Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional. If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. Here’s a closer look at depression treatment options.
Medications
Many types of antidepressants are available, including those below. Be sure to discuss possible major side effects with your doctor or pharmacist.
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
- Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
- Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren’t prescribed unless you’ve tried an SSRI first without improvement.
- Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other drugs haven’t worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications and herbal supplements. Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do. These medications can’t be combined with SSRIs.
- Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications also may be added for short-term use.
Psychotherapy
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help you:
- Adjust to a crisis or other current difficulty
- Identify negative beliefs and behaviors and replace them with healthy, positive ones
- Explore relationships and experiences, and develop positive interactions with others
- Find better ways to cope and solve problems
- Identify issues that contribute to your depression and change behaviors that make it worse
- Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
- Learn to set realistic goals for your life
- Develop the ability to tolerate and accept distress using healthier behaviors
Cognitive behavioral therapy (CBT)
In cognitive behavioral therapy (CBT), a therapist will work with you to uncover unhealthy patterns of thought and identify how they may be causing harmful behaviors, reactions, and beliefs about yourself.
Your therapist might assign you “homework” where you practice replacing negative thoughts with more positive thoughts.
Dialectical behavior therapy (DBT)
Dialectical behavior therapy (DBT) is similar to CBT, but puts a specific emphasis on validation, or accepting uncomfortable thoughts, feelings, and behaviors, instead of fighting them. The theory is that by coming to terms with your harmful thoughts or emotions, you can accept that change is possible and make a recovery plan.
Psychodynamic therapy
Psychodynamic therapy is a form of talk therapy designed to help you better understand and cope with your day-to-day life. Psychodynamic therapy is based on the ideathat your present-day reality is shaped by your unconscious, childhood experiences. In this form of therapy, your therapist will help you reflect and examine your childhood and experiences to help you understand and cope with your life.
Light therapy
Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern.
Hospital and residential treatment
In some people, depression is so severe that a hospital stay is needed. This may be necessary if you can’t care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.
Other treatment options
For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:
- Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide.
- Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.
Natural remedies and lifestyle tips
Exercise. Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.
Avoid alcohol and substance use. Drinking alcohol or misusing substances may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.
Learn how to set limits. Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.
Take care of yourself. You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.
Supplements
Several types of supplements may have some positive effect on depression symptoms.
S-adenosyl-L-methionine (SAMe). Some research suggests this compound may ease symptoms of depression. The effects were best seen in people taking SSRIs. However, the results of this research is not conclusive and more research is needed.
5-hydroxytryptophan (5-HTP). 5-HTP may raise serotonin levels in the brain, which could ease symptoms. Your body makes this chemical when you consume tryptophan, a building block of protein. However, more studies are needed.
Omega-3 fatty acids. These essential fats are important to neurological development and brain health. Adding omega-3 supplements to your diet may help reduce depression symptoms. However, there is some conflicting evidence and more research is needed. Always talk to your doctor before taking supplements, as they may interact with other medications or have negative effects.
Vitamins. Vitamins are important to many bodily functions. Research suggests two vitamins are especially useful for easing symptoms of depression:
- Vitamin B: B-12 and B-6 are vital to brain health. When your vitamin B levels are low, your risk for developing depression may be higher.
- Vitamin D: Sometimes called the sunshine vitamin, vitamin D is important for brain, heart, and bone health. There may be a link between vitamin D deficiency and depression, but more research is needed.