Beyond lifestyle changes, treatments for depression and mood disorders fall into two main categories. You may find that one approach works best for you, or you may decide to combine both treatment types. Before getting started, check to see if your insurance plan places any limits on mental health services. These may not be covered at the same level as other medical services.
Psychotherapy may sound intimidating, but it simply means having a series of appointments with an accredited mental health professional. Although the nature and timing of sessions can vary, typically they focus on helping you lessen distress, solve problems constructively, turn around negative thoughts, deal with emotional issues, and get support from family and friends.
One specific type of psychotherapy is cognitive behavioral therapy (CBT). This approach helps you identify, understand, and then change the negative thoughts you’re having, which in turn can improve your emotional health and ability to function. In other words, you learn to take charge of your thoughts and find solutions, instead of just spinning your wheels and continuing to feel depressed. To find a certified psychologist or therapist in your area, go to the American Psychological Association web site.
Another type of psychotherapy is Emotionally Focused Therapy (EFT), which is one of the most study-proven therapies for couples. Often, issues with depression and anxiety are interrelated with relational issues, resulting in a strained emotional connection, which can worsen depression and anxiety. EFT helps individuals and couples strengthen their emotional bond by helping them identify, experience, make sense of, and strengthen their emotional connection. To find a certified EFT therapist, go to The International Centre for Excellence in Emotionally Focused Therapy.
If psychotherapy isn’t an option for you (whether because of time constraints or cost) or it doesn’t relieve your symptoms entirely, antidepressants may be an important part of your treatment plan. Although another round of medication may worry you, antidepressants are a sound approach to easing depression, certain aspects of grieving, and anxiety. Only health care providers and psychiatrists can prescribe antidepressants; psychologists and psychotherapists can’t. Some antidepressants are also helpful for treating hot flashes, so remember this if you’re having both depression and hot flashes.
Antidepressant medications work by balancing brain chemicals called neurotransmitters, which affect mood and emotions. Examples of neurotransmitters include serotonin, norepinephrine, and dopamine. Commonly prescribed types of antidepressants include:
- SSRIs (selective serotonin reuptake inhibitors) such as Lexapro (chemical name: escitalopram); Celexa (chemical name: citalopram); and Zoloft (chemical name: sertraline).
- SNRIs (selective norepinephrine reuptake inhibitors): Examples include Cymbalta (chemical name: duloxetine); Effexor XR (chemical name: venlaxafine); and Pristiq (desvenlaxafine)
- Wellbutrin (chemical name: bupropion): This medication works on the neurotransmitter dopamine, which controls the brain’s reward and pleasure centers.
There are some other types of antidepressants — including tricyclics and MAOI inhibitors — so you and your doctor will figure out what works best for you with the least side effects. In most cases, your doctor will start you on a lower dose at first, increasing it as needed to improve your symptoms. It can take up to 6 weeks for an antidepressant to provide the relief you’re seeking.
If you’re taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take to manage hot flashes. Some antidepressants — including Paxil, Wellbutrin, Prozac, Cymbalta, and Zoloft — may interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.
Some studies have suggested that the herbal supplement St. John’s wort may be helpful for mild depression, but not as effective for moderate to severe depression. Also, since it’s sold over the counter as a supplement (not as prescription medication), the amount of active ingredient can vary from brand to brand. It’s important to know that St. John’s wort can interfere with the effectiveness of certain chemotherapy medications. Talk with your doctor if you’re considering using this or any other supplement from the drugstore.
“Getting the support you need from family, friends, co-workers, and support groups can help with the blues — but when depression and stubborn sadness hits, you need to take it seriously and reach out for professional attention and care.”– Marisa Weiss, M.D., chief medical officer, Breastcancer.org