Behavioral therapies for depression require a commitment to changing behaviors that make depression worse. They often focus on getting involved in enjoyable or rewarding activities, knowing that if you force yourself to do these things your mood will improve over time. Changing thoughts about certain aspects of life can also be useful. Behavioral interventions for anxiety include safe and gradual exposure to the things that the patient fears. It too involves changing how the patient thinks about those things. Behavioral therapies are effective for depression, and tend to be more effective than medication for anxiety disorders, particularly for long-term relief. For many patients, combining medication and behavioral therapy is better than either one alone for depression, anxiety, and headache.
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.
Be patient. Once you and your doctor have selected an antidepressant, you may start to see improvement in a few weeks, but it may take six or more weeks for it to be fully effective. With some antidepressants, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for the antidepressant to take effect.
Selective serotonin reuptake inhibitors (SSRIs) were launched in the mid to late 1980s. This generation of antidepressants is now the most common class used for depression. Examples include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft). Two medicines, classified as "serotonin modulators and stimulators" or SMS's (meaning they have some similar properties as SSRIs but also affect other brain receptors) are vilazodone (Viibryd) and vortioxetine (Trintellix) Side effects are generally mild, but can be bothersome in some people. They include nausea, stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches.
MAOIs also impair the ability to break down tyramine, a substance found in aged cheese, wines, most nuts, chocolate, certain processed meats, and some other foods. Tyramine, like norepinephrine, can elevate blood pressure. Therefore, the consumption of tyramine-containing foods by a patient taking an MAOI drug can cause elevated blood levels of tyramine and dangerously high blood pressure. In addition, MAOIs can interact with over-the-counter cold and cough medications to cause dangerously high blood pressure. The reason for this is that these cold and cough medications often contain drugs that likewise can increase blood pressure. Because of these potentially serious drug and food interactions, MAOIs are usually only prescribed for people who are thought to be willing and able to manage the many dietary restrictions required by these medications and after other treatment options have failed.
TCAs have been in use since the 1950s when imipramine (Tofranil) was shown to be effective for treating depression. TCAs primarily work by increasing the level of norepinephrine in the brain and to a lesser extent serotonin levels. Some TCAs also are antihistamines (block the action of histamine) or anticholinergic (block the action of acetylcholine, a neurotransmitter), and these additional actions allow for uses of TCAs other than for treating depression as well as additional side effects.
Behavioral activation is the practice of gradually increasing activity to experience more pleasure and mastery in life, according to Joel Minden, Ph.D., a clinical psychologist at the Chico Center for Cognitive Behavior Therapy. The therapeutic technique is relatively new, so it has a limited amount of research backing it. Nonetheless, it did spring from cognitive behavior therapy [CBT], which has mountains of research to support its efficacy.
Depression and anxiety care incorporates individual, group, and family therapy, behavioral therapies, diagnostic assessment, consultation services, tailored treatment plans, and medication evaluation and management. McLean is committed to providing robust patient and family education and support including informational materials, support groups, and assistance with community resources.
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.