Let's Talk About Depression Treatment
There are many approaches to treating depression. Understanding the options and figuring out which ones work best for you can help get your momentum going.by Meirav Devash Wellness Writer
No two cases of depression are alike, so it shouldn’t come as a surprise that the treatments aren’t cut and dried either. You’ll need a bit of patience to find the right solution for your depression type and severity. If the first one you try doesn’t do the trick, keep tweaking until you find a better one. The best thing to do is…as many things as you can! A combo of antidepressants, talk therapy, and lifestyle changes work better together than on their own.
Our Pro Panel
We asked some of the nation's top depression experts to bring you the most up-to-date information possible.
Carol A. Bernstein, M.D.
Psychiatrist, Vice Chair for Faculty Development and Well-Being in the Departments of Psychiatry and Obstetrics and Gynecology
Montefiore Medical Center/Albert Einstein College of Medicine
The Bronx, NY
Charles B. Nemeroff, M.D., Ph.D.
Chief Medical Officer of the Anxiety and Depression Association of America, Professor and Chair of Psychiatry at Mulva Clinic for the Neurosciences
Dell Medical School, The University of Texas
Seema Desai, M.D.
Clinical Assistant Professor, Psychiatrist
Department of Child and Adolescent Psychiatry, NYU School of Medicine; NYU School of Medicine WTC Health Program Clinical Center of Excellence
New York, NY
Bright light therapy is the most popular (and most studied) treatment for winter SAD, according to the American Psychological Association. Likely because the treatment is extremely easy to comply with, since it’s just sitting in front of a special fluorescent lamp each morning for 30 minutes. You can do whatever you want—scroll through your phone, eat breakfast—as long as you’re 12 to 18 inches away from the lamp. The most effective SAD lamps have white light, a brightness level of 10,000 lux, a large light surface, and—if they don’t use LED light—a UV filter. Carex Day-Light Classic Plus Bright Light Therapy Lamp checks all the right boxes.
It does. Meditation might look like closing your eyes and doing nothing, but it can actually alleviate psychological stress. A 2014 review published in the Journal of the American Medical Association of 47 trials with 3,515 participants found that a daily half-hour of mindfulness meditation was about as effective as SSRIs in treating depression. Here’s the thing: You can’t just meditate every once in a blue moon and expect results. You’ve got to meditate consistently—that’s why they call it a practice. By repetitively dropping into a state of relaxed, nonjudgmental awareness, you’re creating new connections in your brain. That means that later, when life stress, depressive thoughts, and rumination occur, that reflex could help you rebound sooner.
People with depression struggle with automatic negative thinking, so finding ways to direct their thinking towards positivity is a challenge. While it may sound a little hokey (particularly to a totally jaded depressed person), when you’re at your most dissatisfied is the perfect time to refocus on appreciating the things in your life you do have rather than the things you don’t. Instead of just jotting down a few quick words (UberEats, Netflix, the cat), experts say it’s better to write a few sentences about just one thing—or even better, a person in your life—and really delve into how thankful you are for it or them. This can help correct your cognitive dissonance and, instead of self-isolating, help reinforce your connection to others.
Yes! Rihanna knows what’s up, so when she says, “I gotta get my body moving, shake the stress away,” everyone knows better than to stop the music. According to recent meta-analyses published in Frontiers in Psychology, Dance Movement Therapy (DMT) decreased people’s depression levels in several studies. Technically, DMT is its own type of therapy, so it’s not really the same as just shaking your butt on the dance floor. But since exercise also helps boost mood and lift depression symptoms, and even unguided jumping around counts as aerobic exercise, we say the evidence is already in. Find a DMT therapist near you here.
First, Let's Recap the Basics of Depression
It’s more than just sadness. You can feel pretty crappy about yourself and life in general. You no longer love doing the things you used to love doing, and your brain can trick you into thinking you’re worthless. You can feel despair, lethargy, and guilt, and sleep problems are common.
Because depression is a cyclical disorder, it won’t typically clear up without some kind of treatment, so it’s important that you seek help and not wait—it’s nothing to be embarrassed or ashamed about. Nearly 18 million Americans experience depression in a given year, and it is the number one cause of disability in the U.S.
It may sound grim, but know that there are many, many treatment options for depression, and odds are you’ll find the one—or the combination—to lift you out of that really bad place. That said, remember that what works for person X may not work for person Y. Just because light therapy cured your best friend’s SAD doesn’t mean it will end your depression. Your disorder might respond better to antidepressants and CBT therapy.
Along with psychotherapy, the first-line treatment for moderate to severe depression is medication. Doctors may prescribe antidepressants, mood stabilizers, and/or atypical antipsychotic pills in order to relieve symptoms of depression. Everyone’s brain is different and depression-fighting medications are not one-size-fits-all.
Unless noted below, there aren’t specific medications that will work better for one type of depression versus another, which is why figuring out what’s most effective for you may take a bit of trial and error.
These are the most common depression medications:
Antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)
How they work: People with depression have lower levels of neurotransmitters like serotonin and norepinephrine, through which the brain’s nerve cells communicate mood, well-being, and anxiety levels. All antidepressants affect one or more neurotransmitters in the brain. When they make more neurotransmitters available in the brain, the “boosted signal” improves communication, which picks up mood and tamps down anxiety.
SSRIs are called “selective” because they affect serotonin only, blocking its reabsorption (i.e. reuptake). SNRIs increase levels of serotonin and norepinephrine in the brain in the same way.
Most common SSRIs: Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). Prozac, in case you’re wondering, is the most studied antidepressant.
Most common SNRIs: Cymbalta (duloxetine) and Effexor XR (venlafaxine)
Why prescribed? Doctors sign more scripts for SSRIs and SNRIs than any other antidepressants because they show the best results with the least side effects.
Antidepressants TCAs (Tricyclic Antidepressants) and MAOIs (Monoamine Oxidase Inhibitors)
How they work: This class of antidepressants predate SSRIs and SNRIs. They function similarly on neurotransmitters, boosting availability of serotonin or norepinephrine (or both) in the synapse, but they’re used less often because of more unpleasant side effects.
Common TCAs: Tofranil (imipramine) and Norpramin (desipramine)
Common MAOIs: Emsam (selegiline) and Marplan (isocarboxazid)
Why prescribed? When SSRIs and SNRIs aren’t getting great results, psychiatrists often still return to these old-school options.
How they work: They stop the reuptake of three neurotransmitters: serotonin, norepinephrine, and dopamine. Some may also block other receptors (more on that, below).
Common atypical antidepressants: Zyban and Wellbutrin (bupropion), and Remeron (mirtazapine)
Why prescribed? Atypical antidepressants are often used in patients with depression who can’t tolerate side effects or aren’t getting adequate results from SSRIs, or they’re used as “augmenters” (add-ons) to boost the effects of your typical antidepressant. But they can also be first-line treatments.
Let’s use Wellbutrin as an example. It stops the reuptake of dopamine and norepinephrine, but also blocks receptors where nicotine binds, so doctors might choose it as the first Rx in the case of a smoker with depression who wants to quit smoking.
Let’s use Wellbutrin as an example. It stops the reuptake of dopamine and norepinephrine, but also blocks receptors where nicotine binds, so doctors might choose it as the first Rx fin the case of a smoker with depression who wants to quit smoking.
Wellbutrin and Zyban are popular atypicals since they’re not associated with weight gain and sexual dysfunction, plus they both have the added benefit of helping with smoking cessation.
Of note: In some instances, these medications can increase anxiety levels, something to watch for given the comorbidity of anxiety disorders and depression.
How they work: These also affect neurotransmitters, but the key to most atypical antipsychotics is to block dopamine. That’s because excess dopamine is associated with hallucinations and delusions—hallmarks of psychosis, for which these drugs are typically prescribed.
Common atypical antipsychotics: Seroquel (quetiapine) or Abilify (aripiprazole)
Why prescribed? Atypical antipsychotics can help with depression as add-ons when SSRIs and SNRIs aren’t providing enough symptom relief.
Of note: These are second-generation antipsychotics, so they don’t carry the physical side effects, such as tics and tremors, that the first-gen ones can cause. That said, drowsiness, dry mouth, and blurred vision are possible.
Otherwise known as “talk therapy,” psychotherapy is a way to help people cope with a whole swath of mental illnesses or emotional issues.
On TV, therapy usually involves reclining on a leather Chesterfield couch while staring at the ceiling and complaining about your mother. (In real life, the couch is optional, and your mom might never even come up.)
No matter if it’s your first time or fifth time dealing with a depressive episode, your therapist will have plenty of experience navigating these waters, so they’re a valuable ally for you.
You can get psychotherapy (also known as “getting your head shrunk”) through a few different kinds of licensed professionals (whose credentials should be clearly listed on their website or hanging on the wall in their office). They include:
psychiatrists, who are M.D.s
psychologists, who have PhDs or PsyDs
licensed social workers: look for the letters LCSW or LSW
licensed professional counselors, or LPCs
licensed marriage or family therapists, a.k.a LMFTs
Since psychiatrists are medical doctors and the only group of this bunch that can prescribe medications, it’s most convenient to see a psychiatrist first (it’s a one-stop shop). But no worries. If you have a different type of therapist who believes you would benefit from meds, they’ll hook you up with a psychiatrist, or your general physician can prescribe them.
There are a several different types of therapy, but don’t stress out too much about which one you choose.
Cognitive Behavioral Therapy (CBT) is popular for depression, with good reason—it’s well studied, and research says it can be as successful as antidepressant medications.
Studies show that a combo of therapy plus medication is even more effective for major depressive disorder (MDD) than either treatment on its own.
As for the “best” kind of talk therapy? That’s whichever one seems most appealing to you, since research so far says they’re all similarly effective. Make sure to check the therapist’s website and read reviews to see if they’re a good match for you. Here are some of the types of therapy that can help:
Psychodynamic Therapy. This is the Freud-based therapy we talked about before (the kind with the couch).
In a short-term version of this therapy, usually lasting 12 to 16 weekly sessions, you and your therapist will mine your past and the present in order to reveal unconscious thoughts that may cause internal conflicts and contribute to symptoms.
Be prepared to think and talk about your childhood a lot as you search for an event that may have led to your depression.
Cognitive Behavioral Therapy (CBT). In five to 20 structured weekly sessions (“structured” meaning it involves behavioral exercises), your therapist will teach you to identify negative or inaccurate automatic thoughts (i.e. “I suck at everything”), and give you methods to reframe them. The main focus is using logic and reason to react to situations instead of letting emotions take the lead.
You’ll likely have homework practicing skills, like keeping a diary to question the validity of negative thoughts (i.e. “Do I really suck at everything or am I confusing a thought with a fact?”).
Eventually, this questioning makes you better at managing your thoughts and helps reshape your reactions in stressful situations. After your CBT training sessions, you can apply the strategies you learned on your own. You can move on to a different type of therapy if there are other issues preventing you from living your best life.
Dialectical Behavioral Therapy (DBT). This offshoot of CBT has a Zen twist. The main focus is learning to accept and tolerate pain and distress without overreacting or lashing out. DBT was originally developed to treat borderline personality disorder, so it’s particularly useful for patients with extreme emotions, impulse disorder problems, and tendencies toward self-harm.
In addition to five to 20 structured weekly sessions with a therapist, DBT also involves weekly group meetings where you practice mindfulness skills, interpersonal effectiveness, emotion regulation, and distress tolerance.
Phone coaching is a part of DBT, too—these calls with your therapist are specifically designed to help work your new coping skills into your daily life.
After your DBT sessions, you’ll be armed with strategies to help you manage your emotions. You can also move on to a different type of therapy, such as CBT, if automatic negative thoughts are still distressing you.
Interpersonal Therapy (IPT). If you believe you’re the average of the five people you spend the most time with, this therapy may be for you.
In 12 to 16 weekly sessions, you and your therapist will address how your relationships with friends, family, and co-workers impact your feelings of depression.
By focusing on the most pressing interpersonal problems, the thinking goes, you’ll be able to develop better coping mechanisms and more beneficial relationships. This can be a big help in building a strong support network for your depression recovery.
If you have winter-onset Seasonal Affective Disorder (SAD, also known as Major Depressive Disorder with a Seasonal Pattern), bright light therapy could unlock a brighter outlook.
It’s relatively cheap and easy to do, so it’s not surprising that it’s the most widely used and investigated treatment for SAD. Research has shown that light therapy provided a “significant immediate reduction of depression scores,” per one study.
Using this therapy during the symptomatic months consists of sitting in front of a special lamp each morning for 30 minutes. That’s it. You can scroll through your phone, eat your breakfast, or do whatever, as long as you’re 12 to 18 inches away from the lamp. SAD lamps aren’t regulated by the FDA, so it’s on you to pick an effective lightbox instead of just clicking the best-looking on Amazon. For the best SAD lamp, choose one with:
brightness level of 10,000 lux
built-in UV filter to protect your eyes, unless the lamp uses LED lights (which aren’t harmful)
If you have treatment-resistant depression that doesn’t get better after psychotherapy and trying more than two classes of antidepressants (such as SSRIs and TCAs), or if you can’t tolerate antidepressants due to nasty side effects, brain stimulation therapies can be another tool in your depression-fighting kit.
These therapies use electric or magnetic pulses to activate or inhibit the brain. (As an aside, if you have any type of non-removable metal in your head, these may not be options for you.)
Since you don’t have a USB port in the back of your head, here are a few ways docs can stimulate the brain:
Electroconvulsive Therapy (ECT)
One benefit of ECT over medication is that it works much faster, which is important when patients are at urgent risk for self-injury or suicide. This therapy is nothing like that scene in One Flew Over the Cuckoo's Nest that might have scared you as a kid. It actually goes something like this:
First, you get a muscle relaxer and short-acting anesthetic that puts you to sleep for about five to 10 minutes.
Electrodes are placed on specific areas of your head.
A controlled set of electrical pulses trigger a short seizure, which sounds dangerous but is generally safe. (Since you’re under anesthesia and on muscle relaxers, you won’t feel anything or even convulse.)
You should wake up five to 10 minutes later, ready to get on with your day.
Usually, you need two to three sessions per week for a total of six to 12 treatments. These treatments aren’t permanent, so you’ll likely still need to take antidepressants or periodically revisit ECT.
One caveat: ECT has been associated with confusion (which may last for several minutes to several days) and memory loss (called retrograde amnesia—patients may have difficulty remembering events before and during treatments). Most of these memory issues clear up after a few months. But these types of side effects are why ECT is not a first-line choice and is better suited to treatment-resistant cases that haven’t responded to other methods of care.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Some docs refer to rTMS as “ECT Lite.” Unlike ECT, it doesn’t require anesthesia, cause a seizure, or carry a risk of memory loss. This noninvasive treatment involves wearing a sci-fi-looking cap or having a device called a magnetic coil placed against your scalp. It delivers quick magnetic pulses to specific areas of the brain thought to play a role in mood regulation.
During stimulation, you’ll hear a loud click (sounds like an MRI machine; the two machines output similar pulses). One session usually lasts about 40 minutes. Usually, you need five sessions per week for four to six weeks.
The average length of remission after rTMS is a little over a year, at which point many patients choose to return for some booster rounds. If you don’t respond to rTMS, ECT might still be a good option.
Vagus Nerve Stimulation (VNS)
When medications and typical brain stimulation therapies don’t do the trick, docs may use this implanted device to stimulate the vagus nerve.
The vagus nerve runs from the brain to the belly and, when stimulated, it turns on the parasympathetic nervous system, which produces feelings of relaxation.
It works kind of like a pacemaker. A device is implanted in your chest that’s wired to the vagus nerve in your neck. Electric pulses are sent from the device to the nerve. Today’s VNS treatments require surgery, but they’ll be easier to try soon: The FDA has approved noninvasive vagus nerve stimulation devices to treat cluster headaches.
VNS was initially used for epilepsy, and since 2005 it’s been FDA-approved for treatment-resistant depression. But—and this is a big but—studies are inconclusive on what percentage of people it works on, and scientists aren’t sure why it helps lift depression when it does work. Some researchers also believe that further trials are needed to confirm its safety for depression.
Mindfulness is the practice of focusing your attention on the present moment and experiencing it without judgement.
When you’re depressed, it’s particularly hard to be aware in the present moment—you tend to drift into ruminating about the past or being worried about the future. Research shows that mindfulness-based interventions decrease rumination and negative bias in depressed folks.
Mindfulness for depression is generally learned through structured meditation-based programs like Mindfulness Based Stress Reduction (MBSR) or Mindfulness Based Cognitive Therapy (MBCT), eight-week courses you can take at many hospitals, meditation centers, and yoga studios.
For MBSR, teachers don’t have to be psychologists or even social workers. Often they’re yoga teachers, but they should be licensed by the MBSR Certification Program.
For MBCT, teachers are psychologists, social workers, counselors, or nurses who are already familiar with vipassana meditation and cognitive behavioral therapy.
This isn’t the same thing as just sitting on a pillow and saying Ohm. Studies show MBCT prevents depressive relapse among the most susceptible people—those with three or more depressive episodes—dropping the risk by 43 percent.
If you’re not ready to do eight weeks, start with a 20-minute mindfulness meditation via an app like Insight Timer or 10% Happier. Can’t hurt, might help.
Researchers have been touting the benefits of regular exercise for decreasing depression at least as far back as 1905, when the American Journal of Psychiatry was still called the American Journal of Insanity. In the years since, getting more exercise has become solid medical advice for treating depression.
Research shows that just 30 minutes of exercise a day can improve mood in people with depression.
In one study, participants who exercised for 30 minutes a day on a treadmill at 70-85% heart rate for 16 weeks had the same benefits as people who took antidepressants, and the exercise group still had a significantly lower rate of depression 10 months later.
No surprises here—we can’t think of a single system in your body that exercise doesn’t improve.
Yoga and Breathing Exercises
Yoga and pranayama (a.k.a. yogic breathing, a foundational practice of controlling the breath) were once mystical endeavors reserved for swamis and ascetics, but they’ve officially gone mainstream.
Between 2012 and 2017, the percentage of Americans practicing yoga increased from 9.5% (22.4 million) to 14.3% (35.2 million)—mostly because they want to feel healthier.
Research shows that a regular yoga practice is an effective complementary treatment for clinical depression, boosting positive feelings, reducing anxiety, improving sleep, and tamping down depressive symptoms.
But how much yoga is the right “dose”? A new study found that people who took both high “doses” (three 90-minute Iyengar yoga classes and four 30-minute breathwork sessions per week) or low “doses” (two 90-minute Iyengar yoga classes and three 30-minute breathwork sessions per week) improved their mental health at the end of three months. So basically, yoga plus breathing exercises are always a good plan.
Can getting stuck with little needles help improve your depression? Maybe.
In Chinese Traditional Medicine, acupuncture works with the belief that ailments are caused by blockages to the flow of qi, or life force, in the body. An acupuncturist inserts fine needles into the skin at certain points on the body, allowing qi to flow through energy channels called meridians.
Research shows that qi or no qi, acupuncture can help manage certain pain conditions like osteoarthritis and headaches. There haven’t been many good studies on how it works for depression. A meta review of 64 studies with 7,104 participants concluded that it may moderately reduce depression severity.
That’s not really a glowing report, though the studies were so low-quality, you’d have to question the results anyway. Better research is needed, but it can’t hurt (more than a pinch) to have your meridians cleared along with more traditional depression treatments.
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