### Instruction:  Disease name:

    Major Depression

: Treatment

The most helpful treatment is a combination of psychotherapy and medication. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed first. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). In general, they are fairly easy to take and relatively safe compared with previous generations of antidepressants. One of the more common side effects is decreased sexual pleasure and delayed orgasm.  Other effective antidepressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron) and duloxetine (Cymbalta). Older classes of antidepressants, tricyclic antidepressants and monoamine oxidase inhibitors, are still in use. They are as effective as the newer ones and can be very useful when someone has not responded well to other treatments.  It usually takes at least two to six weeks of taking any antidepressant to see improvement. It may take several trials to find the medication that works best. Once the right medication is found, it may take up to a few months to find a proper dose and for the full positive effect to be seen.  Sometimes, two different antidepressants are used together. Or a mood stabilizer, such as lithium (sold under several brand names) or valproic acid (Depakene, Depakote), is added. If psychotic symptoms are present, a doctor may prescribe an antipsychotic medication. Examples include haloperidol (Haldol), risperidone (Risperdal), ziprasidone (Geodon), aripiprazole (Abilify) and olanzapine (Zyprexa).  A number of psychotherapy techniques have been demonstrated to be helpful, depending on the causes of the depression, the availability of family and other social support, and personal style and preference. A technique called cognitive behavioral therapy is designed to help a depressed person recognize negative thinking and teaches techniques for controlling symptoms. Psychodynamic, insight-oriented or interpersonal psychotherapy can help depressed people to sort out conflicts in important relationships or explore the history behind symptoms.  If you suffer from depression, you will benefit from educating yourself about the illness. You could also make use of support that may be available in your community.  Options for severe or persistent depression despite the usual medications include electroconvulsive therapy (ECT), ketamine and transcranial medical stimulation.  Antidepressants and suicide risk  The FDA requires antidepressant manufacturers to include a so-called "black box warning" on their product labeling. The warning is intended to address the concern that — only for children, adolescents, and young adults — antidepressants may increase the risk of suicide. This problem has remained a focus of research, but the evidence remains hard to interpret.  Many experts worry that this warning has had a chilling effect on antidepressant treatment. The danger is that doctors and patients both could shy away from a helpful intervention. When depression goes untreated, the risk of suicide goes up. Paradoxically, it is possible that the labeling puts more people at risk for suicide.  A small number of young people taking these medications probably do have an unusual reaction and end up feeling much worse rather than better. Furthermore, any medication taken to affect mood can have an unexpected negative effect.  Therefore, independent of this debate, it is always important to monitor treatment closely. No matter what age you are or what treatment you're getting, report any troubling symptoms or worsening mood to your doctor immediately.