Depression treatment typically involves psychotherapy, medication, or both. These evidence-based approaches help most people who experience depression, and you can start with whichever feels most accessible to you. An estimated 21.0 million adults in the United States had at least one major depressive episode in 2021, representing 8.3% of all U.S. adults (NIMH). Treatment works, and getting help sooner rather than later gives you more options.
What Are the Main Treatment Options for Depression?
The primary treatment options for depression include psychotherapy (also called talk therapy or counseling) and antidepressant medications. Most people respond to one or both of these approaches. If symptoms do not improve with therapy and medication, brain stimulation therapy may be another option, though it is used less frequently and typically only after other treatments have been tried.
What Is Cognitive Behavioral Therapy for Depression?
Cognitive behavioral therapy, or CBT, is one of the most widely studied and recommended therapies for depression. CBT helps people identify and challenge unhelpful thoughts and behaviors that fuel depression. According to NIMH, with CBT, people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings.
The therapy focuses on the connection between thoughts, emotions, and behaviors. When you are depressed, certain thought patterns keep you stuck. CBT teaches you to notice those patterns, test them against evidence, and respond in ways that make room for change.
Sessions are usually weekly, and many people notice improvements within 12 to 20 weeks. The work continues between sessions. Your therapist will give you exercises to practice at home, and those between-session practices are where much of the shift happens.
How Effective Is CBT for Depression?
Research consistently supports the effectiveness of cognitive behavioral therapy for depression. The majority of systematic reviews and meta-analyses have concluded that CBT is an efficacious treatment for depression, with benefits extending beyond the end of treatment.
CBT can be delivered in different formats and still be effective. Group CBT for depression, delivered in routine care settings, has good results in terms of both improvement at the group level and clinical significance at the individual level. Internet-based CBT has also shown promise, with treatment gains maintained six and 12 months after treatment ended.
What Is Interpersonal Therapy?
Interpersonal therapy, or IPT, is another evidence-based approach for treating depression. IPT focuses on interpersonal and life events that impact mood and vice versa, according to NIMH. The therapy helps you understand how your relationships and life circumstances affect how you feel.
IPT is particularly helpful when depression is tied to relationship conflict, loss, major life transitions, or social isolation. Instead of focusing primarily on thoughts like CBT does, IPT addresses the patterns in your relationships and helps you develop healthier ways of connecting with others.
Like CBT, IPT is time-limited and structured, typically lasting 12 to 16 weeks.
How Do Antidepressant Medications Work?
Antidepressants are medications commonly used to treat depression that work by changing how the brain produces or uses certain chemicals involved in mood or stress. The most commonly prescribed types include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
According to NIMH, antidepressants take time to work, usually four to eight weeks. Problems with sleep, appetite, and concentration often improve before mood lifts, so early changes can be a sign the medication is working even if you do not feel better emotionally yet.
Starting an antidepressant requires patience. You and your prescriber may need to adjust the dose or try a different medication if the first one does not help. It can take time to find the right fit, but most people eventually find a medication that works for them.
What If the First Treatment Does Not Work?
Sometimes the first treatment you try does not help as much as you hoped. That does not mean depression is untreatable. Treatment-resistant depression is a recognized pattern, and there are options designed specifically for it.
For treatment-resistant depression, one option is to combine an antidepressant with a different type of medication that may make it more effective, such as an antipsychotic or anticonvulsant medication. Another option is esketamine, a medication approved by the FDA for treatment-resistant depression, delivered as a nasal spray that acts rapidly, typically within a couple of hours, according to NIMH.
If therapy alone has not been enough, adding medication can help. If medication alone has not been enough, adding therapy can give you skills that last beyond the medication.
What Is Brain Stimulation Therapy?
Brain stimulation therapy is used less frequently than psychotherapy and medication, but it can play an important role in treating depression in people who have not responded to other treatments. The therapy generally is used only after a person has tried psychotherapy and medication, according to NIMH.
The most commonly used brain stimulation therapies are electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). ECT involves sending electrical currents through the brain under anesthesia, while rTMS uses magnetic pulses to stimulate nerve cells in the brain. Both have shown effectiveness for treatment-resistant depression.
These treatments are administered by specialized providers, typically in a hospital or clinic setting.
Which Works Better: Therapy or Medication?
Both therapy and medication are effective for depression, and research does not point to one as universally better than the other. The right choice depends on your situation, your preferences, the severity of your symptoms, and what you have access to.
Some people start with therapy and add medication later if needed. Others begin with medication to stabilize symptoms and then add therapy to address the patterns underneath. There is no single right order, and combined treatment is often the most effective approach.
What Does Combined Treatment Look Like?
Combined treatment means using both therapy and medication at the same time. You work with both your prescriber and your therapist, and ideally they communicate with each other about your progress.
The advantage of combining approaches is that medication can reduce symptoms enough to make therapy easier to engage in, while therapy gives you skills that last beyond the medication. When one approach is not enough on its own, combining them can make a real difference.
Not everyone needs combined treatment. If therapy alone is helping, there may be no reason to add medication. If medication alone is managing your symptoms and you feel stable, you might not need therapy right now.
Can Lifestyle Changes Help With Depression?
Stress management techniques like exercise, mindfulness, and meditation can reduce depression symptoms and support the work you do in therapy. Regular physical activity, sleep, nutrition, and social connection all affect how much depression interferes with your day.
These are not substitutes for treatment when depression is significant, but they enhance the effects of therapy and medication. Think of lifestyle changes as part of your treatment plan, not as something to try instead of getting professional help.
How Do You Know When to Get Help?
If you are in crisis or having thoughts of suicide or self-harm, call or text 988 (Suicide & Crisis Lifeline). In an emergency, call 911.
Consider reaching out to a therapist if:
- Your mood has been low most days for more than two weeks
- You have lost interest in activities you used to enjoy
- Depression is interfering with work, relationships, or daily tasks
- You are having trouble sleeping, or sleeping much more than usual
- You feel hopeless, worthless, or like a burden to others
- You are withdrawing from people or places that used to matter
You do not need to wait until depression becomes severe to get treatment. Early intervention can prevent symptoms from becoming more entrenched and give you tools to manage before depression takes over more of your life.
What Can You Expect in the First Session?
The first therapy session is usually an evaluation. Your therapist will ask about your symptoms, how long they have been present, what has been happening in your life, and what you have tried before. They might ask about your family history, your sleep and appetite, and whether you have had thoughts of harming yourself.
The goal is to understand what you are experiencing so your therapist can recommend an approach that fits. You do not have to commit to a full course of treatment before you have that conversation. The first session is as much for you to decide if the therapist feels like a good fit as it is for them to understand your situation.
What If You Have Tried Treatment Before and It Did Not Work?
If you tried therapy or medication in the past and it did not help, that does not mean depression is permanent. It might mean:
- The type of therapy was not the right match for your depression
- The medication dose was too low, or the medication was not the right one for you
- You needed more time than you gave it
- You needed a combination approach instead of one treatment alone
- The therapist or prescriber was not a good fit
Trying a different approach, asking about treatment-resistant options, or working with a different provider can open new possibilities. Depression is treatable, even when the first attempt does not go as hoped.
How Long Does Depression Treatment Take?
The length of treatment varies. Some people feel better within a few months. Others need longer, especially if depression has been present for years or if other factors like trauma or chronic stress are involved.
Therapy is often time-limited. Many evidence-based approaches, like CBT and IPT, are designed to be completed in 12 to 20 sessions. Medication timelines depend on how quickly you respond and whether you experience side effects that require adjustments.
Even after symptoms improve, some people continue therapy at a lower frequency or stay on medication to prevent relapse. Others stop treatment once they feel stable. Your provider can help you decide what makes sense for your situation.
What Should You Do If Your Child or Teen Shows Signs of Depression?
Depression can begin in childhood or adolescence. If your child seems persistently sad, irritable, or withdrawn, has lost interest in activities they used to enjoy, or is struggling with sleep or school, it is worth reaching out to a therapist who works with young people.
Therapy for depression in children and teens often involves the family. Alongside your child's sessions, you might learn how to support them at home in ways that reinforce their progress.
If you or someone in your family is in Michigan and you want support for depression, email us at advbehavioralhealth@gmail.com or use the short form at /get-started. Hanna Newton, LMSW, and the team at Advanced Behavioral Health offer evidence-based therapy for depression by video for children, teens, and adults across Michigan. Appointments are often available within the week.
References
National Institute of Mental Health (NIMH). Depression. https://www.nimh.nih.gov/health/publications/depression
National Institute of Mental Health (NIMH). Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression