Alternatives to Antidepressants

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Alternatives to Antidepressants

Question:

I have suffered from depression for many years. I am tired of taking pills, which are not helping me. Are there any alternatives to taking antidepressants?

Answer:

Some people with depression are lucky -- they get complete relief from taking an antidepressant. But the majority -- even after trying many antidepressants -- get only partial relief. Some get little or no relief at all.

Fortunately, antidepressant medications are not the only treatments. I know you're not asking about other pills, but antidepressants are not the only drugs used to treat depression. Mood stabilizers, antianxiety drugs, and others may help. You may want to explore those options with your doctor.

But, since you're tired of taking pills, I'll point out some of the other approaches.

First, review your health in general. Medical problems and drugs you may take for other conditions can influence mood. Talk with your doctor about this.

The major alternative to drug treatment is psychotherapy. It can be just as effective as antidepressants. The best-studied form of psychotherapy is cognitive behavioral therapy. Other forms are available and may be more suited to your problems, for example, psychodynamic psychotherapy and interpersonal psychotherapy. If your problems stem from relationship tensions, you may benefit from couples or family therapy.

When you consider which kind of psychotherapy might be most helpful, take note of the possible causes of your depression. Then you can address these with a therapist. Possible causes include a new or long-standing stress, tensions in close family relationships, and any major losses (recent or in the past).

A word about alcohol and drugs: You may learn that you use substances in search of relief from depression, but substances can make depression worse. This can be a difficult, but worthwhile problem to confront.

If your depression is in the mild-to-moderate range, these may help:

• Exercise may improve the brain circuits that are responsible for mood. The blood and energy supplied to the brain also improve. On top of that, exercise is good for your general health and self-esteem. It's tough to dive into a new, vigorous exercise program, but even a little exercise, such as a daily 30-minute walk, can be a boon.

• Medication involves focusing and regulating your attention. It can relieve stress and enhance relaxation. Meditation has distinct effects on the brain. When researchers measured brain electrical activity before, immediately after, and four months after a two-month course in mindfulness meditation, they found persistent increased activity in a part of the brain that is associated with joyful and serene emotions.

You might not want to rule out medication completely. Researchers have found that combining psychotherapy and antidepressants is the most effective treatment. By continuing medication, and adding a few of the therapies discussed here, you give yourself the best chance of feeling better.

Other Therapies

To fight depression, some people try so-called "natural" remedies such as St. John's wort, S-adenosyl-L-methionine (SAMe), and omega-3 fatty acids. There is not enough reliable evidence to support their use. Some studies have shown them to be helpful and relatively safe for milder forms of depression, but these studies have generally been small.

These products — sometimes called "nutraceuticals" — are not regulated as drugs, but as dietary supplements. This means it may be difficult to find a product that contains a reliable dosage. It also may be hard to find a reliable list of side effects. Insurance companies usually don't pay for them and they can be expensive. So, if you decide to use them, be cautious.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Last updated:	July 20, 2009