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No matter how severe depression may be, effective treatments are available. The two most common types of treatment are psychotherapy and medications, which can be used individually or together depending on the person's needs.
Because each case of depression is different, it may take some time to find the most effective treatment. A period of trial and error might be needed to determine the right combination of medications and therapies. If common treatments like medications and psychotherapy do not improve your depression symptoms, your doctor may suggest alternative options, such as brain stimulation therapies or experimental treatments.
Also known as talk therapy or simply as therapy, psychotherapy has been used to treat depression since the late 1800s. Therapy may be used to treat depression on its own or in combination with antidepressant medications. The goal of psychotherapy is to address the underlying psychological causes of depression. Therapy can help people with depression cope with grief or loss, better manage relationship conflicts, and navigate life transitions more effectively. Most therapy sessions are conducted by a licensed, trained mental health professional.
You may be wondering, how long does therapy take to treat depression? The answer to this question is often a very personal one. Psychotherapy can be short-term, involving just a few sessions, or long-term, lasting several months or even years. Common therapies for major depressive disorder include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and eye-movement desensitization and reprocessing (EMDR).
Therapy can be one-on-one with a therapist or involve others, such as group therapy, couples therapy, or family therapy. Therapy involving others can add an element of social support as well as education for partners or family members about depression.
Before selecting a therapist, it’s helpful to learn about the different approaches to talk therapy and find one that feels right for you. After receiving referrals from your doctor or researching therapists on your own, schedule a preliminary conversation with each. Ask how they would approach treating your depression and use this conversation to gauge your comfort level with them. Trusting your therapist is essential for effective treatment.
Cognitive behavioral therapy, also called cognitive therapy, focuses on identifying and correcting negative thought patterns that contribute to depression. It helps individuals gain clearer perspectives on challenging situations and teaches more effective problem-solving strategies. During therapy, your therapist may assign “homework,” such as reading or practicing techniques learned during sessions. CBT is typically scheduled once a week and lasts six to 20 weeks. However, some individuals may need longer treatment depending on the severity of their depression.
Interpersonal psychotherapy (also called interpersonal therapy) focuses on identifying and improving patterns in interpersonal relationships that may be contributing to depression. During IPT, the therapist serves as a supportive ally, helping you navigate difficult interpersonal transitions, such as conflict, life changes, or loss. IPT sessions are typically scheduled once a week for 12 to 16 weeks. This structured time frame is designed to encourage individuals receiving IPT to take action.
Eye-movement desensitization and reprocessing therapy help with depression by addressing negative beliefs connected to past trauma. The therapy involves multiple phases, during which a therapist guides you in processing painful memories using eye movements or other sensory techniques. This reprocessing shifts negative thoughts into more positive or neutral ones.
EMDR can be combined with other treatments and is typically conducted over several sessions, allowing you to work through difficult memories at a comfortable pace. Open communication with your therapist is essential for keeping the process safe and effective.
Psychodynamic therapy focuses on understanding how your interactions with the world influence your emotions and behaviors. Your therapist may ask open-ended questions and use techniques like free association to help uncover and explore negative feelings and behaviors, including those that are unconscious. Once these patterns are identified and understood, you can begin to work through and overcome them. This therapy can be especially beneficial for individuals who struggle with forming and maintaining relationships.
Most medications prescribed to treat depression target one or more of the three neurotransmitters (chemical messengers in the brain) believed to regulate mood: serotonin, norepinephrine, and dopamine. So, how does medication help depression? There are several types of antidepressants categorized by their effects on these chemicals.
Common side effects of most antidepressants include:
It’s important to remember that you may need to try more than one antidepressant before you find one that is right for you. When deciding on an antidepressant, your doctor will consider:
If you’re trying to conceive or are currently pregnant or breastfeeding, it’s important to let your doctor know before starting an antidepressant. Some medications carry a risk of birth defects or complications during pregnancy. Some may also affect a baby’s development when passed through breast milk.
Following are the most common classes of antidepressants.
Selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication prescribed for depression. These drugs work by increasing the levels of serotonin in the brain. This neurotransmitter is often called the brain’s “feel-good” chemical.
Common SSRIs include:
SSRIs generally have fewer side effects at high doses than other antidepressants.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs, but in addition to increasing serotonin levels, they also boost norepinephrine. Low levels of norepinephrine are believed to contribute to symptoms like brain fog (difficulty thinking or concentrating), which is common in people with depression.
Commonly prescribed SNRIs are duloxetine (Cymbalta, Drizalma Sprinkle, Irenka) and venlafaxine (Effexor).
Monoamine oxidase inhibitors (MAOIs) are the oldest class of prescription antidepressants. They work by preventing the breakdown of the neurotransmitters responsible for mood regulation. MAOIs are less commonly prescribed today because they can cause more severe side effects and potentially life-threatening interactions with certain foods or other medications. As a result, if you take an MAOI, you may need to follow specific dietary restrictions.
MAOIs include tranylcypromine (Parnate) and phenelzine (Nardil).
Tricyclic antidepressants, sometimes referred to as cyclic antidepressants, are another earlier class of medications used to treat depression. They work by preventing nerve cells from reabsorbing norepinephrine and serotonin, allowing these neurotransmitters to remain available in the brain.
Common tricyclics include:
Atypical antidepressants are newer medications that don’t fit into the traditional categories of antidepressants. They work by altering levels of one or more neurotransmitters, but they each use different approaches.
Drugs in this class include:
Bupropion is known to be one of a small number of antidepressants that don’t have sexual dysfunction as a side effect.
In addition to traditional antidepressants, other classes of drugs are also used to treat depression and anxiety. Antipsychotics are primarily used for bipolar disorder but can also be prescribed for depression. They help regulate mood by influencing the activity of neurotransmitters such as dopamine and serotonin, which play key roles in mood stabilization.
Common antipsychotics include:
Wondering how to treat both depression and anxiety? Anxiolytics and benzodiazepines, such as lorazepam (Ativan, Lorazepam Intensol, Loreev XR) and clonazepam (Klonopin), are commonly prescribed for anxiety. These medications work by enhancing the effect of a neurotransmitter called gamma-aminobutyric acid (GABA), which helps calm the brain and reduce anxiety.
Mood stabilizers, which were developed originally to treat trigeminal neuralgia and seizures, are prescribed off-label to treat bipolar disorder and certain types of depression. They work by balancing neurotransmitters in the brain, helping to stabilize mood swings and prevent extreme highs (mania) and lows (depression).
Common mood stabilizers include:
Notably, lithium and lamotrigine are approved by the U.S. Food and Drug Administration (FDA) for bipolar disorder. Gabapentin is specifically indicated for treating partial seizures, nerve pain from shingles, and restless leg syndrome. However, it’s sometimes prescribed off-label for anxiety or mood stabilization.
Stimulants approved to treat people with attention deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD) include amphetamine/dextroamphetamine (Adderall) and methylphenidate (Ritalin). They work by increasing the levels of dopamine and norepinephrine in the brain, which can help improve energy, motivation, and concentration in people with depression. In some cases, stimulants may be prescribed off-label to help treat certain symptoms of depression.
Ketamine (Ketalar) is an anesthetic sometimes used off-label for treatment-resistant depression. Treatment-resistant depression is defined as depression that hasn’t improved after trying at least two other antidepressants.
How does ketamine work for depression? Unlike traditional antidepressants, ketamine rapidly restores connections between damaged brain cells by working on the brain’s glutamate system. Studies have shown that ketamine can relieve symptoms of depression within a few hours of receiving the first intravenous (into the vein) infusion. Due to potential side effects — including dissociation (out-of-body experience), high blood pressure, blurred vision, nausea, and vomiting — and the risk of misuse, ketamine infusions are usually given under direct physician supervision in an outpatient clinic setting.
In recent years, the FDA has approved esketamine (Spravato), a nasal spray derived from ketamine, for treatment-resistant depression. Similar to ketamine, esketamine works by targeting the brain’s glutamate system and helping to repair damaged brain cell connections. The drug is unique in that it can be used at the same time as oral antidepressants. Esketamine is usually given under medical supervision for the first dose, with the option of at-home use afterward, depending on the provider’s evaluation.
Never change your dose or stop your medication without consulting your doctor. While antidepressants are not addictive, stopping them suddenly can cause withdrawal symptoms or a relapse of depression. Some drugs prescribed off-label for depression, such as benzodiazepines and stimulants, may have the potential for addiction. It’s important to use them only as directed by your physician.
For the most part, antidepressants are safe to take. However, the FDA requires all antidepressants to carry a “black box” warning, its most serious alert because some children, teenagers, and young adults may experience suicidal thoughts or behavior while on antidepressants. This risk is highest during the first month of treatment or after a dosage change.
Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.
Are you curious how to get help for depression if medications and psychotherapy are ineffective? While these treatments can be effective for many people living with depression, others may benefit from non-medication medical treatments that target brain function and mood regulation. These options offer alternative approaches for those who have not found relief with more conventional methods.
Seasonal affective disorder (SAD) is a type of depression that occurs at certain times of the year, typically in the fall and winter months, when there is less natural sunlight. Researchers have found that light therapy may help relieve SAD symptoms. The treatment involves exposure to a light box each morning for 20 to 30 minutes, positioned 16 to 24 inches from the face. During light therapy, you should keep your eyes open but do not gaze directly at the light. You may read or perform another activity during light therapy.
Light boxes are not regulated by the FDA for safety or effectiveness, so it’s important to choose one that filters out most or all ultraviolet (UV) light. The effectiveness of different light boxes may vary from person to person. It’s a good idea to consult your health care provider for guidance on selecting a light box that's appropriate for your needs.
Brain stimulation therapies are treatments that use electrical or magnetic impulses to alter brain activity and improve mood. These therapies are often considered for people with depression who haven’t responded to medications or psychotherapy.
These therapies include:
These therapies are typically used for a set period and are not intended for long-term or maintenance use.
Many people try alternative ways to treat depression, including acupuncture, yoga, meditation, and supplements containing St. John’s wort, S-adenosylmethionine (SAMe), or omega-3 fatty acids. Although some individuals report feeling better with these natural treatments, most have not been proven safe or effective in clinical trials. It's also important to note that the FDA does not regulate the purity or safety of nutritional supplements.
Due to the potential for dangerous medication interactions, it’s important to discuss any plans to use natural or complementary treatments with your health care provider.
Several clinical trials have shown that exercise can be significantly beneficial for people with depression. It’s important to choose a type of physical activity you enjoy and can do consistently, starting with small amounts each day. As you become accustomed to the activity, gradually increase the duration and consider exercising with friends or family for additional motivation.
Nutrition can play an important role in mental health. Researchers have found that people who eat a nutritious, balanced diet are less likely to report being depressed and to develop chronic diseases.
Deep brain stimulation (DBS) is an experimental treatment (not FDA-approved) for treatment-resistant depression. It involves implanting a device to stimulate specific areas of the brain. Originally developed for Parkinson’s disease, DBS has shown potential for improving symptoms in people with severe depression, though it may take time to notice changes. While research studies suggest DBS is safe and effective, more clinical studies are necessary before it gains FDA approval.
Some people with depression participate in clinical trials to gain access to new treatments. A clinical trial is a research study that tests the safety and effectiveness of new therapies, medications, or medical devices. To join a clinical trial, individuals typically need to meet specific eligibility criteria and can enroll through medical centers, research institutions, or by speaking with their health care provider about available trials.
Depression can severely impact a person’s quality of life, affecting relationships, work, and overall well-being. Fortunately, many evidence-based treatment options are available, including medications, psychotherapy, non-drug therapies, complementary treatments, and emerging options like brain stimulation. What works for one person may not work for another, so it’s essential to explore different treatment options.
It's important to work closely with your health care provider to find a treatment plan that aligns with your needs and goals. Keep your provider informed about your progress, any side effects, or changes in your symptoms. With patience and collaboration, you can find the right approach to manage depression and improve your quality of life.
MyDepressionTeam is the social network for people who suffer from depression and their loved ones. On MyDepressionTeam, more than 148,000 members come together to ask questions, give advice, and share their stories with others who understand life dealing with depression.
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Kelsey Stalvey, Pharm.D.
received her Doctor of Pharmacy from Pacific University School of Pharmacy in Portland, Oregon, and went on to complete a one-year postgraduate residency at Sarasota Memorial Hospital in Sarasota, Florida.
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