The SSRIs work by keeping serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. This, in turn, helps arouse (activate) cells that have been deactivated by depression, thereby relieving the depressed person's symptoms. SSRIs have fewer side effects than the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). SSRIs do not interact with the chemical tyramine in foods, as do the MAOIs, and therefore do not require the dietary restrictions of the MAOIs. Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and are less likely to predispose to heart-rhythm disturbances like the TCAs do. Therefore, SSRIs are often the first-line treatment for depression. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), escitalopram (Lexapro), vortioxetine (Trintellix), and vilazodone (Viibryd).
Atypical antidepressants are considered “atypical” because these agents do not fit into any of the other classes of antidepressants. Each medicine in this category has a unique mechanism of action in the body. However, like other antidepressants, atypical antidepressants affect the levels of dopamine, serotonin, and norepinephrine in the brain. Brintellix and Viibryd inhibit reuptakeof serotonin but also act on serotonin receptors.
Buspirone is marketed as an antianxiety medication; however, it may have antidepressant effects at doses above 45 mg/day. The antidepressant effects may increase when buspirone is used in combination with SSRIs and TCAs in patients with treatment-resistant depression. Buspirone is a partial 5-HT1A agonist with serotonergic and some dopaminergic effects in the CNS. It has anxiolytic effects but may take up to 2-3 weeks for full efficacy.

It's often difficult to come to grips with the confusion and uncertainty that characterize the problems of anxiety and depression when you keep them to yourself and try to figure it out on your own. A consultation with a professional therapist can often help you through that doubt and uncertainty. If you are in need of a therapist, there are several good national organizations which can help you find a professional in your area.
Symptoms of depression and anxiety are most common among people with chronic migraine, which is when headache attacks occur on 15 or more days a month. For people with fewer headaches, depression or anxiety puts them at risk for more headaches over time. Symptoms of depression and anxiety also impact other areas of health. Migraine patients with depression or anxiety have higher medical costs, are at increased risk for suicide, and have higher levels of disability than migraine patients without depression or anxiety. Also, and perhaps most importantly, headache treatments don’t work as well when the depression or anxiety is not also being treated. Untreated patients are less likely to follow medicine or behavior treatment plans. They also show less response to headache medications, and are more likely to relapse. For these reasons, treating all these conditions is very important.

Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

There are various methods you could use to sooth the symptoms of depression. All of us could stand to exercise more often, but exercise is especially helpful for the depressed mind. It enables you to better handle stress, and the endorphins released during exercise give you a mental boost. Aside from the mental health benefits, the Centers for Disease Control and Prevention (CDC) report that physical activity helps you sleep better at night.


Dietary restrictions are not required for the 6 mg/24 hour patch because there is no risk of hypertensive crisis with this dose, given the lack of MAOa inhibition. Higher doses require dietary restrictions. The patch may be beneficial to those that cannot take oral medications. To avoid serotonin syndrome, initiating and stopping selegiline must be handled carefully.
People who are depressed will usually show a style of thinking that focuses on negative views of the world. They often think of themselves as worthless and of the world as being a bad or unfair place, and they are without hope that their lives will improve in the future. When something bad happens, they blame themselves, but when good things happen, they tell themselves they are just lucky. Furthermore, people with depression are less likely to recognize and appreciate positive events when they happen; rather, they tend to be more tuned into the bad things in their lives and brood over those events.

Therapy. Many people benefit from psychotherapy—also called therapy or counseling.7,8 Most therapy lasts for a short time and focuses on thoughts‚ feelings‚ and issues that are happening in your life now. In some cases‚ understanding your past can help‚ but finding ways to address what is happening in your life now can help you cope and prepare you for challenges in the future.With therapy, you’ll work with your therapist to learn skills to help you cope with life, change behaviors that are causing problems‚ and find solutions. Do not feel shy or embarrassed about talking openly and honestly about your feelings and concerns. This is an important part of getting better.Some common goals of therapy include:


Perimenopause, which is the time of life immediately before and after menopause, can last as long as 10 years. While perimenopause and menopause are normal stages of life, perimenopause increases the risk of depression during that time. Also, women who have had depression in the past are five times more likely to develop major depression during perimenopause.
Persistent depressive disorder, formerly referred to as dysthymia, is a less severe but usually more long-lasting type of depression (dysphoric) compared to major depression. It involves long-term (chronic) symptoms that do not disable but prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with persistent depressive disorder also experience episodes of major depression. Double-depression is the name for this combination of the two types of depression.

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Understanding the main pharmaceutical options requires becoming familiar with a number of acronyms: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), NDRIs (norepinephrine–dopamine reuptake inhibitors), TCAs (tricyclic antidepressants), and MAOIs (monoamine oxidase inhibitors). These represent categories of drugs, grouped together because of their effect on various neurotransmitters (chemical messengers) in the brain.

Additional medication can also be taken. That might help to relieve the symptoms, but no antidepressant can guarantee that. It can take a long time for a medication to start helping some people. Other people still have symptoms even after trying several different medications. They can then discuss the alternative treatment options with their doctor.
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.6 Why smokers are more likely than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause‚ smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
Depression can lead to isolation. Loneliness is a common experience with 80% of the population under 18 years of age. A lack of interaction and connection can worsen depression symptoms. Obviously, you can’t make your child have friends or force them to socialize. Some children find it hard to socially interact and make the first move with new friends. That’s why this subject matter is delicate and takes time. You can:

Educate Yourself. Depression is a type of illness, and illnesses tend to make people feel out of control. One way to regain a sense of control is to educate yourself about your illness. You can do this by talking with your doctors and therapists, by listening to what other people who have had depression have to say about it, and by reading as much as you can. The more you know about what depression is and how it may be treated, the better chance you have of figuring out the combination of treatments and techniques that will help you feel better. There are literally thousands of self-help books out there for depression. Some of them are even worth reading. We provide a list of such books we consider worthwhile at the end of this document.
Patience is required because the treatment of depression takes time. Sometimes, the doctor will need to try a variety of antidepressants before finding the medication or combination of medications that is most effective for the patient. Sometimes, it's necessary to increase the dosage to be effective or decrease the dosage to alleviate medication side effects.

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.

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.

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.
On the other end of the spectrum, researchers are exploring a salvage medication for people with suicidal depression: ketamine, a street drug that can induce hallucinations and out-of-body experiences but that can also provide astonishingly swift relief from depression. Ketamine is currently undergoing clinical trials; meanwhile, physicians warn that this drug can be abused.
In the 1950s and '60s, health care professionals divided depression into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970s and '80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive illness? Although experts sometimes dispute these issues, most agree on the following:
In the practice of evidence-based medicine, it’s considered less wise to prescribe treatments that rely too heavily on hypothetical explanations for how they might work in the body. Instead, we should rely on high-quality, low-bias research that proves which treatments work best. In that light, take the Botox research — and for that matter, Celebrex and ketamine too — with a few grains of salt. The Botox review looked at a very small number of patients, and the researchers were looking at their own original clinical trials. A couple of them have ties to Botox’s maker, Allergan. All three approaches need more research on benefits and harms.
Depression can have a significant impact on the structure and function of many parts of the brain. This can result in many negative consequences. For example, people with severe depression are at higher risk of suffering from anxiety, chronic depression, other emotional issues, or having more medical problems or chronic pain. The trouble thinking (cognitive problems) that depression sufferers may experience can persist even after the illness resolves. People with a chronic illness, such as diabetes and heart disease, who also have depression tend to have worse outcome of their medical illness.
When you’re depressed, it can feel like there’s no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.
Some medical conditions can trigger depressive symptoms in individuals. This is called depressive disorder due to another medical condition. Endocrine and reproductive system disorders are commonly associated with depressive symptoms. For example, people with low levels of the thyroid hormone (hypothyroidism) often experience fatigue, weight gain, irritability, memory loss, and low mood. When the hypothyroidism is treated it usually reduces the depression. Cushing's syndrome is another hormonal disorder caused by high levels of the hormone cortisol which can also cause depressive symptoms. Other conditions that have been found to cause depression include conditions such as HIV/AIDS, diabetes, strokes, Parkinson’s disease etc.

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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