What to Expect From Treatment for Major Depressive Disorder

Therapist talking with a patient

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Depression is a serious condition that can impact many areas of a person’s life. Because there are many factors that can contribute to major depressive disorder, treatment approaches can vary, so there is no single way to treat it. Because there is no “one-size-fits-all” treatment, your individual experience may vary. However, there are certain things that you can expect in terms of how you will begin treatment, the approaches your doctor might recommend, and the results you might experience.

Here are some of the effects you can expect during major depressive disorder treatment.

How to Start Treatment

Treatment usually begins when you see a doctor concerning possible symptoms of depression that you may be experiencing. Such symptoms can include changes in:

  • Mood (hopelessness, apathy, sadness)
  • Behaviors (irritability, crying, isolation)
  • Cognition (poor concentration, trouble focusing, negative thoughts)
  • Sleep (insomnia, excessive sleepiness, difficulty falling or staying asleep)

Your primary care physician may diagnose you and or refer you to a psychiatrist or other mental health professional.

Your doctor will ask you questions about your symptoms including what type of symptoms you have, how long you have had them, and how severe they are. In addition to assessing your symptoms, your doctor will also explore possible physiological factors that might contribute to depression.

Survey findings by the National Institutes of Mental Health (NIMH) found that 17.3 million U.S. adults (or about 7.1 percent of the population) experienced depression in 2017.

What Happens After You Are Diagnosed

After you are diagnosed with major depressive disorder, there are a few different things that can happen. The right one for you may depend upon your symptoms and what your doctor thinks is causing your depression.

Ruling Out Medical Causes

Your doctor may start by addressing any underlying conditions that might be a factor. Chronic illnesses, thyroid conditions, certain medications, and substance use can cause or contribute to symptoms of depression.

Hypothyroidism, or underactive thyroid, can be a common medical cause that contributes to depression, particularly among women. If blood tests reveal that you have hypothyroidism, your doctor may prescribe medications designed to treat the thyroid condition, which may help alleviate depressive symptoms.

Once any underlying conditions have been addressed, your doctor may then:

  • Prescribe an antidepressant. Antidepressants work by balancing the chemicals in your brain called neurotransmitters. These neurotransmitters, which include serotonin, dopamine, and norepinephrine, have an effect on emotions and moods.
  • Refer you to a mental health professional such as a psychiatrist, psychologist, or counselor. Psychotherapy for depression can include a range of techniques including talk therapy, cognitive-behavioral therapy, interpersonal therapy, psychodynamic therapy, and individual counseling. Talk therapy involves discussing issues that contribute to your depression symptoms. Cognitive-behavioral therapy focuses on the underlying negative thought patterns that contribute to symptoms of depression.

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Research has found that psychotherapy is about as effective as antidepressants in treating depression. However, the effects of antidepressants stop fairly quickly once use is discontinued. The effects of psychotherapy, on the other hand, are usually longer-lasting.

In many cases, your treatment will involve a combination of antidepressant medication and psychotherapy.

How to Know If Treatment Is Working

Once you begin treatment, you may notice some effects fairly quickly, although it may take time to find the medication and treatment approach that is right for you.

What to Expect From Antidepressants

If you are taking antidepressants, you may begin to experience some benefits fairly quickly, but most people will not begin feeling the full impact until several weeks after beginning the medication.

In addition to treating your symptoms of depression, however, you may also experience side effects, which can vary depending upon the type of antidepressant you are taking. Some common side effects of antidepressants include dry mouth, sexual side effects, nausea, insomnia, restlessness, weight gain, headaches, and constipation.

While side effects such as these are usually manageable, you should still inform your doctor if you do experience any of these.

Not all antidepressants work for everyone, and you may need to adjust your dose or even try a different type of medication. It may seem frustrating or slow-going at times, but carefully monitoring your progress and symptoms can help ensure that you are receiving the best treatment for your needs.

If you do not begin to notice any positive changes in your symptoms after six to eight weeks, talk to your doctor. In most cases, your doctor or psychiatrist may want you to continue to take a specific medication for a while in order for it to reach its full effectiveness. However, if you are not seeing any results, it is worth consulting your doctor to discuss changing your dose, switching antidepressants, or trying another approach.

Anyone taking antidepressants should be monitored carefully, particularly during the first few weeks of treatment. People may sometimes experience a worsening of symptoms or may start to have suicidal thoughts.

Never stop taking your antidepressant without talking to your doctor. Suddenly stopping your medication can make your symptoms worse, so it is important to develop a plan with your doctor to gradually lower your dosage and allow your body to readjust.

What to Expect From Psychotherapy

Psychotherapy focuses on helping people understand the thoughts, behaviors, and emotions that can contribute to symptoms of major depressive disorder. Some of the treatment effects you may experience when you are undergoing psychotherapy depend largely on your individual symptoms and the specific techniques that are used.

How It Helps

Psychotherapy, no matter what approach is used, can help you get a better handle on some of the factors that might be contributing to your feelings of depression. A big part of this includes reframing negative thinking, improving your relationships, managing stress, and looking for new ways of handling life's problems.

You will likely begin a regular treatment schedule that involves meeting with your therapist once or twice a week, depending on your needs. Just as with medication-based approaches to depression treatment, psychotherapy takes time. However, your therapist can also help you develop new coping skills that will help you to manage your stress, deal with negative thoughts and emotions, and manage your fears. Such skills can be particularly helpful as you wait for antidepressant treatments to begin working.

You may not start to feel any significant positive results from psychotherapy for several weeks and treatment may last for several months or even a year or longer. You will work with your therapist to determine when you feel that it is time to stop treatment.

Psychotherapy alone is not recommended for people with severe depression. Symptoms of severe depression include thoughts or plans of suicide, psychosis, impairments in basic functioning, and poor judgment that may result in self-harm. Patients with such symptoms should see a psychiatrist and may require hospitalization.

Changes to Expect

Changes you can expect to experience during major depressive disorder treatment include:

  • Improvements in mood
  • Fewer negative thoughts
  • More motivation
  • Feeling better able to handle stress
  • Improved ability to cope with daily living
  • Decreases in feelings of sadness or hopelessness
  • Less irritability
  • More interest in activities you previously enjoyed
  • Improved sleep
  • Less anxiety

Even if you are noticing improvements in your depressive symptoms, it is important to keep an eye out for signs of relapse. Talk to your doctor or therapist if you notice that your depressive symptoms are returning or worsening at any point during your treatment.

When to Ask for Additional Help

If you do not notice any improvement in your symptoms or they seem to be getting worse, talk to your doctor or psychiatrist. There are a number of other options available for treatment-resistant depression including:

  • Electroconvulsive therapy (ECT): The use of ECT has been a source of controversy within psychiatry, but it has been shown to be effective in the treatment of depression. In this process, patients are placed under general anesthesia. Then, a small and painless electrical current is delivered to the brain. This causes a brief seizure which can help relieve depressive symptoms. Patients typically receive ECT in sessions over a period of a few weeks. People may feel relief from their symptoms fairly quickly, but they may also experience side effects including memory loss, confusion, headaches, and nausea.
  • Vagus nerve stimulation (VNS): This involves a surgical procedure to implant a device that sends electrical signals to the vagus nerve as a way to improve mood.
  • Deep brain stimulation (DBS): DBS involves implanting electrodes in areas of the brain associated with emotion. Side effects and risks include bleeding, nausea, breathing problems, seizures, and stroke.
  • Repetitive transcranial magnetic stimulation (rTMS): This involves placing a device against the skull to transmit magnetic waves into specific areas of the brain. Patients remain awake during these sessions and do not experience any pain.

ECT and other types of brain-stimulation are typically only used for patients who have not responded to medication and psychotherapy. 

Other Steps You Can Take

Making lifestyle changes is an important part of treating major depressive disorder. There are a number of things that you can do to help supplement your treatment and find relief. Some of these changes can help alleviate symptoms in the short-term and aid in your long-term recovery.

Exercise May Be Helpful

Research has shown that regular physical activity can not only help prevent depression, it can also help alleviate symptoms. The idea that exercise may actually help treat depressive symptoms has been the subject of debate, but some evidence suggests that the beneficial effects may have actually been underestimated. 

A meta-analysis of the research concluded that exercise has a large and significant beneficial effect on depression (including major depressive disorder), supporting the idea that exercise is an evidence-based depression treatment.

Stick to a Schedule

It can also be helpful to resume some of the activities that you enjoyed before you began experiencing symptoms of depression. Depression can not only cause you to lose interest in the things you used to be passionate about; it can also make it difficult to stay on top of daily chores like doing the dishes or laundry. Seeing these things pile up makes it even more difficult to feel upbeat and motivated.

So when you are trying to manage your symptoms, focus on doing small things each day that will help restore your routines and sense of normalcy. If you have fallen out of a routine, create some sort of schedule that provides structure in your day.

Get Enough Sleep

Insomnia and other sleep disturbances are a common symptom of depression. Antidepressants may help with those symptoms, but you may also want to try relaxation techniques or have your doctor prescribe a medication to help with your sleeping difficulties.

Research has shown that sleep disturbances are a risk factor for depression. Insomnia also increases the duration and severity of depression and makes relapse more likely.

A Word From Verywell

In addition to doing these things, it is important that you always take your medicine as prescribed, communicate with your doctor or therapist about how you are feeling, and give your treatment time to work.

Major depressive disorder is a serious condition, but it is treatable. It may take some time to find the right approach for your needs, but understanding what you can expect in terms of treatment effects can help you better recognize how your treatment is working.

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