Materiały źródłowe

• #1 Management of Depression in Adults: A Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38856993/

  Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women. […] Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. […] A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression.

• #2 Psychiatry.org – What Is Depression?

  https://www.psychiatry.org/patients-families/depression/what-is-depression

  Depression is among the most treatable of mental disorders. Between 70% and 90% percent of people with depression eventually respond well to treatment. […] To diagnose depression, a healthcare professional will conduct a thorough diagnostic evaluation that includes a comprehensive interview to discuss your symptoms in addition to your personal, medical and family histories. Moreover, a physical examination should be performed to screen for underlying medical conditions that may mimic depression such as hormonal imbalances, vitamin deficiencies, neurological problems and drug or alcohol use. […] Antidepressants may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. […] Psychotherapy, or talk therapy, is also often recommended. Cognitive behavioral therapy (CBT), one of the most common forms of psychotherapy, has been found to be effective in treating depression. […] ECT is a medical treatment that is generally reserved for those with severe depressive episodes who have not responded to other treatments. […] Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications.

• #3 Patient education: Depression treatment options for adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics/print

  Patient education: Depression treatment options for adults (Beyond the Basics) […] This topic reviews the initial treatment of depression in adults. […] For all of these reasons, getting treatment for depression is very important. […] Initial treatment of depression depends on several factors, including the severity of symptoms and your preferences. […] In general, options include: […] Mild symptoms – People with mild depression have some symptoms but generally do not have severe distress or inability to function. Treatments for people with mild symptoms include „watchful waiting” (being closely monitored by a doctor or nurse), psychotherapy, and exercise. […] Moderate symptoms – People with moderate depression have more symptoms and may have thoughts of suicide. Doctors usually recommend antidepressant medications or psychotherapy.

• #4 Patient education: Depression treatment options for adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics

  Patient education: Depression treatment options for adults (Beyond the Basics) […] This topic reviews the initial treatment of depression in adults. […] For all of these reasons, getting treatment for depression is very important. […] Initial treatment of depression depends on several factors, including the severity of symptoms and your preferences. […] In general, options include: […] Mild symptoms – People with mild depression have some symptoms but generally do not have severe distress or inability to function. Treatments for people with mild symptoms include „watchful waiting” (being closely monitored by a doctor or nurse), psychotherapy, and exercise. […] Moderate symptoms – People with moderate depression have more symptoms and may have thoughts of suicide. Doctors usually recommend antidepressant medications or psychotherapy.

• #5 Patient education: Depression treatment options for adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics/print

  Severe depression – People with severe depression have many symptoms that interfere with their ability to function. When people are severely depressed, a combination of antidepressant medication and psychotherapy may be called for. […] During treatment, your doctor will assess how treatment is working and recommend adjustments as needed (for example, changing the dose of an antidepressant). […] Antidepressants — There are several classes of antidepressant medications. […] Selecting an antidepressant — For people with mild to moderate depression who start treatment with an antidepressant, experts suggest SSRIs. […] Your doctor can talk to you about the different medication options and help you choose one based on your situation and preferences. […] Psychotherapy — All forms of psychotherapy include support from a professional who is focused on helping you to make positive changes.

• #6 Patient education: Depression treatment options for adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics

  Severe depression – People with severe depression have many symptoms that interfere with their ability to function. When people are severely depressed, a combination of antidepressant medication and psychotherapy may be called for. […] Antidepressants – There are several classes of antidepressant medications. […] Selecting an antidepressant – For people with mild to moderate depression who start treatment with an antidepressant, experts suggest SSRIs. […] Psychotherapy – All forms of psychotherapy include support from a professional who is focused on helping you to make positive changes. […] Research shows that psychotherapy is about as effective as antidepressants. […] In addition to antidepressants and psychotherapy, there are other things you can do to help manage your depression.

• #7 Types of Psychotherapy for Depression

  https://www.verywellmind.com/types-of-psychotherapy-for-depression-1067407

  Cognitive therapy helps people learn to identify common patterns of negative thinking (known as cognitive distortions) and turn those negative thoughts into more positive ones, thus improving mood. […] Cognitive therapy is usually short-term and goal-focused. […] Behavioral therapy is centered on changing behaviors that affect emotions. […] Because cognitive therapy and behavioral therapy work well together to treat depression and anxiety disorders, the two are often combined in an approach called cognitive behavioral therapy (CBT). […] Research suggests that CBT can be effective in the treatment of depression and may have lasting effects that prevent future relapses of depressive symptoms. […] Dialectical behavior therapy is mostly based on CBT. […] The National Alliance on Mental Health states that DBT has been shown to be effective in the treatment of mental illnesses, including depression.

• #8 Treatments for depression – Beyond Blue – Beyond Blue

  https://www.beyondblue.org.au/mental-health/depression/treatments-for-depression

  A mental health professional will work with you to identify unhelpful thought and behaviour patterns. Unhelpful thoughts and behaviours can make you feel more depressed and stop you from getting better. […] CBT will help you replace unhelpful thoughts and behaviours with new ones that reduce your depression. It can be delivered one-on-one with a professional, in groups, or online. […] Behaviour therapy is used as part of CBT. Unlike CBT it doesnt attempt to change beliefs and attitudes. […] Behaviour therapy focuses on encouraging activities that are rewarding, pleasant or satisfying. It aims to reverse the patterns of avoidance, withdrawal and inactivity that make depression worse. […] IPT is a structured psychological therapy that focuses on problems in personal relationships and the skills needed to deal with these. Relationship problems can have a significant negative effect on someone experiencing depression.

• #9 Depression Treatment: Therapy, Medication, and More | Psych Central

  https://psychcentral.com/depression/depression-treatment

  BA therapy can help people change behaviors, which in turn may help change their moods. […] In ACT, acceptance and mindfulness are key. […] In PST, your therapist may help you define the problem, brainstorm alternative realistic solutions, select a helpful solution, and put that solution in place and evaluate it. […] STPP focuses on interpersonal relationships and unconscious thoughts and feelings. […] Family or couples therapy can help if depression is impacting your family dynamic or the health of your relationships. […] Antidepressants are the most commonly prescribed medications for depression. […] Most antidepressants prescribed today are both safe and effective when taken according to your healthcare professional’s directions. […] SSRIs are some of the most prescribed antidepressants for depression.

• #10 Treatments for depression – Beyond Blue – Beyond Blue

  https://www.beyondblue.org.au/mental-health/depression/treatments-for-depression

  IPT helps you recognise patterns in your relationships that can make your depression worse. […] MBCT uses 'mindfulness meditation’ and is usually delivered in group therapy. It teaches you to focus on the present moment without trying to change it. […] If you have mild or moderate depression, online therapies can be effective. Theyre sometimes known as e-therapies or computer-aided psychological therapy. […] Antidepressant medication can effectively treat moderate to severe depression and some anxiety disorders. […] It can take a while for you to see improvements. Antidepressants take at least 2 weeks before they start to help. Your depression symptoms are likely to begin to improve after 4 to 6 weeks. […] Deciding which antidepressant is best for you can be complex. Even if a treatment is proven to be effective, it may not be equally effective for every person.

• #11 Depression Treatment | Skyland Trail | Atlanta

  https://www.skylandtrail.org/our-programs/what-we-treat/depression/adult-depression/

  As a holistic treatment center for depression, a dietician and personal trainer help clients boost their mood through healthy eating and active living. […] Clients who have lost interest in all activities participate in hands-on groups that reintroduce fun, joy, color, texture, nature, music, and movement. […] Learn new skills and tools for preventing and managing depressive episodes. […] Specialized groups support clients who identify as LGBTQ or BIPOC as well as clients in similar stages of life or with similar challenges, for example clients who are parents, clients who are experiencing grief or loss, or clients working toward sobriety. […] Cognitive Behavioral Therapy (CBT) is a well-tested specialized type of psychotherapy shown to be effective in treating depression. […] Clients with co-occurring borderline personality disorder may be assigned to the dialectical behavior therapy (DBT) recovery community. DBT also may be appropriate for clients with depression who struggle with emotion regulation, self-harm, or frequent suicide attempts.

• #12 Pharmacologic Management of Adult Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html

  A change in treatment should be considered for patients who have not improved after four to 12 weeks of treatment. […] Once remission is achieved, treatment should be continued at the same dose for at least six to 12 months to prevent relapse. […] The decision of when to terminate treatment is based on the patient’s risk of recurrence. […] Tapered withdrawal of SSRIs and SNRIs is necessary to prevent an unpleasant discontinuation syndrome; the risk of this is highest with paroxetine and venlafaxine. […] Current evidence supports the effectiveness of counseling in the treatment of depression, and a recent meta-analysis suggests that the combination of psychotherapy and medication is more effective than medication alone. […] Meta-analyses have shown cognitive behavior therapy to have effectiveness similar to antidepressant medication for patients with mild to moderate depression, as well as for severely depressed outpatients.

• #13 Pharmacologic Management of Adult Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html

  Cognitive behavior therapy also has value for relapse prevention. […] A recent meta-analysis suggests interpersonal therapy to be as effective as medication. […] Electroconvulsive therapy remains an effective treatment for depression, but its effects do not persist with time, and concerns about cognitive impairment make it an unpopular treatment choice.

• #14 Depression Treatment & Management: Approach Considerations, Pharmacologic Therapy for Depression, Psychotherapy

  https://emedicine.medscape.com/article/286759-treatment

  Drugs used for treatment of depression include the following: Selective serotonin reuptake inhibitors (SSRIs), Serotonin/norepinephrine reuptake inhibitors (SNRIs), Serotonin (5HT)-1a agonists, Atypical antidepressants, Serotonin-Dopamine Activity Modulators (SDAMs), Tricyclic antidepressants (TCAs), Monoamine oxidase inhibitors (MAOIs), N-methyl-D-aspartate (NMDA) receptor antagonists, St. John’s wort. […] SSRIs have the advantage of ease of dosing and low toxicity in overdose. SSRIs are greatly preferred over the other classes of antidepressants for the treatment of children and adolescents, and they are also the first-line medications for late-onset depression. This recommendation is supported by the 2019 APA guideline. […] The adverse-effect profile of SSRIs is less prominent than that of some other agents, which promotes better compliance. Common adverse effects include gastrointestinal upset, sexual dysfunction, and changes in energy level (ie, fatigue, restlessness).

• #15 Medications for Treatment of Depression – Psychiatric Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/psychiatric-disorders/mood-disorders/medications-for-treatment-of-depression

  Several drug classes and drugs can be used to treat depression: […] Choice of medication may be guided by past response to a specific antidepressant. Otherwise, SSRIs are often the initial medications of choice. […] Patients and their loved ones should be warned that a few patients may seem more agitated, depressed, and anxious within a week of starting an antidepressant or increasing the dose; symptoms that worsen with treatment should be reported to the physician. […] Evidence suggests that risk of suicidality does not differ among classes of antidepressants, including SSRIs, SNRIs, tricyclic antidepressants, and MAOIs. […] SSRIs include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone. […] A few patients may seem more agitated, depressed, and anxious within a week of starting SSRIs or increasing the dose, and there have been concerns about SSRIs and potential suicidality.

• #16 Medications for Treatment of Depression – Psychiatric Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/psychiatric-disorders/mood-disorders/medications-for-treatment-of-depression

  Discontinuation symptoms (eg, irritability, anxiety, nausea) can occur if the medication is stopped abruptly; such effects are less likely with fluoxetine. […] Serotonin modulators have antidepressant and anxiolytic effects but do not cause sexual dysfunction. […] These medications (eg, desvenlafaxine, duloxetine, levomilnacipran, venlafaxine, vortioxetine) have a dual 5-HT and norepinephrine mechanism of action, as do tricyclic antidepressants (TCAs). […] Bupropion is currently the only medication in this class. It can help depressed patients with concurrent attention-deficit/hyperactivity disorder or cocaine use disorder and those trying to stop smoking. […] Although effective, these medications are now rarely used because overdose causes toxicity and they have more adverse effects than other antidepressants.

• #17 Medications for Treatment of Depression – Psychiatric Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/psychiatric-disorders/mood-disorders/medications-for-treatment-of-depression

  Their primary value is for treating refractory or atypical depression when selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and sometimes even electroconvulsive therapy (ECT) are ineffective. […] Agomelatine has fewer adverse effects than most antidepressants and does not cause daytime sedation, insomnia, weight gain, or sexual dysfunction. […] Numerous studies have shown that subanesthetic, rather than anesthetic, doses of ketamine often produce a uniquely rapid, though typically short-lived, resolution of depressive symptoms in patients with treatment-resistant major depressive disorder. […] The majority of patients given an antidepressant dose of ketamine experience a global improvement in depressive symptoms that peaks in 3 to 4 hours and then, in most cases, wanes over the next 1 to 2 weeks.

• #18 Depression Treatment & Management: Approach Considerations, Pharmacologic Therapy for Depression, Psychotherapy

  https://emedicine.medscape.com/article/286759-treatment

  According to the 2023 American College of Physicians (ACP) guideline (the most recent release of the guideline) on using second-generation antidepressants to treat depressive disorders, patient preferences should be given serious consideration when choosing the best course of pharmacotherapy for patients with depressive disorders. The patient may want to avoid use of a particular antidepressant if he or she had a previous negative experience with the drug. […] The 2023 ACP guideline advises that treatment for major depressive disorder should be altered if the patient does not have an adequate response to pharmacotherapy within 6-8 weeks. Once satisfactory response is achieved, treatment should be continued for 4-9 months in patients with a first episode of major depression that was not associated with significant suicidality or catastrophic outcomes. In those who have had 2 or more episodes of depression, a longer course of maintenance treatment may prove beneficial.

• #19 List of 90 Depression Medications Compared

  https://www.drugs.com/condition/depression.html

  Depression is treatable with high rates of success. Treatments may include: […] Psychotherapy […] Antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs). […] Responses to antidepressants vary, and most antidepressants take 4 to 6 weeks for full effect. About 50% of patients respond to the first treatment, whereas others may have to try a few different types of antidepressants before they find the best one for them. […] There are several things you can do to help with your symptoms as well, such as: […] Setting realistic and daily goals […] Developing strategies to work through crises situations […] Developing coping and problem-solving skills […] Learning how to develop positive relationships […] Replacing negative thoughts with positive ones.

• #20 Psychiatry.org – What Is Depression?

  https://www.psychiatry.org/patients-families/depression/what-is-depression

  Depression is among the most treatable of mental disorders. Between 70% and 90% percent of people with depression eventually respond well to treatment. […] To diagnose depression, a healthcare professional will conduct a thorough diagnostic evaluation that includes a comprehensive interview to discuss your symptoms in addition to your personal, medical and family histories. Moreover, a physical examination should be performed to screen for underlying medical conditions that may mimic depression such as hormonal imbalances, vitamin deficiencies, neurological problems and drug or alcohol use. […] Antidepressants may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. […] Psychotherapy, or talk therapy, is also often recommended. Cognitive behavioral therapy (CBT), one of the most common forms of psychotherapy, has been found to be effective in treating depression. […] ECT is a medical treatment that is generally reserved for those with severe depressive episodes who have not responded to other treatments. […] Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications.

• #21 Medications for Treatment of Depression – Psychiatric Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/psychiatric-disorders/mood-disorders/medications-for-treatment-of-depression

  If one SSRI is ineffective, another SSRI can be substituted, or an antidepressant from a different class may be used instead. […] Therapeutic response with most classes of antidepressants usually occurs in about 2 to 3 weeks (sometimes as early as 4 days or as late as 8 weeks). […] Continued therapy with an antidepressant for 6 to 12 months (up to 2 years in patients 50) is usually needed to prevent relapse. […] Most antidepressants, especially SSRIs, should be tapered off (by decreasing the dose by about 25%/week) rather than stopped abruptly; stopping SSRIs abruptly may result in discontinuation syndrome (nausea, chills, muscle aches, dizziness, anxiety, irritability, insomnia, fatigue).

• #22 Management of Depression in Adults: A Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38856993/

  A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]). […] Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

• #23 Patient education: Depression treatment options for adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics/print

  Research shows that psychotherapy is about as effective as antidepressants. […] In addition to antidepressants and psychotherapy, there are other things you can do to help manage your depression. […] Exercise in particular may have an especially positive effect on depression. […] Many people with depression also have problems with anxiety and sleeplessness. […] For people with severe depression, experts suggest a combination of antidepressant medication and psychotherapy. […] Another reasonable treatment for severe depression is electroconvulsive therapy (ECT), particularly in people who are actively thinking about suicide and who may be in danger of following through on their plans. […] If you are thinking about getting pregnant, it is important to work with your doctor to make a plan before getting pregnant, if possible. […] Whether or not you take an antidepressant, your doctor may suggest other things to reduce the risk of depression relapse during pregnancy. Starting or continuing psychotherapy is an important option for depression treatment during pregnancy.

• #24 Depression Treatment & Management: Approach Considerations, Pharmacologic Therapy for Depression, Psychotherapy

  https://emedicine.medscape.com/article/286759-treatment

  A wide range of effective treatments is available for major depressive disorder. Medication alone (see Medication) and brief psychotherapy (e.g., cognitive-behavioral therapy, interpersonal therapy) alone can relieve depressive symptoms. There is also empirical support for the ability of brief psychotherapy (CBT) to prevent relapse. […] In children and adolescents, however, pharmacotherapy by itself is insufficient treatment. Moreover, in all patient populations, the combination of medication and psychotherapy generally provides the quickest and most sustained response. Combination therapy has also been associated with significantly higher rates of improvement in depressive symptoms; increased quality of life; and better treatment compliance, especially when treatment is needed for longer than 3 months.

• #25 Treatment-resistant depression – Wikipedia

  https://en.wikipedia.org/wiki/Treatment-resistant_depression

  Treatment-resistant depression (TRD) is often defined as major depressive disorder in which an affected person does not respond adequately to at least two different antidepressant medications at an adequate dose and for an adequate duration. […] Despite being called treatment-resistant, there are many treatment options available which are described in the treatment section below. […] There are multiple strategies that can be used when a medication course is found to be ineffective. The first would be to increase the dosage of medication. Another option is to switch the patient to a different medication. The last two strategies, combination therapy and augmentation therapy, include adding a medication to the patient’s current treatment. […] Increasing the dosage of an antidepressant is a common strategy to treat depression that does not respond after adequate treatment duration.

• #26 Treatment-resistant depression – Wikipedia

  https://en.wikipedia.org/wiki/Treatment-resistant_depression

  Studies have shown a wide variability in the effectiveness of switching antidepressants, with anywhere from 25 to 70% of people responding to a different antidepressant. […] Ketamine has been tested as a rapid-acting antidepressant for treatment-resistant depression in bipolar disorder, and major depressive disorder. […] Electroconvulsive therapy (ECT) is generally only considered as a treatment option in severe cases of treatment-resistant depression. […] There is sparse evidence on the effectiveness of psychotherapy in cases of treatment-resistant depression. However, a review of the literature suggests that it may be an effective treatment option. […] A Cochrane systematic review has shown that psychological therapies (including cognitive behavioural therapy, dialectical behavior therapy, interpersonal therapy and intensive short-term dynamic psychotherapy) added to usual care (with antidepressants) can be beneficial for depressive symptoms and for response and remission rates over the short term (up to six months) for patients with treatment-resistant depression.

• #27 Ketamine for treatment-resistant depression: When and where is it safe? – Harvard Health

  https://www.health.harvard.edu/blog/ketamine-for-treatment-resistant-depression-when-and-where-is-it-safe-202208092797

  Ketamine has been widely used for treatment-resistant depression (TRD) that is, severe depression that has not improved with several other therapies, including people who are experiencing suicidal thoughts. […] A prescription version of ketamine called esketamine (Spravato), given through a nasal spray, was approved in 2019 by the FDA for hard-to-treat depression. […] The effectiveness of ketamine nasal spray for TRD was first demonstrated for short-term treatment in research that showed meaningful decreases in depression scores for the group given ketamine over the group that received a placebo. […] A longer-term study found that nasal ketamine (plus their regular antidepressant) helped people stay in stable remission 16 weeks into treatment. […] Relief from TRD with ketamine happens rapidly: instead of waiting for an antidepressant medicine to hopefully provide some relief over the course of weeks, people who are suffering under the crushing weight of depression can start to feel the benefits of ketamine within about 40 minutes.

• #28 Depression Treatment & Management: Approach Considerations, Pharmacologic Therapy for Depression, Psychotherapy

  https://emedicine.medscape.com/article/286759-treatment

  Electroconvulsive therapy (ECT) is a highly effective treatment for depression. Onset of action may be more rapid than that of drug treatments, with benefit often seen within 1 week of commencing treatment. A course of ECT (usually up to 12 sessions) is the treatment of choice for patients who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves. […] Bright-light therapy (BLT) for seasonal affective disorder is used at an intensity of 10,000 lux for 30-90 minutes daily, usually within 1 hour of arising in the morning. […] The 2023 ACP guideline advises clinicians to choose second-generation antidepressants on the basis of adverse effects, cost, and patient preferences, since all these agents have comparable efficacy. Patient status, response to therapy, and adverse effects of antidepressants should be assessed within 12 weeks of starting therapy.

• #29 Depression Treatment: Therapy, Medication, and More | Psych Central

  https://psychcentral.com/depression/depression-treatment

  SNRIs work by boosting the levels of two neurotransmitters serotonin and norepinephrine in your brain. […] TCAs are older antidepressants, and while they’re not prescribed as often as SSRIs and SNRIs, they still help some people manage depression. […] MAOIs aren’t prescribed as frequently as other types of antidepressants anymore. […] Atypical antidepressants don’t fall into any of the other antidepressant classes. […] Brain stimulation therapies help treat depression with electricity acting on the brain. […] ECT is considered an effective treatment option for severe, chronic, or treatment-resistant depression. […] rTMS is a newer type of brain stimulation that may be an alternative to and more accessible than ECT. […] In some cases, hospitalization may be the best way to keep someone safe if their depression is severe.

• #30 Depression Treatment Options for Adults | Gemini TMS

  https://www.geminitms.com/depression-treatment-options-for-adults/

  In addition to psychotherapy and medication, certain lifestyle changes can also have a significant impact on your overall mood and well-being. […] Transcranial magnetic stimulation, commonly known as TMS, is a breakthrough in depression treatment. This non-invasive procedure uses magnetic fields to stimulate nerve cells in the brain, specifically targeting areas involved in mood control and depression. […] The benefits of TMS are numerous and significant, such as: Non-Invasive and Drug-Free: TMS does not require surgery or implantation of electrodes. Moreover, it doesn’t involve medications, meaning it doesn’t carry the risk of side effects that often come with antidepressant use. […] High Success Rate: Studies have shown that TMS when used either by itself or in combination with medication, has a high success rate in reducing the symptoms of depression. […] Remember, it’s important to discuss these options with your healthcare provider to see if TMS could be a beneficial addition to your individualized treatment plan.

• #31 Exercise is an all-natural treatment to fight depression – Harvard Health

  https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression

  Exercise is as effective as antidepressants in some cases. […] Research shows that exercise is also an effective treatment. „For some people it works as well as antidepressants, although exercise alone isn’t enough for someone with severe depression,” says Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School. […] Exercise supports nerve cell growth in the hippocampus, improving nerve cell connections, which helps relieve depression,” explains Dr. Miller. […] „Start with five minutes a day of walking or any activity you enjoy. Soon, five minutes of activity will become 10, and 10 will become 15.” […] „Pick something you can sustain over time,” advises Dr. Miller. „The key is to make it something you like and something that you’ll want to keep doing.”

• #32 Moderate Depression: Symptoms, Treatment, and Coping

  https://www.verywellmind.com/what-is-moderate-depression-5072794

  While antidepressants are the most effective choice for people who have severe depression, lifestyle modifications may be a helpful choice for people who have mild or moderate symptoms of major depressive disorder. […] Regular physical activity has been shown to help prevent and treat depression. Studies have even shown that exercise can be an effective first-line treatment in cases of mild to moderate depression. […] Practicing good self-care can be helpful when coping with symptoms of depression.

• #33 Treatment – Depression in adults – NHS

  https://www.nhs.uk/mental-health/conditions/depression-in-adults/treatment/

  Antidepressants are not addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose. […] Mindfulness involves paying closer attention to the present moment, and focusing on your thoughts, feelings, bodily sensations and the world around you to improve your mental wellbeing. […] Brain stimulation is sometimes recommended by a specialist to treat severe depression that has not responded to other treatments. […] If you have tried several different antidepressants and there’s been no improvement, a specialist may offer you a medicine called lithium in addition to your current treatment.

• #34

  https://www2.hse.ie/conditions/clinical-depression/treatment/

  Mindfulness is recommended for preventing depression, if you have had 3 or more bouts of depression. […] Electroconvulsive therapy (ECT) can treat severe depression. It is used when the depression has not responded to other treatments. […] Lithium can be used with antidepressants. It can be used for reducing suicidal behaviour and as a mood stabiliser.

• #35 Depression – Mental Health Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/mental-health-disorders/mood-disorders/depression

  Electroconvulsive therapy is sometimes used to treat people with severe depression, including people who have psychosis, are threatening suicide, or are refusing to eat. […] Phototherapy using a light therapy box is the most effective treatment for seasonal depression but may be helpful for other types of depressive disorders. […] Other therapies that stimulate the brain may be tried when initial treatments are ineffective.

• #36 Treatment of Depression | Psychology Today

  https://www.psychologytoday.com/us/basics/depression/treatment-of-depression

  Behavioral activation is a proven source of relief in depression, and while a therapist can help, patients can put it into action on their own. […] Studies consistently show that an anti-inflammatory and metabolically functional diet, regular exercise, exposure to sunlight, social support and companionship, sleep, and sex have an effect on depressive symptoms. […] Exercise is one of the most effective ways to jump-start neuroplasticity the exit ramp from depression. […] Engaging in any form of exercise restores a sense of control over one’s life. Studies show that even 15 minutes of physical activity daily especially in the afternoon can have beneficial effects on mood, energy, and sleep.

• #37 Major depressive disorder: hypothesis, mechanism, prevention and treatment | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01738-y

  Dietary adjustment is an effective, safe, and widely applicable method for preventing MDD, especially by inhibiting MDD-related pathological inflammation. […] Increasing evidence suggests that physical exercise can prevent some mental disorders in addition to cardiovascular disease. […] Social support may have an influence on depression through neuroendocrine pathways, and social support can improve a person’s psychological wellbeing and make the individual more resistant to stress. […] The American Medical Association recommends psychological interventions for individuals who are at a high risk of MDD. […] Acupuncture, which mainly includes traditional body needling, moxibustion, EA, and laser acupuncture, is a traditional Chinese treatment modality used to treat various diseases. […] In conclusion, the common antidepressants can improve some depressive symptoms in some patients with depression, but are always associated with the risk of adverse effects or recurrence.

• #38 Depression Treatment – HelpGuide.org

  https://www.helpguide.org/mental-health/depression/depression-treatment

  Strong social networks reduce isolation, a key risk factor for depression. […] Eating well is important for both your physical and mental health. […] Sleep has a strong effect on mood. […] Make changes in your life to help manage and reduce stress. […] If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. […] If there is no underlying medical cause for your symptoms of depression, talk therapy can be an extremely effective treatment. […] There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy (CBT), interpersonal therapy, and psychodynamic therapy. […] Therapy helps you step back and see what might be contributing to your depression and how you can make changes.

• #39 Pharmacologic Management of Adult Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html

  Treat depression at adequate doses of antidepressants for a minimum of four to eight weeks before labeling a treatment regimen ineffective. […] Monitor patients taking antidepressants for side effects, suicidality, and effectiveness. […] Consider a change in therapy if there is no improvement after four to 12 weeks of antidepressant treatment. […] After treatment failure with an antidepressant, the next option may be a different medication of the same class, a medication from a different class, or augmentation with a second agent. […] The choice of initial treatment with antidepressants should be based on safety, anticipated side effects, and cost. […] Monitoring should be more frequent immediately after treatment onset and after changes in treatment. […] An adequate trial consists of four to eight weeks of treatment. Adjustments in dosage should be made as needed and tolerated.

• #40 Pharmacologic Management of Adult Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html

  A change in treatment should be considered for patients who have not improved after four to 12 weeks of treatment. […] Once remission is achieved, treatment should be continued at the same dose for at least six to 12 months to prevent relapse. […] The decision of when to terminate treatment is based on the patient’s risk of recurrence. […] Tapered withdrawal of SSRIs and SNRIs is necessary to prevent an unpleasant discontinuation syndrome; the risk of this is highest with paroxetine and venlafaxine. […] Current evidence supports the effectiveness of counseling in the treatment of depression, and a recent meta-analysis suggests that the combination of psychotherapy and medication is more effective than medication alone. […] Meta-analyses have shown cognitive behavior therapy to have effectiveness similar to antidepressant medication for patients with mild to moderate depression, as well as for severely depressed outpatients.

• #41 Depression Treatment & Management: Approach Considerations, Pharmacologic Therapy for Depression, Psychotherapy

  https://emedicine.medscape.com/article/286759-treatment

  The 2019 APA guideline emphasizes the need to customize a treatment plan for each patient based on a careful assessment of symptoms, including rating scale measurements administered by a clinician or the patient, as well as an analysis of therapeutic benefits and side effects. […] Treatment should maximize patient function within specific and realistic goals. The initial modality should be chosen on the basis of the following: Clinical assessment, Presence of other disorders, Stressors, Patient preference, Reactions to previous treatment. […] Psychotherapy is often conducted on an outpatient basis with weekly, 60-minute sessions. Although there is wide variation in practice, psychotherapy tends to be time-limited (eg, 16 sessions). […] A treatment is considered efficacious if there is evidence from two or more settings that it is superior to no treatment. A therapy is considered to be possibly efficacious if there is research support from one or more studies in a single setting. It is recommended that individuals seeking psychotherapy for depression receive one with empirical support.

• #42 Pharmacologic Treatment of Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0200/pharmacologic-treatment-of-depression.html

  When discontinuing antidepressants, cognitive behavior therapy should be used to help prevent relapse and recurrence of depressive symptoms. […] For the general adult population, treatment should start with a second-generation antidepressant or psychotherapy. […] If an antidepressant is selected, modest evidence shows that escitalopram, mirtazapine, paroxetine, venlafaxine, and amitriptyline are most effective in reducing depressive symptoms by greater than 50% at eight weeks. […] Psychotherapy (e.g., behavior therapy, cognitive therapy, cognitive behavior therapy, interpersonal psychotherapy, psychodynamic therapy, supportive therapy) is also a first-line treatment for depression. […] The combination of psychotherapy and pharmacotherapy may be more effective than either treatment alone for moderate or severe depression and may reduce risk of relapse and recurrence.

• #43 Depression: Causes, Symptoms, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/9290-depression

  Depression is treatable usually with talk therapy, medication or both. […] The good news is that treatments can be very effective in improving symptoms. […] Depression is one of the most treatable mental health conditions. Approximately 80% to 90% of people with depression who seek treatment eventually respond well to treatment. […] Treatment options include: Psychotherapy (talk therapy) involves talking with a mental health professional. Your therapist helps you identify and change unhealthy emotions, thoughts and behaviors. […] Prescription medicine called antidepressants can help change the brain chemistry that causes depression. […] Brain stimulation therapy can help people who have severe depression or depression with psychosis. […] If you have symptoms of depression, see a healthcare provider or mental health professional. They can give you an accurate diagnosis and suggest treatment options. […] The sooner you get help, the sooner you can feel better.

• #44 Overview – Depression in adults – NHS

  https://www.nhs.uk/mental-health/conditions/depression-in-adults/overview/

  The good news is that with the right treatment and support, most people with depression can make a full recovery. […] Treatment for depression can involve a combination of lifestyle changes, talking therapies and medicine. Your recommended treatment will be based on how severe your depression is. […] Talking therapies, such as cognitive behavioural therapy (CBT), may also be used for mild depression. […] For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. If you have severe depression, you may be referred to a specialist mental health team for intensive specialist talking treatments and prescribed medicine. […] Many people with depression benefit by making lifestyle changes, such as getting more exercise, cutting down on alcohol, giving up smoking and eating healthily. […] Reading a self-help book or joining a support group are also worthwhile. They can help you gain a better understanding about what causes you to feel depressed. Sharing your experiences with others in a similar situation can also be very supportive.

• #45 Depression | Mental Health America

  https://www.mhanational.org/conditions/depression

  Depression is very treatable, with the overwhelming majority of those who seek treatment showing improvement. The most commonly used treatments are antidepressant medication, psychotherapy, or a combination of the two. […] The choice of treatment depends on the pattern, severity, persistence of depressive symptoms, and the history of the illness. As with many illnesses, early treatment is more effective and helps prevent the likelihood of serious recurrences. Depression must be treated by a physician or qualified mental health professional. […] For some people, depression can be very stubborn to treat and may require additional treatment options.

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