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Finding the right treatment for depression can be as difficult as convincing someone that they need help. However, clinical depression is one of the most treatable of all medical illnesses.

Today, most people with depression can be treated successfully with antidepressant medications, "talk" therapy (psychotherapy), or a combination of the two. Experts agree that successful treatment also hinges on early intervention. And early treatment increases the likelihood of preventing serious recurrences.

· Drug treatment
There are different types of antidepressants:

Existing antidepressant drugs -
These are known to influence the functioning primarily of either or both of two neurotransmitters in the brain--serotonin and norepinephrine.

Older medication drugs -
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) affect the activity of both of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to significant side effects, or, in the case of MAOIs, dietary and medication restrictions.

Newer medication drugs -
Selective serotonin reuptake inhibitors (SSRIs) have fewer side effects than the older drugs, making it easier for people, including older adults, to adhere to treatment.

Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another.

Although some improvement may be seen in the first few weeks, antidepressants usually must be taken regularly for three to four weeks (and sometimes longer) before full therapeutic benefits occur.

The medication most often used to treat bipolar disorder is lithium (Eskalith, Lithane, Lithobid, Cibalith-S). Lithium evens out mood swings in both directions, from mania to depression, and depression to mania. It is used not just for manic attacks or flare-ups of the illness, but also as an ongoing maintenance treatment for bipolar disorder.

Antidepressant drugs are not considered to be candidates for abuse. However, as is the case with any type of medication, use of antidepressants must be carefully monitored to make sure the correct dosage is being given. Care also is needed when antidepressants are discontinued.

As is often seen with antibiotics, people may be tempted to stop antidepressants too soon. They may feel better and think they no longer need the medication, or they may believe the medication isn't working. But quickly stopping certain antidepressants is linked to side effects ranging from flu-like symptoms to sensory disturbances. As a result, new labeling, as specified by the FDA, recommends that patients taper off these medications slowly. If a person encounters problems going off a drug, he or she is advised to consult a physician rather than reduce dosage without supervision.

· Psychotherapy
In psychotherapy, also called "talk therapy," a person discusses with a mental health professional the feelings, thoughts and behaviours that seem to cause difficulty. The goal of psychotherapy is to help people understand and manage their problems so that they can function better. Finding a therapist who believes in recovery is the first step. Someone who can teach you to think differently and learn new behaviours.

Psychotherapy can help people with bipolar disorder, and their families, identify early warning signs and manage emotional stress, which may help prevent a bipolar episode.

People need to help themselves "break the bad habits in their lives that set them up for depression." Waking up and going to sleep at the same time each day, for example, might help those people prone to bouts of insomnia due to irregular sleep patterns. People are responsible for their own recovery. They must learn to take care of themselves and structure their lives so that they're less likely to trigger an episode.

When people are unresponsive to psychotherapy and medications, or the combination of the two works too slowly to relieve severe symptoms, such as psychosis or recurring thoughts of suicide, electroconvulsive therapy (ECT) may be considered. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a 30-second seizure within the brain; however, the person does not consciously feel the stimulus. Three sessions per week typically are given for full therapeutic benefit. Like antidepressants, ECT is believed to affect the chemical balance of the brain's neurotransmitters.

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