Depression Treatment: Your Options

Medically Reviewed by Jennifer Casarella, MD on February 01, 2023
Written by Debra Fulghum Bruce, PhD
8 min read

Your treatment plan for depression will depend on what type you have and how severe it is. Some people get psychotherapy. They also might take antidepressants or follow other treatments. Exercise can help, too.

If that’s not enough, you have still more options. For example, your doctor may suggest brain stimulation techniques such as electroconvulsive therapy or transcranial magnetic stimulation.

If you have bipolar depression, your doctor might prescribe mood stabilizers, depending on your symptoms and medical history. Antidepressants or certain antipsychotic meds might also help.

Everyone is unique. You may need to try different meds and at different dosages to find the best treatment for you. It takes a while for an antidepressant to take full effect. You may meet with several doctors or therapists before you find the one you want to work with. Patience and openness will help put you on the path to feeling better.

Called antidepressants, these can help lift your mood and ease your sadness and hopelessness. Work with your doctor to find one that works best for you with the fewest side effects.

It’s all about the brain circuitry that helps manage your mood.

The three key chemicals are norepinephrine, serotonin, and dopamine. Research shows that in depression, brain circuits that use these chemicals don't work right. Antidepressants tweak the chemicals so that your circuits work better. That can help improve your mood, although researchers don’t understand exactly how.

Usually, your doctor will advise you to keep taking the meds for a while even after you start feeling better. That helps lower the chances that your symptoms will come back. How long you may need to stay on antidepressants will depend on your mix of symptoms, how much they improve, and whether you’ve had depression before.

Tell your doctor if you’re taking any other meds, supplements, or herbs. They can interfere with antidepressants. The major types are:

SSRIs (selective serotonin reuptake inhibitors) are the most often prescribed type of antidepressant. They improve how brain circuits use serotonin. Examples include:

  • Citalopram (Celexa). You’ll usually take this as a pill once a day. As with all antidepressants, it can take a few weeks to work fully.
  • Escitalopram (Lexapro). You also take this daily. It causes side effects similar to those of other SSRIs, like nausea, headache, sexual side effects, and insomnia.
  • Fluoxetine (Prozac). Prozac lasts in your system longer than most other antidepressants. So it may take several weeks for it to reach a steady level, and several weeks to leave your body once you stop taking it.
  • Fluvoxamine (Luvox). This is more often prescribed for obsessive-compulsive disorder and social anxiety disorder.
  • Paroxetine (Paxil). You can take this in tablet or liquid form, once a day.
  • Sertraline (Zoloft). You can take this as a tablet or as a liquid you mix with water or juice.

SNRIs (serotonin and norepinephrine reuptake inhibitors) affect brain circuits that use both serotonin and norepinephrine. These SNRIs treat depression:

  • Desvenlafaxine (Pristiq). This is a long-acting tablet you take once a day.
  • Duloxetine (Cymbalta). You’ll usually take this capsule once or twice a day. It can take 1-4 weeks before the drug works fully. It causes similar side effects as several other antidepressants, like vomiting and nausea.
  • Levomilnacipran (Fetzima). You take one long-action capsule a day.
  • Venlafaxine (Effexor). You take this as a tablet or capsule with food, usually two to three times a day.

Some antidepressants also affect brain circuits, but work in different ways. Examples include:

  • Mirtazapine (Remeron). This is usually taken at bedtime.
  • Wellbutrin (Bupropion). This is taken once or twice a day, depending on the formulation. It can help with smoking cessation but should not be used by people who have seizures or an eating disorder. 

 

These are an older type of antidepressant. Sometimes they’re called cyclic antidepressants. Like SNRIs, these mainly affect levels of norepinephrine and serotonin and work well. But they can have more side effects than other drugs, so they’re usually not the first prescription choice.

They help keep up the levels of serotonin and norepinephrine in the brain, which in turn can improve your mood. These drugs can cause similar side effects, including nausea and drowsiness. Examples include:

  • Amitriptyline (Amitid, Elavil, Endep, Etrafon). You may take one to four tablets a day. It can take a few weeks to take full effect.
  • Imipramine (Tofranil). You usually take one or more of this pill daily. You can expect it to take full effect in about 1-3 weeks.

These were the first type of antidepressant. Today, you might try them if you don’t get relief from other depression drugs. You must avoid certain foods like cheese and aged meats, and certain medications (like decongestants or some cough syrups or certain prescription painkillers) that can interact dangerously with MAOIs.

Most common side effects from MAOIs are dry mouth, nausea, headaches, drowsiness, and trouble sleeping. Examples:

  • Isocarboxazid (Marplan). Usually, you take two to four tablets a day. It could take 6 weeks or longer to take full effect. This drug can be habit-forming, so take it only as your doctor prescribed.
  • Phenelzine (Nardil). You’ll usually take a tablet three times a day. It takes about a month to work fully. Your doctor may slowly lower your dose over time.
  • Selegiline (Emsam). You can get this as a skin patch, which may cause fewer side effects than taking the drug by mouth.

Your doctor may also put you on other medications, such as stimulants and anti-anxiety drugs. That’s especially likely if you have another mental or physical condition. Anti-anxiety medications or stimulants don’t treat depression by themselves.

Combining antidepressants with other meds, such as those used to treat schizophrenia or bipolar disorder, can also help.

It’s called psychotherapy, and also talk therapy. You meet with a psychiatrist, psychologist, social worker, or other trained mental health professional. You will learn new ways to handle the challenges and mindset that depression can bring.

If your depression is mild to moderate, psychotherapy may work as well as an antidepressant.

You can get talk therapy on your own, with your family, or in a group. Your doctor will help you find the best type for you.

Types of Psychotherapy. There are several types, but they all have the same goal – to understand the causes of your depression, help you feel more in control, and teach you ways to handle how the condition makes you feel. The idea is to track your moods and practice new ways to react to people and things that happen.

  • Individual therapy involves just you and a therapist.
  • Group therapy is with two or more other patients. It can be helpful to see that others have problems like yours.
  • Couples therapy helps your spouse or partner understand your depression. They learn how their words or actions can help.
  • Family therapy helps loved ones learn how depression affects you and how they can support you.

Therapists have different ways of helping. This is known as their “approach.” A therapist may use a mix of these methods.

  • Interpersonal therapy helps people change their behavior with family and friends. It helps you communicate better and improve your self-esteem. It usually lasts for 3 or 4 months.
  • Psychodynamic therapy looks at problems that may have started in childhood. It can take a few months, or even years.
  • Cognitive behavioral therapy(CBT) helps you understand and change incorrect beliefs and negative feelings. Exercises you do at home can help you become more aware of your thoughts and make positive changes.

Write down your goals for therapy and talk about them with your therapist. As time passes, look at the list to see if you’re making progress. After a few visits, your therapist should be able to tell you how long your therapy may last.

Some people do better with therapy, while others do better with medication. Some use both to treat depression. Talk with your therapist about which approach is best for you.

Exercise can help with mild depression. One review of studies on the topic found that it works as well as drugs or psychotherapy in easing depression symptoms and keeping them at bay.

Different “doses” of exercise may work for different people. You may want to start working out for 45-60 minutes, three to five times a week. If that sounds like too much, remember that some is better than none. And you may still need medicine or psychotherapy to feel better.

Electroconvulsive therapy can work for severe depression that doesn’t respond to other treatments. Also called electroshock therapy, it’s the best proven option for such people.

You’ll be given medicine to go to sleep while a doctor sends a brief and painless electric current through your scalp to your brain. This current induces a seizure. Electroshock therapy is safe.

Sometimes, doctors use electroconvulsive therapy when a person is a threat to themselves and others and it’s too dangerous to wait until medications take effect.

Transcranial magnetic stimulation (TMS) is used to treat major depression in adults who have already tried one antidepressant.

Your doctor places an electromagnetic coil over the side of your scalp. It creates a magnetic field that sends an electric current to stimulate nerve cells in the brain’s prefrontal cortex, which is one of the regions that controls mood.

There’s not as much evidence that TMS works as there is for electroshock therapy. It also differs in these ways:

  • It uses a much smaller electric current.
  • It targets a specific part of the brain.
  • It doesn’t cause a seizure or loss of consciousness.
  • You don’t need to be sedated.

You would get the procedure four to five times a week for up to 6 weeks. You won’t need to stay in a hospital.

Vagus nerve stimulation is a brain stimulation surgery for people whose depression has resisted other treatments.

A doctor implants a pacemaker-like device, which is the size of a stopwatch, in your chest. Its wires lead to the left vagus nerve in your neck. The device sends regular electrical impulses to this nerve, which relays information to and from the brain.

Studies suggest that this treatment can work well and triggers changes in the region of the brain linked to depression. But it can take 6 months or more for you to notice any improvements in your symptoms.

 

Keep your appointments. Practice exercises your therapist gives you. Treatment helps, and without it, you might get worse.

To find a therapist, you might ask family members and friends you trust. Or ask your doctor. Read about therapists online. Or call a community mental health center. 

Remember, you don’t have to deal with depression on your own. Help is out there.