Social Anxiety-->

Note: The following is presented for informational purposes only. Assessment and treatment should always be directed through one-on-one consultation with a trained professional.

Although I specialize in treating Anxiety Disorders, I am also trained (and Certified) in the treatment of Depression. Many of my patients have at least some degree of Depression (often due to their Anxiety Disorder), and so we frequently need to treat this as well. As with Anxiety Disorders, there are two forms of effective treatment for Depression: Therapy and Medications.

Cognitive Behavioral Therapy for Depression

Cognitive Behavioral Therapy is best-documented and one of the most effective psychotherapies for Depression. Approximately 70% of patients respond to CBT for Depression and the effects appear to be more long-lasting than medication treatment alone.

The main techniques used in CBT for Depression are Behavioral Activation and Thought Restructuring. Thought Restructuring teaches patients specific ways to talk back to self-deprecating thoughts. The goal Thought Restructuring is to make self-deprecating thoughts decrease in both frequency and intensity, which usually starts happening after about 2-3 weeks. Behavioral Activation encourages patients to fight back against the tendency to "hibernate" when they are depressed. Patients are encouraged to leave the house more often, call friends, and re-engage in activities that used to give them pleasure. In other words, patients are encouraged to re-start seeking pleasure rather than avoiding pain. Cognitive Behavioral Therapy for Depression typically takes 10-16 weeks to complete.


Medications for Depression

Medications are also effective for Depression (i.e. ~70% of patients respond to the first medication they try, and ~90% of patients respond if they eventually try three different medications overall). The most frequently used medications are the antidepressants known as Selective Serotonin Re-uptake Inhibitors (i.e. SSRI's). There are currently 6 SSRI's: Prozac, Luvox, Paxil, Zoloft, Celexa, and Lexapro. Each of these medications appears to be equally effective, so the choice of medication is often based on other considerations (i.e. Is it sedating or energizing?, Does it interact with other medications?). For Depression, these medications typically take 2-6 weeks to kick-in.

There are several other medications that are also useful for depression and are sometimes prescribed instead of SSRI's. These include Wellbutrin, Effexor, Remeron, and Serzone - which have roughly the same effectiveness of SSRI's but different side effects and different levels of effectiveness against anxiety. Additionally, if these recently developed medications are ineffective for Depression, older medications such as the Tricyclic Antidepressants and MAO Inhibitors (which have more side effects) will often still have a good chance of success against depression.


Combining Medications and CBT for Depression

The American Psychiatric Association's current practice guidelines suggest that in mild to moderate depression, using CBT alone or Medications alone is a reasonable first alternative, whereas in severe and/or recurrent depression treatment should be with a combination of Medications and psychotherapy such as CBT.

In patient's with mild-moderate depression, I usually recommend trying CBT alone first as this treatment has longer lasting benefits than medications alone. In contrast, I usually advise patient with severe symptoms, or patients who have not responded to CBT or Medications alone, or patients who want the best chance of getting relief from their symptoms right off the bat to start both medications and CBT. Once their symptoms have resolved and patients have been feeling good for 6-12 months, I often recommend trying to taper off of medications to see if they still need it. If patients have a strong feeling about just trying CBT alone or just trying Medications alone, I support whatever they want to try and give them feedback on how things are progressing as we move along.

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