Not all people who experience these vulnerabilities become depressed. Many people have positive influences on various levels which counter these predispositions, alter their schemas and provide protection against depression. In other words, they are resilient. For those who do become depressed, there are treatments which are often quite successful. There is considerable controversy though, over “what works best”. As can be seen from the symptoms above, depression can strike at three levels – thoughts, emotions, and physical changes. The most effective treatment for depression is a combination of medication and various forms of psychotherapy (see the link to the article by Larry Sandburg, MD, under the “FAQ” tab) which may address more than one level of symptoms. I believe that a combination of medication and other forms of therapy, termed “integrative psychopharmacology” is often effective. In my practice, I have seen my clients augment their response to treatment when “stuck” by introducing the correct medication(s).
There are three major classes of medication used to treat depression, which are tricyclics, the first class of medication discovered in the 1950’s, the MAO inhibitors, and the newer serotonin and seratonin-norephinephrine reuptake inhibitors (SSRI’s and SNRI’s). Each of these classes of medication works on different neurotransmitter systems in different ways and has its own side effect profile. For a comprehensive review of medication for depression, see.
Research has shown that medication, now most commonly SSRI’s and SNRI’s is helpful for about 50-60% of people, although there are problems with some of this research. Medication is not the panacea that many people hoped it to be and has significant side effects. While it can certainly be helpful in reducing symptoms, other forms of treatment should also be sought.
Psychotherapy for Depression
There are many forms of psychotherapy that can be helpful for treatment of depression and I will discuss a few here. Traditional psychoanalysis and psychodynamic forms of psychotherapy, which explore unconscious content and focus on personality structure and defenses can be helpful for depression. However, there is little research conducted to determine their effectiveness. Although psychodynamically-oriented approaches may be very helpful in alleviating depressive thoughts and behaviors, forms of therapy with a stronger research base are often used. Cognitive behavioral therapy (CBT) is often used to help a depressed client gain objectivity about specific negative cognitive distortions he or she may have been living with for years. A CBT therapist might help a client reflect on the evidence for these distortions, allowing for space to disconfirm them and attempt to use alternate thoughts, and reinforced other behaviors, in their place. For a more detailed review of CBT see:
Interpersonal psychotherapy for depression is a time-limited, manualized approach. It rests on the premise that negative life events and depressed mood interact bi-directionally. An IPT therapist will take a thorough interpersonal history and draw associations between depressed states, interpersonal relationships and life events. For more details on IPT see
Other Forms of Treatment- Brain Stimulation
For depression that is “treatment-resistant”, or does not respond to medication and psychotherapy, treatment is often augmented by other forms of medication including stimulants, lithium, or certain newer antipsychotic medications. However, the most effective treatment for severe or treatment resistant depression remains electroconvulsive therapy (ECT), which is a much maligned but highly effective treatment if conducted properly. ECT is a form of brain stimulation. Modern ECT is painless and fast, and produces minimal memory loss if tailored to each person’s needs. For an updated review of ECT, and other forms of brain stimulation see: