Depression — what to take?

Medical body content is still in Romanian:

Symptoms (DSM-5 criteria)

At least 5 of the following, for more than 2 weeks:

• Persistent sad mood.
• Anhedonia (loss of interest/pleasure).
• Weight/appetite changes.
• Sleep disturbances (insomnia/hypersomnia).
• Fatigue.
• Psychomotor agitation or slowing.
• Feelings of worthlessness/guilt.
• Concentration difficulties.
• Recurrent thoughts of death/suicide.

Treatment

Psychotherapy — CBT, interpersonal psychotherapy. Effectiveness similar to medication in mild-to-moderate forms.

Pharmacological (Rx):

• SSRIs (sertraline, escitalopram, fluoxetine, paroxetine) — first line.
• SNRIs (duloxetine, venlafaxine).
• Bupropion, mirtazapine, vortioxetine, agomelatine.
• Tricyclics — second line.
• MAOIs — rare.

Duration: minimum 6-12 months after remission for a first episode. Indefinite for recurrences.

Transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT) — severe/resistant cases.

Ketamine/esketamine — resistant depression.

OTC — caution

St John's wort (Hypericum) — effective in mild depression. Caution: multiple drug interactions (contraceptives, anticoagulants, statins, cytostatics). Do not combine with SSRIs — serotonin syndrome.

Omega-3 EPA 1-2 g/day — adjuvant.

Vitamin D3 — evidence for correcting deficiency.

SAMe, folate (L-methylfolate) — adjuvants in resistant treatment.

Lifestyle

• Aerobic exercise — proven antidepressant effect.
• Regular sleep.
• Light exposure (especially seasonal depression).
• Socialisation.
• Mediterranean diet.
• Limit alcohol.

Medical disclaimer: the information in this guide is for informational purposes only and does not replace advice from a doctor or pharmacist. For diagnosis and treatment, consult a healthcare professional.