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MENTAL HEALTH

Get Out from Under the Dark Cloud: Treatment Options for Depression

August 22, 2019

Symptom Guides > Mental Health > Get Out from Under the Dark Cloud: Treatment Options for Depression

by

Dr. Ross Nelson

Dr. Ross Nelson is a licensed clinical psychologist and entrepreneur in Palo Alto, CA. He received his doctorate from the California School of Professional Psychology, and has professional expertise in cognitive behavioral therapy. He has worked in outpatient services at Kaiser Permanente, and as a psychologist for the startup, Crossover Health. Today, Dr. Nelson runs a private practice and is also the founder of Welleo Health. He is passionate about evidence-based therapy and addressing the global mental health crisis.

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Coping with depression can feel like a never-ending struggle. Some describe it as living under a dark, heavy, suffocating cloud. Clinical depression is a serious health condition that can truly interrupt your life and leave you feeling empty and hopeless. However, it is possible to get out from under that cloud. In this article, we will review a number of treatment options for depression including individual therapy, medication, and self-help options.

It is important to keep in mind that just as no two people are exactly alike, treatment for depression can look quite different from person to person. What may work for one person may not be the solution for another. If you are looking for a depression treatment plan for yourself or someone close to you, you don’t have to do it alone. Working with a qualified medical or mental health professional (or a combination of the two) can help you find the right solution for you.

Topics we will explore include:

• Individual Therapy for Depression
• Psychiatric Medications for Depression
• Self-Help Resources for Depression
• Mobile Apps for Depression

Individual Therapy for Depression

Individual therapy (or “talk therapy”) is a form of treatment where individuals work one-on-one with a trained mental health professional to learn how to deal with negative thought patterns, feelings, and behaviors. The personal insight and skills taught in these sessions have the potential to not only ease depression, but also help to prevent a relapse. The typical length of time for therapy for depression is 12-16 weekly sessions, but the number of sessions varies based on the complexity of the depression, the therapist's style, and other variables.

 

In therapy for depression, the goal is to identify your unique negative thought patterns that are triggering depressive feelings, and then utilize certain skills to change those patterns to ultimately feel (and think) better. You will be guided to self-reflect in order to identify the specific negative thoughts that are triggering the depression. In doing so, you can learn when and how negative emotions occur so you can take appropriate steps when needed.

 

Talk therapy can come in many styles when it comes to treating depression, but the approaches listed below are the most common and have the most evidence showing that they work:

 

  • Cognitive-Behavioral Therapy (CBT): A shorter-term form of therapy that helps clients to challenge and overcome thought patterns that can lead to depression and can help them to engage in more constructive and pleasurable behaviors.

 

  • Dialectic Behavioral Therapy (DBT): A skills-based therapy that includes mindfulness, regulating emotions and distress, as well as improving interpersonal skills.

 

  • Acceptance and Commitment Therapy (ACT): A style of therapy that focuses on “psychological flexibility,” mindfulness, and accepting (rather than challenging) negative thoughts.

 

  • Mindfulness-Based Stress Reduction (MBSR): A shorter-term (typically 8 weeks) form of therapy that blends mindfulness, yoga, meditation, body awareness, and looking into patterns of thoughts, feelings, and actions that hold us back from successfully getting in touch with our sense of well-being.

 

Keep in mind that when you are in a therapy session, in order for it to be effective, it is incredibly important for you to be completely honest, to come consistently to sessions, and to be willing to do the work. It is with frank and open discussions that you will be able to move forward and break out of your depressive hold. You will likely also see improvements faster if you are willing to engage in therapy homework between sessions.

 

For some, finding the right therapist can be a bit of a challenge. Here are some variables to consider when searching for a therapist:

 

  • Credentials: Therapists can hold a number of different degrees. Masters-level clinician degrees include Licensed Clinical Social Workers (LCSW), Licensed Marriage and Family Therapists (LMFT), and Licensed Professional Clinical Counselors (LPCC). Doctoral-level clinician degrees include Licensed Doctor of Clinical Psychology (PsyD) and Licensed Doctor of Philosophy (PhD). To look up a therapist’s license, consult the therapist’s state licensing board website.

 

  • Fees: It’s a good idea to ask about fees prior to scheduling your first session. Therapy out of pocket can be expensive (i.e. $100-$300 per 45-minute session, depending on location, experience, and expertise). Not all therapists take insurance. If you wish to use insurance or employee assistance program (EAP), contact your insurance company or EAP for a list of in-network therapists. If a prospective therapist is an out-of-network provider, ask if he or she can provide you with a ”Superbill” that you can submit to your insurance company for potential reimbursement. If not, ask the therapist if he or she offers a “sliding scale” that can reduce your cost depending on your income level. If none of those options are available, and you’re concerned about the cost of therapy, seek out a supervised intern/resident or a community clinic that may be funded by a government grant, etc.

 

  • Style of Therapy: As mentioned above, there are a number of different styles or “theoretical orientations” of therapy (including numerous additional styles not listed above). You are encouraged to ask your therapist what style they offer (or read about them online) to ensure it is “evidence-based.”

 

  • Right Fit: Other variables to consider include gender preference, cultural, ethnic, or religious preference, experience/expertise, the estimated length of treatment, location (including in-office vs. online/video-based therapy), therapeutic “chemistry” and personality matches.

 

Feel free to “shop around” to find a provider you feel you can trust, who is non-judgemental, and skilled in treating your depression. If you are not satisfied with the services or style of the first therapist you meet, it’s okay to seek out another provider. A nice starting point for finding a therapist is on the Psychology Today directory. There, you can search for a provider by location, specialty, gender, and style, and you can find therapist biographies.

Psychiatric Medications for Depression

Psychiatric medications are sometimes used in conjunction with therapy for the treatment of depression. Some people choose to try medication without individual therapy. While not optimal, it can be practical for many sufferers, and it can work more quickly than therapy alone. However, this approach doesn’t help to address what is driving the depression. Psychiatric medications are typically prescribed by primary care physicians (PCP) or psychiatrists. It’s not uncommon for individuals who have never taken psychiatric medications to talk to their PCP about starting on an antidepressant prior to being referred to a psychiatrist, and you can do this in the K Health app. It’s important to note that many people on medication experience uncomfortable side-effects (such as weight gain, sexual problems, nausea, or allergic reactions) that can accompany this form of treatment, and it’s important to work through these issues with your doctor.

 

I won’t cover all of the possible medications your doctor may prescribe, however, below is a list of the more commonly prescribed antidepressants:

 

  • Selective Serotonin Reuptake Inhibitors (SSRIs): This class of medication includes drugs like Zoloft, Prozac, Sarafem, Celexa, Lexapro, Paxil, Pexeva, Brisdelle, and Luvox. Doctors prescribe SSRIs when they believe that your depression is a function of an imbalance in serotonin levels in the brain.

 

  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): This class of medication affects levels of serotonin and norepinephrine in the brain. The most commonly prescribed drugs in this category include Pristiq, Khedezla, Cymbalta, Fetzima, and Effexor XR. These drugs are sometimes prescribed when depression is accompanied by chronic pain, which can either be contributing to the depression or making it worse.

 

  • Tricyclic Antidepressants: (TCAs): These are older drugs that are usually the go-to option for those who can’t tolerate the negative side effects of SSRIs and SNRIs. They include drugs like amitriptyline, amoxapine, clomipramine, doxepin, imipramine, nortriptyline, protriptyline, and trimipramine.

 

  • Dopamine Reuptake Blockers: Medications that fall into this class include Wellbutrin, Forfivo, and Aplenzin. These are milder forms of medication and commonly are used to treat seasonal depression.

 

There are, of course, other medications that are commonly (or less-commonly) prescribed. These alternatives are often prescribed when an individual is not responding well to first-line antidepressants, or when dealing with multiple psychiatric conditions at a time. Again, since not everyone’s chemistry is the same, at times you may need to “try” a variety of different medications to find the ones for which your body’s chemistry is best suited.

Self-Help Resources for Depression

We live in a world where information about any and everything can be easily found. The same is true for depression. We have created an article about Self-Help Tips for Depression. For additional information about depression and the different forms of treatments offered, here are some highly recommended and informative books and apps to consult.

 

Books for Depression

 

Feeling Good: The New Mood Therapy
By David D. Burns
Feeling Good is the gold standard cognitive-behavioral therapy self-help book for depression. The book has an extensive list of exercises to help conquer negative thoughts and overcome negative feelings.

 

The Happiness Trap: How to Stop Struggling and Start Living: A Guide to ACT
By Russ Harris
The Happiness Trap focuses on improving depression through acceptance and commitment therapy. With these tools, you can clearly lay out your values and pursue them through committed action and mindfulness.

 

Mind Over Mood, Second Edition: Change How You Feel by Changing the Way You Think

By Dennis Greenberger and Christine A. Padesky

Mind Over Mood offers a number of CBT and mindfulness therapy techniques and exercises to help you improve your depression.

 

The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness

By Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn

The Mindful Way Through Depression teaches its readers how to systematically use mindfulness to break the cycle of their depression.

Mobile Apps for Depression

  • Moodpath helps mobile app users challenge negative thinking with questions that screen for signs of a depressive episode. Users can use the questions to measure their mental well-being and to increase awareness of their thoughts and feelings. Exercises are included to correct negative thought patterns.

 

  • Headspace is a mobile app that offers a plethora of guided meditation exercises to help treat depression and other mental health conditions.

 

  • MoodKit is a mobile app that helps users experiencing depression. Based on CBT, MoodKit offers users a variety of tools to support mood improvement.

 

Coping with and managing depression can be challenging, but there are resources out there to support you in regaining control over your mood and your life. If you still are not sure where to start, consult a therapist or your primary care provider for further information.

 

Continue reading for self-guided techniques for dealing with depression.

“Depression can truly interrupt your life and leave you feeling empty and hopeless. However, it is possible to get out from under that cloud.”

Chat with a doctor about the best option to treat your depression. Download K Health.

by

Dr. Ross Nelson

Dr. Ross Nelson is a licensed clinical psychologist and entrepreneur in Palo Alto, CA. He received his doctorate from the California School of Professional Psychology, and has professional expertise in cognitive behavioral therapy. He has worked in outpatient services at Kaiser Permanente, and as a psychologist for the startup, Crossover Health. Today, Dr. Nelson runs a private practice and is also the founder of Welleo Health. He is passionate about evidence-based therapy and addressing the global mental health crisis.

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