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Expert Q&A

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What are alternatives to antidepressants?

Asked by Tim Schwadron, Denver, Colorado

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To treat depression, what remedy do you suggest other than antidepressants? I'm taking 200mg of Zoloft, but I feel just as depressed as I did two years ago. My sex drive has virtually ended. Is there not another way to treat depression? Possibly talk therapy once or twice a week?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Tim:

You have already hit upon the other treatment for depression that is supported strongly by data from well-designed studies, and that is psychotherapy. Most people who do not specialize in psychiatry don't realize that studies have again and again shown that regular psychotherapy works at least as well as antidepressants and may have the added benefit of producing longer-lasting effects once the treatment is finished.

We know a fair amount about who is more likely to respond to medications or therapy.

For example, people who become so depressed that their sleep becomes profoundly disrupted or that they lose touch with reality and develop psychotic symptoms are more likely to benefit from a medication-based approach.

On the other hand, a large study published several years ago found that people who were depressed and had a history of early abuse or neglect were much more likely to respond to psychotherapy than medications. I don't know your specific situation, but if you are someone who has had to deal with a history of early adversity, psychotherapy might be an especially appropriate choice.

Let me make a couple of comments about your medication situation.

If you have been taking 200 mg a day of Zoloft (generic sertraline) on a daily basis for two years and you are still significantly depressed, you need to do something to change your pharmacological treatment, even if you don't enter psychotherapy. That 200mg a day is a lot of Zoloft.

It is no surprise that you have sexual side effects. Obviously I can't make specific recommendations, but there are a number of options available pharmacologically that might help improve your depression, and I strongly recommend that you discuss these other therapeutic options with your clinician.

Several antidepressants are associated with much less sexual dysfunction than is Zoloft, and you might consider a trial of these agents (for example bupropion and mirtazapine) if you haven't tried them already. Remember also that medications and psychotherapy appear to be synergistic, meaning that the combination for many patients is better than either alone.

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