Category: Mental Health

Does caffeine make depression worse?

Anxiety, Depression, Mental Health

Does caffeine make depression worse?

There’s no clear link between caffeine intake and depression. However, caffeine intake and depression may be linked indirectly for people who are particularly sensitive to the effects of caffeine or who have too much caffeine.

Caffeine can cause sleep problems that affect mood.Caffeine can make it harder to fall asleep and stay asleep. Lack of sleep can worsen depression. If you have trouble sleeping, don’t drink caffeinated beverages late in the day. Some people need to limit caffeine to the morning or quit drinking caffeinated beverages completely to avoid sleep problems.

Also, anxiety and depression often occur together, and caffeine can worsen anxiety.

Stopping abruptly can worsen depression. If you regularly drink caffeinated beverages, quitting can cause a depressed mood until your body adjusts. It can also cause other signs and symptoms, such as headaches, fatigue and irritability.

If you have depression, consider limiting or avoiding caffeine to see if it helps improve your mood. To lessen these withdrawal effects, gradually reduce the amount of caffeinated beverages you drink.

What does “clinical depression” mean?

Depression, Mental Health

Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

To diagnose clinical depression, many doctors use the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Signs and symptoms of clinical depression may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness

• Angry outbursts, irritability or frustration, even over small matters

• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

• Sleep disturbances, including insomnia or sleeping too much

• Tiredness and lack of energy, so even small tasks take extra effort

• Reduced appetite and weight loss or increased cravings for food and weight gain

• Anxiety, agitation or restlessness

• Slowed thinking, speaking or body movements

• Feelings of worthlessness or guilt, fixating on past failures or self-blame

• Trouble thinking, concentrating, making decisions and remembering things

• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

• Unexplained physical problems, such as back pain or headaches

Symptoms are usually severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities.

Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.

Sources: The Mayo Clinic, McLean Hospital, NAMI

Anorexia Nervosa: Symptoms

Eating Disorders, Mental Health, Youth Mental Health

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn’t really about food. It’s an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia’s serious complications.

Symptoms

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not making expected developmental weight gains

• Thin appearance

• Abnormal blood counts

• Fatigue

• Insomnia

• Dizziness or fainting

• Bluish discoloration of the fingers

• Hair that thins, breaks or falls out

• Soft, downy hair covering the body

• Absence of menstruation

• Constipation and abdominal pain

• Dry or yellowish skin

• Intolerance of cold

• Irregular heart rhythms

• Low blood pressure

• Dehydration

• Swelling of arms or legs

• Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

• Severely restricting food intake through dieting or fasting

• Exercising excessively

• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them

• Frequently skipping meals or refusing to eat

• Denial of hunger or making excuses for not eating

• Eating only a few certain “safe” foods, usually those low in fat and calories

• Adopting rigid meal or eating rituals, such as spitting food out after chewing

• Not wanting to eat in public

• Lying about how much food has been eaten

• Fear of gaining weight that may include repeated weighing or measuring the body

• Frequent checking in the mirror for perceived flaws

• Complaining about being fat or having parts of the body that are fat

• Covering up in layers of clothing

• Flat mood (lack of emotion)

• Social withdrawal

• Irritability

• Insomnia

• Reduced interest in sex

Causes

The exact cause of anorexia is unknown. As with many diseases, it’s probably a combination of biological, psychological and environmental factors.

• Biological. Although it’s not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.

• Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they’re never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

• Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it’s rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

• Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.

• Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

• Transitions. Whether it’s a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

• Anemia

• Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure

• Bone loss (osteoporosis), increasing the risk of fractures

• Loss of muscle

• In females, absence of a period

• In males, decreased testosterone

• Gastrointestinal problems, such as constipation, bloating or nausea

• Electrolyte abnormalities, such as low blood potassium, sodium and chloride

• Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

• Depression, anxiety and other mood disorders

• Personality disorders

• Obsessive-compulsive disorders

• Alcohol and substance misuse

• Self-injury, suicidal thoughts or suicide attempts

Prevention

There’s no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

Is it possible to have depression and anxiety at the same time?

Anxiety, Depression, Mental Health

Is it possible to have depression and anxiety at the same time?

Depression and anxiety are different conditions, but they commonly occur together. They also have similar treatments.

Feeling down or having the blues now and then is normal. And everyone feels anxious from time to time — it’s a normal response to stressful situations. But severe or ongoing feelings of depression and anxiety can be a sign of an underlying mental health disorder.

Anxiety may occur as a symptom of clinical (major) depression. It’s also common to have depression that’s triggered by an anxiety disorder, such as generalized anxiety disorder, panic disorder or separation anxiety disorder. Many people have a diagnosis of both an anxiety disorder and clinical depression.

Symptoms of both conditions usually improve with psychological counseling (psychotherapy), medications, such as antidepressants, or both. Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques or getting regular exercise, also may help. If you have either condition, avoid alcohol, smoking and recreational drugs. They can make both conditions worse and interfere with treatment.

Sources: The Mayo Clinic, McLean Hospital, NAMI, NIMH

Antidepressants and Sexual Side Effects

Depression, Medications, Mental Health, Side Effects

Sexual side effects are common with antidepressants in both men and women, so your concern is understandable. Effects on sexual function can include:

• A change in your desire for sex

• Erectile problems

• Orgasm problems

• Problems with arousal, comfort and satisfaction

The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem.

Antidepressants with the lowest rate of sexual side effects include:

• Bupropion (Wellbutrin XL, Wellbutrin SR)

• Mirtazapine (Remeron)

• Vilazodone (Viibryd)

• Vortioxetine (Trintellix)

Antidepressants most likely to cause sexual side effects include:

• Selective serotonin reuptake inhibitors (SSRIs), which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

• Serotonin and norepinephrine reuptake inhibitors (SNRIs),which include venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).

• Tricyclic and tetracyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and clomipramine (Anafranil).

• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). However, selegiline (Emsam), an MAOI that you stick on your skin as a patch, has a low risk of sexual side effects.

If you’re taking an antidepressant that causes sexual side effects, your doctor may recommend one or more of these strategies:

• Waiting several weeks to see whether sexual side effects get better.

• Adjusting the dose of your antidepressant to reduce the risk of sexual side effects. But always talk with your doctor before changing your dose.

• Switching to another antidepressant that may be less likely to cause sexual side effects.

• Adding a second antidepressant or another type of medication to counter sexual side effects. For example, the addition of the antidepressant bupropion may ease sexual side effects caused by another antidepressant.

• Adding a medication to improve sexual function, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra, Staxyn). These medications are approved by the Food and Drug Administration only to treat sexual problems in men. Limited research suggests that sildenafil may improve sexual problems caused by antidepressants in some women, but more information is needed on its effectiveness and safety in women.

Stopping medication because of sexual side effects is a common problem, and for most people this means depression returns. Work with your doctor to find an effective antidepressant or combination of medications that will reduce your sexual side effects and keep your depression under control.

If you’re pregnant or trying to become pregnant, tell your doctor, as this may affect the type of antidepressant that’s appropriate.

Be patient. Everyone reacts differently to antidepressants, so it may take some trial and error to identify what works best for you.

Sources: The Mayo Clinic, McLean Hospital, NAMI

What antidepressant is right for me?

Depression, Medications, Mental Health

Antidepressants are a popular treatment choice for depression. Although antidepressants may not cure depression, they can reduce symptoms. The first antidepressant you try may work fine. But if it doesn’t relieve your symptoms or it causes side effects that bother you, you may need to try another.

So don’t give up. A number of antidepressants are available, and chances are you’ll be able to find one that works well for you. And sometimes a combination of medications may be an option.

Finding the right antidepressant

There are a number of antidepressants available that work in slightly different ways and have different side effects. When prescribing an antidepressant that’s likely to work well for you, your doctor may consider:

• Your particular symptoms. Symptoms of depression can vary, and one antidepressant may relieve certain symptoms better than another. For example, if you have trouble sleeping, an antidepressant that’s slightly sedating may be a good option.

• Possible side effects. Side effects of antidepressants vary from one medication to another and from person to person. Bothersome side effects, such as dry mouth, weight gain or sexual side effects, can make it difficult to stick with treatment. Discuss possible major side effects with your doctor or pharmacist.

• Whether it worked for a close relative. How a medication worked for a first-degree relative, such as a parent or sibling, can indicate how well it might work for you. Also, if an antidepressant has been effective for your depression in the past, it may work well again.

• Interaction with other medications. Some antidepressants can cause dangerous reactions when taken with other medications.

• Pregnancy or breast-feeding. A decision to use antidepressants during pregnancy and breast-feeding is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, certain antidepressants, such as paroxetine (Paxil, Pexeva), may be discouraged during pregnancy. Work with your doctor to find the best way to manage your depression when you’re expecting or planning on becoming pregnant.

• Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, venlafaxine (Effexor XR) may relieve symptoms of anxiety disorders and bupropion may help you stop smoking. Other examples include using duloxetine (Cymbalta) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraines.

• Cost and health insurance coverage. Some antidepressants can be expensive, so it’s important to ask if there’s a generic version available and discuss its effectiveness. Also find out whether your health insurance covers antidepressants and if there are any limitations on which ones are covered.

Types of antidepressants

Certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Most antidepressants relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells. Each type (class) of antidepressant affects these neurotransmitters in slightly different ways.

Many types of antidepressant medications are available to treat depression, including:

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

• Serotonin and norepinephrine reuptake inhibitors (SNRIs).Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima).

• Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. More commonly prescribed antidepressants in this category include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Wellbutrin SR, Wellbutrin XL, others). Bupropion is one of the few antidepressants not frequently associated with sexual side effects.

• Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren’t prescribed unless you’ve tried other antidepressants first without improvement.

• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medications haven’t worked, because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods — such as certain cheeses, pickles and wines — and some medications, including pain medications, decongestants and certain herbal supplements. Selegiline (Emsam), an MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medications can’t be combined with SSRIs.

• Other medications. Your doctor may recommend combining two antidepressants, or other medications may be added to an antidepressant to enhance antidepressant effects.

Antidepressants and risk of suicide

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Making antidepressants work for you

To get the best results from an antidepressant:

• Be patient. Once you and your doctor have selected an antidepressant, you may start to see improvement in a few weeks, but it may take six or more weeks for it to be fully effective. With some antidepressants, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for the antidepressant to take effect.

• Take your antidepressant consistently and at the correct dose. If your medication doesn’t seem to be working or is causing bothersome side effects, call your doctor before making any changes.

• See if the side effects improve. Many antidepressants cause side effects that improve with time. For example, initial side effects when starting an SSRI can include dry mouth, nausea, loose bowel movements, headache and insomnia, but these symptoms usually go away as your body adjusts to the antidepressant.

• Explore options if it doesn’t work well. If you have bothersome side effects or no significant improvement in your symptoms after several weeks, talk to your doctor about changing the dose, trying a different antidepressant (switching), or adding a second antidepressant or another medication (augmentation). A medication combination may work better for you than a single antidepressant.

• Try psychotherapy. In many cases, combining an antidepressant with talk therapy (psychotherapy) is more effective than taking an antidepressant alone. It can also help prevent your depression from returning once you’re feeling better.

• Don’t stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause significant withdrawal-like symptoms unless you slowly taper off your dose. Quitting suddenly may cause a sudden worsening of depression.

• Avoid alcohol and recreational drugs. It may seem as if alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug problems.

Sources: The Mayo Clinic, NAMI, NIH, NIMH

Atypical Depression: Symptoms

Depression, Mental Health

Any type of depression can make you feel sad and keep you from enjoying life. However, atypical depression — also called depression with atypical features — means that your depressed mood can brighten in response to positive events. Other key symptoms include increased appetite, sleeping too much, feeling that your arms or legs are heavy, and feeling rejected.

Despite its name, atypical depression is not uncommon or unusual. It can affect how you feel, think and behave, and it can lead to emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.

Treatment for atypical depression includes medication, talk therapy (psychotherapy) and lifestyle changes.

Symptoms

Symptoms of atypical depression can vary from person to person. Key signs and symptoms may include:

• Depression that temporarily lifts in response to good news or positive events

• Increased appetite or weight gain

• Sleeping too much but still feeling sleepy in the daytime

• Heavy, leaden feeling in your arms or legs that lasts an hour or more in a day

• Sensitivity to rejection or criticism, which affects your relationships, social life or job

For some people, signs and symptoms of atypical depression can be severe, such as feeling suicidal or not being able to do basic day-to-day activities.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your mental health professional.

• Call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use their webchat on suicidepreventionlifeline.org/chat.

• Seek help from your primary doctor or other health care provider.

• Reach out to a close friend or loved one.

• Contact a minister, spiritual leader or someone else in your faith community.

If a loved one or friend is in danger of attempting suicide or has made an attempt:

• Make sure someone stays with that person.

• Call 911 or your local emergency number immediately.

• Or, if you can do so safely, take the person to the nearest hospital emergency room.

Causes

It’s not known exactly what causes atypical depression or why some people have different features of depression. Atypical depression often starts in the teenage years, earlier than other types of depression, and can have a more long-term (chronic) course.

As with other types of depression, a combination of factors may be involved. These include:

• Brain differences. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems change, leading to depression.

• Inherited traits. Depression is more common in people whose blood relatives also have the condition.

Risk factors

Risk factors for atypical depression may include:

• History of bipolar disorder

• Misuse of alcohol or recreational drugs

• Traumatic childhood experiences

• Environmental stressors

Your risk of atypical depression may also increase if you have:

• Blood relatives with a history of depression, bipolar disorder or alcoholism

• Stressful life events, such as the death of a loved one

Complications

Like other types of depression, atypical depression is a serious illness that can cause major problems. Atypical depression can result in emotional, behavioral and health problems that affect every area of your life.

For example, atypical depression can be associated with:

• Weight gain due to an increased appetite

• Personal and work relationship problems due to rejection sensitivity

• Drug or alcohol use due to trouble coping

• Other mental health disorders such as anxiety

• Suicide from feelings of depression

Prevention

There’s no sure way to prevent atypical depression, but these strategies may help.

• Take steps to control stress, to increase your resilience and to boost your self-esteem.

• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.

• Get treatment at the earliest sign of a problem to help prevent depression from worsening.

• Consider long-term maintenance treatment to help prevent a relapse of symptoms.

Sources: The Mayo Clinic, McLean Hospital, NAMI

Antonine Wall

Ancient Roman Empire/Republic, Ancient World, Mental Health

Hadrian’s wall gets all the press, but…

The Antonine Wall, known to the Romans as Vallum Antonini, was a turf fortification on stone foundations, built by the Romans across what is now the Central Belt of Scotland, between the Firth of Forth and the Firth of Clyde. Representing the northernmost frontier barrier of the Roman Empire, it spanned approximately 63 kilometres (39 miles) and was about 3 metres (10 feet) high and 5 metres (16 feet) wide.

Treatment Resistant Depression

Coping Strategies, Depression, Medications, Mental Health, Mental Illness Treatments, Therapies

If you’ve been treated for depression but your symptoms haven’t improved, you may have treatment-resistant depression. Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren’t enough. They may not help much at all, or your symptoms may improve, only to keep coming back.

If your primary care doctor prescribed antidepressants and your depression symptoms continue despite treatment, ask your doctor if he or she can recommend a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

The psychiatrist reviews your medical history and may:

• Ask about life situations that might be contributing to your depression

• Consider your response to treatment, including medications, psychotherapy or other treatments you’ve tried

• Review all of the medications you’re taking, including nonprescription drugs and herbal supplements

• Discuss whether you’re taking your medications as prescribed and following other treatment steps

• Consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems

• Consider a diagnosis of another mental health condition,such as bipolar disorder, which can cause or worsen depression and may require different treatment; dysthymia, a mild but long-term (chronic) form of depression; or a personality disorder that contributes to the depression not getting better

Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps.

Medication strategies

If you’ve already tried an antidepressant and it didn’t work, don’t lose hope. You and your doctor simply may not have found the right dose, medication or combination of medications that works for you. Here are some medication options that your doctor may discuss with you:

• Give your current medications more time. Antidepressants and other medications for depression typically take four to eight weeks to become fully effective and for side effects to ease up. For some people, it takes even longer.

• Increase your dose, if indicated. Because people respond to medications differently, you may benefit from a higher dose of medication than is usually prescribed. Ask your doctor whether this is an option for you — don’t change your dose on your own as several factors are involved in determining the proper dose.

• Switch antidepressants. For a number of people, the first antidepressant tried isn’t effective. You may need to try several before you find one that works for you.

• Add another type of antidepressant. Your doctor may prescribe two different classes of antidepressants at the same time. That way they’ll affect a wider range of brain chemicals linked to mood. These chemicals are neurotransmitters that include dopamine, serotonin and norepinephrine.

• Add a medication generally used for another condition.Your doctor may prescribe a medication that’s generally used for another mental or physical health problem, along with an antidepressant. This approach, known as augmentation, may include antipsychotics, mood stabilizers, anti-anxiety medications, thyroid hormone or other drugs.

• Consider the cytochrome P450 (CYP450) genotyping test, if available. This test checks for specific genes that indicate how well your body can process (metabolize) a medication. Because of inherited (genetic) traits that cause variations in certain cytochrome P450 enzymes, medications may affect people differently. But a CYP450 test isn’t a sure way to tell which antidepressant will work — it only provides clues. And this test is not always covered by insurance.

Psychological counseling

Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression. For example, psychotherapy can help you:

• Find better ways to cope with life’s challenges

• Deal with past emotional trauma

• Manage relationships in a healthier way

• Learn how to reduce the effects of stress in your life

• Address substance use issues

If counseling doesn’t seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else. As with medications, it may take several tries to find a treatment that works. Psychotherapy for depression may include:

• Cognitive behavioral therapy. This common type of counseling addresses thoughts, feelings and behaviors that affect your mood. It helps you identify and change distorted or negative thinking patterns and teaches you skills to respond to life’s challenges in a positive way.

• Acceptance and commitment therapy. A form of cognitive behavioral therapy, acceptance and commitment therapy helps you to engage in positive behaviors, even when you have negative thoughts and emotions. It’s designed for treatment-resistant conditions.

• Interpersonal psychotherapy. Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression.

• Family or marital therapy. This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression.

• Psychodynamic treatment. The aim of this counseling approach is to help you resolve underlying problems linked to your depression by exploring your feelings and beliefs in-depth.

• Dialectical behavioral therapy. This type of therapy helps you build acceptance strategies and problem-solving skills. This is useful for chronic suicidal thoughts or self-injury behaviors, which sometimes accompany treatment-resistant depression.

• Group psychotherapy. This type of counseling involves a group of people who struggle with depression working together with a psychotherapist.

Procedures to treat depression

If medications and psychotherapy aren’t working, you may want to talk to a psychiatrist about additional treatment options:

• Electroconvulsive therapy (ECT). While you are asleep, a carefully measured dose of electricity is passed through your brain, intentionally triggering a small, brief seizure. ECT seems to cause changes in brain chemistry that can relatively quickly reverse symptoms of major depression. Although there are potential side effects, such as temporary confusion or temporary memory loss, a series of ECT treatments may provide significant relief of severe depression.

• Repetitive transcranial magnetic stimulation (rTMS).Generally only used when ECT isn’t effective, rTMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. An electromagnetic coil is placed against your scalp near your forehead. The electromagnet used in rTMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression.

• Vagus nerve stimulation (VNS). Generally, VNS is only tried after other brain stimulation therapies such as ECT and rTMS have not been successful in improving symptoms of depression. VNS stimulates the vagus nerve with electrical impulses. This treatment uses a device implanted in your chest that’s connected by a wire to a nerve in your neck (vagus nerve). Electrical signals from the implant travel along the vagus nerve to the mood centers of the brain, which may improve depression symptoms.

Be sure to find out whether your insurance covers any treatment that’s recommended.

Other steps you can take

To make the most of depression treatment:

• Stick to your treatment plan. Don’t skip therapy sessions or appointments. It’ll take time to get better. Even if you feel well, don’t skip your medications. If you stop, depression symptoms may come back, and you could experience withdrawal-like symptoms. If side effects or drug costs are a problem, talk with your doctor and pharmacist to discuss options.

• Stop drinking or using recreational drugs. Many people with depression drink too much alcohol or use recreational drugs or marijuana. In the long run, alcohol and drugs worsen depression and make it harder to treat. If you can’t stop drinking alcohol or using drugs on your own, talk to your doctor or mental health professional. Depression treatment may be unsuccessful until you address your substance use.

• Manage stress. Relationship issues, financial problems, an unhappy work life and many other issues can all contribute to stress, which in turn worsens depression. Try stress-reduction techniques such as yoga, tai chi, meditation, mindfulness, progressive muscle relaxation or writing your thoughts in a journal.

• Sleep well. Poor sleep may worsen depression. Both the amount of time and how well you sleep can affect your mood, energy level, ability to concentrate and resilience to stress. If you have trouble sleeping, research ways to improve your sleep habits or ask your doctor or mental health professional for advice.

• Get regular exercise. Exercise has a direct effect on mood. Even physical activity such as gardening or walking can reduce stress, improve sleep and ease depression symptoms.

Don’t settle for a treatment that’s partially effective at relieving your depression or one that works but causes intolerable side effects. Work with your doctor or other mental health professional to find the best treatment possible, even though it may take time and effort to try new approaches.

Sources: The Mayo Clinic, McLean Hospital, NAMI, NIH, NIMH