Version October 2024
| What is depression |
| Depression is a common medical condition that affects the chemistry and functioning of the brain. It can be time limited or, occasionally, become chronic. |
| Symptoms of depression |
| Depression can cause emotional symptoms, such as anger, anxiety, and sadness. It can also interfere with memory and concentration and cause physical symptoms, such as fatigue, lack of energy, and agitation. Depression can sometimes cause or worsen existing physical symptoms, such as headache, abdominal or other pain, and muscle tension. Suicidal thoughts and behavior may also occur. |
| Rationale for treatment |
| Depression is a treatable medical condition. Antidepressant medications and psychotherapy are evidence-based treatments that improve depression outcomes. |
| Benefits of antidepressant treatment and psychotherapy include symptom resolution, return to normal function, reduced risk of relapse, and potential improvement in outcomes of other chronic diseases (eg, diabetes and cardiovascular disease). |
| Earlier treatment may be more effective than delayed treatment in achieving remission. |
| Treatment options |
| Treatment options for depression include antidepressants, psychotherapy, or both. Exercise can also be effective. |
| Key points about psychotherapy |
| Psychotherapy is as effective as antidepressants for treating most cases of depression. Some types of psychotherapy with efficacy for treating depression include cognitive behavioral therapy, interpersonal therapy, and problem-solving therapy. Therapy can be short term (8 to 16 sessions). |
| Key points about taking antidepressants |
| Antidepressants need to be taken every day to work. |
| Discuss what time of day is best to take the medication and whether to take it with food. |
| Discuss ways to remember to take the medication. |
| Give specific instructions on when to increase the dose of the antidepressant. Discuss that most people start with a low dose and then gradually increase the dose to maximize its effectiveness. |
| Antidepressant side effects |
| Side effects with antidepressants are common during initial treatment, but many are minor and improve or resolve after the first 2 weeks. |
| Provide information about common side effects of the prescribed antidepressant. |
| For SSRIs/SNRIs: Discuss that antidepressants can transiently increase anxiety, agitation, and/or irritability. In young adults, they can occasionally increase suicidal thoughts. If these symptoms are severe or a marked departure from baseline symptoms, the patient should contact their clinician. |
| Time frame for response to treatment with antidepressants |
| Symptom improvement can occur as early as 1 to 2 weeks; however, for some patients, a response will require 6 to 12 weeks. |
| Some patients will not improve after 6 to 12 weeks and may need to try another antidepressant. |
| Duration of treatment with antidepressants |
| Patients should continue antidepressant treatment for at least 6 months after their symptoms return to baseline. Early discontinuation of antidepressants can increase the risk of relapse. |
| Tailor duration of antidepressant treatment to the individual patient. Dosing should aim to achieve a maximal, but well-tolerated, dose. |
| How to discontinue the antidepressant |
| Abrupt discontinuation of antidepressants occasionally causes withdrawal symptoms, especially in patients who have been taking the antidepressant for many months. Discontinuation symptoms do not indicate addiction or dependence. |
| Patients taking the antidepressant for more than 2 weeks should taper the dose. The rapidity of taper varies depending on the specific antidepressant and how long the patient has been taking the medication. It should be adjusted if patients develop symptoms during tapering. Patients taking the antidepressant for less than 2 weeks can stop without tapering. |
| Patients who decide to discontinue their antidepressant should contact their clinician to discuss how to do so. |
| When to contact the clinician |
Patients should contact their clinician if:
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| Importance of follow-up |
| Follow-up is the key to the successful treatment of depression. Follow-up allows clinicians to monitor depressive symptoms, response to antidepressant therapy, and side effects. Patients should discuss when and how to follow up with their clinician and schedule regular appointments. |
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