows symptoms to worsen and can cause serious problems to occur such as severely impaired health and occupational functioning, damage to your interpersonal relationships, and suicidal thoughts and behavior. A small but significant minority of people die from depression-caused suicides each year.
Americans are obsessed with happiness, yet we are increasingly depressed: Some 15 million Americans battle the disorder, and increasing numbers of them are young people. Mental anguish is hard on your health. People suffering from depression have three times the risk of experiencing a cardiac event. In fact, depression affects the entire body. It weakens the immune system, increasing susceptibility to viral infections and, over time, possibly even some kinds of cancer—a strong argument for early treatment of depression. It interferes with sleep, adding to feelings of lethargy, compounding problems of focus and concentration, and generally undermining health. Those suffering from depression also experience higher rates of diabetes and osteoporosis. Sometimes depression manifests as a persistent low mood, a condition known as dysthymia. It is usually marked by years-long periods of low energy, low self-esteem, and little ability to experience pleasure.
suggests exercise can be an effective treatment for depression because it’s a natural mood booster and releases feel-good hormones. However, for some people, exercise or a gym can trigger anxiety and fear. If that’s the case for you, look for more natural ways to move, such as walking around your neighborhood or looking for an online exercise video you can do at home.
A complete physical and psychological diagnostic evaluation by professionals will help the depressed person decide the type of treatment that might be best for him or her, including if they are in need of treatment for a physical condition that is causing or contributing to their depressed mood. However, if the situation is urgent because a suicide seems possible, having loved ones take the person to the emergency room for evaluation by an emergency-room doctor is essential. If the patient makes a suicide gesture or attempt, call 911. The patient might not realize how much help he or she needs. In fact, he or she might feel undeserving of help because of the negativity and helplessness that is a part of depressive illness.
Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. If PPD affects a woman's ability to function, this is a sure sign that she needs to see her health care professional right away. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as one year. While PPD is a serious condition, it can be treated with medication and counseling.
Bennabi D, Yrondi A, Charpeaud T, Genty JB, Destouches S, et al. Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental). BMC Psychiatry. 2019 Jan 30. 19 (1):50. [Medline].
When you’re suffering from deep, disabling depression, the idea that a pill can give you back your life—and sense of hope—is incredibly appealing. But are antidepressants always the best treatment option? What are the potential side effects and safety concerns? And are there any truly effective non-drug alternatives? These are some of the important questions to think about when considering antidepressant treatment. Learning about what antidepressants can (and can’t) do will enable you to weigh the benefits against the risks, make a more informed decision, and find the depression treatment that’s right for you.
When your doctor recommends an antidepressant to fight depression—such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)—it's about more than just boosting your mood. Depression has many potential physical effects. "Most people aren't aware that depression can lead to other health problems," says Dr. Amanda Hernandez, a geriatrician at Harvard-affiliated Massachusetts General Hospital.
When these types of thoughts overwhelm you, it’s important to remember that this is a symptom of your depression and these irrational, pessimistic attitudes—known as cognitive distortions—aren’t realistic. When you really examine them they don’t hold up. But even so, they can be tough to give up. You can’t break out of this pessimistic mind frame by telling yourself to “just think positive.” Often, it’s part of a lifelong pattern of thinking that’s become so automatic you’re not even completely aware of it. Rather, the trick is to identify the type of negative thoughts that are fueling your depression, and replace them with a more balanced way of thinking.
Depression is a serious mental health disorder that affects the whole body including mood and thoughts. It touches every part of one’s life. It is important to know that depression is not a weakness or character flaw—it is a chemical imbalance in the brain that needs to be treated. If you have one episode of depression, you are at risk of having more throughout life. Without treatment, depression can happen more often and become more serious. Scientists believe that depression doesn’t have a singular cause, but may be brought on by a traumatic event, changes in life circumstances, genetics, changes in the brain, or alcohol or drug abuse.

I have also suffered a recent brain injury (concussion). Medication is not an option for my panic and anxiety symptoms. I am now taking cranio- sacral therapy providing significant relief. How I recovered from my horrific addiction to phsyco meds 10 years ago is still a very painful memory not to be easily forgotten. I am convinced & am choosing a holistic safer route instead of the dead end road of pharmaceutical therapy. God Bless. Julie


Some 16 million Americans a year struggle with depression, an illness that comes in many forms—from major depression to dysthymia and seasonal affective disorder. In addition, depressive episodes are features of bipolar disorder. Depression is an illness that increasingly afflicts people worldwide, interfering with concentration, motivation, and many other aspects of everyday functioning. It is a complex disorder, involving many systems of the body, including the immune system, either as cause or effect. It disrupts sleep and it interferes with appetite, in some cases causing weight loss, in others weight gain. Because of its complexity, a full understanding of depression has been elusive.
Sticking to your treatment plan is one of the most important things you can do. It’s easy to get discouraged in the first few weeks of treatment. You may not want to continue. All types of treatment can take a few months before you notice a difference. It’s also easy to feel like you’re doing much better and stop treatment all together. Never stop treatment without consulting your doctor first.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They are highly effective and generally cause fewer side effects than the other antidepressants. SSRIs help to alleviate symptoms of depression by blocking the reabsorption or reuptake of serotonin in the brain. Serotonin is a naturally occurring neurotransmitter (chemical) that is used by brain cells to communicate. As SSRIs mainly affect the levels of serotonin and not levels of other neurotransmitters, they are referred to as “selective.”
Schizophrenia is associated with an imbalance of dopamine (too much) and serotonin (poorly regulated) in certain areas of the brain. Finally, the depressive disorders appear to be associated with altered brain serotonin and norepinephrine systems. Both of these neurochemicals may be lower in depressed people. Please note that depression is "associated with" instead of "caused by" abnormalities of these neurochemicals because we really don't know whether low levels of neurochemicals in the brain cause depression or whether depression causes low levels of neurochemicals in the brain.
Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.
You may feel too exhausted to talk, ashamed at your situation, or guilty for neglecting certain relationships. But this is just the depression talking. Staying connected to other people and taking part in social activities will make a world of difference in your mood and outlook. Reaching out is not a sign of weakness and it won’t mean you’re a burden to others. Your loved ones care about you and want to help. And if you don’t feel that you have anyone to turn to, it’s never too late to build new friendships and improve your support network.

Feeling down from time to time is a normal part of life, but when emotions such as hopelessness and despair take hold and just won’t go away, you may have depression. Depression makes it tough to function and enjoy life like you once did. Just trying to get through the day can be overwhelming. But no matter how hopeless you feel, you can get better. By understanding the cause of your depression and recognizing the different symptoms and types of depression, you can take the first step to feeling better and overcoming the problem.
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