The majority of patients suffering from depression benefit from medication, which in many cases is essential for optimal recovery. It has now been shown that a combination of medication and psychotherapy is the most effective treatment for many patients. The decision to initiate treatment, which is often difficult for the depressed patient, should always be discussed in detail with the patient.
The Very Principle of Establishing Drug Treatment
In some cases, psychotherapy may be the first option. Depending on the degree of suffering, previous experience with medication, the patient’s attitude toward different forms of therapy, and the analysis of the patient’s situation, prescribing medication as a first-line treatment may be more or less appropriate.
Thus, a patient with a history of several depressions and who has had good results with a given medication will benefit from a prescription at the first consultation. While another patient whose depressive state has little impact on their daily functioning and is linked to a life event (illness of a loved one, promotion at work, etc.) will benefit from another approach (relaxation, cognitive behavioral therapy).
The Different Classes of Drugs That Can Be Prescribed
🌸 Antidepressants Themselves
- ✓ Act on different neurotransmitters* in the brain, such as serotonin, adrenaline, dopamine;
- ✓ Ideally improve the symptoms of depression, they are to be taken as a continuous treatment, i.e. regardless of any possible variation in the depressive state from one day to the next;
- ✓ There are herbal antidepressants recognized by official medicine.
💤 Sedatives and Sleeping Pills
These two classes of drugs are quite often combined with antidepressants, as many depressed patients experience anxiety and insomnia because, unlike antidepressants, they have an effect from the start of taking them.
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⚠️ Risks of Addiction
The fear of addiction is probably the main argument for patients to refuse drug treatment. It is important to know that the development of an addiction to any substance also depends on the attitude one has towards the substance in question.
If we know that alcohol is a substance that can be pleasurable in certain situations, we are much less likely to develop an addiction problem than if we use it as a remedy in many situations experienced as difficult: insomnia, shyness, relationship conflict, etc.
Obviously, every substance has its own potential for addiction: the risk of nicotine addiction is among the highest. Furthermore, the medications prescribed for depressive states, antidepressants themselves, do not cause addiction, but the vast majority of sedatives and sleeping pills can cause addiction syndrome, depending on personal sensitivity, the duration of treatment and the dosage.
📋 Potential Side Effects
The sometimes very long list of side effects listed in the leaflet can frighten the patient. Adverse effects can affect all systems of the human body; here are some examples:
- ➤ Digestive system: constipation, diarrhea, abdominal discomfort, nausea;
- ➤ Nervous system: tremors, headaches, anxiety;
- ➤ Endocrine system: increased appetite, weight gain and loss:
- ➤ Skin system: sweating, rash:
- ➤ Cardiovascular system: hypotension, palpitations, feeling of “dizziness”, cardiac arrhythmia;
- ➤ Sexual system: erectile dysfunction, reduced libido;
- ➤ Psychic system: anxiety, concentration problems, irritability, sleep disorders.
Side effects generally appear at the beginning of treatment and disappear or decrease significantly thereafter. In principle, all side effects (undesirable) are reversible when treatment is stopped.
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Interaction with Other Drugs
Many situations are described where drugs taken together can influence each other, sometimes to the point that simultaneous intake is prohibited.
💊 Medication Side Effects to Watch For – Especially in Elderly Patients
Many medications, both psychiatric and non-psychiatric, have similar side effects, such as fatigue and low blood pressure. This should be taken into account when combining several medications, especially in elderly patients.
🧠 Epilepsy Medications and Drug Interaction Risks
Some drugs used in the treatment of epilepsy increase the catabolism (breakdown) of other drugs, which then risk having a blood concentration that is too low and the daily dosage then needs to be increased.
⚠️ MAOIs – Rarely Used Antidepressants with Strict Precautions
A specific class of antidepressants (very rarely used today) called MAOIs, after taking a 15-day waiting period, must be observed before prescribing a new antidepressant. Non-selective monoamine oxidase inhibitors (MAOIs) were among the first antidepressants used in the treatment of depression, developed in the 1950s. They are very rarely prescribed today because of their side effects and the dietary restrictions to which they are linked.
🌿 Caution with Herbal Medicines – Risk of Serotonin Syndrome
Herbal medicines are not always harmless, so they should not be combined with antidepressants that increase serotonin levels because there is a risk of serotonin syndrome.
⏳ When Antidepressants Start Working – What to Expect
The time that normally elapses before the medication begins to work. While sedatives and sleeping pills generally work within half an hour of taking them, antidepressants generally take 2 weeks to work, with variations in both directions. This period can seem very long to a patient in pain, especially since, as mentioned above, side effects can appear as early as the first day of taking them.
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The Possible Duration of Treatment
Here too, a distinction must be made between the different classes of drugs:
💊 With Antidepressants
It is generally suggested to continue treatment from the moment one has recovered from depression for 6-12 months, after which the dosage can be gradually reduced and the risk of a relapse is reasonably low.
Obviously, each situation must be analyzed individually: a patient who has already had numerous depressive episodes will have to continue treatment for much longer, while another, who suffers from any side effect, may possibly stop treatment earlier.
🌙 With Sedatives and Sleeping Pills
Sedatives and sleeping pills should be taken for the shortest possible time; as soon as remission begins, it is recommended to try to gradually reduce these medications.
What is true for all forms of therapy, i.e., that they should not be stopped without the advice of the therapist, is particularly true for drug treatment: both the end and the beginning of the treatment must be discussed in detail with the prescribing physician.
🧠 Neurotransmitters
Also called “neuromediators“, these are molecules in the brain that act on alertness, memory, feelings of well-being, stress, etc. Examples of neurotransmitters: acetylcholine, adrenaline, noradrenaline, dopamine, serotonin, histamine, glutamate, neuropeptides, etc.
What Are the Treatments for Depression?
Once the diagnosis of depression has been made, you can implement several therapeutic approaches.
💊 Drug Treatments
Drug therapies are the first-line treatment. These treatments mostly act on the balance of neurotransmitter production: serotonin, norepinephrine, and dopamine. Several therapeutic molecules are sometimes combined.
Recently, a new molecule, ESKETAMINE, was granted marketing authorization as a nasal spray for the treatment of depression in the United States. However, 38% of patients do not respond to drug treatments and 54% of them show no remission of depression symptoms after 12 weeks of treatment.
🧲 Transcranial Magnetic Stimulation (TMS)
For these so-called “pharmaco-resistant” patients, physical treatments are considered. These therapies are based on transcranial (non-invasive) electrical or magnetic stimulation of brain regions identified as being involved in the development of the disease.
Transcranial magnetic stimulation (TMS) involves using a magnetic field in the cerebral cortex to alter the electrical activity that allows information to be transmitted between neurons. This therapy has been shown to be effective in other psychiatric and neurological conditions and appears to work in depression.
⚡ Electroconvulsive Therapy (ECT)
Electroshock therapy, a little more invasive, is highly effective in the most severely ill patients. It involves electrical stimulation of specific regions of the cortex rather than magnetic fields. Finally, for the most severe cases of depression, resistant to other therapies, deep brain stimulation is indicated.
This stimulation is carried out using electrodes implanted in specific regions of the brain and which deliver, like a pacemaker for the heart, permanent electrical stimulation to the neurons of very targeted regions of the brain.
🧘 Behavioral Therapies
In association with these treatments, psychotherapies, behavioral therapies and meditation are very beneficial therapeutic approaches for preventing recurrences of major depressive episodes. Neurofeedback, for example, a technique used to self-relax and modify stress levels, could contribute to improving attention disorders in people with depression.
With the aim of increasing practitioners’ potential for action, connected objects, mobile objects, allow remote contact with the patient and collect more information about the person and are rapidly expanding.
💬 Take the First Step Toward Recovery
Depression treatment works best when it’s tailored to your unique needs. Talk to a qualified professional today to find the right plan for you — whether it’s medication, therapy, or advanced treatments like TMS or ECT.
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✅ FAQs About Effective Depression Treatment
What are the most effective ways to treat depression?
The most effective treatments for depression include a combination of medication and psychotherapy. Depending on the severity and type of depression, modern therapies like TMS, ECT, and behavioral therapies may also be recommended.
How long does it take for antidepressants to start working?
Antidepressants usually take about 2 weeks to show noticeable effects, though some patients may experience improvement sooner or later. Sedatives and sleeping pills work faster, often within 30 minutes.
Are antidepressants safe and do they cause addiction?
Most antidepressants are safe and non-addictive. However, sedatives and sleeping pills can carry a risk of addiction depending on personal sensitivity, dosage, and duration of treatment.
What are the common side effects of depression medications?
Depression medications can cause side effects affecting the digestive system, nervous system, endocrine system, skin, cardiovascular system, sexual function, and mood. Most side effects are temporary and reversible once treatment is stopped.
What are alternative or advanced treatments if medication doesn’t work?
For patients not responding to medication, advanced treatments include transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), deep brain stimulation, and behavioral therapies. These therapies target brain function and help manage severe or treatment-resistant depression.