The Latest on the Medications and Therapies That Treat Depression

Published in June 2024, a recent paper in The Journal of the American Medical Association (JAMA) reviews the latest research on managing depression in adults.

What is Major Depression?

In everyday language, the word depression is used in diverse ways and can refer to anything from passing feelings of sadness and unhappiness to chronic grief and deep despair. When clinicians and therapists use the term depression, however, they usually mean major depression, which is a serious mental illness.

Major depression is a mood disorder defined by persistent feelings of sadness and/or a loss of pleasure and interest in regular activities. It is often accompanied by a variety of symptoms including excessive guilt, lack of energy, concentration difficulties, recurrent thoughts of death or suicide, and significant changes in sleep, appetite/weight, and psychomotor behavior (e.g., agitation).

The lifetime prevalence of depression—which refers to the proportion of the population that will at some point develop this mood disorder—is high, especially among women: Roughly one in six men and one in three women will eventually develop depression.

Some researchers, however, have suggested masculine depression is much more common in men.

Effective Treatments for Depression

First-line treatments for depression consist of antidepressant medications and psychotherapy. But which ones are most effective?

Based on their review of previous meta-analyses of randomized clinical trials, Simon et al. (the authors of the recent paper in JAMA) offer the following conclusions:

Effective psychotherapeutic interventions for depression include behavioral activation, brief psychodynamic therapy, cognitive therapy, interpersonal therapy, mindfulness-based therapy, and problem-solving therapy.

Compared with usual care but without psychotherapy, the above psychological treatments had at least medium-sized effects. The standardized mean differences ranged from 0.50 (for short-term dynamic psychotherapy) to 0.73 (for behavioral activation).

Medications for depression were also effective. Compared to placebo, 21 antidepressants had either small or medium effects.

These medications consisted of bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), fluvoxamine (Luvox), amitriptyline (Elavil), desvenlafaxine (Pristiq), levomilnacipran (Fetzima), milnacipran (Savella), mirtazapine (Remeron), nefazodone (Serzone), vilazodone (Viibryd), Agomelatine (Valdoxan), clomipramine (Anafranil), vortioxetine (Brintellix), reboxetine (Edronax), and trazodone (Desyrel).

The standardized mean differences ranged from 0.23 (for fluoxetine) to 0.48 (for amitriptyline).

The research also showed that for more severe or chronic depression, a combination of antidepressants and psychotherapy was more effective than either modality alone. The standardized mean differences were approximately 0.3. This corresponds to “typical response rates of 50 percent with psychotherapy or medication alone,” but “65 percent for combined treatment.”

What if the first antidepressant prescribed fails to improve symptoms? Then, the following options should be considered: switching medications, adding another antidepressant, or augmenting with a different type of medication (e.g., stimulants, antipsychotics, thyroid hormones). According to the data, these three approaches have a nearly equal likelihood of success.

Source: Surprising_SnapShots/Pixabay

Takeaway

If you have low mood, excessive shame and guilt, concentration difficulties, and other symptoms of depression, you may have major depression. So please see a qualified mental health professional for assessment and treatment options.

Your healthcare provider will evaluate your symptoms to determine the presence of depression or another condition that shares some symptoms with depression; for example, bipolar disorder, borderline personality disorder, drug withdrawal, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD).

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In terms of treatments for depression, both psychotherapy and medications have been shown to help.

Commonly prescribed antidepressants have small- to medium-sized effects, with amitriptyline having the largest effect. (I have discussed the best antidepressants for depression in more detail in a previous article.

Behavioral and psychological interventions can also alleviate depression. These include:

• Behavioral activation
• Brief psychodynamic psychotherapy
• Cognitive therapy
• Interpersonal therapy
• Mindfulness-based therapy
• Problem-solving therapy

(To learn more about the above psychological treatments for depression, see my article here.)

Sadly, despite the benefits of medications and psychotherapy, there are multiple barriers to treatment for depression. Some examples are cost, availability, access, and stigma. As a result, many individuals with depression do not receive the help they need.

Telehealth and telemedicine (e.g., videoconferencing, telephone modalities) may hold the key to eliminating a number of these barriers without sacrificing quality of care. Indeed, preliminary research shows that telehealth tends to produce “similar outcomes as face-to-face provision of psychotherapy and psychiatry services.”