The two main treatments for persistent depressive disorder are medications and talk therapy (psychotherapy). The treatment approach your doctor recommends depends on factors such as:
- Severity of your symptoms
- Your desire to address emotional or situational issues affecting your life
- Your personal preferences
- Previous treatment methods
- Your ability to tolerate medications
- Other emotional problems you may have
Psychotherapy may be the first recommendation for children and adolescents with persistent depressive disorder, but that depends on the individual. Sometimes antidepressants are also needed.
The types of antidepressants most commonly used to treat persistent depressive disorder include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Talk with your doctor or pharmacist about possible side effects.
Finding the right medication
You may need to try several medications or a combination before you find one that works. This requires patience, as some medications take several weeks or longer for full effect and for side effects to ease as your body adjusts.
Don't stop taking an antidepressant without talking to your doctor — your doctor can help you gradually and safely decrease your dose. Stopping treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.
When you have persistent depressive disorder, you may need to take antidepressants long term to keep symptoms under control
Antidepressants and pregnancy
If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.
FDA alert on antidepressants
Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the most serious warning for prescriptions.
In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So watch them for possible worsening depression and contact the doctor right away if this occurs, or get emergency help if suicidal behaviors occur.
Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy or psychological counseling.
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss which type of therapy is right for you, your goals for therapy and other issues, such as the length of treatment.
Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify issues that contribute to your depression and change behaviors that make it worse
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Find better ways to cope and solve problems
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for medical care.
For example, the herbal supplement called St. John's wort is not approved by the Food and Drug Administration (FDA) to treat depression in the U.S., though it's a popular depression treatment in Europe. It may help improve mild or moderate depression, but the overall evidence is not conclusive.
St. John's wort can interfere with a number of medications, including blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John's wort while taking antidepressants because the combination can cause serious side effects.
FDA doesn't monitor supplements
Dietary supplements aren't approved and monitored by the FDA the same way medications are. You can't always be certain of what you're getting and whether it's safe. Also, because some herbal and other dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.