Depression Treatment: The Options

Depression is a serious mental health condition that causes real pain for the people who have it and for their loved ones.

The good news is that there are many effective treatments for depression — and the earlier treatment starts, the better. Here’s an overview of the treatment options, keeping in mind that there is no one-size-fits-all solution.

Because the development of depression is multifactorial — often influenced by biological, psychological, and social factors — the best strategy usually involves a combination of approaches.

RELATED: Detecting and Diagnosing Depression: It Can Look Different in Men and Women and in Teenagers, Too

Psychotherapy Focuses on Thoughts and Behaviors

Psychotherapy, or talk therapy, is designed to help people identify and effectively deal with the psychological, behavioral, interpersonal, and situational aspects of their depression.

• Adapt to a crisis or another current situational difficulty.
• Identify negative or distorted beliefs and behaviors, and replace them with positive, healthy ones. Or create a list of more realistic beliefs to balance out the distorted ones when they occur.
• Identify life problems that contribute to depression and change behaviors that worsen it.
• Address relationships and experiences to improve interactions with other people.
• Develop skills to better cope with stress and solve problems.
• Identify issues in life that feed into depression and learn how to avoid behaviors that make these problems worse.
• Regain a sense of control and satisfaction in life to counter symptoms of depression such as anger and hopelessness.
• Learn how to set realistic life goals.
• Develop healthier behaviors that enhance the ability to tolerate and accept stress.

• Cognitive Behavioral Therapy This strategy helps people identify harmful or ineffective patterns of thinking and behavior and replace them with more accurate thoughts and functional behaviors.
• Supportive Therapy This treatment method is geared toward helping people develop better self-esteem through encouragement and strengthen healthy coping techniques. It could also help people decrease their anxiety and improve social and community functioning.
• Psychodynamic Therapy This intervention is intended to improve one’s self-awareness and alter old behavioral or thought patterns by focusing on how underlying belief patterns and experiences from one’s childhood impact their mental state in adulthood.
• Interpersonal Therapy This option helps patients understand underlying issues and learn healthy ways to express emotions and improve their communication with others.

Antidepressant Medications Alter Brain Chemistry

Although it’s unclear exactly how they help with depression, antidepressants are drugs that moderate neurotransmitters, chemicals in the brain such as serotonin, norepinephrine, and dopamine. These chemicals play many roles and are thought to impact things like mood and motivation.

• Selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressants
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic and tetracyclic antidepressants

Some widely used antidepressants, such as buproprion (Wellbutrin), don’t fall into the above categories.

RELATED: Depression Medication: Which One Is Right for You?

Electroconvulsive Therapy May Help Treatment-Resistant Depression

That said, not everyone reacts the same way to ECT, notes Elizabeth Wassenaar, MD, regional medical director of the Pathlight Mood and Anxiety Center in Denver. She explains that people typically should not drive the day they receive treatment, and some people may opt to take a day off from work for a day or two.

ECT is initially administered three times a week for an average of three to five weeks, says Dr. Wassenaar. After this initial series, ECT treatments are typically given less frequently — twice a week, once a week, every other week, or even less often — she explains, adding that ECT is often covered by insurance.

• Headaches
• Muscle pain
• Nausea
• Confusion

The side effect of memory impairment has raised questions in the medical community about the benefits versus risks of ECT for treatment-resistant depression. But, Wassenaar says, there are ways to lessen the impact of this side effect.

“ECT procedures are evolving, and one can work with their psychiatrist on ways to minimize the side effect [of memory impairment],” she says.

RELATED: How to Cope With Caregiver Depression

Breakthrough Treatments Work in Novel Ways

Researchers continue to make progress in developing new kinds of antidepressant treatments. One such breakthrough is psychedelic-assisted treatment. In 2019, the U.S. Food and Drug Administration (FDA) approved two first-of-their-kind medications:

• Esketamine (Spravato), a nasal spray, may help people who aren’t responding to other antidepressants. It is derived from ketamine, a widely used anesthetic (and psychedelic party drug), and it is only administered at certified treatment centers because of the possibility of abuse and addiction. While traditional antidepressants can take weeks to take effect, esketamine acts quickly, usually within hours.

  

• Brexanolone (Zulresso), a hormone thought to be associated with postpartum depression, is the first medication specifically approved for new mothers with postpartum depression. It’s administered as an intravenous infusion in a healthcare setting for two and a half days (60 hours) continuously, and it usually works within a few days. It is chemically similar to endogenous allopregnanolone, a hormone thought to be associated with postpartum depression.

  

Some mental health providers offer ketamine-assisted psychotherapy — in which ketamine treatment is administered in conjunction with a psychotherapy session — says Sarah Norring, PhD, director and program manager at PsyBio Therapeutics in Coconut Creek, Florida.

Ketamine-assisted psychotherapy can be beneficial for treatment-resistant depression and acute or severe suicidal thoughts or behaviors, she adds.

Dr. Norring cautions that any risks associated with psilocybin — known recreationally as “magic mushrooms” — have not been fully studied. “All potential therapies, approved or self-medication in nature, should be fully discussed with an appropriately trained and licensed healthcare professional before being considered for use,” Norring says.

Another breakthrough treatment for depression, recently approved by the FDA in August 2022, is dextromethorphan-bupropion (Auvelity), an N-methyl D-aspartate receptor antagonist. Unlike other antidepressants, which usually take at least six weeks to work, Auvelity typically works within a week of consistent use.

Lifestyle Changes May Play a Role

People with severe depression require help from medical professionals — they can’t treat themselves — but some lifestyle changes can supplement other treatments or counter mild depression:

• Exercise can release mood-enhancing chemicals and improve brain function.

  

• Yoga, meditation, or other mind-body techniques can lower stress and relieve negative emotions.
• Support groups for people with depression can be found through organizations like the National Alliance on Mental Illness.

Nutrition May Aid in Managing Depression

Good nutrition, in addition to expert treatment, is often a cornerstone for the management of any mental illness. “In a state of malnutrition (poor nutrition), most treatments for depression will have limited efficacy (they won’t work as well),” Wassenaar explains.

Some nutrients may help people with depression feel better:

• Omega-3 fatty acids, found in seafood like salmon and shrimp
• Fiber, found in bell peppers, beans, and whole-grain bread and cereal
• Lycopene, found in watermelon and tomatoes
• B vitamins, found in asparagus and cucumbers
• Vitamin D, found in milk, yogurt, and eggs
• Flavonoids, found in cherries, strawberries, and blueberries

Resources We Love

Substance Abuse and Mental Health Services Administration (SAMHSA)

Led by the U.S. Department of Health and Human Services, SAMHSA is geared toward advancing public health efforts to lessen the impact of substance use and mental illness among Americans. If you need help finding treatment for depression or similar mental health issues, reach its national helpline at 800-662-HELP (4357).

National Alliance on Mental Illness (NAMI)

Dedicated to bettering the lives of Americans affected by mental illness, NAMI offers several resources for depression, including free discussion groups. Find one in your area.

Blurt

This social enterprise emphasizes the importance of talking about depression and raising public awareness about this condition. Have a look at its blog posts authored by people living with depression, including how to prepare for your first mental health appointment.

Additional reporting by Pamela Kaufman and Michelle Pugle.