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Depression is a serious medical illness that affects around 7% of adults, which is over 20 million people in the United States, according to the National Institute of Mental Health. Children can also have depression, with around 4% of children in the U.S. having a diagnosis of depression, according to the Centers for Disease Control and Prevention (CDC).
What is depression?
Major depressive disorder, often referred to as depression, can range from mild to severe, and symptoms include:- Feeling sad
- Loss of interest in activities you once enjoyed
- Weight loss or gain
- Trouble sleeping or sleeping too much
- Fatigue and feeling tired
- Feeling worthless or hopeless
- Problems with concentration
- Suicidal thoughts or preoccupation with death
Clinical depression can affect people from all walks of life. Women, in particular, may be more vulnerable to experiencing depression than men, although depression can affect both men and women. Despite being a common condition, depression is often underdiagnosed and undertreated.
RELATED: Depression statistics | Anxiety vs. depression
How is depression diagnosed?
There isn’t a laboratory test or scan to diagnose depression. Doctors base their diagnosis on a description of your symptoms and look for specific information on your mood, behavior, and daily activities. During an initial health care assessment, you might be asked to complete screening questionnaires, such as:- Beck Depression Inventory: Twenty-one questions about your symptoms. You respond to each item with a score of zero through three.
- Hamilton Depression Rating Scale: A questionnaire with 21 questions and is frequently used to determine the severity of your depression after diagnosis.
- Zung Self-Rating Scale: A rating scale that measures the severity of your depressive symptoms. The scale consists of 20 questions and is then given a score between 20 and 80. A score above 69 indicates severe depression.
Many people start the diagnostic process with their primary physician. Your physician might request laboratory tests to rule out physical causes of your symptoms; for example, thyroid disorders and vitamin deficiencies may cause depressive symptoms.
During your doctor’s appointment, make sure your physician is aware of all medications you are taking, as some drugs can cause side effects that may mimic symptoms of depression. If you are diagnosed with depression, you may be prescribed antidepressants or referred to a mental health specialist for further care.
Once you receive a diagnosis of depression, here are some questions you can ask your doctor:
- What type of depression do I have?
- Do you suggest medications, psychotherapy, or both?
- Can depression affect my sleep and eating habits?
- Can my depression be causing physical pain?
- Are there other health conditions that could be causing these symptoms?
- What medication do you suggest, and what are the side effects of it?
- Are there lifestyle changes I can make to improve my symptoms?
- Are there alternative treatments?
Depression treatment options
There is no definitive cure for depression; however, there are many effective treatments to reduce or eliminate symptoms. The type of depression, how long symptoms have been present, other health conditions, and tolerance of side effects all play a role in determining which treatment is best for you.Almost all people with depression receive some relief with treatment, with between 80% and 90% responding well to treatment. Treatment may include prescription drugs, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs); psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy; or both medication and psychotherapy.
For people with treatment-resistant depression, or depression that does not respond to other treatments, various options are available. For example, electroconvulsive therapy (ECT) is sometimes used for those who have not responded to other treatments. A five-year study found that using a vagus nerve stimulation device can also help improve the quality of life in those with treatment-resistant depression. You can find ongoing clinical trials on the website CenterWatch.com.
The following provides an overview of each type of treatment:
Psychotherapy
Psychotherapy, also known as talk therapy, is effective in treating depressive disorder. Some of the more common types of psychotherapy include:- Cognitive-behavioral therapy: Works to help an individual change unhelpful thought patterns and provide practical steps for managing symptoms.
- Interpersonal therapy: Looks at external factors, such as relationships, and their role as contributing factors to depressive symptoms. The therapist works with you to improve personal relationships and find ways to resolve conflicts.
- Psychodynamic therapy: Places emphasis on resolving past issues that might be contributing to negative behaviors and feelings.
- Psychoeducation: Teaches you about depression symptoms, how to recognize early warning signs and steps to take before a relapse occurs.
- Support groups: Can be led by a therapist or by someone who also has depression. During group therapy sessions, you can talk freely about your feelings and share experiences as well as practical ways to overcome negative emotions.
Brain stimulation therapies
Your doctor might suggest brain stimulation therapies if other treatment methods have not provided relief from symptoms. These include electroconvulsive therapy, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. They work by stimulating different areas of the brain.Antidepressant medications
There are several different classes of antidepressant medications, and each works to relieve symptoms differently. Antidepressants may take around two weeks to start improving symptoms and can take up to eight weeks or more to be fully effective. It may require trying a few different dosages and medications before finding the one that works for you.Medications for depression target specific brain chemicals, called neurotransmitters, such as serotonin, norepinephrine, and dopamine. The most commonly used classes of drugs used are:
Selective serotonin reuptake inhibitors
SSRIs target serotonin and are the most widely used medications for depression. Common SSRIs include:- Prozac (fluoxetine)
- Zoloft (sertraline)
- Paxil (paroxetine)
- Celexa (citalopram)
- Lexapro (escitalopram)
Serotonin and norepinephrine reuptake inhibitors
SNRIs increase levels of the brain chemicals serotonin and norepinephrine. Common SNRIs include:- Effexor XR (venlafaxine)
- Pristiq (desvenlafaxine)
- Cymbalta (duloxetine)
- Fetzima (levomilnacipran)
Serotonin modulators
Serotonin modulators are a class of drugs that work by increasing levels of serotonin in the brain or directly stimulating or blocking serotonin receptors.- Serzone (nefazodone)
- Desyrel, Desyrel Dividose (trazodone)
- Viibryd (vilazodone)
- Trintellix (vortioxetine)
Atypical antidepressants
Atypical antidepressants are a class of drugs that may affect multiple neurotransmitters, including serotonin, dopamine and norepinephrine. These may work in different ways to regulate mood and treat depression. The most commonly used atypical antidepressants are:- Wellbutrin (bupropion)
- Remeron (mirtazapine)
Tetracyclic and tricyclic antidepressants
Tetracyclic and tricyclic antidepressants (TCAs) were once considered a first-line treatment for depression, but are now mostly used for hard-to-treat or treatment-resistant depressive symptoms. These are less commonly used since they tend to have more side effects and more interactions with other medications. They work to increase serotonin and norepinephrine in the brain. The most commonly used are:- Elavil (amitriptyline)
- Norpramin (desipramine)
- Zonalon (doxepin)
- Tofranil (imipramine)
- Pamelor (nortriptyline)
- Vivactil (protriptyline)
- Surmontil (trimipramine)
- Asendin (amoxapine)
- Ludiomil (Maprotiline)
Monoamine oxidase inhibitors
MAOIs can have severe side effects, so they are rarely used. Due to potential drug interactions, they should never be taken in combination with SSRIs, certain seizure medications, and many other types of medications. MAOIs include: While antidepressant medications help many people, up to 30% of people taking antidepressants do not improve or experience a short-lived improvement. In some cases, other medications may be recommended for treatment-resistant depression.Researchers have been working with the medication ketamine. This medication was first developed as an anesthetic agent for various surgical or diagnostic procedures. However, it may also be used to reduce depressive symptoms.
The medication Esketamine (ketamine) was approved by the Food and Drug Administration (FDA) in March 2019 and is available as a nasal spray. In one study, 70% of patients using an oral antidepressant and Esketamine improved compared to just over half of the control group.
However, the U.S. Food and Drug Administration (FDA) created a Risk Evaluation and Mitigation Strategy (REMS) due to the potential risks of using the drug. A REMS is a drug safety program that the FDA requires for specific medications with serious potential safety issues to help ensure that the benefits of using the drug outweigh its risks.
What is the best medication for depression?
There are many treatments for depression, but there is no "best" medication. What works for one person might not work for another since everyone reacts differently to medicines. Your doctor will take your medical condition, medical history, and other medications you are taking into consideration when suggesting a treatment for you.Be sure to speak with your doctor about potential side effects and drug interactions with other medications you might be taking. All antidepressants carry a Boxed Warning, often called a “black box warning,” designed to call attention to serious or life-threatening risks. The specific Boxed Warning cautions that antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder or other psychiatric disorders.
Best medications for depression
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What are common side effects of depression medications?
As with all medications, antidepressants may cause undesired responses to the medication. While these side effects often diminish within a few weeks of use, some may persist for longer.Consult your doctor about the risks and benefits of a particular medication. Many people find the benefits outweigh the risks; however, some people find it challenging to tolerate some side effects. You should always seek medical advice before stopping a medication.
Common side effects of selective serotonin reuptake inhibitors (SSRIs) may include:
- Sexual dysfunction
- Drowsiness
- Weight gain
- Insomnia
- Anxiety
- Dizziness
- Headache
- Dry mouth
- Blurred vision
- Nausea
- Rash or itching
- Tremor
- Constipation
- Stomach upset
- Nausea
- Dry mouth
- Headache
- Dizziness
- Sweating
- Insomnia
- Constipation or diarrhea
- Fatigue
- Increased heart rate
- Erectile dysfunction
- Decreased appetite
- Dry mouth
- Drowsiness
- Sedation
- Nausea
- Insomnia
- Appetite increased
- Weight increased
- Dizziness
- Anxiety
- Dyspepsia
- Sinusitis
- Tremor
- Dry mouth
- Constipation
- Headache
- Feeling nervous
- Mouth sores
- Changes in taste
- Weight gain or loss
- Excessive sweating
- Heart palpitations
- Sleepiness during the daytime
- Dizziness
- Low blood pressure
- Dry mouth
- Headache
- Upset stomach
- Back pain
- Constipation or diarrhea
- Difficulty urinating
- Feeling disconnected from one's body and thoughts
- Altered perception of reality
- Decreased awareness of surroundings
- Sedation
- Nausea
- Dizziness
- Headache
- Distorted taste
- Diminished sense of touch
- Anxiety
- Fatigue
- Increased blood pressure
- Vomiting
Serotonin syndrome
In addition to these side effects, many antidepressants may carry a risk of serotonin syndrome, which occurs when the level of serotonin rises to a dangerous level. It is rare and typically happens when combining antidepressants or medications that increase serotonin levels. For example, taking the herbal supplement St. John’s Wort may increase the risk of serotonin syndrome when taking it with another antidepressant. Symptoms of serotonin syndrome may include:- Anxiety
- Confusion
- Agitation
- Sweating
- Muscle twitching or spasm
- Shivering, shaking, or trembling
- Diarrhea
- Fever
- Increased heart rate
- Rapid eye movements
- Vomiting
Depression treatment without medication
Exercise
Besides the physical benefits, such as protecting against heart disease or diabetes, improving sleep, and lowering blood pressure, exercise may also help improve emotional and mental health. High-intensity exercise can cause the brain to release endorphins, which are considered the feel-good chemicals, according to Harvard Health. Low-intensity activity sustained over time may also offer benefits. When you exercise, your body releases neurotrophic or growth factor proteins, which may lead to new connections between nerve cells and improved brain function.Meditation
Meditation may help decrease depressive symptoms, according to John Hopkins Medicine. Madhav Goyal, M.D., reviewed 47 studies on meditation and found that it “appeared to provide as much relief from some depression symptoms as other studies have found with antidepressants.” Mindfulness meditation, which involves focusing on the present moment, was found to be most effective. Goyal believes that regular meditation can help reduce the worries and fears that accompany depression.Diet
What you eat may also affect symptoms of depression. A study published in 2017 found that eating a modified Mediterranean diet, which is high in vegetables, fruits, whole grains, fish, legumes, nuts, and extra virgin olive oil, improved mental health. The results found that around 30% of those who ate a healthy diet achieved remission from major depression. Only 8% of those in the control group experienced an improvement in depression symptoms.Sleep Hygiene
Getting adequate sleep may be helpful in managing episodes of depression. Studies have shown that individuals who improved their sleep quality experienced a significant reduction in depression symptoms, positively affecting their daily life. Healthy sleep hygiene habits may include keeping a consistent sleep schedule, avoiding electronic devices before bed, and creating a comfortable resting environment.Social support
Social support in the form of assistance and emotional or physical comfort from friends and family may also have a positive impact on symptoms of depression. One study found that individuals with depression who received strong social support, such as from family members, were more likely to see improvements in their condition. Therefore, being able to depend on a strong network for support from others may be beneficial for mental well-being.Natural treatments – herbs and supplements
St. John’s Wort – A review of studies, which looked at 35 studies with 6,993 participants, found that St. John’s Wort is more effective than a placebo and may be similarly effective to antidepressant medication for people with mild to moderate depression. However, St. John’s Wort may cause adverse effects and be linked to drug interactions that may increase the risk of serotonin syndrome.Chamomile – A small study in 2012 found that chamomile may provide more relief from depression than a placebo. However, this study was small, with only 57 participants. Further studies are needed before determining the benefits of this herbal supplement for treating depression.
Saffron – Saffron might be an effective way of managing symptoms of depression and anxiety, according to a review of studies published in 2018. The herb may have antidepressant effects with fewer side effects than conventional antidepressants. However, more research is needed to confirm its effects.
Omega-3 fatty acids – Omega-3 fatty acids, found in fatty fish, walnuts, and flaxseeds, have been linked to improvements in depression symptoms. Omega-3 fatty acid supplements may be a potential option for managing depression alongside other treatments. One analysis of 26 different studies found that omega-3 fatty acids may help improve depression symptoms.
Finding the right depression treatment
Finding the right treatment for depression starts with getting a proper diagnosis, which may include various medical tests done by your doctor or a mental health specialist. After a diagnosis, you may work closely with your healthcare provider, who will consider things like the type of depression you have, whether you have any other mental health issues, and the medical history of you and your family.A healthcare provider will work with you to create an appropriate treatment plan. This plan might include different options, such as talk therapy, medication, and lifestyle changes. For example, cognitive therapy, dialectical behavior therapy, and interpersonal therapy are forms of talk therapy that may be useful in treating depression. In addition, you may be recommended medication, which can include different types of antidepressants.
In many cases, finding the right depression treatment can involve a process of trial and error. You might find that a particular treatment option is not working to relieve your symptoms after some time. However, various treatment options are available, and it’s normal to work with a healthcare provider in trying different options to find the one that works for you.