Depression (Major Depressive Disorder - MDD) is a treatable condition. Effective care often combines psychotherapy, medication, and lifestyle adjustments. Treatment plans are tailored to each individual’s needs, depending on the severity of symptoms and personal circumstances.

 

Psychotherapy

Psychotherapy is a cornerstone of depression treatment, especially for mild to moderate cases, or as a complement to medication. Common approaches include:

 

1. Cognitive Behavioural Therapy (CBT)

• Core idea: Thoughts, emotions, and behaviours are closely interconnected. Negative thinking patterns can trigger negative emotions and unhelpful behaviours. By restructuring thoughts, patients can improve mood and actions.

• Focus: Behavioural experiments and cognitive restructuring to reduce helplessness and self‑criticism.

• Best for: Patients with low mood, self‑doubt, excessive worry, or social withdrawal.

2. Interpersonal Psychotherapy (IPT)

• Core idea: Emotions are strongly linked to relationships. Improving interpersonal interactions supports emotional recovery.

• Focus: Addressing conflicts, role transitions (e.g., job loss, divorce), and grief.

• Best for: Depression related to major life events or interpersonal stress.

3. Mindfulness‑Based Therapy

• Core idea: Mindfulness practice enhances awareness of the present moment and reduces overreaction to negative emotions.

• Focus: Accepting emotions rather than resisting them, lowering relapse risk.

• Best for: Patients with recurrent depression or co‑existing anxiety.

4. Supportive Psychotherapy

• Core idea: Providing emotional support, encouragement, and practical coping strategies.

• Focus: Creating a safe space for dialogue and reducing feelings of isolation.

• Best for: Patients needing stable emotional support and lifestyle guidance.

 

Pharmacotherapy (Medication)

Medication is especially important for moderate to severe depression. Antidepressants regulate brain neurotransmitters, improving mood and daily functioning. Prescriptions must be managed by a doctor, with dosage adjusted based on effectiveness and side effects.

Common Classes of Antidepressants:

1. SSRIs (Selective Serotonin Reuptake Inhibitors)

   • Examples: Sertraline, Escitalopram

   • Advantages: Fewer side effects, generally well tolerated

2. SNRIs (Serotonin‑Norepinephrine Reuptake Inhibitors)

   • Examples: Venlafaxine, Duloxetine

   • Advantages: Regulate both serotonin and norepinephrine, improving mood and energy. Helpful for patients with both depression and chronic pain.

3. TCAs (Tricyclic Antidepressants)

   • Older medications, still effective for some patients

   • Note: More side effects, requiring close monitoring

4. Other Antidepressants

   • Examples: Mirtazapine, Bupropion

   • Features: Can be tailored to specific symptoms such as insomnia or fatigue

Treatment duration: Typically at least 6–12 months to prevent relapse. Never stop medication abruptly—always taper under medical supervision.

 

Lifestyle Modifications

Healthy daily habits are powerful allies in recovery. Even with therapy or medication, lifestyle changes remain a vital foundation for emotional well‑being.

Recommended adjustments:

• Regular exercise: 30 minutes of moderate activity (e.g., brisk walking, swimming, yoga) 3–5 times per week

• Balanced diet: Plenty of fruits, vegetables, whole grains, and lean protein; reduce high‑sugar, high‑fat foods

• Adequate sleep: Maintain consistent sleep routines, avoid late nights

• Limit alcohol and caffeine: Excess can disrupt sleep and mood stability

• Build social support: Stay connected with family and friends, join community activities or support groups

 

Depression treatment is most effective when it combines psychotherapy, medication, and lifestyle changes. With the right support and early intervention, recovery is not only possible but highly achievable.

 

 

Complete Guide to Antidepressant Medications

Depression (Major Depressive Disorder - MDD) is a common but treatable mental health condition. For people with moderate to severe depression, medication is often an essential part of recovery.

Many people misunderstand antidepressants, worrying that they may cause “addiction” or “change one’s personality.” In fact, antidepressants are not addictive drugs. They work by regulating brain neurotransmitters to help restore emotional balance.

This guide explains the different types of antidepressants, how they work, their benefits, side effects, and when they are most suitable—so you can feel more informed and confident during treatment.

 

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

Examples: Sertraline, Escitalopram, Fluoxetine, Paroxetine

• How they work: Block the reuptake of serotonin, increasing its availability in the brain to improve mood, anxiety, and sleep.

• Advantages:

  • Fewer side effects, generally well tolerated

  • Effective for most depression and anxiety cases

  • Widely used with strong safety record

• Disadvantages/Side effects:

  • Early side effects: stomach upset, headache, mild anxiety

  • Possible sexual side effects (reduced libido, delayed ejaculation)

  • Must taper gradually to avoid withdrawal symptoms

• Best suited for:

  • First‑time antidepressant users

  • Depression with anxiety symptoms

 

2. Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)

Examples: Venlafaxine, Duloxetine, Desvenlafaxine

• How they work: Block reuptake of both serotonin and norepinephrine, boosting mood and energy.

• Advantages:

  • Broader improvement in mood and motivation

  • Effective for depression with chronic pain (e.g., fibromyalgia, neuropathic pain)

  • May improve focus and daytime energy

• Disadvantages/Side effects:

  • Can raise blood pressure, cause sweating

  • Must taper gradually to avoid withdrawal

  • Slightly more side effects than SSRIs

• Best suited for:

  • Patients not responding to SSRIs

  • Depression with chronic pain or low motivation

 

3. Norepinephrine–Dopamine Reuptake Inhibitors (NDRIs)

Example: Bupropion

• How it works: Increases norepinephrine and dopamine, enhancing motivation, focus, and pleasure.

• Advantages:

  • No sexual side effects; may improve SSRI‑related sexual dysfunction

  • Helpful for depression with fatigue, sleepiness, poor concentration

  • Also used as a smoking cessation aid

• Disadvantages/Side effects:

  • May cause insomnia, anxiety, dry mouth

  • Not suitable for people with seizure history or eating disorders

• Best suited for:

  • Depression with fatigue and low motivation

  • Patients wishing to avoid sexual side effects

 

4. Tricyclic Antidepressants (TCAs)

Examples: Amitriptyline, Nortriptyline, Imipramine

• How they work: Block serotonin and norepinephrine reuptake, affecting multiple receptors.

• Advantages:

  • Effective for some treatment‑resistant depression

  • Can help with depression plus chronic pain or migraines

• Disadvantages/Side effects:

  • Strong anticholinergic effects (dry mouth, constipation, blurred vision, urinary retention)

  • Risk of heart rhythm problems

  • Dangerous in overdose—requires close monitoring

• Best suited for:

  • Patients unresponsive to newer antidepressants

  • Depression with chronic pain

 

5. Tetracyclic Antidepressants

Example: Mirtazapine

• How it works: Blocks certain receptors, indirectly increasing serotonin and norepinephrine release.

• Advantages:

  • Improves sleep, reduces anxiety

  • Increases appetite—helpful for underweight patients

  • Few sexual side effects

• Disadvantages/Side effects:

  • Weight gain, drowsiness

  • Possible swelling in some patients

• Best suited for:

  • Depression with insomnia or poor appetite

  • Patients needing calming effects

 

6. Melatonin‑Based Antidepressants

Example: Agomelatine

• How it works: Regulates melatonin and serotonin receptors, improving circadian rhythm and mood.

• Advantages:

  • Improves sleep quality and daytime alertness

  • Few sexual side effects

  • Minimal withdrawal symptoms

• Disadvantages/Side effects:

  • Requires liver function monitoring

  • Possible headache, dizziness

• Best suited for:

  • Depression with disrupted sleep cycles

  • Patients sensitive to other drug side effects

 

7. Other Antidepressants

Tianeptine (Stablon)

• Unique mechanism: Enhances serotonin reuptake (unlike most antidepressants) and regulates glutamate and neuroplasticity.

• Advantages: Effective for anxious depression, good gastrointestinal tolerance, rapid onset.

• Cautions: Risk of dependence with misuse; not a first‑line drug in many regions.

Monoamine Oxidase Inhibitors (MAOIs)

• Examples: Phenelzine, Tranylcypromine, Moclobemide (RIMA)

• Advantages: Effective for atypical depression and treatment‑resistant cases

• Cautions: Strict dietary restrictions (aged cheese, wine, cured meats), drug interactions, risk of hypertensive crisis.

Vortioxetine (Brintellix)

• Mechanism: Multi‑modal serotonin modulator, may improve cognition (attention, memory)

• Advantages: Fewer sexual side effects, mild withdrawal, helpful for depression with cognitive impairment

• Cautions: Nausea, headache, diarrhea; higher cost; newer drug with limited long‑term data

Trazodone

• Mechanism: Serotonin antagonist and reuptake inhibitor (SARI) with sedative effects

• Advantages: Improves sleep, few sexual side effects, reduces anxiety

• Cautions: Daytime drowsiness, dizziness, low blood pressure; rare risk of priapism in men

 

sychiatrist’s Key Reminders

1. Antidepressants are not addictive – but must be taken regularly as prescribed and tapered gradually.

2. Patience is needed – benefits usually appear after 2–4 weeks.

3. Side effects are often temporary – many improve within days to weeks.

4. Never stop suddenly – abrupt discontinuation can cause withdrawal or relapse.

5. Medication is only one part of treatment – best results come from combining medication, psychotherapy, and lifestyle changes.

 

Antidepressants are safe, effective, and life‑changing when used correctly under medical supervision. Understanding the different types, benefits, and precautions helps patients feel empowered and supported on their journey to recovery.