Treating Depression: Depression

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Treating depression

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If we were all carbon copies of one another, identifying the causes of depression and its proper treatment would be simpler. But unique differences in life experience, temperament, and biology make treatment a complex matter. No single treatment works for everyone. However, research suggests that many people benefit from a combination of medication and therapy (see "Drugs and therapy: A winning combination?").

Often, treatment is divided into three phases. Keep in mind, though, that there are no sharp lines dividing the phases, and very few people take a straight path through them.

In the acute phase, the aim is to relieve your symptoms. Generally, this occurs within 6–12 weeks, but it may take longer depending on your response to the first treatments you try.
In the continuation phase, you work with your doctor to maximize your improvements. Further treatment adjustments, such as modifying dosage of a medication, can help. This period takes another four to five months.
In the maintenance phase, the aim is to prevent relapse. Ongoing treatment is often necessary, especially if you have already experienced several depressive episodes, have chronic low mood, or have risk factors that make a recurrence more likely.

Who should you see for treatment?

On your road to treatment, your primary care doctor may be your first stop. A good primary care doctor can assess your symptoms with an eye to whether you have any underlying medical problems. If your doctor believes that depression is the main problem, he or she may suggest an antidepressant. Sometimes the initial response to the medication is good. If so, you may not need to go further.

However, if you don't respond well to the first medication, your doctor may refer you to a mental health professional, such as a psychiatrist, psychologist, social worker, or psychiatric nurse. Most primary care doctors aren't equipped to do a more detailed review of the mood problem or to take treatment further with psychotherapy or different medications.

You can also find a mental health professional through a local clinic or hospital or through recommendations from family members or friends. While some insurance plans leave the choice of therapist up to you, others limit you to professionals enrolled in their networks. Therefore, it's worthwhile to check with your insurer before choosing a doctor.

Since states have different requirements about who may hang out a shingle as a therapist, inquire about the therapist's training, and opt only for one who has been formally trained and certified (see "Ten questions to ask when choosing a therapist"). Some people like to meet with a few therapists before making the commitment to work with one. Even the most highly recommended person may not be the right match for you. Beginning therapy can be uncomfortable, but if a therapist's demeanor or office set-up puts you off, you needn't waste your time trying to make the situation work.

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Last updated:	January 23, 2007

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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