What If My Depression Doesn't Go Away?

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Excerpted from a Harvard Special Report
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At Your Appointment

What to Ask About Depression

Until doctors have a way to test people ahead of time to see which treatment will work for each individual, finding the right approach is a matter of trial and error. Depending on the severity of the depression and other factors, including your preference, you may start with either psychotherapy or medication, or a combination of the two.

If the first drug you try doesn't work after four to eight weeks of treatment, your doctor may increase your dosage. If that doesn't work, he or she may suggest that you switch to another drug in the same class or a drug in a different class. You can try several different antidepressants in sequence until you find one that is most helpful. Your doctor may also recommend adding psychotherapy if that hasn't been part of your treatment plan.

If you still don't respond to these therapies, your doctor may prescribe an additional medication, such as lithium or an antipsychotic medication, to be taken with the antidepressant. Depending on the type of symptoms and their severity, the next step may be trying electroconvulsive therapy or light therapy.  Newer therapies, such as vagus nerve stimulation or repetitive transcranial magnetic stimulation, are other options for you and your doctor to discuss. Your doctor or mental health professional is also likely to address life circumstances or losses that may be putting pressure on you or a problem with substance abuse that may be getting in the way of your progress.

Having to go through all of these steps may sound discouraging, but finding the treatment that works for you will be worth the effort.

One major study, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, took a close look at how people respond to "real world" treatment, where they try a series of treatments until they find one that works. More than half of the people who participated in the study went into remission after two treatment levels. Overall, 70% of all the people who didn't withdraw from the study got relief from all their symptoms of depression.

You can improve your chances for successful treatment by taking steps to help yourself, including understanding how to take your medication, discussing your plan in detail with your doctor and abiding by it, and keeping up with therapy appointments

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Last Review Date: Oct 31, 2013

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