Depression and Anxiety: Treatment

Treatment usually includes pharmacologic and nonpharmacologic therapies, along with treatment of any coexisting medical and psychiatric conditions.

A wide variety of antidepressant and anxiolytic medications are available. For depressive disorders, selective serotonin reuptake inhibitors and tricyclic antidepressants are most commonly used. In many cases, several weeks of therapy are necessary before medications take effect. Successful relief of symptoms occurs in about half of patients. For anxiety disorders, antidepressants, benzodiazepines, and buspirone are commonly used.

Psychotherapy may be effective used alone or in combination with medications, and improves the outcome of medication treatments. Interpersonal psychotherapy and cognitive–behavioral therapy can be as effective as medications in the acute treatment of depressed outpatients, and the latter has an enduring effect that reduces the risk for relapse. Treatment with a combination of medication and psychotherapy may enhance the probability of response over either treatment alone, especially in persons with chronic depression.³ Cognitive–behavioral therapy is also a well–established effective treatment for generalized anxiety disorder.⁴

Studies suggest that exercise may be as efficacious as medications for the treatment of depression over both the short term and long term. The apparent antidepressant effect of exercise has been attributed to the correction of dysregulation of the central monoamines, reduction of stress–induced hypothalamic–pituitary axis hyperactivity, distraction from negative emotions, and improvement in self–esteem and self–efficacy.⁵

Caffeine avoidance, self–hypnosis, meditation, exercise, and relaxation techniques are helpful in treating anxiety disorders.⁶

Due to the evidence that major depression and anxiety disorders are associated with nicotine dependence,⁷ referral to a smoking cessation program may be indicated. Treatment with certain antidepressants (eg, bupropion) may facilitate smoking cessation.⁸