Treatment varies depending on the severity of the depression.

A dysthymia-like depression, mild to moderate depression can usually be treated effectively by psychotherapy. In the case of a major depression, the recommended treatment is psychotherapy combined with taking an antidepressant medication.

Several recent studies have shown that antidepressant drugs are especially effective in cases of major depression⁷⁷. In practice, however, antidepressants are often prescribed for moderate depression.

Regardless of the severity of depression, combining “standard” medical treatment with therapy is effective.

In the event that suicidal behavior is evident, it is necessary to resort to thehospitalization. Treatment with electroshock, the purpose of which is to induce a seizure to stimulate the brain, is used in certain cases of major depression that do not respond to other treatments. They are administered under general anesthesia, 2 to 3 times a week for 6 to 12 weeks. It is not known exactly by what mechanisms these treatments work.

In recent years, a new treatment has given promising results in the event of failure of the usual treatments: transcranial magnetic stimulation⁹⁴(transcranial magnetic stimulation or TMS). It is prescribed to people with major depression who have resisted two antidepressants from different classes.

This treatment is carried out using a powerful electromagnet which is at the origin of a magnetic field of short duration. During the sessions, the brain is therefore subjected to short and repeated magnetic impulses for a time defined by the protocol. It does not require general anesthesia, unlike electroshock.

Psychotherapy

Undertake a psychotherapy often helps to understand the meaning of his depression or, at least, what started it. Such therapy also makes it possible to find the means to feel better on a daily basis. You learn to react better to the trials and successes that mark your life. It is then possible to adopt behaviors that protect against a relapse¹⁷.

There are several psychotherapeutic approaches. The cognitive and behavioral therapy is one of the most effective short-term depression methods. Likewise, therapy based on mindfulness (“Mindfulness”) is a recent and proven approach. But the effectiveness of treatment does not depend solely on the type of approach. The personal commitment and will of the depressed person, as well as the relationship of trust that he forges with his therapist would be even more important factors of success. To find out more about the different types of psychotherapy, see our Psychotherapy sheet.

Antidepressant drugs

There are several classes of antidepressants. Here are the most frequently prescribed.

• The imipramic antidepressants, including clomipramine (Anafranil®), amitriptyline (Elavil®, Redomex®, Laroxyl®) and imipramine (Tofranil®), dosulepin (Prothiaden®), doxepin (Sinequan®, Quitaxon®), maprotiline (Ludiomil®), nortriptyline (Nortrilen®). Used since the early 1960s, they cause many side effects (drowsiness, weight gain, constipation, dry mouth, low libido, etc.). It is used less nowadays.

   

• The selective serotonin reuptake inhibitors (SSRIs or serotonergic antidepressants), including citalopram (Celexa®, Seropram®), fluoxetine (Prozac®), fluvoxamine (Luvox®, Floxyfral®), paroxetine (Paxil®, Deroxat®, Divarius®) and sertraline (Zoloft®). This is usually the first choice of treatment for severe depression. Their effectiveness is equivalent to that of tricyclic antidepressants, but they are better tolerated. However, they can be associated with certain side effects: agitation, nausea, nervousness, insomnia, headaches and low libido.

   

• The serotonin and norepinephrine or norepinephrine reuptake inhibitors (IRSN), such as venlafaxine (Effexor®), Duloxetine (Cymbalta®), Milnacipran hydrochloride (Ixel®). They are among the most effective of the antidepressants because they work on two types of neurotransmitters at the same time. However, they can cause more side effects. Usually, they are used when other medications are insufficient to relieve symptoms.

   

• MAOIs (monoamine oxidase inhibitors.

  They are rarely used in France. Iproniazide phosphate (Marsilid®), Moclobémide (Moclamine®), Phénelzine (Nardelzine®, Nardil®)

It is not easy to find a drug with an optimal therapeutic effect. To achieve this, you sometimes have to experiment with different products over several weeks or months.

In addition, a significant proportion of people with depression respond little or no response to antidepressants. The psychiatrist can then prescribe them 2 drugs of different classes simultaneously.

Note on withdrawal from antidepressants

Antidepressants should never be stopped suddenly, as they can cause symptoms if you stop. The dose should therefore be reduced gradually over a few weeks, following the doctor’s advice. However, there are normally no dangerous withdrawal symptoms with antidepressants, only discomforts passengers.

It is desirable, but not always essential, to wait a few days (or more, depending on the drug) before starting another pharmacological or natural treatment. Check with your doctor.

Support or self-help groups

Group psychotherapy sessions are organized in hospitals, clinics and even in private offices as part of short therapy (12 to 15 weeks). For people with depression, this is a way to break isolation or maintain a valuable social bond. There are also groups for relatives of people living with depression.