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.

It’s one of the most common mental disorders in the United States, affecting at least 21 million adults (about 8.3 percent of the adult population), as well as nearly four million adolescents between ages 12 and 17, according to the National Institutes of Mental Health (NIMH). For a majority of these men and women, and an even higher proportion of these adolescents, depression results in severe impairment, per NIMH.

The good news is that there are many effective treatments for depression — and the earlier the treatment starts, the better.

Because the development of depression is multifactorial — often influenced by biological, psychological, and social factors — the best strategy usually involves a combination of approaches; and keep in mind that there is no one-size-fits-all solution. Here’s an overview of the options.

RELATED: Depression Symptoms and Diagnosis: It Can Look Different in Men and Women and in Teenagers, Too

• 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.

There are several common types of psychotherapy used to treat depression, according to the American Psychiatric Association.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) helps people identify harmful or ineffective patterns of thinking and behavior and replace them with more accurate thoughts and more functional behaviors.

Supportive Therapy

Supportive therapy 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

Psychodynamic therapy is intended to improve a person's self-awareness and alter old behavioral or thought patterns by focusing on how underlying beliefs and experiences from childhood impact the person's mental state in adulthood.

Interpersonal Therapy

Interpersonal therapy helps patients understand underlying issues and learn healthy ways to express emotions and improve their communication with others.

About 13 percent of Americans age 18 or older report taking antidepressants, according to the National Center for Health Statistics, with women about twice as likely as men to take antidepressants (roughly 17 percent versus 8 percent).

Many types of depression medications are available today. Most fall into the following drug classes, grouped by their effect on brain chemistry, per Mayo Clinic:

• 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.

All these medications require a prescription from a physician and usually take several weeks to begin working. They also have possible side effects, such as weight gain, fatigue, and restlessness, that your doctor should discuss with you, per Mayo Clinic.

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

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.

ECT passes an electrical current through the brain while the person is under general anesthesia, causing a brief, controlled seizure that affects neurons and brain chemistry, according to the National Alliance on Mental Illness (NAMI). Typically the person wakes up 5 or 10 minutes afterward and is ready to resume normal activities in about an hour, per NAMI.

That said, not everyone reacts the same way to ECT, notes Elizabeth Wassenaar, MD, a 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 or two off from work.

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.

In addition to memory loss, temporary side effects of ECT may include the following, NAMI states:

• 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.

Another option for treatment-resistant depression is transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate neurons, targeting the brain area thought to be involved with regulating moods, according to NAMI.

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, according to Cleveland Clinic.
• 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, per Cleveland Clinic.

Some mental health providers offer ketamine-assisted psychotherapy — in which ketamine treatment is administered in conjunction with a psychotherapy session — says Sarah Norring, PhD, the 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.

Though not yet FDA-approved, another psychedelic drug called psilocybin has shown promise for both depression and treatment-resistant depression in clinical trials. A small clinical trial published in November 2020 in JAMA Psychiatry suggested that psilocybin treatment, along with supportive psychotherapy, may yield rapid and enduring relief from depressive symptoms among adults with major depressive disorder.

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.

Although many people with depression require treatment from medical professionals, certain lifestyle changes can supplement those treatments, per Mayo Clinic:

• Exercise can release mood-enhancing chemicals and improve brain function, according to Harvard Medical School.
• Yoga, meditation, or other mind-body techniques can lower stress and relieve negative emotions.
• Support groups can connect people with depression with others who are going through similar experiences. They can be found through organizations like the National Alliance on Mental Illness.

Nutrition May Aid in Depression Management

Good nutrition, in addition to expert treatment, is a cornerstone of management for 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.

In fact, research has demonstrated an increasingly clear role for nutrition in managing depression. For example, the SMILES trial, published in January 2017 in BMC Medicine, found that dietary counseling given by a registered dietitian to people with moderate to severe depression “may provide an efficacious and accessible treatment strategy for the management of this highly prevalent mental disorder.”

Other research has shed light on a potential link between diet, depression, and gut health. A review article published in July 2019 in Nutrients indicated that the quality of one’s diet affects the gut microbiota (bacteria and other microorganisms that occur naturally in your gut), which can in turn affect depression risk.

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

Some people with depression turn to the herb St. John’s wort as a home remedy, but doctors are concerned about interactions with other medications, according to Mayo Clinic. Do not use St. John’s wort while you're taking antidepressants, since the combination can result in serious side effects, per Mayo Clinic.