Procedures to treat depression

If medications and psychotherapy aren't working, you may want to talk to a psychiatrist about these additional treatment options:

  • Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to trigger a brief seizure. Although many people are leery of ECT and its potential side effects (such as confusion or amnesia), it can offer immediate relief of even severe depression when other treatments don't work.
  • Vagus nerve stimulation. This treatment uses a device implanted in your chest that's connected by a wire to a nerve in your neck (the vagus nerve). Electrical signals from the implant travel along the vagus nerve to the mood centers of the brain, which may improve depression symptoms.
  • Transcranial magnetic stimulation. With this treatment, magnetic fields are used to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain. As with ECT and vagus nerve stimulation, transcranial magnetic stimulation appears to improve depression by stimulating areas of your brain that control mood.

Other steps you can take

There are a number of things you can do to make the most of depression treatment:

  • Take your medications exactly as prescribed. Treatment may not work if you stop taking your medication, skip or lower a dose, or forget to take a dose. Many people get off track. This can happen for a number of reasons, including problems with side effects, thinking you don't need a medication because you feel better or simply forgetting. If you do stop taking your medication, contact your doctor to address any problems and get back on track. If the cost of the medication is a problem, talk to your doctor about it — he or she may be able to suggest ways to reduce the cost of treatment.
  • Stop drinking or using drugs. Many people with depression drink too much alcohol or use illegal drugs, which worsens depression. If you can't stop drinking alcohol or using drugs on your own, talk to your doctor or mental health provider. Depression treatment may be unsuccessful until you address your substance use.
  • Manage stress. Relationship issues, financial problems, an unhappy work life and a number of other issues can all contribute to stress, which in turn worsens depression. Try stress-reduction techniques such as yoga, meditation or journaling. Psychotherapy can be especially helpful in resolving stressful situations and learning how to reduce the effects of stress in your life.
  • Sleep well. Poor sleep may worsen your depression. Both the amount of time you sleep and how well you sleep can affect your mood, energy level, ability to concentrate and resilience to stress. If you have trouble sleeping, research ways to improve your sleep habits on your own or ask your doctor or mental health provider how to improve your sleep.
  • Get regular exercise. Exercise has a direct effect on mood. Even gentle physical activity such as gardening or walking can reduce stress, improve sleep and ease depression symptoms.

Don't settle for a treatment that's partially effective at relieving your depression, or one that works but causes intolerable side effects. Keep working with your doctor and other mental health providers to find the best treatment possible, even though it may take time and effort to try new approaches.

Aug. 23, 2011 See more In-depth