The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
In general, the severe depressive illnesses, particularly those that are recurrent, will require antidepressant medications, phototherapy for winter seasonal depression (or ECT or TMS in severe cases) along with psychotherapy for the best outcome. If a person suffers one major depressive episode, he or she has up to about a 75% chance of a second episode. If the individual suffers two major depressive episodes, the chance of a third episode is about 80%. If the person suffers three episodes, the likelihood of a fourth episode is 90%-95%. Therefore, after a first depressive episode, it may make sense for the patient to come off medication gradually. However, after a second and certainly after a third episode, most clinicians will have a patient remain on a maintenance dosage of the medication for an extended period of years, if not permanently.
Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, bupropion (Wellbutrin, Aplenzin, Forfivo XL) may help relieve symptoms of both attention-deficit/hyperactivity disorder (ADHD) and depression. Other examples include using duloxetine (Cymbalta) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraines.
The study has also gone beyond to compare the level of depressive mood between the victims and non-victims of the daily bullying. Although victims were predicted to have a higher level of depressive mood, the results have shown otherwise that exposure to negative acts has led to similar levels of depressive mood, regardless of the victim status. The results therefore have concluded that bystanders and non-victims feel as equally depressed as the victim when being exposed to acts such as social abuse.[29]
Although many people are fearful of ECT, this technique is arguably the safest and most effective medical treatment for severe depression although there can be some memory related side effects. ECT is more rapid in its effect than antidepressant drugs, and CBT and antidepressants remain useful adjuncts to treatment since they can help prevent relapse after ECT is completed.

Tricyclic antidepressants (TCAs) were one of the first approved antidepressants. Although they are effective, they have been replaced by newer antidepressants that generally cause fewer side effects. Like SNRIs, TCAs work by blocking the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. Additionally, they block muscarinic M1, histamine H1, and alpha-adrenergic receptors.

We are learning more about the interactions of the neurochemicals, the chemical messengers in the brain, and their influence on depression. Moreover, researchers now study new categories of neurochemicals, such as neuropeptides and substance P. As a result, we will soon be able to develop new drugs that should be more effective with fewer side effects. We are also learning startling things about how maternal stress early in pregnancy can profoundly affect the developing fetus. For example, we now know that maternal stress can greatly increase the risk for the fetus to develop depression as an adult.
It is important to communicate regularly with your doctor when you are taking an antidepressant, especially if you are prescribed any other medications. Keep track of your symptoms so that they can find the best medication for your depression, and also keep track of any side effects you experience. If you’re having trouble finding a medication that works, drug-genetic testing can help your doctor determine appropriate options. If you become pregnant or are breastfeeding, be sure to ask what medication is safest.
Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
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