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Treatment for Depression

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

There is no cure for major depressive disorder (MDD), also called clinical depression or depression. But there are options to manage symptoms. The first-line treatment options for depression are antidepressant drugs and talk therapy.1

Response to treatment

Some people have only a single episode of MDD symptoms that responds to treatment. These people are said to be in remission. Their risk of another episode occurring is higher than that of someone who has never had an episode. But they may have few or no severe symptoms in the future.1,2

On the other hand, some people live with repeated episodes that do not respond well to treatment. This is called treatment-resistant depression. Each person’s experience will be different.1,2

Who treats MDD?

Just like symptoms vary, the treatment team may vary, too. Each person with MDD will have a team that is tailored to their needs. People with mild depression may need only their primary care doctor and a therapist.3,4

People with more severe depression may need a psychiatrist and other mental health or social support staff. A psychiatrist is a doctor who specializes in diagnosing and treating mental health conditions.3,4

Common members of an MDD treatment team include:4

  • Primary care provider (PCP) or family medicine doctor
  • Psychiatrist
  • Psychologist
  • Mental health counselors or other therapists
  • Clinical social workers
  • Psychiatric or mental health nurse practitioners
  • Pharmacists
  • Case managers
  • Nutritionists or dietitians

How often you need to visit each member of your team will vary. Often, your PCP or psychiatrist will serve as the point person for your team. They can point you in the right direction to find the support you need.3,4

Where are people with MDD treated?

There are different levels of care that occur in different places. The right level of care for a person is based on their:5,6

  • Symptom severity
  • Safety needs
  • Access to social support

Most people will be treated in outpatient care. This means they live at home and visit their doctor or therapist for regularly scheduled appointments. For example, a person may see the doctor who manages their prescription drugs once a month. They may see their therapist once a week. In between these appointments, they live at home and carry out daily tasks.5,6

If a person needs more support than outpatient care, their doctor may refer them to an intensive outpatient (IOP) or partial hospitalization program (PHP). In both of these cases, the person still lives at home. But they go to a treatment center most days. At the treatment center, they may have doctor’s appointments, therapy sessions, group activities, and social skills training.5,6

The main difference between IOPs and PHPs is how many hours the person spends in treatment. IOP is typically 3 hours per day for 3 to 5 days per week. PHP can be up to 6 to 8 hours per day for 5 days a week.5,6

In cases of crisis, or when a person is a danger to themselves or others, residential treatment or hospitalization may be needed. Residential treatment facilities are places where people live and get consistent care.5,6

Hospitalization is necessary only for the most severe episodes. Once the person is stable, their care team will make a plan to transition them to a residential program, PHP, IOP, or outpatient plan.5,6

Treatment methods

Most people with MDD take antidepressant medicines and attend therapy to treat their condition. Some people also find certain complementary treatment methods or lifestyle changes helpful.

Antidepressant drugs

Antidepressant drugs affect the activity of neurotransmitters in the body. Neurotransmitters are chemicals the brain uses to send signals. These signals control mood, behavior, thoughts, and more.7,8

While the exact cause of depression is not known, many experts believe an imbalance of neurotransmitters plays a role. Common neurotransmitters that antidepressant drugs affect include serotonin, norepinephrine, and dopamine.7,8

The most common types of antidepressant drugs used to treat MDD include:1,7,8

  • Selective serotonin reuptake inhibitors (SSRIs), like Zoloft® and Prozac®
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), like Cymbalta® and Effexor®
  • Tricyclic and tetracyclic antidepressants (TCAs), like Elavil®
  • Monoamine oxidase inhibitors (MAOIs), like Nardil®
  • Atypical antidepressants, like Wellbutrin®, Remeron®, and Trintellix®

The side effects of each drug can vary based on the neurotransmitters it impacts. Talk with your doctor about what side effects you can expect from the drug they prescribe.1,7,8

Also, many antidepressant drugs can interact with other drugs. Before beginning treatment for MDD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.7,8

Finding the right drug for you can take time. You may need to try different options and doses before finding the best plan for you. This is often a trial-and-error process that can take months.1,7,8

Psychotherapy

In addition to antidepressant drugs, many people benefit from talk therapy (psychotherapy). Research suggests that a treatment plan that includes both drugs and therapy has the strongest effect on depression symptoms and the best long-term outcomes.1

The type of therapy a person needs depends on their symptoms and goals. Some types of therapy are done 1-on-1 with a therapist. Other types are done in groups or with loved ones. You may be able to attend telemedicine sessions on your phone or computer. This can help you more easily access therapy.1

Common forms of psychotherapy used to treat people with depression include:1

  • Cognitive behavioral therapy (CBT)
  • Interpersonal therapy (IPT)
  • Behavioral therapy
  • Problem-solving therapy (PST)
  • Psychodynamic psychotherapy

Each type of therapy is given by a trained professional and may be specialized for your care. Your doctor can help you find a therapist in your area and determine the best therapy options to try.

Complementary treatment methods

Some people with MDD pursue other options along with traditional treatments like antidepressants and therapy. Nontraditional options that are used alongside prescribed treatments are called complementary treatment methods.9,10

A strong, well-rounded treatment plan may include both traditional and complementary treatment methods. This combination is called integrative medicine.9,10

Examples of complementary treatments used in MDD include:9,11

  • Vitamin supplements such as vitamin D, B6, B9 (folate), and B12
  • Other supplements such as St. John’s wort, omega-3 fatty acids, or S-adenosyl methionine (SAMe)
  • Acupuncture
  • Yoga
  • Mindfulness, meditation, or guided imagery
  • Hypnotherapy
  • Massage
  • Dance or music therapy
  • Tai chi
  • Breathing exercises

How effective each complementary method is can vary. And the research into some methods is less clear than others. Talk with your doctor before trying any new complementary option. Some, like supplements, may have risks or additional safety considerations.9,11

Lifestyle changes

Making certain lifestyle changes also may help improve depression symptoms. Changes that people with MDD commonly try include:9,11-13

  • Getting regular exercise
  • Drinking plenty of water
  • Eating a well-balanced diet
  • Avoiding recreational drugs
  • Quitting smoking
  • Cutting back on alcohol
  • Practicing good sleep hygiene to get better sleep

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