Psychological makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression. A serious loss, chronic illness, difficult relationship, financial problem or any unwelcome change in life patterns can also trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive illness. A variety of antidepressant medications and psychotherapies can be used to treat depressive illnesses.
Some people do well with psychotherapy, some with antidepressants.
It is important to note that most people can be successfully treated for depression on an outpatient basis. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. Lithium is the treatment of choice for manic-depressive illness and some forms of recurring, major depression. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes the dosage must be increased to be effective.