How To Treat Depression
There are a wide variety of treatment options available for depression, but it can take some trial and error to find one — or a combo — that works effectively for you.
There isn’t one cause of depression but it’s not a character flaw, a weak mind, or because you deserve it.
Depression is a blend of biological, social, and psychological factors. It’s important to find out the type of depression that you have to effectively treat depression.
Find the right treatments can be tricky because something may work for one person but not for yourself.
It’s common for treatments to take weeks to kick in unless you’re using psychedelics under a physician’s guidance.
The treatment options range from antidepressant medicines to natural ways to manage depression, we’ve included all the scientific literature that we can find to give you the most up-to-date information for treating depression.
Remember that treating depression is often a marathon and not a sprint.
While recovering from depression, it’s important to have patience and self-compassion along the way.
Here are the treatments for depression
Antidepressants | Mainline of defence
Today, antidepressants (chiefly SSRIs) are still the first-line treatment for depression, even though they’ve been controversial since becoming available.
The response to treatment with SSRIs is moderate and variable, however, ranging from 40 to 60 percent, with remission rates ranging from 30 to 45 percent.
Several non-pharmaceutical approaches to manage depression symptoms include public health interventions, exercise, diet changes, meditation, sauna use, light therapy, and the use of certain psychedelic substances.
A 2008 meta-analysis concluded that although antidepressants were statistically more effective than a placebo in reducing symptoms of depression, their benefits were not clinically meaningful, because the size of the reduction did not meet the guidelines set by researchers.
In 2018 the largest meta-analysis of antidepressants to date combined 522 controlled trials and found that antidepressants led to a small reduction in symptoms of depression.
They were also associated with higher study dropout rates as a result of adverse events.
Some authors have disputed these results, suggesting the benefits of antidepressants are smaller and the risks higher, due to many of the analyzed trials suffering from poor study design, poor choice of statistical analysis methods, and potential publication bias (meaning studies with positive results, considered more interesting, are more likely to be published).
Exercise, physical activity, and movement
Several observational studies have found that people who are physically active are less likely to develop depression.
There’s a type of research method that provides evidence of links between modifiable risk factors and disease based on genetic variants within a population called Mendelian randomization.
A study that used the method demonstrated that higher levels of physical activity may be causally linked with a reduction in depression.
There are randomized-controlled trials that have found exercise mitigates depressive symptoms, facilitates recovery from depressive disorders, and prevents relapse.
Exercise and physical activity promote a wide range of neurogenic and neuroprotective responses that manage depressive symptoms such
- increases in tryptophan transport into the brain to support serotonin synthesis
- prevention of the formation of neurotoxins associated with depression
- increases in anti-inflammatory factors
- increases in the neurotrophin BDNF.
A meta-analysis of 25 randomized controlled trials that compared exercise to control groups found that exercise reduced depressive symptoms. The effect was particularly strong for moderate to vigorous aerobic exercise.
Exercise has been shown to improve sleep in people with depression. They found that compared to doing nothing, aerobic (with or without treatment as usual or health education), mind-body (with or without treatment as usual), and strength exercises all improved sleep quality. Compared to treatment as usual, only mind-body exercise plus treatment as usual and vigorous strength exercise improved sleep quality.
Note: “Mind-body” exercises refer to activities such as yoga, tai chi, or qi gong.
Observational evidence has indicated that those who meet the Centers for Disease Control and Prevention’s (CDC) guidelines for both aerobic and muscle-strengthening exercise had the lowest prevalence of depressive symptom severity.
The CDC recommends:
- 75–150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity
- 2 or more days a week of muscle-strengthening activities
The smiles trial was a 12-week randomized controlled trial involving people who had moderate to severe depression who received either dietary support that encouraged the consumption of healthy foods versus social support only, those who received the dietary support had fewer symptoms of depression at the end of the trial.
Fruits and vegetables are important because they provide essential nutrients such as folate and B Vitamins but they also have bioactive compounds such as polyphenols, isothiocyanates, stilbenes, and others.
These type of compounds place a hormetic effect in the body that triggers a mild (but beneficial) cellular stress to reduce inflammation and protect the cells from damage
Decreases in processed meats, refined carbohydrates, and other highly processed foods have also been associated with greater mental well-being.
Omega-3 fatty acids (omega 6 to 3 ratio)
Natural foods such as Salmon provide omega-3 fatty acids which are important for the brain and depression.
These omega-3 fatty acids have important anti-inflammatory, immunomodulatory, and neuroprotective properties.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are fatty acids found in fatty fish and fish oil supplements which promote the production of anti-inflammatory mediators such as resolvins and protectins.
A systematic review and meta-analysis of 31 observational studies with more than 20,000 cases of depression published in the Journal of Affective Disorders in 2016 supported the claim that dietary omega-3 is associated with a lower risk of depression.
A trial of 28 people with depression who took an omega-3 fatty acid supplement had significant improvements in their depressive symptoms compared to those who took a placebo.
Another trial which involved 20 people with recurrent depression used a combination of omega-3 fatty acids along with their antidepressant therapy showed marked reductions in their symptoms.
A meta-analysis of studies that investigated the therapeutic value of omega-3 fatty acids suggest that administration of high dose supplemental omega-3 fatty acids in conjunction with antidepressant therapies offer the greatest promise in treating the symptoms of depression
More than 30 clinical trials have tested different omega-3 preparations in people with depression.
Most studies have used omega-3s as add-on therapy for people who are taking prescription antidepressants with limited or no benefit.
Fewer studies have examined omega-3 therapy alone.
Clinical trials typically use EPA alone or a combination of EPA plus DHA, at doses from 0.5 to 1 gram per day to 6 to 10 grams per day.
To give some perspective, 1 gram per day would correspond to eating three salmon meals per week.
Probiotics | Cultivating the right ecosystem
Your gut and your brain communicate much more often than you’d think.
In fact, all the time.
They communicate through the vagus nerve, which runs from the brain to the gut.
There is very good potential for consuming gut inhabitants (aka probiotics and fermented foods) and impacting brain-related diseases, concentration, focus, and brain fog.
Probiotics and fermented foods are live microorganisms that impact all aspects of our health.
They not only help manage IBS, improve cardiovascular health, but they also help manage mood, anxiety, depression, and other mental illness.
The reason that probiotics might have an effect on a person’s mood relates to the vagus nerve via the gut-brain axis.
The communication between the gut and brain is through a variety of mechanisms that include neural, endocrine, and immune pathways that interact with the intestinal microbiota.
A randomized, triple-blind, placebo-controlled trial involving 20 healthy adults who took a probiotic supplement containing 2.5 billion bacteria per gram of
- Bifidobacterium bifidum W23
- Bifidobacterium lactis W52
- Lactobacillus acidophilus W37
- Lactobacillus brevis W63
- Lactobacillus casei W56
- Lactobacillus salivarius W24,
- Lactococcus lactis (W19 and W58)
for four weeks experienced reduced reactivity to sad mood, as evidenced by reduced rumination and aggressive thoughts.
These findings suggest that taking a certain probiotics may help reduce the negative thoughts associated with a sad mood.
Taking a probiotic supplement made up of multiple strains of bacteria can have increased effectiveness through an additive or synergistic effect of the individual strains, compared with mono-species supplements.
Sauna use and hyperthermia –
Research shows that they can make you feel euphoric.
The changes may be long-lasting as well.
Sauna use has been shown to reduce symptoms of depression, likely through its effects on the expression of heat shock proteins, transcriptional regulators, and pro-and anti-inflammatory factors.
Charles Raison did two studies in which they placed individuals with major depression into a high-tech infrared heating device, induced hyperthermia, and then watched to see what it would do to their depressive symptoms.
In the first study of 16 individuals with major depression, a single hyperthermia treatment reduced their depression scores almost by 50% five days later.
The results from this first study were exciting, but the study had a significant weakness: There was no inactive comparative condition (i.e. placebo or sham) that would allow us to know whether the positive effect was specific to the high heat or resulted more from the many non-specific mood-enhancing effects of entering a study.
They performed a larger study in which we randomly treated half the participants with active hyperthermia and the other half with a “sham” treatment that mimicked every aspect of the hyperthermia treatment except the high heat.
The participants who were exposed to a single session of whole-body hyperthermia in which core body temperature was elevated to 38.5°C (101.3°F) experienced an acute antidepressant effect that was apparent within a week of treatment and persisted for six weeks after treatment.
The results of the follow-up study echoed those found in the first study – a single session of hyperthermia produced a rapid and powerful antidepressant effect. And remarkably, none of this effect was seen in depressed patients who received the sham treatment.
In a randomized controlled trial involving 28 people diagnosed with mild depression, participants who received four weeks of sauna sessions experienced reduced symptoms of depression – such as improved appetite and reduced body aches and anxiety.
The control group received bed rest instead of sauna therapy.
Getting light at this time can suppress dopamine (an antidepressant, and feel-good hormone) and inhibit learning.
If you wake up in the middle of the night and get light exposure once in a while, it is ok, but if this is a routine, you might experience mood challenges, anxiety, unreliable focus, and metabolism disorders.
Exposure to bright light though, particularly blue light, boosts alertness and improves mood by acting as a robust circadian trigger in the morning and daytime hours.
However, when you viewing bright light in the middle of the night, it blunts dopamine and suppresses activation of the reward system.
A study involving 20 healthy men and women was able to reduce their cortisol levels by keeping participants in an environment free of time cues for 10 days and having seven hours of exposure to approximately 10,000 lux of bright light.
This is equivalent to the amount of light available at dawn or dusk.
Participants who were exposed to dim light (similar to candlelight) experienced little change in cortisol levels.
You can simply asses the light around you by downloading the app – “light meter” or “lux meter”
We know that poor sleep is a strong risk factor for suicide.
SAD, seasonal affective disorder, has been long associated with changes in light and that bright light therapy is a useful treatment.
Though recent research suggests it may be effective in treating non-seasonal depression as well.
A randomized control trial involving 122 adults with depression, bright light treatment, both as monotherapy (single therapy) and in combination with the SSRI fluoxetine (commonly known as Prozac®) markedly reduced the participants’ symptoms of depression.
The combination treatment had the most consistent effects.
We know that bright light affects our sleep-wake cycle, especially at night.
It does this because melanopsin, a light-sensitive protein that shifts the activity of cells in the brain’s suprachiasmatic nucleus into an active day pattern
80% of depressed patients report poor sleep quality, a common feature of depression.
Psychedelic drugs, a class of hallucinogenic compounds that includes LSD, mescaline, psilocybin, and ketamine, have long been known for their psychoactive properties.
Recent studies are finding that drugs such as LSD and psilocybin can help to alleviate depression, anxiety, and addiction.
More studies have assessed the therapeutic potential of psilocybin for various conditions, including end-of-life anxiety, obsessive-compulsive disorder, and smoking and alcohol dependence, with promising preliminary results
These drugs work in part by activating the 5-HT2A serotonin receptors, which modulate a wide range of physiological functions, including mood.
In a randomized double-blind trial, researchers were able to show that psilocybin produced substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer.
Approximately 80% of the participants continued to experience the positive effects on their mood six months later.
In a small open-label feasibility trial involving 12 adults with treatment-resistant depression, the participants experienced marked decreases in symptoms of depression, anxiety, and anhedonia following psilocybin administration
The first meta-analytic review evaluating the clinical effects of classic psychedelics vs placebo for mood states and symptoms of depression found that LSD and psilocybin were similarly effective at alleviating negative moods in healthy individuals and people with mood disorders.LSD, psilocybin, and ayahuasca alleviated depression acutely (3 hours to 1 day) and on the medium term (2 to 15 days). Psilocybin also alleviated depression in the long term (16 to 60 days).
In another meta-analysis in August 2020, looked at psilocybin on symptoms of anxiety and depression.
In all 4 trials, psilocybin resulted in large reductions in anxiety and depression (data on 69 participants), even 6 months after treatment (data on 117 participants).
In the 3 trials with a control group, the psilocybin group experienced greater reductions in anxiety and depression. While the results are promising, heterogeneity between studies was high, especially for psilocybin dose, and 3 trials included individuals with terminal cancer (limiting generalizability).
Interestingly enough, a growing body of evidence suggests that psychedelic drugs may also modulate the immune system, a mechanism that may have relevance for depression.
Studies in cells have demonstrated that an amphetamine psychedelic drug suppresses TNF-alpha-related inflammation and inhibits the production of the pro-inflammatory cytokine, IL-6, and others through its activation of the serotonin 5-HT2A receptor, in the same fashion as other psychedelic drugs
Cell studies have demonstrated that an amphetamine psychedelic drug suppresses TNF-alpha-related inflammation and inhibits the production of the pro-inflammatory cytokine, IL-6, and others through its activation of the serotonin 5-HT2A receptor, in the same fashion as other psychedelic drugs.
Similar effects were observed in mice after the administration of an amphetamine psychedelic.
Transcranial direct current stimulation
tDCS is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain.
This brain stimulation is an effective treatment for depression.
Transcranial direct current stimulation uses a weak electrical current that is delivered to the scalp electrodes via a portable battery-powered stimulator.
It does this by changing brain activity in a certain desired region or neural network by strengthening or weakening the communication between neurons.
A double-blind randomized sham-controlled trial that involved 30 adults showed marked improvements from tDCS.
These participants demonstrated a poor response to SSRI therapy but found improvements in their depression that persisted one month after the treatment.
Depressed people often have an inability to interpret or “read” emotions such as anger, happiness, disgust, on others’ faces.
A randomized crossover placebo-controlled study involving demonstrated that tDCS improved emotion recognition deficits commonly associated with depression.
We know that emotional stress is a trigger that can increase the risk of developing depression.
There are some interventional trials that have utilized mindfulness and meditation to mitigate stress and reduce the risk of depression.
A randomized, controlled, comparative efficacy trial involving 76 adults with moderate stress levels found that mindfulness meditation improves depressive symptoms.
They experienced that their depressive symptoms were greater than the group that only received health education.
A meta-analysis that looked at the effects of mindfulness interventions on depressive symptoms in adolescents.
The overall mindfulness groups showed reduced scores for depression.
Of these, 10 studies reported a significant improvement. Notably, funded studies reported greater effects than those that were not.
There was a slightly greater, but not significant, reduction in depression with mindfulness-based cognitive therapy compared to mindfulness-based stress reduction and adapted mindfulness interventions.
When mindfulness interventions were coupled with counseling, significantly greater reductions in depression were reported.
Interventions in middle-adolescents (15–17 years) tended to have a greater, but no significant effect on depression than those in early (10–14 years) and later (older than 17 years) adolescents.
School-based interventions showed a greater, but not significant, effect on depression than those conducted in clinical settings.
Finally, studies with follow-up further from the intervention showed greater improvements in depression.
A Systematic Review and Meta-analysis of 47 studies involving 3,515 people found that mindfulness meditation was moderately effective at reducing anxiety, depression, and pain.
Public health interventions
Strategies for treating older adults with depression that utilize different structured activities (exercise) and problem-solving strategies, along with psychotherapy and/or antidepressants, have been effective in reducing the number of days the participants experienced depressive symptoms.
In a study involving more than 400 older adults seen in primary care clinics, the ones that were randomized to intervention programs involving exercise or problem-solving strategies experience an average of 115 more depression-free days per year than those who received the typical care.
Having your serum copper levels assessed if you have postpartum depression is important.
We suggest talking with your doctor and trying other treatments (above) for your depression. You can also talk to your doctor about the addition of zinc, SAMe, or creatine to your SSRI as they’ve been shown to support the medication.
The STAR-D trial, a large effectiveness trial (n = 4,000), looked at the effect of SSRIs and other medications for the treatment of depression. As an effectiveness trial, STAR-D looked at “real” patients with comorbidities (as opposed to efficacy trials, which use “perfect patients” with no comorbidities to minimize confounding effects). Only 30% of patients went into complete remission with the first step of treatment with an SSRI (citalopram) at the highest tolerated dose.
Almost 50% experienced a response (a 50% reduction in symptoms of depression on a standardized scale).
You’ll have a poor response to antidepressants if you have
- a comorbid anxiety disorder, failure of first or subsequent antidepressant trials.
- Within STAR-D, among those who failed three treatment steps, only 13% responded to the next treatment.
Good response to antidepressants: An acute response to an antidepressant predicts long-term response.
- A 20% or greater improvement within 2 weeks of treatment resulted in a higher chance of remission, compared with those who don’t initially respond, who then had a less than 5% chance of remission.