How to Combine Different Forms of Depression Treatment With Your Depression Therapist

Depression treatment oftentimes requires a long-term approach that involves trying multiple treatments. Everyone responds to different depression treatments differently, and you may need to try a few different treatment options before you find the right one for you. It’s common for depression treatment to include a combination of treatments; for example, antidepressants with talk therapy, or […]

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Depression treatment oftentimes requires a long-term approach that involves trying multiple treatments. Everyone responds to different depression treatments differently, and you may need to try a few different treatment options before you find the right one for you. It’s common for depression treatment to include a combination of treatments; for example, antidepressants with talk therapy, or antidepressants with TMS therapy. It’s not necessary to combine treatments, but in many cases, a combination approach can be beneficial. 

Depression treatments that can be combined include talk therapy, medication, and TMS. New York City psychiatrists work with each patient to create a personalized treatment plan that fits the needs of each individual. It’s important to talk to your psychiatrist about what’s right for you. What are some of the combination therapies used to treat depression?

Talk Therapy Combined With Antidepressants

Talk therapy is a first-line treatment option that helps patients to identify thought and behavioral patterns that may be contributing to depression. If you’re looking for a depression therapist, NYC is home to therapists with all kinds of backgrounds. One type of therapy, called cognitive-behavioral therapy or CBT, is especially helpful in treating depression and is even proven to be just as effective as antidepressants.(1) CBT helps patients reframe negative thoughts into positive ones, and change negative behavioral patterns that can contribute to depression. It can also help patients manage feelings of shame, sadness, and worthlessness, feelings that are common among people with depression.

Not everyone will respond to the same type of therapy. The type of therapy that may work for you will depend on your past experiences and the underlying causes of your depression. Other types of therapy that effectively help patients manage depression symptoms include interpersonal therapy and psychodynamic therapy. Interpersonal therapy helps patients learn new ways to communicate, which can help them work through interpersonal conflicts that may be contributing to their depression. Psychodynamic therapy helps patients identify how past experiences affect their current thoughts, feelings, and behaviors.(2)

If therapy alone does not help alleviate your symptoms, your doctor may recommend combining talk therapy with an antidepressant. Research shows that patients with severe and/or recurrent depression have significantly higher recovery rates when their treatment involves a combination of talk therapy and antidepressants, compared to talk therapy alone.(3,4) Studies also show that a combination of antidepressant medication and cognitive-behavioral therapy has a lower rate of relapse compared to patients who take antidepressants alone or who only do talk therapy.(5,6)

Combination Medications

Most people receiving treatment for depression are taking at least one antidepressant. Typically, doctors prescribe a low dose of one antidepressant, and increase the dose if necessary, before ruling that it does not work. Antidepressants come in different classes–each one affecting different neurotransmitters (chemicals in the brain). Examples of antidepressant classes include SSRIs (selective serotonin reuptake inhibitors), MAOIs (monoamine oxidase inhibitors), and tricyclic antidepressants.

Patients should try antidepressants from different classes because while targeting one neurotransmitter may not work, targeting a different one might. If an antidepressant from one class does not improve depression symptoms, your doctor will prescribe an antidepressant from a different class. In some cases, your doctor may recommend combining two different classes of antidepressants or combining an antidepressant with anti-anxiety medication.

When a patient takes one antidepressant at a time, this is referred to as monotherapy. Combination therapy is the name given to treatment that involves taking two antidepressants at the same time. Multiple research studies show that combination therapy is more effective in reducing depression symptoms, compared to monotherapy with just one antidepressant.(7,8) 

Antidepressants Combined With TMS Therapy, NYC Has a New Combination Depression Treatment.

If antidepressants aren’t relieving depression symptoms, even when combined with talk therapy or another medication, consider trying repetitive transcranial magnetic stimulation (also referred to as rTMS or TMS) in NYC. TMS is a medication-free alternative to antidepressants that reduces and eliminates depression symptoms using magnetic pulses. TMS regulates brain activity in certain areas of the brain associated with depression. During TMS sessions, magnetic pulses are carefully administered to the head. These magnetic pulses create an electrical response within the brain that restructures communication pathways between brain cells. This restructuring allows the brain to form new communication pathways that reduce depression symptoms.(9,10)

TMS is proven to reduce and eliminate depression symptoms, even in patients who do not respond to antidepressants. A study conducted at 42 clinics across the US reported that patients who did not experience an improvement in depression symptoms with antidepressants did respond to TMS. More specifically, 58% of patients responded to treatment and 37.1% achieved remission.(11) A follow-up of this study also shows that TMS provides long-lasting results. This follow-up study found that 62.5% of patients who achieved remission continued to be in remission or show response to treatment one year later.(12) 

TMS therapy in NYC may be used together with an antidepressant to augment the effects of the antidepressant. Sometimes, patients will show initial improvement with an antidepressant, and then stop seeing results. In these situations, combining TMS therapy with an antidepressant can effectively reduce depression symptoms. An analysis of seven clinical trials shows that TMS therapy significantly increases the effects of antidepressants. In this analysis, patients who received both TMS therapy and antidepressants had higher response and remission rates, compared to patients who took antidepressants alone.(13) If you’re interested in learning more about TMS, NYC has options.

Learn More About TMS, NYC Has Options for Depression Treatment 

If you’re looking for a depression therapist, NYC has many experienced psychiatrists that offer a wide range of treatment options, including TMS therapy. NYC depression therapists can help you find the right therapy or the right combination of therapies that not only reduce or eliminate your depression symptoms, but also reduce the risk of relapse. It’s important to work closely with your doctor to find the treatment that meets your specific needs. If you’re currently working with a psychologist or psychiatrist, talk to your doctor about what type of depression treatment is right for you.

Resources:

  1. Gartlehner G, Gaynes BN, Amick HR, et al. Comparative Benefits and Harms of Antidepressant, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.2016;164(5):331-41. https://pubmed.ncbi.nlm.nih.gov/26857743/. Accessed April 03, 2021.
  2. Eisenberg JM. Comparing Talk Therapy and Other Depression Treatments With Antidepressant Medicines. Comparative Effectiveness Review Summary Guides for Consumers [Internet]. Published September 13, 2016. https://www.ncbi.nlm.nih.gov/books/NBK396564/. Accessed April 05, 2021.
  3. Hollon SD, DeRubeis RJ, Fawcett J, Amsterdam JD, Shelton RC, Zajecka J, Young PR, and Gallop R. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder. JAMA Psychiatry. 2014;71 (10):1157-64. https://pubmed.ncbi.nlm.nih.gov/25142196/. Accessed April 03, 2021.
  4. Family Institute at Northwestern University. “Combining anti-depressants, therapy may be a powerful treatment option for major therapy.” ScienceDaily, Published 11 March 2015. www.sciencedaily.com/releases/2015/03/150311160240.htm. Accessed April 03, 2021.
  5. Paykel ES, Scott JD, Teasdale J, et al. Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Arch Gen Psychiatry. 1999;56: 829-835. https://pubmed.ncbi.nlm.nih.gov/12884889/. Accessed April 05, 2021.
  6. Teasdale JD, Segal ZV, Williams JM, et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol.2000;68:615-623. https://pubmed.ncbi.nlm.nih.gov/10965637/. Accessed April 05, 2021.
  7. Blier P, Ward HE, Tremblay P, et al. Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010;167(3):281-8. https://pubmed.ncbi.nlm.nih.gov/20008946/. Accessed April 05, 2021.
  8. Moret C. Combination/augmentation strategies for improving the treatment of depression. Neuropsychiatr Dis Treat. 2005;1(4):3019. https://pubmed.ncbi.nlm.nih.gov/18568111/. Accessed April 05, 2021.
  9. Kozyrev V, Staadt R, Eysel UT, and Jancke D. TMS-induced neuronal plasticity enables targeted remodeling of visual cortical maps. Proceedings of the National Academy of Sciences. 2018;115(25):6476-6481. https://www.pnas.org/content/115/25/6476. Accessed April 05, 2021.
  10. Ruhr-University Bochum. What effect does transcranial magnetic stimulation have on the brain? Published June 5, 2018. https://www.sciencedaily.com/releases/2018/06/180605103511.htm. Accessed April 05, 2021.
  11. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety. 2012;29(7):587-96. https://pubmed.ncbi.nlm.nih.gov/22689344/. Accessed April 05, 2021.
  12. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. The Journal of Clinical Psychiatry. 2014;75(12):1394-401. https://www.psychiatrist.com/jcp/depression/multisite-naturalistic-observational-study-transcranial. Accessed April 05, 2021.
  13. Bangshan L, Zhang Y, Zhang L, and Li L. Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC Psychiatry. 2014; 14: 342. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264336/. Accessed April 05, 2021.
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