Your doctor should ask you about alcohol and drug use, and if you have thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and if treated, what treatments they may have received and which were effective. Last, a diagnostic evaluation will include a mental status examination to determine if your speech or thought patterns or memory have been affected, as often happens in the case of a depressive or manic-depressive illness. Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders.
Some people do well with psychotherapy, some with antidepressants.
ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. The treatment is given in the hospital under sedation so that people receiving ECT do not feel pain. Lithium is the treatment of choice for bipolar disorder 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.