Treatment for depression

Depression is a real medical condition, and it can be treated. Care usually means talk therapy, medicine, or both.¹ The hard part is often getting started, and then sticking with care long enough for it to work.

This page explains the main options, how doctors match them to how severe the depression is, and what to expect in the first weeks and months. It also shows how you and your care team can measure whether treatment is working.

The main treatment options

There are three main paths. Many people use more than one over time.

Other approaches can help too. Regular group exercise, guided self-help books or programs, and self-help steps are options for milder depression.⁵ When depression does not improve after several tries, there are stronger treatments, such as brain stimulation and esketamine nasal spray.¹ See when depression doesn't get better.

How doctors match treatment to severity

Your doctor will first check how severe the depression is. They may use a short questionnaire called the PHQ-9 (nine questions about the past two weeks). Scores run from 0 to 27. Scores of 5, 10, 15 and 20 mark mild, moderate, moderately severe and severe depression.¹¹ Read more on getting checked for depression.

These are general patterns, not fixed rules. Your past experience, other health problems, medicines you already take, cost and what is available near you all matter. Some people do not want medicine. Others cannot easily get to weekly therapy. A good plan fits your life.

Stepped care: starting simple and stepping up

Many clinics use stepped care. You start with the simplest treatment likely to help. If you are not getting better, the care team "steps up" to a stronger or added treatment.²

For example, a person with mild depression might start with guided self-help or a short course of therapy. If their scores do not drop after some weeks, they might add medicine or move to more intensive therapy. The key is that someone keeps checking, so no one stays stuck on a plan that is not working.

Collaborative care: a team in your doctor's office

Many people with depression are treated by their regular doctor, not a psychiatrist. Collaborative care is a proven way to make that care work better.

In this model, your primary care doctor works with two other people:⁸

• A care manager, often a nurse, social worker or counselor. They check in with you often, track your symptoms and may offer brief therapy.
• A psychiatric consultant. This mental health doctor reviews cases with the care manager and suggests changes when someone is not improving.

More than 90 randomized trials show collaborative care works better than usual care for depression.⁹ One major trial, called IMPACT, studied 1,801 adults aged 60 and older in primary care. After a year, 45% of people in collaborative care had their symptoms cut at least in half. In usual care, 19% did.⁷ That is more than twice as many people, about 9 in 20 versus 4 in 20.

Medicare and collaborative care. Medicare Part B may pay for these services, billed month by month. You will be asked to sign an agreement first. After the Part B deductible, you usually pay 20% of the Medicare-approved amount. Not every office offers it, so ask.¹³ To find this kind of care, see finding geriatric mental health care.

What to expect, week by week

1. The first visit. Your doctor asks about your symptoms, sleep, appetite, alcohol use, medicines and any thoughts of suicide. They may do an exam and lab tests to rule out other causes, such as thyroid problems.¹
2. Weeks 1 to 4. If you start therapy, you will usually meet once a week. If you start medicine, your doctor should check on you regularly, especially early on.⁵ Sleep, energy and appetite often improve before mood does.¹
3. Weeks 4 to 8. Most antidepressants take about this long to show their full effect.¹ In therapy, you are practicing new skills between sessions.
4. Around weeks 8 to 12. You and your doctor look at your scores. If you have not improved by at least half, it is time to change the plan.¹⁰
5. After you feel well. Treatment continues for months to help keep depression from coming back.²

Side effects. All medicines can have side effects.¹ Tell your doctor about any that bother you. There may be a different medicine that suits you better. Read the antidepressant medicines page for side effects and older-adult cautions.

If the first try does not work. This is common. It does not mean treatment will never work for you. In a large U.S. study called STAR*D, about 1 in 3 people became symptom-free on the first medicine. About half were symptom-free after two steps of treatment.⁶ Changing the medicine, adding therapy, or adding a second medicine can all help.

How long treatment lasts

Therapy. A course of CBT or behavioral activation is often about 8 sessions, and sometimes more. IPT usually runs 8 to 16 sessions.⁵ Some people return later for "booster" sessions.

Medicine. Feeling better is not the same as being finished. Guidelines say to keep taking an antidepressant for at least six months after symptoms go away.² People who have had several episodes may be advised to stay on it much longer.

For people at high risk of depression coming back, therapies such as CBT, IPT or MBCT can also help prevent relapse.²

Measuring progress

Depression can cloud how you see your own progress. A short, repeated questionnaire gives you and your care team a clearer picture. This is called measurement-based care.

A major U.S. guideline recommends using a symptom scale at the start and at regular visits, and the PHQ-9 is commonly used.² Collaborative care teams check symptoms at every contact.¹⁰ Here is what the goals usually mean:

• Response: your score drops by at least half. For example, from 18 down to 9.¹⁰
• Remission: you have few or no symptoms left. This is the real goal of treatment.
• No response after about 10 to 12 weeks: the plan should change.¹⁰

You can track your own mood between visits with our check-in. Bring your results to appointments. Write down questions, side effects and changes in sleep, appetite or energy.

Depression treatment in later life

Treatment works in later life too, but a few things differ. For older adults, the American Psychological Association guideline recommends group CBT, IPT, group life review (talking through memories of your life with others) and newer antidepressants.⁴ See reminiscence and life review.

Medicines need extra care in later life. For adults 65 and older with mild to moderate depression, the VA/DoD guideline suggests therapy first, partly because medicines carry added safety risks at this age.² If you do take medicine, your doctor will usually start low and go slow. Medicare Part B covers therapy, medication management and one depression screening each year. It covers visits with psychiatrists, psychologists, clinical social workers, marriage and family therapists, and mental health counselors.¹² Read depression in later life and what Medicare covers for mental health.

Getting started

• Talk with your regular doctor. They can treat depression or refer you.
• Learn about how to find a therapist and paying for therapy. Many therapists offer video visits. See online therapy and apps.
• If English is not your first language, ask for a free medical interpreter or a therapist who speaks your language.
• If you are helping a loved one, see helping someone with depression and supporting someone in treatment.

When to get help right away

Treatment takes patience, but most people do feel better. If the first plan does not work, there are many more options to try.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.