Depression Treatment: The Options

Depression can be a serious mental illness that causes real pain for the people who have it and for their loved ones.

According to the National Institute of Mental Health, depression is one of the most common mental disorders in the United States, affecting more than 17 million adults (about 7 percent of the adult population), as well as more than 3 million adolescents between ages 12 and 17.

For a majority of these men and women, and an even higher proportion of these children, depression results in severe impairment. (1)

The good news is that there are many effective treatments for depression — and the earlier treatment starts, the better. Here’s an overview of the treatment options, keeping in mind that there is no one-size-fits-all solution.

And because the development of depression is multifactorial — often influenced by biological, psychological, and social factors — the best strategy usually involves a combination of approaches.

RELATED: Detecting and Diagnosing Depression: It Can Look Different in Men and Women and in Teenagers, Too

Psychotherapy Focuses on Thoughts and Behaviors

Psychotherapy, or talk therapy, is designed to help people identify and effectively deal with the psychological, behavioral, interpersonal, and situational aspects of their depression.

Each type of psychotherapy has different goals. According to the Mayo Clinic in Rochester, Minnesota, these goals include helping people in these ways: (2)

• Adjust to a crisis or other 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 four common types of psychotherapy used to treat depression: (3)

• Cognitive Behavioral Therapy This strategy helps people identify harmful or ineffective patterns of thinking and behavior and replace them with more accurate thoughts and functional behaviors.
• Supportive Therapy This treatment method 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 This intervention is geared toward improving one’s self-awareness and altering old behavioral or thought patterns by focusing on how underlying belief patterns and experiences from one’s childhood impact their mental state in adulthood.
• Interpersonal Therapy This option helps patients understand underlying issues and learn healthy ways to express emotions and improve their communication with others.

RELATED: 9 Different Types of Depression

Antidepressant Medications Alter Brain Chemistry

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.

About 13 percent of Americans age 18 and 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). (4)

Many types of depression medications are available today. Most fall into the following drug classes, grouped by their effect on brain chemistry: (2)

• 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 Wellbutrin (buproprion), don’t fall into the above categories.

All of 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. (2)

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

Electroconvulsive Therapy May Help Treatment-Resistant Depression

When psychotherapy and medications don’t relieve symptoms of depression, or there is a high risk of suicide, doctors may turn to electroconvulsive therapy (ECT). Once called electroshock therapy, ECT has come a very long way since it was first used in the 1940s. According to Mayo Clinic experts, it’s safe, though there is the potential for side effects such as memory loss that may or may not be temporary, depending on the person. (5)

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. Typically the person wakes up 5 or 10 minutes afterward and is ready to resume normal activities in about an hour, according to the National Alliance on Mental Illness. (6)

That said, not everyone reacts the same way to ECT, notes Elizabeth Wassenaar, MD, regional medical director of the Pathlight Mood and Anxiety Center in Denver. She explains that people cannot drive the day they receive treatment, and some people find they cannot work the next day.

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 — explains Wassenaar. She adds that ECT is often covered by insurance.

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

• 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. (6)

RELATED: How to Cope With Caregiver Depression

Breakthrough Treatments Work in Novel Ways

Researchers continue to make progress in developing new kinds of antidepressant treatments, such as psychedelic-assisted treatments.

In 2019, the Food and Drug Administration (FDA) approved two first-of-their-kind medications:

• Spravato (esketamine), 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. (7)
• Zulresso (brexanolone), 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 a hormone thought to be associated with postpartum depression. (8)
  

Some mental health providers offer ketamine-assisted psychotherapy — in which ketamine treatment is administered in conjunction with a psychotherapy session — says Sarah Norring, PhD, 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, could potentially yield rapid and enduring relief of depressive symptoms among adults with major depressive disorder. (9)

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.

Lifestyle Changes May Play a Role

People with severe depression require help from medical professionals — they can’t treat themselves — but some lifestyle changes can supplement other treatments or counter mild depression:

• Exercise can release mood-enhancing chemicals and improve brain function. (10)
• Yoga, meditation, or other mind-body techniques can lower stress and relieve negative emotions.
• Support groups for people with depression can be found through organizations like the National Alliance on Mental Illness.

Nutrition May Aid in Managing Depression

Good nutrition, in addition to expert treatment, is often a cornerstone for the management of 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 provided 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.” (11)

Other research has shed light on a potential link between diet, depression, and gut health. A review article published in July 2019 in Nutrients indicates that the quality of one’s diet impacts the gut microbiota (bacteria and other microorganisms that occur naturally in your gut), which can in turn affect depression risk. (12)

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 and beans
• 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

RELATED: 10 Foods That Could Soothe Seasonal Depression

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. Do not use St. John’s wort while you're taking antidepressants, since the combination can result in serious side effects. (2)

Resources We Love

Substance Abuse and Mental Health Services Administration (SAMHSA) Led by the U.S. Department of Health and Human Services, SAMHSA is geared toward advancing public health efforts to lessen the impact of substance use and mental illness among Americans. If you need help finding treatment for depression or similar mental health issues, reach its national helpline at 800-662-HELP (4357).

National Alliance on Mental Illness (NAMI) Dedicated to bettering the lives of Americans affected by mental illness, NAMI offers several resources for depression, including free NAMI Connection support groups. Find one in your area.

Blurt This social enterprise emphasizes the importance of talking about depression and raising public awareness about this condition. Have a look at its blog posts authored by people living with depression, including how to prepare for your first mental health appointment.

Additional reporting by Pamela Kaufman and Michelle Pugle.