Major Depressive Disorder Treatment Overview

When to see a healthcare provider

See a healthcare provider if you have symptoms of major depressive disorder. It’s important to see a provider if your depression is affecting your life, for example, preventing you from maintaining good hygiene, caring for loved ones, or attending work or school. You should also see a provider if you have passive thoughts of self-harm or suicide, meaning you don’t intend to act on them. If you have an active plan to take your life, go to the nearest emergency room or psychiatric hospital.

Getting diagnosed

• A psychiatrist or mental health professional (a psychologist or social worker) will typically diagnose you based on your symptoms.
• You may be asked to complete a standardized questionnaire that asks you how often you experience symptoms of depression to get an accurate diagnosis.

What to expect from your visit

Antidepressant medications may be prescribed for major depressive disorder. There are several types of antidepressants. Each person reacts differently to them, so it may take some time to find the one that works best for you.

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft) are sometimes the first antidepressants your provider will prescribe.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include duloxetine (Cymbalta) and venlafaxine (Effexor XR), tend to have fewer side effects.
• Monoamine oxidase inhibitors (MAOIs) tranylcypromine (Parnate) and phenelzine (Nardil) may have more side effects.
• Tricyclic antidepressants like imipramine (Tofranil) and nortriptyline (Pamelor) are more likely to have side effects.
• There are also atypical antidepressants, which don’t fit into any of the above categories but may still be used to treat symptoms of depression. They include vilazodone (Viibryd) and bupropion (Wellbutrin).

There are several types of talk therapy your doctor may recommend that can help depression.

• Cognitive behavioral therapy (CBT) is the most well-studied therapy. CBT addresses distorted thoughts and feelings about yourself.
• Interpersonal therapy (IPT) focuses on problems in your current relationships that may be worsening your depression.
• In psychodynamic therapy, the focus is on helping you understand yourself. This may be done by looking for recurring emotional themes and patterns, discussing past experiences and how they play a role in your current struggles, and more.

Prescription medications for major depressive disorder

• SSRIs: fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro)
• SNRIs: duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), levomilnacipran (Fetzima)
• Tricyclic antidepressants: imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, desipramine (Norpramin)
• MAOIs: tranylcypromine (Parnate), phenelzine (Nardil), isocarboxazid (Marplan)
• Atypical antidepressants: trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd), bupropion (Wellbutrin)

Types of providers

• A primary care provider can sometimes prescribe medications and may refer you to a mental health professional.
• A psychiatrist can help diagnose you and prescribe medications.
• A psychologist or social worker can provide talk therapy.

How to manage depression at home

You should always see a healthcare provider—either your primary care provider or a behavioral health provider (psychologist, social worker)—to get a diagnosis of major depressive disorder. Symptoms can include sleep problems, loss of energy, and feeling sad, hopeless, tearful, or empty for most of the day nearly every day.

There are no OTC medications that treat major depressive disorder. But you can make lifestyle changes that can lessen some symptoms and help you get back into a normal routine.

Tips for treating major depressive disorder

• Create an activity schedule to help keep you accountable when you are struggling to motivate yourself to complete everyday tasks. (For example: 7 am wake up, 7:15 am walk the dog, 8 am take a shower, etc.) Some people immediately begin to feel more competent and energized by crossing tasks off a list, while others may not notice a change in mood for several weeks.
• Go to sleep and wake up at the same time every day, including weekends. Your natural sleep/wake cycle can become disrupted when you have depression. Getting enough sleep may help improve your mood and energy.
• Exercise can help reduce depression by releasing dopamine, a brain chemical that provides feelings of pleasure. A 15-minute walk may be enough to trigger the release.
• Spend time outside, especially if the sun is out. People with depression are more likely to have low vitamin D and stay indoors. Sun exposure causes your skin to produce vitamin D. If you live in a cold or cloudy climate, vitamin D supplements are a good alternative. Being outdoors with nature can also help ground you and make you feel more connected to life.
• Eat meals at regularly scheduled times, which can help with symptoms of overeating or prevent unwanted weight loss. Even if you do not have a big appetite, preparing something small will help you maintain a daily eating routine.
• Call a friend or family member to talk about how you are feeling. Or,  if you’re having trouble participating in everyday life, ask them to help get you out of the house. You may feel more motivated if you’re with another person.
• Avoid alcohol or other drugs during a major depressive episode. Alcohol often makes depression worse, while other substances can intensify thoughts of self harm or suicide.
• Consider trying alternative medicine, such as acupuncture, yoga, or reiki.
• Keep a diary. Journaling can help you work through your negative thoughts and feelings. By putting them “outside yourself” (on paper), you may feel lighter and less depressed.