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Depression (Major depressive disorder)

Depression (Major depressive disorder)

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Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.  Also, called major depressive disorder or clinical depression, it affects how you feel, think and behave and 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.  Most people with depression feel better with medication, psychological counseling or both.

Here are some things to think about when considering which treatment you may choose:

  • How is depression affecting your daily life?
  • Which possible unwanted effects from treatment concern you?
  • How much time are you able to put into your treatment?
  • How might the cost of treatment affect your decision?
  • Which treatment feels like the best fit for you?

Ask your health care professional

  • Which treatment or combined treatments do you think may be best for me?  Why?
  • How long will it take to know if a treatment is working?
  • What do I need to know about possible side effects from treatments?
  • If a treatment helps, how long would I need to continue it?
  • How does the use of alcohol and other substances affect depression and its treatment

If your first treatment did not help enough, your provider can help you switch to a different treatment or add another treatment to the first one.

This set of questions includes some reasons other people have given for choosing how to treat their depression.  We are interested in what is important to you.

Please mark on a scale from 1-10 how important each of the following are to you as you are thinking about how to treat your depression.

How important is it to you to…

 

Not Important

Extremely Important

1. get relief from your symptoms of depression

2
3
4
5
6
7
8
9
10

2. minimize out-of-pocket costs?

2
3
4
5
6
7
8
9
10

3. avoid taking antidepressant medicine?

2
3
4
5
6
7
8
9
10

4. avoid counseling?

2
3
4
5
6
7
8
9
10

5. Which treatments do you want to do to treat your depression?

  • Anti-depressant  medicine only
  • Depression counseling or therapy only
  •   A combination of anti-depressant medicine and depression counseling or therapy
  • I am not sure

 

Options

WATCHFUL WAITING

TALK THERAPY

MEDICATION

This means no active treatment.  You may see your provider more often to check your symptoms, compare options, and discuss your
lifestyle and coping strategies. 

Talk
therapy works by helping you solve problems and clarify your thoughts.  Treatment usually lasts 8 to 10 week, but
can last longer.

Therapy options include:

IN PERSON: 

Meeting with a therapist every
1 to 2 weeks for 30 to 60 minutes.  You may also do homework.

A visit by phone or computer is an option

Selective Serotonin Reuptake Inhibitors (SSRI’s) and Serotonin Norepinephrine reuptake inhibitors (SNRI’s) are medications that help with symptoms.  The pills are usually taken once a day.  Treatment usually lasts for 6 to 12 months.

 

What are the risks?

WATCHFUL WAITING

TALK THERAPY

MEDICATION

Watchful waiting can cause your symptoms to continue or get worse.

Talk therapy can cause discomfort, anxiety and stress. 

Cost – some insurances have limited coverage, more money out of pocket

SSRI’s can cause side effects.  Nausea, diarrhea and drowsiness each affect up to 17 out of every 100 people.  Up to 13 out of 100 people have sexual problems.  Sweating, shaking, difficulty sleeping, and dry mouth are less common.

 

How likely is the treatment to cause unwanted effects?

WATCHFUL WAITING

TALK THERAPY

MEDICATION

Watchful
waiting is unlikely to cause any unwanted effect in people with mild to moderate depression.  If it is used by people with more severe depression medication or talking therapies, it may delay them getting effective treatment.

Most talking therapies don’t have unwanted effects. At first, a person may find it difficult to talk about their feelings and the problems that may be making depressed.  This may get easier as they get to know
their therapist.  A person may not find it easy to make changes to the way they think and feel.  A therapist is trained to give support as a person makes changes that can improve their symptoms of depression.

All types of antidepressants cause side effects. They are usually mild and many of them wear off after a few weeks and
the body gets used to them. Antidepressants are not addictive like tranquilizers, alcohol and nicotine.  People don’t need to keep increasing the dose to get the same effect, or get cravings if they stop taking them.  People may have withdrawal effects when they stop taking them suddenly

 

Is there anything else I can do?

WATCHFUL WAITING

TALK THERAPY

MEDICATION

Exercise, healthy eating and visiting with friends can help
with symptoms.  Other resources may be available at your workplace, in your community or online. 

Exercise, healthy eating and visiting with friends can help
with symptoms.  Other resources may be available at your workplace, in your community or online. 

Exercise, healthy eating and visiting with friends can help
with symptoms.  Other resources may be available at your workplace, in your community or online. 

Contents from AHRQ, BMJ Group, Mayo Clinic and Massachusetts General