Deciding an appropriate therapy for depression continues as the subject of debate. Certainly if an underlying medical disorder or a medication causes the depression, the immediate course of action appears straightforward. Hypothyroidism, HIV, beta blockers, cardiac medicines and drugs meant to treat psychiatric disease represent examples of the association.

Arguments exist about when to employ non-medicine treatments for depression such as cognitive behavioral therapy versus more traditional antidepressant drugs. Some studies demonstrate very little if any difference in response between these therapies. However the benefits of CBT continue long after the 6-8 sessions while antidepressants provide relief only during ongoing therapy.

Evolving concerns suggest too many individuals receive inappropriate prescriptions for antidepressants. In England and Australia preferred therapy formild to moderate depression avoids use of oral medicines. Studies now suggest only minimal differences between antidepressants and inactive placebo therapy for these patients.

Although heralded as directed therapy for depression, the newer drugs including the SSRIs – Prozac, Paxil, Zoloft, Celexa, Lexapro – and the SNRIs – Effexor, Cymbalta – may not provide the anticipated relief. Worse yet, the side effects may be considerably greater than anticipated and dwarf any improvement in symptoms.

Alternative therapies for depression include ketamine, modafinil, thyroid replacement, methylphenidate, light therapy and transcranial magnetic stimulation. None of these is firmly entrenched in our armamentarium.