Defining and Treating Depression

What is depression?

Depression is often defined by what it is not. That is, while we all feel sad from time to time, and traumatic events like the death of a loved one can cause anyone to feel extreme anguish, depression is distinct from this kind of sadness. Major Depressive Disorder, as defined by the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5), is characterized by things like markedly depressed mood for most of the day, persistent trouble sleeping (either too much or too little), and feelings of worthlessness. Depression, too, is often characterized by its lack of apparent cause; it is a recurring disease that usually is unrelated to the circumstances of one’s daily life. It is important to remember when reading this website that you cannot diagnose yourself, and that diagnosis and treatment of any disease requires an individual relationship with a medical provider. The cause of chronic depression is still largely unknown, and the model of mental illness that is dependent on malfunctioning brain chemicals like serotonin is incomplete at best.

How do we treat depression?

Thankfully, while our understanding of the precise mechanisms underlying depression is still in its infancy, treatments for the disease have advanced markedly and there are several effective options now available. Many professionals consider psychotherapy alone to be the best frontline treatment for depression, and for many patients, psychotherapy without medication has a tremendous benefit. However, as I have written, the combination of psychotherapy and appropriate medication is usually the most effective treatment for major depression. Below, I’ve put together some brief information about a few of the medicines I use to treat depression. This is meant to be purely informational and the decision about what, if any, psychotropic medicine to use in treating your depression or other mental health issues will be made collaboratively between provider and patient.

Escitalopram

The first of the so-called selective serotonin reuptake inhibitors, fluoxetine (Prozac), was brought to market in the United States in 1988. This class of antidepressants was revolutionary. While it came under plenty of criticism, much of which focused on the cultural implications of the drug’s popularity and questions of whether it was being overprescribed, there is no doubt that fluoxetine and its cousins have had a net positive impact. Time has shown that, despite their limitations, SSRIs have been very effective in treating the chronic, debilitating disease that is major depression.

Of course many things have changed since 1988, and today one of the most commonly used of the SSRIs is escitalopram (Lexapro). Escitalopram was released in the early 2000s, but it is actually a modified version of another antidepressant, citalopram (Celexa). Escitalopram’s chemistry means it is the S-enantiomer of citalopram. Pharmacologically this is supposed to make a “purer,” more effective drug. It also has the added benefit of having extended the patent life for the pharmaceutical company that created citalopram. Escitalopram has been generic for many years, as are the other medicines mentioned on this website unless noted otherwise. Regardless of the motives behind Pharma’s creative tinkering, escitalopram has proven to be effective in treating depression and generalized anxiety disorder. The National Alliance on Mental Illness has a very comprehensive page on side effects and other important information about escitalopram.

Bupropion