Depression is treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings; sometimes called “psychotherapy”), or a combination of the two. Remember: No two people are affected the same way by depression. There is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Because information about medications is always changing, the following section may not list all the types of medications available to treat depression. Check the Food and Drug Administration (FDA) website (www.fda.gov) for the latest news and information on warnings, patient medication guides, or newly approved medications.

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress.

There are several types of antidepressants:

There are other antidepressants that don’t fall into any of these categories and are considered unique, such as Mirtazapine and Bupropion.

Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage.

Most antidepressants are generally safe, but the U.S. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers, and young adults under age 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Common side effects listed by the FDA for antidepressants are:

Other more serious but much less common side effects listed by the FDA for antidepressant medicines can include seizures, heart problems, and an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a life-threatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles.

Your doctor may have you see a talk therapist in addition to taking medicine. Ask your doctor about the benefits and risks of adding talk therapy to your treatment. Sometimes talk therapy alone may be the best treatment for you.

The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255), or you can visit www.suicidepreventionlifeline.org.

How Should Antidepressants Be Taken?

People taking antidepressants need to follow their doctor’s directions. The medication should be taken in the right dose for the right amount of time. It can take 3 or 4 weeks until the medicine takes effect. Some people take the medications for a short time, and some people take them for much longer periods. People with long-term or severe depression may need to take medication for a long time.

Once a person is taking antidepressants, it is important not to stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It’s important to give the body time to adjust to the change. People don’t get addicted, or “hooked,” on the medications, but stopping them abruptly can cause withdrawal symptoms. If a medication does not work, it may be helpful to be open to trying another one.

Antidepressants are generally considered safe, but some studies have suggested that they may have unintentional effects, especially in young people. The FDA adopted a “black box” warning label—the most serious type of warning—on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or suicide attempts in children, adolescents, and young adults up through age 24.

The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor.

Finally, the FDA has warned that combining the newer SSRI or SNRI antidepressants with one of the commonly used “triptan” medications used to treat migraine headaches could cause a life-threatening illness called “serotonin syndrome.” A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.

The benefits of antidepressant medications may outweigh their risks to children and adolescents with depression. To find the latest information, talk to your doctor and visit www.fda.gov.

You may have heard about an herbal medicine called St. John’s wort. St. John’s wort is an herb. Its flowers and leaves are used to make medicine. It is one of the top-selling botanical products in the United States. But St. John’s wort is not a proven therapy for depression. The FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety and effectiveness.

Taking St. John’s wort can weaken many prescription medicines, such as:

For more information, please visit the website for the National Center for Complementary and Integrative Health at https://nccih.nih.gov/.

For more information on medications for depression, please visit the FDA website at www.fda.gov. You can also find information on drugs, supplements, and herbal information on the National Library of Medicine’s Medline Plus website (www.nlm.nih.gov/medlineplus/druginformation.html).

Several types of psychotherapy—or “talk therapy”—can help people with depression. There are several types of psychotherapies that may be effective in treating depression. Examples include cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy.

CBT can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.

IPT is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.

PST can improve an individual’s ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.

For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.

More information on psychotherapy is available on the NIMH website at www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

Your therapist could be only a mouse click or email away. There are many therapy programs available online or on the computer (e.g., DVDs, CDs), and some research shows that Internet-based therapies may be just as helpful as face-to-face. But results can vary from program to program, and each program is different.

Many of these therapies are based on the two main types of psychotherapies—CBT and IPT. But they may be in different formats.

For example, you might learn from materials online and get support from your therapist by email. It could be a video conferencing session that progresses much like a face-to-face session. Or you may use a computer program with video, quizzes, and other features with very little contact with a therapist. Sometimes these therapies are used along with face-to-face sessions. Sometimes they are not.

There are pros to receiving therapy on the Internet or on the computer. These options could provide more access to care if you live in a rural area where providers aren’t available or if you have trouble fitting sessions into your schedule. Also, tech-savvy teens who feel uncomfortable with office visits may be more open to talking to a therapist through a computer screen.

There are also cons. For example, your health insurance may only cover therapy that is face-to-face. And although these various formats may work for a range of patients, they also may not be right for certain patients depending on a variety of factors.

If you are interested in exploring Internet or computer-based therapy, talk to your doctor or mental health provider. You may also be able to find an online mental health care provider on your own. But remember that there are many online “therapists” who may lack the proper training or who may try to take advantage of you. Speak with your provider first to see if he or she can provide a recommendation or trusted source for more information. You can also check the online provider’s credentials and ask about his or her treatment approach. Sometimes you may need to have a conversation with more than one provider to find the right one for you. If cost is an issue, be sure to also contact your health insurance provider to see what’s covered and what’s not.

If you have a smartphone, tablet, or “phablet” (phone tablets), you may have noticed that there are many mobile applications, or apps, marketed as support for people with depression. Some of these apps aim to provide treatment and education. Other apps offer tools to help you assess yourself, manage your symptoms, and explore resources.

With a few taps on the screen, you could have information and tools to help your depression in the palm of your hand. But, just like with online health information, it is important to find an app that you can trust.

Here are a few things that are important to remember about mobile apps for depression:

Many mobile apps for depression provide information or general patient educational tools. Because these are not considered medical devices, the FDA does not regulate them.

Some mobile apps carry minimal risks to consumers or patients, but others can carry significant risks if they do not operate correctly. The FDA is focusing its oversight on mobile medical apps that:

NIMH does not currently offer any mobile apps, but NIMH’s website, www.nimh.nih.gov, is mobile-friendly. This means you can access the NIMH website anywhere, anytime, and on any device—from desktop computers to tablets and mobile phones.

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. There are a lot of outdated beliefs about ECT, but here are the facts:

Some people believe that ECT is painful or that you can feel the electrical impulses. This is not true.Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses.

Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat severe depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). In 2008, the FDA approved rTMS as a treatment for major depression for patients who have not responded to at least one antidepressant medication. In 2005, the FDA approved VNS for use in treating depression in certain circumstances—if the illness has lasted 2 years or more, if it is severe or recurrent, and if the depression has not eased after trying at least four other treatments. VNS is less commonly used, and more research is needed to test its effectiveness.