How to Treat Depression: Therapy, Medication, Procedures, & Self Help

Identifying Depression & Depressive Symptoms

At times, depression can keep you in bed all day or prevent you from taking care of basic tasks for yourself or others. Symptoms of depression are ranging, dynamic and often include a variety of issues that affect someone’s physical and mental health.

Some common symptoms of depression include:

• Low mood or irritability
• Poor energy and fatigue
• Limited interest in activities and poor motivation
• Feeling sped up or slowed down
• Feeling excessively guilty, worthless, or down
• Changes to diet, weight, and sleep
• Poor concentration, focus, and decision-making skills
• Thoughts of death, dying, and suicide

Many depressive symptoms could be rooted in physical health issues. These medical conditions could create new symptoms, worsen existing symptoms, or masquerade as depression while being something else completely. Symptoms of depression could stem from cancer, heart disease, stoke, lupus, Alzheimer’s disease, multiple sclerosis, and physical concerns, so people should always consult with their primary care doctor to understand interactions between physical and mental health.⁸

Once other variables are ruled-out and a depressive diagnosis is confirmed, it is time to explore available treatments like:

• Therapy: Helpful meetings with a therapist to help note the impact of depression while working to modify thoughts, feelings, and behaviors to lessen its influence.
• Medications: Various psychiatric medications strive to adjust brain chemistry to create a healthier balance of neurotransmitters.
• Brain stimulation: Electrical currents, magnetic fields, and other stimulating procedures to trigger wanted brain changes and decreased depression
• Natural options: Herbs, nutritional supplements, and natural remedies with a tradition of effectiveness in reducing depression
• Lifestyle changes: Physical activity, sleep changes, eating a diet focused on foods that help with depression, and other healthy habits to increase happiness and shrink symptoms of depression.

With depression treatment, there are many paths toward recovery, and no one has to choose just one. Many treatments integrate with each other to provide a comprehensive treatment plan to create the best results.

Therapy for Depression

Therapy for depression is a safe and effective form of treatment. Also called talk therapy or psychotherapy, the practice involves a therapist meeting with a person to talk about what depression feels like, investigate symptoms, identify possible causes, and find resolutions for the depression.¹

A person may consider therapy if they are:¹

• Experiencing periods of high stress linked to a loss, relationship conflict, or changes at work, home, or school
• Noticing changes in mood, energy, sleep, diet, or motivation
• Hoping to improve the health and well-being of a loved one
• Seeking treatment options after a professional diagnosed them with depression or a related disorder

For many, therapy is an accessible and low-risk option to address unwanted symptoms. Even better, health insurances regularly pay for established, evidence-based forms of therapy, and in most situations, the person does not need a prescription or a referral to get started.

One therapy session can look quite different from another based on the location and treatment type. Therapy can occur in a number of settings like offices, schools, or the home in an online setting.

Some of the most effective therapy types for depression include:

Cognitive Behavioral Therapy

CBT for depression is a therapy style backed by extensive research and testing. With CBT, the therapist offers education regarding the connection between thoughts, feelings, and behaviors. By investigating negative, unhealthy thoughts and planning behavioral changes through new coping skills, the individual in treatment can move towards more desirable feelings.2

CBT uses structured sessions to produce helpful outcomes efficiently. This time-limited treatment style may conclude between eight and sixteen sessions.²

CBT is an umbrella term that includes many branches of therapy including:

• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavioral Therapy (DBT)
• Schema Therapy

Interpersonal Therapy 

Interpersonal therapy (IPT) focuses on a person’s relationships with friends, family, classmates, and coworkers to see how these interactions affect depressive symptoms. With unhealthy relationships making depression worse, IPT hopes to find ways to modify communication when possible and avoid problematic people and relationships.

Like CBT, IPT uses a short-term treatment approach to improve symptoms in a limited number of sessions.²

Psychodynamic Therapy

Rather than focusing on the person’s conscious awareness of their actions and thoughts, psychodynamic therapy turns towards the unconscious mind for answers about motivation and symptoms. Psychodynamic therapy helps people understand the impact of past experiences and then work to limit their impact.

This therapy type uses two separate modes of treatment, with short-term and long-term options.²

Internal Family Systems

Internal Family Systems (IFS) notes that each person within a family is made up of “parts” and the “Self.” In IFS, the parts that make up each person are not bad. Rather, some parts may have been forced into undesirable or negative roles. With this philosophy, IFS hopes to enable the person to access the Self to repair damage and bring their functioning into a new balance.⁹

Motivational Interviewing

Instead of the therapist working to create the motivation for change in the client, motivational interviewing (MI) is a therapy technique based on the client building their own motivation. MI emphasizes empathy, self-efficacy, and changing self-talk for the client, while the therapist works to develop discrepancy by pointing out times when the client’s actions do not match their goals. MI acknowledges that clients will resist change often, so therapists learn how to “roll with the resistance” and encourage the wanted changes.¹⁰

Eye Movement Desensitization and Reprocessing

If the depression was a reactive response to some form of trauma, EMDR for depression may be helpful to treat the underlying trauma and in that way relieve the depression symptoms.

Play Therapy

Depending on the age of the individual in treatment and their presenting problems, play therapy is another treatment option. With the use of toys, art, and other forms of play, play therapy helps younger people with depression practice changing their views, attitudes, and behavior. Play therapy is especially helpful for children with aggressive, defiant, and attention-seeking behaviors linked to depressive disorders.³

Types of Therapy to Avoid

With people looking to feel better quickly, and some therapists looking to experiment with new techniques, clients may encounter other forms of therapy. It’s important to note that many therapeutic orientations lack impartial research to understand their effectiveness and others have been proven ineffective.

Because of this, anyone seeking treatment for depression should be critical of treatments that include:⁴

• Rebirthing therapy: The act of being symbolically reborn to aid in attachments
• Dream interpretation: Analyzing the content of dreams to draw conclusions for life
• Therapeutic touch: The therapist touching, holding, or hugging client to improve relationships and mood
• Hypnotic age regression: Prompting the client to access memories while under hypnosis

These therapies can worsen symptoms or create new ones. Clients should always feel empowered to ask their therapist about the theoretical style used and become educated on the topic to learn if that orientation is an appropriate fit for their needs.

Questions to Ask a Therapist Before Beginning

Therapists will employ a range of therapy styles with tremendous variability based on their previous experiences and education.

To learn more about the treatments, someone interested in therapy should ask questions like:¹

• What are your credentials? Are you licensed with the state? If so, how were those earned?
• Do you have a specialty?
• What type of therapy do you offer, and do you have any special training in this?
• What goals will you work towards in therapy?
• How will you protect my privacy and confidentiality?
• Can I contact you between sessions? Do you use texting, email, or social media?
• Is there a timeframe that you expect to see an improvement in my symptoms?
• How often will sessions be?
• Do you collaborate with other therapists about treatment or receive supervision about cases?
• Will you accept friends, family members, and other loved ones to attend these sessions?
• What will your role be as a therapist? Will you do more listening or talking?

Pay attention to the answers to these questions. Each person should have control over their treatment and be a fully involved member of their treatment team. If the responses do not seem in your best interests, it could be time to move on to another therapist.

Medication for Depression

Medications for depression, called antidepressants, work to increase the amounts of certain chemicals in the brain with the hopes of limiting symptoms. Just like with therapy for depression, there is no one medication universally prescribed to improve symptoms in all people. However, with continued innovation, many available medications can improve symptoms.

Because there may be some trial and error involved, people using medications to address their depression should use patience while the prescriber finds the best medication at the best dose. Ask your prescriber about what you can expect while taking antidepressants to better understand the variability between medications and how they may affect you.

When taking antidepressants, remember:⁵

• Antidepressants require a prescription and are often covered by health insurances
• It can take time for medications to work (a month or longer)
• Never stop taking a medication without consulting with the prescriber
• Do not give up if you need to try more than one medication – prescribers learn a lot about what may help based on what does not help
• Antidepressants have side effects, so consult with the prescriber if they become problematic.
• Medications help depression by increasing the amounts of certain chemicals called neurotransmitters, but experts are not exactly sure how they work

Antidepressants fit into five different classes:

• Serotonin Reuptake Inhibitors: This group includes selective serotonin reuptake inhibitors (SSRIs), the most commonly used drugs for depression, and serotonin modulators, a group of newer medications that target more serotonin receptors in the brain. Serotonin reuptake inhibitors typically have fewer side effects compared to other antidepressants.⁵
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Like SSRIs, this class of medication helps to encourage more serotonin in the brain. SNRIs also increase norepinephrine, another neurotransmitter related to mood. SNRIs may also trigger some side effects like nausea, anxiety, and dizziness.⁵
• Atypical antidepressants: These target dopamine, as well as serotonin and norepinephrine to add another layer of effects on mood. These may have more side effects than the SSRIs and SNRIs, but fewer than the other classes.⁵
• Tricyclics and Tetracyclics: If someone is not responding well to the above medications, a prescriber may trial a tricyclic or tetracyclic. Like other antidepressants, these medicines help to increase the serotonin and norepinephrine in the brain, but these may trigger more serious side effects.⁵
• Monoamine Oxidase Inhibitors (MAOIs): MAOIs are older medications that require a special diet to avoid serious side effects. Despite the risks, MAOIs help to slow the breakdown of dopamine, norepinephrine, and serotonin in the brain to manage the effects of depression.⁵
• Ketamine: Still somewhat experimental, professionals are using small doses of ketamine for depression. Currently, the drug is mostly used as an anesthetic for people and animals.

Questions to Ask Your Prescriber About Medications

Like with therapy, people interested in seeking medication for their depression should come prepared with a list of questions to ensure this treatment is a good match for their needs.

Some questions for a prescriber include:^1,5

• What is your degree, your education, and your experience? Are you a psychiatrist, a general practitioner, a nurse, or some other type of prescriber?
• Do you treat mental health issues exclusively or only occasionally?
• Do you think these symptoms will be well-managed with one medication or a combination?
• Do you think therapy is an important part of this treatment plan?
• Will you communicate with my therapist if needed?
• Are you available for consultation in between appointments?
• What happens if side effects emerge?
• What happens if I miss a dose?
• Will the appointments always be with you, or will I see various prescribers?
• How will we know treatment is effective?

The use of medications may lead to rare side effects, so establishing a safety plan with the prescriber is critical.

Procedures for Depression

Outside of therapy and medications, there are several additional options for the treatment of depression. These procedures are available to people who have not responded well to other treatments or for people who seek an alternative path. Procedural techniques carry unique risks and benefits, so consulting with the treatment team is always recommended.

Depending on location, these options could be widely available or difficult to obtain. They could be fully covered with health insurance or they could cost hundreds or thousands of dollars in out-of-pocket expenses.

Procedural treatments for depression include:²

Electroconvulsive Therapy (ECT)

ECT involves electrical currents being passed through the brain to affect the functioning of neurotransmitters with the goal of decreasing depression. ECT may be done in an inpatient or outpatient setting under the care of medical professionals. ECT has progressed in recent years, making the procedure safe and effective for people with severe depression, high suicide risk, or no benefit from antidepressants.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation is an approved treatment for epilepsy and depression and includes a device being implanted under the skin on the chest to send signals to the left vagus nerve. New noninvasive models are currently approved in Europe to treat depression.¹¹

Repetitive Transcranial Magnetic Stimulation (rTMS)

TMS utilizes magnetic coils being placed on the scalp to non-invasively send magnetic pulses through the brain to stimulate neurons. By activating these brain cells, TMS aims to improve mood regulation and depressive symptoms.

Complementary & Alternative Medicines (CAM)

In recent years, there has been a renewed interest in exploring ways natural products can aid depression treatment. Natural remedies, herbs, and dietary supplements may help lessen depression for some people. Because the quality of herbs and supplements can vary greatly, those interested in pursuing CAM remedies should consult with an expert for a personalized plan.

CAM options are generally safe, but people interested in options like St. John’s wort and folate should always check with their prescriber before trying them as these natural remedies could create very serious interactions with medications.

7 Lifestyle Changes & Self-Help Strategies for Depression

Numerous studies show that therapy and medications are effective ways to treat depression, but adding lifestyle changes and self-help strategies can enhance the benefits of professional interventions.

A person with depression can gain additional power and control over their symptoms with these seven self-help strategies:⁶

1. Exercise

Increasing physical activity will help increase the level of wanted neurotransmitters like serotonin in the brain. Exercise for depression can also help self-esteem, increase feelings of empowerment, and build new social relationships.

2. Improved Diet

Without a steady stream of nutrition, the body cannot form new brain chemicals to fight depression. When rebuilding a diet, plan to eat plenty of healthy foods, drink enough water, avoid sugary beverages, and eat foods with probiotics to support the digestive system.

3. Focus on Good Sleep

Sleep is essential to restoring a person’s mental and physical health, and people who lack sleep tend to see life in more negative ways. Prioritize sleep by seeking ways to increase the quality and quantity of daily rest.

4. Limit Alcohol & Other Drugs

Using substances like alcohol, marijuana, and other drugs may seem like helpful ways to manage depression, but their use may increase symptoms in the long-term. Avoid substance abuse and devote energy to healthier coping skills.

5. Find Ways to Reduce Stress

Though people can see the connection between stress and depression, cutting back on stress can seem impossible at times. To reduce stress, focus on identifying the cause of stress, practicing relaxation techniques, and searching for resolutions.

6. Cultivate Healthy Relationships

Depression can cause healthy relationships to shrink, so people must devote more time, energy, and attention to finding and strengthening healthy relationships. Joining a team or support group, enrolling in a class, volunteering time, or bonding with a pet can help foster healthy relationships.

7. Find a Purpose

With the hopelessness linked to depression, having a purpose or feeling useful can be challenging but necessary. To define their purpose, a person can reflect on their strengths and pay attention to what brings joy and happiness.

These lifestyle changes are mostly free and readily accessible to people wanting to improve their depression. Even if they lack the motivation to make physical changes, devoting time to cognitive changes can begin the fight against depression.

Questions to Ask Your Care Team About Lifestyle & Self Help

It will be the individual’s decision to start lifestyle and self-help strategies for improving their depression, but speaking with other members of the treatment team can help refine plans to increase their effectiveness.

Consider asking your treatment team:

• What types of exercise would be more appropriate for my fitness levels – yoga, running, walking, swimming, tai chi?
• What are some sleep hygiene tips to improve my rest?
• Can you help establish a healthy diet and eating plan that fits my needs?
• Are there available support groups, volunteer opportunities, or community activities that could help with my relationships?
• Is my alcohol or other drug use affecting my depression? How can I improve it?
• What stress reduction and relaxation techniques would be best for me?
• How can I find purpose and meaning in life when my optimism is so low?

Remember, above all else, treatment for depression can work. People may feel discouraged and letdown, but depression will not alleviate without consistent and dedicated treatment. Even if a person feels far from it, they can achieve their goals.

Hospitalization for Depression

At times, symptoms of depression will become so severe the person will require a period of inpatient hospitalization. Inpatient hospitalization involves living in the hospital and receiving treatment from a team of psychiatrists, social workers, therapists, nurses, and other support staff until symptoms improve and safety is reestablished. In most cases, an inpatient stay is brief, and the person can follow up with other levels of care after hospitalization ends.⁷

Some reasons to seek hospitalization for depression include:⁷

• Thinking about or planning to harm oneself
• Thinking about or planning to harm someone else
• Being unable to care for their health and well-being
• Experiencing extreme paranoia, hallucinations, or delusional thinking due to depression with psychotic features

People may voluntarily seek inpatient hospitalization by calling a local crisis line or presenting to their nearest emergency department. At other times, people will require involuntary hospitalization because depression is creating such intense symptoms, like active suicidal ideation. In either case, the person’s health and safety will be the primary concern.

Final Thoughts on Depression Treatments

No one can predict what depression treatments will work or not work for them—until they try. As long as people enter the process with appropriate levels of patience and persistence, they will find treatments to effectively manage their symptoms of depression.