The Stages of Depression Treatment

  • If at First You Don't Succeed
    About half of people with depression feel much better after the first treatment they try. And of that group, about two-thirds become symptom-free. But if you're one of the others, don't despair. With your doctor's help, you can gradually step up the intensity of your treatment until you find the approach that works for you. Here's how the process works.

  • Take the First Step
    The initial treatment for depression may be an antidepressant, psychotherapy, or both. If you start with an antidepressant, the American Psychiatric Association (APA) says that the first choice is usually one of these newer types: SSRIs (such as Prozac and Zoloft), SNRIs (such as Effexor and Cymbalta), bupropion (Wellbutrin), or mirtazapine (Remeron). Be patient; it can take four to eight weeks to feel the full benefit.

  • Increase the Dose
    Some people take an antidepressant for weeks, yet still don't feel much improvement. If that happens to you, the next step may be to ratchet up the dose. But as the dose goes up, so does the risk of troublesome side effects. The goal is to find the right amount of medication that works for you while limiting the drug's side effects.

  • Switch Antidepressants
    If one antidepressant doesn't work well for you, another may be more successful. Various types of antidepressants act in different ways and have different side effects. For example, some people experience loss of sex drive when taking SSRIs, a popular type of antidepressant. If that happens, changing to bupropion (Wellbutrin), a non-SSRI antidepressant, may help.

  • Layer on Therapy
    When an antidepressant alone isn't enough, another option is to add psychotherapy to your treatment. According to the APA, two main therapies for depression include cognitive-behavioral therapy, which helps you change negative thought patterns and behaviors, and interpersonal therapy, which helps you work on relationship issues that play a role in depression.

  • Ramp Up Therapy
    Just as you can up the dose of a medication, you can boost the intensity of psychotherapy. If you aren't feeling any better at all after a month of therapy, you might start seeing the therapist more often. Or you might try a new approach, such as problem-solving therapy, which helps you identify and address problems that interfere with everyday life and contribute to depression.

  • Add Another Medicine
    When you need further help, the next step is often to add a second medication to the one you're already taking. This may be another antidepressant with a different mode of action. Or it may be a non-antidepressant drug, such as a mood stabilizer, an antipsychotic, or a thyroid hormone. Click here to learn more about the specific drugs used in conjunction with antidepressants.

  • Move to Advanced Options
    Even if you've tried medicine and therapy without success, there are still options available. Electroconvulsive therapy (ECT) stimulates the brain with an electrical current, which produces a brief seizure. eECT is a time-honored, safe and effective treatment option. One study found that ECT relieves severe depression more than 80% of the time.

  • Another Advanced Treatment
    A more controversial option is vagus nerve stimulation (VNS). In VNS, a small, surgically implanted device sends electrical pulses through a major nerve that carries messages back and forth between the brain and major organs. Although this treatment has been approved by the FDA for select patients, studies have not yet shown convincingly that it is effective.

    Bottom line: You and your doctor have a wide variety of treatment strategies available to help relieve depression. It sometimes take work to find that one strategy that works best for any given individual, but the rewards are worthwhile indeed!

The Stages of Depression Treatment
  1. Questions and Answers About the NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study - Background. National Institutes of Health. National Institute of Mental Health. http://www.nimh.nih.gov/funding/clinical-research/practical/stard/backgroundstudy.shtml
  2. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Agency for Healthcare Research and Quality. http://www.guideline.gov/content.aspx?id=24158
  3. Depression. National Institutes of Health. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/index.shtml
  4. Depression and Stroke. National Institutes of Health. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression-and-stroke/index.shtml
  5. Brain Stimulation Therapies. National Institutes of Health. National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml
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Last Review Date: 2019 Jul 29
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