Antidepressants are usually taken daily. The goal in the first few weeks and months is to relieve the symptoms and, if possible, make the depression go away. Once that has been achieved, the treatment is continued for at least four to nine months. This continuation therapy is necessary to stop the symptoms from coming back. The medication is sometimes taken for longer to prevent relapses. The duration of treatment also depends on how the symptoms develop over time and whether there is an increased risk of relapse. Some people take antidepressants for several years.
Bupropion inhibits neuronal dopamine reuptake and decreases the rate of norepinephrine activity. In addition to major depressive disorder, the indications for bupropion include smoking cessation. Off-label indications include attention-deficit/hyperactivity disorder and depression associated with bipolar disorder. Common side effects include headache and mild weight loss. Unlike other antidepressants, bupropion does not cause sexual dysfunction.
Medication. Many people with depression find that taking prescribed medications called antidepressants can help improve their mood and coping skills. Talk to your doctor about whether they are right for you. If your doctor writes you a prescription for an antidepressant‚ ask exactly how you should take the medication. If you are already using nicotine replacement therapy or another medication to help you quit smoking, be sure to let your doctor know. Several antidepressant medications are available‚ so you and your doctor have options to choose from. Sometimes it takes several tries to find the best medication and the right dose for you, so be patient. Also be aware of the following important information:

Connect with others. It’s common to withdraw when you’re feeling depressed, but this can make you feel worse. Try to reconnect with friends. Again, make your goal realistic: if you’ve been avoiding your friends altogether, a starting point might be to send a text or (finally) to reply to one. If you don’t feel like leaving the house, you could ask them to come and hang out with you at home.


Major depression is characterized by at least five of the diagnostic symptoms of which at least one of the symptoms is either an overwhelming feeling of sadness or a loss of interest and pleasure in most usual activities. The other symptoms that are associated with major depression include decrease or increase in appetite, insomnia or hypersomnia, psycho motor agitation or retardation, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt, recurrent thoughts of death and suicidal ideation with or without specific plans for committing suicide, and cognitive difficulties, such as, diminished ability to think, concentrate and take decisions. The symptoms persist for two weeks or longer and represent a significant change from previous functioning. Social, occupational, educational, or other important functioning is also impacted. For instance, the person may start missing work or school, or stop going to classes or their usual social activities. 

TCAs are safe and generally well tolerated when properly prescribed and administered. However, if taken in overdose, TCAs can cause life-threatening heart-rhythm disturbances. Some TCAs can also have anticholinergic side effects, which are due to the blocking of the activity of the nerves that are responsible for control of the heart rate, gut motion, visual focus, and saliva production. Thus, some TCAs can produce dry mouth, blurred vision, constipation, and dizziness upon standing. The dizziness results from low blood pressure that occurs upon standing (orthostatic hypotension). Anticholinergic side effects can also aggravate narrow-angle glaucoma, urinary obstruction due to benign prostate enlargement (hypertrophy), and cause delirium in the elderly. Patients with seizure disorders or a history of strokes should avoid TCAs.


Sometimes it is best to both take medication and see a therapist. Medications can be helpful in many cases. Sometimes people are afraid of acting and thinking strangely, or becoming dependent on drugs used to treat anxiety and depression. When these medications are taken as prescribed by a doctor, bad side effects can be reduced or eliminated and there is little risk of becoming addicted to them. Remember that these medications are not the same as street drugs used to get high.
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.
ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.
The new world of pharmacogenetics holds the promise of actually keeping the genes responsible for depression turned off so as to avoid the illnesses completely. Also, by studying genes, we are learning more about the matching of patients with treatment. This kind of information can tell us which patients do well on which types of drugs and psychotherapy regimens.
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.
Getting support plays an essential role in overcoming depression. On your own, it can be difficult to maintain a healthy perspective and sustain the effort required to beat depression. At the same time, the very nature of depression makes it difficult to reach out for help. When you’re depressed, the tendency is to withdraw and isolate so that connecting to even close family members and friends can be tough.
Mental health concerns among college students have increased in recent years—rates of depression, anxiety, substance use and suicidal behaviors have all increased. One in four college students had a psychiatric diagnosis in the past year, and racial-ethnic minority students maybe at high risk of undetected mental illnesses, according to new research published in Psychiatric Services.
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.
Medication may be right for you if depression is interfering with your ability to function in an important part of your life—work, school, or in your relationships, for example. However, many people use antidepressants when therapy, exercise, or self-help strategies would work just as well or better—minus the unpleasant side effects. Even if you decide to take medication, it’s a good idea to pursue therapy and lifestyle changes that can help you get to the bottom of your underlying issues and develop the tools to beat depression for good. See Coping with Depression and Depression Treatment
Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake and also has a weak effect on norepinephrine and dopamine neuronal reuptake. It has slight anticholinergic effects and may cause more weight gain than other SSRIs. Paroxetine is sometimes prescribed for indications that are not FDA approved, such as eating disorders and the relief of vasomotor symptoms of menopause.
Serotonin syndrome: Serotonin syndrome is a serious medical condition that can occur when medications that alter the concentration of serotonin in the brain are taken together. Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. Examples of medications that can cause serotonin syndrome include antidepressants, some pain relievers such as meperidine (Demerol) or tramadol (Ultram), St. John's wort, medicines used to treat migraine headaches called triptans, and some street drugs such as cocaine.
Serotonin and norepinephrine reuptake inhibitors or SNRIs are the newest class of antidepressants. SNRIs work by increasing the levels of serotonin and norepinephrine that are active in the brain. Serotonin and norepinephrine are produced by nerves and released into the surrounding tissues where they can attach to nearby receptors on other nerves, thereby stimulating the other nerves. The released serotonin and norepinephrine then are taken up and released again by the nerves that produce them. SNRIs block the uptake ("reuptake") of the serotonin and norepinephrine so that more of the serotonin and norepinephrine are free in the tissues surrounding the nerves.
For example, abruptly stopping an SSRI such as paroxetine can cause dizziness, nausea, flu-like symptoms, body aches, anxiety, irritability, fatigue, and vivid dreams. These symptoms typically occur within days of abrupt cessation, and can last one to two weeks (up to 21 days). Among the SSRIs, paroxetine and fluvoxamine cause more pronounced discontinuation symptoms than fluoxetine, sertraline, citalopram, escitalopram, vortioxetine, and vilazodone. Some patients experience discontinuation symptoms despite gradual tapering of the SSRI. Abrupt cessation of venlafaxine, duloxetine, desvenlafaxine, or levomilnacipran can cause discontinuation symptoms similar to those of SSRIs.
If you tend to worry a lot, even when there’s no reason, you may have anxiety. It may be something you are so used to that you may think it’s just “how you are.” Common worries include health, money, family, or work. While everyone worries about these things once in a while, if you always expect the worst, it can get in the way of living a normal life. Though researchers are still investigating the causes of anxiety, they have identified the areas of the brain responsible for fear and anxiety and are using proven studies to increase knowledge in this field in an effort to create improved treatments for anxiety and related disorders.
The relationship between these emotions — and their associated clinical conditions, anxiety disorders and mood disorders — is complex and somewhat idiosyncratic. For one person, anxiety can lead to avoidance and isolation, and isolation, in turn, can result in a lack of opportunity for pleasurable experiences and then, low mood. For another individual, feeling down may zap them of the energy to do things they typically enjoy, and attempts to re-engage with the world after being out of practice may result in some nervousness.
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.
When you’re depressed, just getting out of bed can seem like a daunting task, let alone working out! But exercise is a powerful depression fighter—and one of the most important tools in your recovery arsenal. Research shows that regular exercise can be as effective as medication for relieving depression symptoms. It also helps prevent relapse once you’re well.
Research utilizing brain-imaging technologies, such as magnetic resonance imaging (MRI), shows that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior appear to function abnormally. It is not clear which changes seen in the brain may be the cause of depression and which ones the effect.
The SSRIs are not thought to be as worrisome in patients with cardiac disease, as they do not appear to exert any effect on blood pressure, heart rate, cardiac conduction, or cardiac rhythm; however, dose-dependent QT prolongation has been reported with citalopram. Because of the risk for QT prolongation, citalopram is contraindicated in individuals with congenital long QT syndrome. [103, 104]
Persistent Depressive Disorder; refers to a longer lasting form of depression. While Major Depressive Disorder is diagnosed if an individual experiences symptoms for at least 2 weeks, Persistent Depressive Disorder is used when symptoms of depression are present on most days for at least two years, but do not reach the severity of a major depressive episode. (Prior to the release of the DSM-5 this was more commonly known as Dysthymia.)
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.
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.
Clinical depression is different from normal sadness — like when you lose a loved one, experience a relationship breakup, or get laid off from work — as it usually consumes a person in their day-to-day living. It doesn’t stop after just a day or two — it will continue for weeks on end, interfering with the person’s work or school, their relationships with others, and their ability to just enjoy life and have fun. Some people feel as if a huge hole of emptiness has opened inside when experiencing the hopelessness associated with this condition. In any given year, 7 percent of Americans will be diagnosed with this condition; women are 2 to 3 times more likely to be diagnosed than men (American Psychiatric Association).

Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.
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.
Some people find that herbal remedies, such as St. John’s Wort, help with their depression symptoms. Remember that even herbal remedies can have side effects and may interfere with other medications. Dosages can also vary depending on the brand you use. Talk about the risks and benefits of herbal or other alternative treatments with your health care provider and make sure they know all the different treatments you’re trying.
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. 
Getting support plays an essential role in overcoming depression. On your own, it can be difficult to maintain a healthy perspective and sustain the effort required to beat depression. At the same time, the very nature of depression makes it difficult to reach out for help. When you’re depressed, the tendency is to withdraw and isolate so that connecting to even close family members and friends can be tough.
Interpersonal and cognitive/behavioral therapies are two of the short-term psychotherapies that research has shown to be helpful for some forms of depression. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression. A form of cognitive behavioral therapy, dialectical behavior therapy (DBT) tends to focus on intensive, simultaneous acceptance of the depression sufferer's abilities, while motivating emotionally healthy changes using a highly structured approach. This form of therapy treats severely or chronically depressed people. Psychodynamic therapies sometimes treat depression. They focus on resolving the patient's internal psychological conflicts rooted in childhood. Long-term psychodynamic therapies are particularly important if there seems to be a lifelong history and pattern of inadequate ways of coping (maladaptive coping mechanisms) by using negative or self-injurious behavior.
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.

Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.
Selegiline inhibits MAOb at lower doses and both forms at higher doses. Because it does not inhibit MAOa, it does not require dietary restrictions at lower doses. Lower doses of oral selegiline (Eldepryl) appear to lack antidepressant properties and are usually prescribed to treat Parkinson disease. Higher doses are used to treat major depressive disorder, and the selegiline transdermal patch is FDA approved for this indication. Selegiline is sometimes used off-label to treat attention-deficit/hyperactivity disorder.

Thus far in this document, we've described therapies that are generally best prescribed and monitored by clinical professionals. However, it is also possible to take a self-help approach to the treatment of depression under certain circumstances. Self-help approaches emphasize what people can do for themselves rather than what professionals can offer.
Much work remains to help determine the best treatment options for different types of patients. We also need to better understand the impact that treating depression and anxiety has on headache. Remember, it is extremely important to obtain best treatment for each disorder: the depression or anxiety and the headache disorder. Safe and effective drug and behavioral therapies are available, so talk with your provider about any symptoms that you have.

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.”

This class of drugs is frequently used for short-term management of anxiety and as an add on treatment, in treatment resistant anxiety disorders.They are not recommended as a treatment for Post Traumatic Stress Disorder. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.

Focus on behaviors. If the person is reluctant to seek help, then don’t try to convince the person that a mood disorder is causing the problems. Instead, talk about their behaviors and the ways in which treatment can help. For example, after you have listened and sympathized with the person’s feelings, try to agree on wellness goals (e.g., consistent sleep and feeling less irritable). Then, try to assign some action steps that you can agree on to reach these goals (e.g., after two weeks, if the person does not improve, you will set up a medical evaluation).

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.
The new world of pharmacogenetics holds the promise of actually keeping the genes responsible for depression turned off so as to avoid the illnesses completely. Also, by studying genes, we are learning more about the matching of patients with treatment. This kind of information can tell us which patients do well on which types of drugs and psychotherapy regimens.
The presence of maternal-fetal stress is another risk factor for depression. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. Researchers believe that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.
Tricyclic antidepressants (TCAs) were developed in the 1950s and '60s to treat depression. They are called tricyclic antidepressants because their chemical structures consist of three chemical rings. TCAs work mainly by increasing the level of norepinephrine in the brain synapses, although they also may affect serotonin levels. Doctors often use TCAs to treat moderate to severe depression. Examples of tricyclic antidepressants are amitriptyline (Elavil), protriptyline (Vivactil), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), trimipramine (Surmontil), and perphenazine (Triavil).
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.

Obsessive Compulsive Disorder (OCD) is when a person has unwanted, intrusive, persistent or repetitive thoughts (whakaaro), feelings, ideas, or sensations (obsessions) which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those thoughts. For example, the person may be afraid of germs and try to relieve the anxiety through repeated hand washing or avoiding touching things like door knobs. They may know these thoughts (whakaaro) are unreasonable but be unable to stop them. When OCD is severe and left untreated, it can be very distressing, and get in the way of work (mahi), school (kura) and normal life at home. 
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.
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
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