Behavioral and cognitive therapies may help reintegrate the patient into a social environment after severe depression and may help prevent relapses, especially for episodic depression. Psychotherapy may be conducted by a psychiatrist, clinical psychologist, or mental health social worker, or it may require an interdisciplinary team. Treatment of severe depression with melancholic features is primarily pharmacologic. Choosing a drug depends primarily on which one produces the fewest adverse effects. Monoamine oxidase inhibitors are used less often because they have significant adverse effects and because they are not more effective than other drugs.
Sexual dysfunction is a problem for some persons who take SSRIs.
Also, SSRIs can cause akinesthesia and other movement disorders. 25 mg po daily, or paroxetine 10 mg po daily. A typical starting dose for the tricyclic antidepressant nortriptyline is 10 to 25 mg po at night with gradual increases. Adjuncts may augment the response to antidepressants. For example, low-dose lithium may augment the effect of tricyclic antidepressants and SSRIs, and carbamazepine may reduce a patient's tendency to cycle in and out of depressive episodes.