If you’ve been diagnosed with clinical depression, also known as major depressive disorder (MDD), rest assured there are many treatment options available. Some people will experience only one depressive episode in their life, while others may have depression throughout their lives and require ongoing treatment. Treatment for depression often includes a combination of prescription medication and psychotherapy. There are some lifestyle changes you can make also to manage depression symptoms. While some treatment methods help only in the short run, some can help you establish coping skills that offer lifelong benefits.
Prescription Medications
Your doctor may suggest antidepressants to help relieve symptoms and prevent their recurrence. Different types of antidepressants have different effects on the chemicals in your brain responsible for mood management, but in general they help you feel emotionally well and restore your ability to function in everyday life. They are also used to effectively reduce anxiety, restlessness, sleep problems, and suicidal thinking.
Research has shown that over the course of several weeks prescription medication can be effective at treating symptoms related to moderate, severe, and chronic depression but are less likely to do so in mild cases. However, they come with side effects, so it’s important to discuss the pros and cons of antidepressants with your doctor.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants. They are often used as first-line treatment for depression because they cause fewer side effects than other antidepressants. Studies have shown that SSRIs are also effective at preventing relapse of MDD.
Serotonin is associated with mood regulation, and SSRIs prevent the reabsorption of serotonin back into nerve cells, which increases the level of this neurotransmitter in the brain. A rise in serotonin levels can improve symptoms and make people more responsive to other types of treatment, such as psychotherapy.
SSRIs that are approved by the U.S. Food and Drug Administration (FDA) for treating depression include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
SSRIs come with certain increased risks in who are pregnant or breastfeeding or children, adolescents, or young adults because there’s an increased risk of serious side effects in these populations. SSRIs also need to be used with caution if a person has certain underlying health problems, such as diabetes, epilepsy, and kidney disease.
Many people who take SSRIs experience mild side effects in the beginning of treatment that improve with time. SSRIs can interact with other medicines, including some over-the-counter painkillers and herbal remedies, such as St John’s wort.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are another class of medications commonly prescribed to treat depression. They work by preventing or blocking the reuptake of both serotonin and noradrenaline, increasing the levels of these neurotransmitters in the brain to help regulate mood and relieve depression.
SNRIs that are FDA-approved for treating depression include:
- Cymbalta (duloxetine)
- Fetzima (levomilnacipran)
- Pristiq (desvenlafaxine)
- Effexor (venlafaxine)
SSRIs and SNRIs can potentially lead to dangerously high levels of serotonin, particularly when used with other medications that impact serotonin, resulting in a condition called serotonin syndrome. People with this condition experience confusion, agitation, muscle jerks, sweating, shivering, diarrhea, and high body temperature.
Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
NDRIs work by inhibiting the reuptake of norepinephrine and dopamine, increasing their levels in the brain. Norepinephrine helps regulate alertness and concentration, while dopamine helps with mood regulation. This class of antidepressants may also be prescribed for ADHD, narcolepsy, and Parkinson’s disease.
The most popular NDRI used to treat depression is Wellbutrin (bupropion). It causes anxiety in some people, but it is an effective treatment for anxiety for others. NDRIs are often prescribed for those who don’t respond well to SSRIs or SNRIs or people who can’t tolerate the side effects of those medications.
Symptoms of an NDRI overdose can include seizures, hallucinations, heart problems, and loss of consciousness. If you suspect you or someone close to you has overdosed on an NDRI, go to the emergency room immediately or call 911.
Tricyclic Antidepressants (TCAs)
TCAs were one of the the first category of antidepressants on the market but have generally fallen out of favor compared with newer antidepressants. They work like SSRIs by preventing the reabsorption of serotonin and norepinephrine, but they lead to more side effects. A study found TCAs are less tolerated compared with SSRIs, and significantly more patients taking TCAs discontinued treatment.
These medications are sometimes prescribed when other antidepressants don’t work. They are also used to treat obsessive-compulsive disorder, anxiety disorders, and chronic pain.
TCAs that are FDA-approved for treating depression include:
- Amitriptyline
- Amoxapine
- Desipramine (Norpramin)
- Doxepin
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline
- Trimipramine
Monoamine Oxidase Inhibitors (MAOIs)
MOAIs are less commonly prescribed today for major depressive disorder (MDD) because newer medications with fewer side effects are now available. MAOIs work by inhibiting monoamine oxidase, an enzyme that breaks down serotonin, dopamine, and norepinephrine, resulting in higher levels of these chemicals in the brain, which helps improve mood and reduce anxiety.
These medications are typically prescribed only when all other antidepressants have failed because they have a high risk of drug interactions and can interact with certain foods, including aged cheese, smoked meat, and beer. They should never be used together with SSRIs.
Types of MAOI commonly used for depression include:
- Parnate (tranylcypromine sulfate)
- Emsam (selegiline)
- Marplan (isocarboxazid)
- Nardil (phenelzine)
The Food and Drug Administration issued a warning that children, adolescents, and young adults being treated with SSRIs and other antidepressants should be monitored closely for worsening symptoms, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy or at times of dosage changes.
Therapies
Many talk therapy options are available for treating depression, but researchers have found the following provide good results for patients with depression.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is the most evidence-based form of talk therapy for patients with depression. It works by targeting and changing negative thought and behavior patterns and empowering patients with coping skills and lifestyle management strategies to support overall mental wellness and reduce likelihood of relapse. Exact duration depends on the severity of depression. CBT is often time-limited, and may only include eight to 16 sessions in some cases.
Interpersonal Therapy
Interpersonal therapy (ITP) is based on the idea that depression is in part related to our social relationships. It focuses on providing you with skills and strategies to make healthy changes in four areas:
- Enhancing social support
- Decreasing interpersonal stress
- Facilitating emotional processing
- Improving interpersonal skills
Therapists teach individuals to evaluate their interactions and improve how they relate to others. For acute major depression, this form of therapy typically takes place once a week and lasts for 12 to 16 weeks.
Psychodynamic Therapy
Psychodynamic therapy focuses on how depression is related to past experiences, unresolved conflicts, and unacknowledged or repressed traumas. Therapists engaged in this type of therapy help patients recognize and understand how negative patterns of behavior and feelings are rooted in past experiences and how they can work to resolve them. Psychodynamic therapy, which can be short- or long-term, promotes emotional healing through self-reflection and personal growth.
People with depression can develop unhealthy coping strategies, such as isolating themselves from others and shutting down when faced with conflict. Additional forms of psychotherapy can help them learn healthier ways of communicating with others and behaving, which include supportive counseling, behavioral activation, problem-solving therapy, and family or couples therapy.
Alternative Treatments
There is a wide array of alternative treatments for people seeking relief from depression, but these should never be started without consulting a doctor. Some of these treatments, such as herbal remedies, can cause serious side effects and interact with antidepressants.
Dietary Supplements
Herbal supplements made from plants such as St. John’s Wort are largely unregulated, meaning you cannot ensure individual product safety or quality. That said, review studies comparing St. John’s Wort to SSRIs showed comparable results in efficacy and safety for treating mild to moderate forms of depression. St. John’s Wort has similar chemical properties to some SSRIs, and works by increasing levels of serotonin. The risk of combining this supplement with other SSRIs is substantial, however.
You can also ask your doctor if folate supplementation may be right for you. The link between folate deficiency and depression is well documented, with studies suggesting that around a third of patients with depression may be folate-deficient. Keep in mind that folate supplementation may mask vitamin B12 deficiency, so it’s a good idea to ask your doctor for a blood test to check vitamin levels before starting any folate supplements.
Exercise
Exercise is such a popular way to naturally improve moods that its benefits are now commonly referred to as “the exercise effect.” Exercising works by increasing the body’s natural feel-good chemicals called endorphins. It has also been shown to have a positive impact on improving nerve cell connections in the hippocampus.
Stress and Relaxation Techniques
Stress and relaxation techniques can help a person relieve symptoms of depression. They can also help with daily functioning since they foster emotional resilience and help a person learn to self-soothe.
Popular techniques that have shown effective include:
- Deep breathing exercises
- Mindfulness meditations
- Yoga
- Self-hypnosis
These techniques are most effective when combined with lifestyle modifications, including good nutritional habits, regular exercise, and a strong support system.
Lifestyle
While you should never try to treat or cure a mental disorder without the help of a qualified professional, there are many ways you can support your own recovery and improve your overall well-being if you are living with depression.
Science-supported ways to improve your mood include:
- Improve eating habits: Try to consume a variety of foods, including fruits and vegetables, each day and limit your intake of sugar and processed food items.
- Be social: If you’re finding it difficult to socialize, try doing it in limited periods of time but more frequently or combining it with your daily physical activity goals.
- Prioritize sleep quality: Develop and maintain a consistent sleep-and-wake time, use the bedroom solely for sleep, avoid bright and blue light (like light from phone screens) before bed, and engage in an unwinding routine each night.
- Spend time with animals: You don’t need to get a pet if this isn’t in your time, energy, or financial budget. You can spend time with animals by visiting friends who have pets, offering to pet-sit, visiting the local zoo or sanctuary, or volunteering at a shelter.
A Word From Verywell
Depression treatment is not one size fits all. While your social network and support system can help, you should never rely on them or strangers on the internet for medical advice. Talk to your doctor about the best depression treatment approach for you. It can take a few tries to find the right approach to depression treatment, and this should always be done under the guidance of a doctor or mental health professional. Thoroughly discuss the pros and cons of each treatment option with your doctor. With support from a trained professional, you can start feeling better and minimize the effects of depression on your everyday life.