Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Depression can result in severe emotional, behavioral, health and even legal and financial problems that affect every area of your life.

Complications that depression may cause or be associated with include:

• Suicide
• Alcohol abuse
• Substance abuse
• Anxiety
• Heart disease and other HeartCare-Info conditions
• Work or school problems
• Family conflicts
• Relationship difficulties
• Social isolation

Treatments and drugs

Numerous treatments for depression are available. Standard depression treatment options include:

• Medications
• Psychotherapy
• Electroconvulsive therapy (ECT)

Emerging and less-studied treatments for depression include:

• Brain stimulation
• Complementary and alternative treatments

In some cases, your primary care doctor can treat your depression. In other cases, you may benefit from treatment with a qualified mental health provider, such as a psychiatrist, psychologist or social worker.

Try to be an active participant in your depression treatment. Working together, you and your doctor or therapist can decide which treatment options may be best for your situation, depending on your symptoms and their severity, your personal preferences, insurance coverage, affordability, treatment side effects and other factors. In some cases, though, depression is so severe that a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making.

Here's a closer look at your depression treatment options.

Medications
Dozens of medications are available to treat depression. Most people find the best relief of depression symptoms by combining medications and psychotherapy. Some medications for depression are antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat depression. Doctors also can use their HeartCare-Info judgment to prescribe other medications that haven't been FDA approved to treat depression but that may be effective anyway — a common and perfectly legal practice called off-label use.

There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring biochemicals in your brain to change your mood. To determine which antidepressant may be best for you, doctors typically follow general practice guidelines. They may also ask you to take a blood test called the cytochrome P450 test, which can help identify genetic factors that influence your response to certain antidepressants (as well as some other medications).
Other factors that are considered when choosing an antidepressant are your symptoms, your family history of depression, and other conditions you may have. Don't give up until you find an antidepressant or medication that's suitable for you — you have a good chance of finding one that works and that doesn't have intolerable side effects, even if it takes a few tries.

Most antidepressants are equally effective. But some pose a higher risk of serious side effects. Here's how antidepressants and other medications are generally considered when you're starting treatment for depression:

• Typical first choices. Many doctors start treatment with antidepressants by prescribing an antidepressant known as an SSRI — a selective serotonin reuptake inhibitor. This is because the side effects of the medications in the SSRI class of antidepressants are generally more tolerable than are those of other types of antidepressants, and they also generally work well. SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

  Other common first choices for antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), combined reuptake inhibitors and receptor blockers, and tetracyclic antidepressants.

• Typical second choices. The class of antidepressants called tricyclic antidepressants (TCAs) has been around longer than has the SSRI class, and TCAs are still effective. But because TCAs tend to have more numerous and more severe side effects, they're often not prescribed until you've tried SSRIs first without an improvement in your depression.
• Typical last choices. The class of antidepressants called monoamine oxidase inhibitors (MAOIs) is often prescribed as a last resort, when other medications haven't worked. That's because MAOIs, while generally effective, can have serious harmful side effects. They also require strict dietary restrictions because of rare but potentially fatal interactions with certain foods. Newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.
• Other medication strategies. Your doctor may also suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect, which is sometimes called augmentation.