How is Depression Treated?

Treatment for depression typically includes antidepressant medication to relieve symptoms; psychotherapy to learn how to change the problematic thoughts, behaviors, and relationships that play a role in depression; or a combination of the two.

A wide variety of antidepressant medications have been used to treat depression. However, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have the strongest evidence for their effectiveness. Both types of antidepressants work by altering levels of certain neurotransmitters. However, SSRIs are less likely to result in adverse side effects. Other types of antidepressants also work by altering neurotransmitter activity.

Of the psychotherapeutic approaches, cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have the most research support for their effectiveness in treating depression. Cognitive-behavioral therapy focuses on changing negative ways of thinking and behaving that are associated with depression. Interpersonal psychotherapy focuses on improving dysfunctional relationships that may be contributing to or impaired by depression.

Electroconvulsive therapy (ECT) may be helpful for people whose depression is severe, life-threatening, or does not respond well to other forms of treatment. In ECT, mild electrical simulation is applied to the brain to induce brief seizures. An average of six to twelve treatments over a period of three to four weeks is usually required. After a successful course of treatment, antidepressants may be all that is needed to reduce subsequent depressive episodes. However, in some cases, additional doses of ECT may be required. Like all somatic therapies, ECT has serious potential side effects, with some patients reporting confusion or memory impairment. However, in most instances, these problems diminish within a few weeks following treatment, and most people report that the positive effects far outweigh the alternative—suffering from severe, long-term, and/or suicidal depression.

Certain types of antidepressant medication, certain forms of psychotherapy, and ECT are the only treatments that have been scientifically demonstrated to be effective to date. However, other forms of care may be helpful.

Alternative treatments including herbal products and dietary supplements are often used by people with depression. Among the more popular products are St. John’s wort, Omega-3, and SAM-e. Research into the safety and effectiveness of these remedies is relatively new, and findings vary. Some clinical trials have found St. John’s wort to be helpful for people with mild to moderate depression. One potential problem with the use of herbal treatments is that doses are not standardized, which means that the amount of the active ingredient may vary widely across different manufacturers, or even across different batches prepared by the same manufacturer. Inactive ingredients may also vary. Anyone considering the use of such remedies should consult with his or her physician, as they may alter the effectiveness of other medications.

Other interventions such as regular exercise and enhanced social support are often used in the treatment of people with depression, and have been demonstrated to be effective in helping to prevent depression as well.

The choice of treatment depends on the specific diagnosis and severity of symptoms, and ideally should be made jointly by the treating professional, the person with depression, and in the case of children or adolescents, parents or other caregivers. Treatment may be delivered in a variety of settings, for example, in outpatient clinics, residential treatment centers, or inpatient facilities. Inpatient hospitalization may be required when the depressed person is suicidal or otherwise dangerous, engages in high-risk behavior, abuses alcohol or drugs, or does not respond to treatment in less restrictive settings.