Just as the symptoms and causes of depression can differ from person to person, so too can suitable treatment approaches. There are two main types of treatment options for depression: antidepressant medications and psychological counseling (psychotherapy).
NPF recommends a holistic, comprehensive approach to depression. Although antidepressants are often effective in reducing symptoms, they should seldom be used alone. In most cases, the best approach is a combination of antidepressant medication, counseling, exercise and social support.
The following are treatment options for depression.
Most people with depression are treated with a class of drugs called selective serotonin reuptake inhibitors (SSRIs). They include:
- fluoxetine (Prozac®)
- sertraline (Zoloft®)
- paroxetine (Paxil®)
- citalopram (Celexa®)
- escitalopram (Lexapro®)
In addition, there are several non-SSRI antidepressants used to treat depression. They include:
- venlafaxine (Effexor®)
- mirtazapine (Remeron®)
- buproprion (Wellbutrin®)
- tricyclic antidepressants (Amoxapine)
These medications work equally well, though they differ slightly in their side effects and interactions with other medications. But individuals do not react the same way to these drugs, so if one trial of antidepressant medication fails, another medication, or combination of medications, as well as complementary treatments should be tried until symptoms are under control. It can take some trial and error to find the right treatment.
Note: People with PD who suffer from mental health comorbidities should not be given amoxapine. If they are taking an MAO-B inhibitor for their PD, the current practice is to avoid concurrent tricyclic, SSRI, or SNRI (serotonin and norepinephrine reuptake inhibitor) antidepressants . There is some controversy on this point, and some neurologists and neuropsychologists are comfortable prescribing an MAO-B inhibitor concurrently with antidepressants if done under their close supervision. For hallucinations and delusions, PD patients shouldn’t take any neuroleptics except for pimavanserin, quetiapine or clozapine.
Psychotherapy is a broad term used to refer to the many varieties of counseling or talk therapy available today. This is an important treatment option for people with depression and is often used in combination with medication.
Research from NPF’s Parkinson’s Outcome Project found that rates for depression were lowest among patients receiving care from clinics with the most active approach to counseling.
Here are ways therapy can be beneficial:
- Cognitive behavioral therapy (CBT), one technique that has been shown to be very effective, helps people change negative thinking patterns and behaviors in order to reduce symptoms of depression. Learning these skills helps people cope better and think positively for the long term.
- Counseling sessions can provide vital support, understanding and education. Patients may be seen alone, as a couple or family, or in a group.
- Psychotherapy offers an alternative to antidepressants. Some people with PD may not tolerate, respond fully, or want to take an antidepressant.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a standard treatment option for people with severe or non-responsive depression, meaning no other treatments work. Although in the past movies and other media have portrayed it in a frightening way, it is the most relatively safe and effective treatment available for severe depression, and it also temporarily improves motor symptoms in PD. The major drawbacks include: the time involved in getting the treatment, the need to undergo general anesthesia many times, and possible memory problems and/or confusion as a complication of treatment. It is contraindicated for those with deep brain stimulators.
Exercise has been found to be a simple therapeutic approach for improving mood and depression. It can include walking, stretching, yoga, tai-chi and all basic forms of physical activity.
Non-Conventional and Complementary Therapies for Depression
- Light therapy
- Relaxation Techniques
- Massage Therapy
- Music Therapy
Page reviewed by Dr. Joash Lazarus, NPF Movement Disorders Fellow, Department of Neurology at Emory University School of Medicine.