Health Education

Depression treatment and medications

Cropped SingleCare logo By | January 2, 2020
Medically reviewed by Jeff Fortner, Pharm.D.

What is depression? | Depression diagnosis | Depression treatment options | Depression medications | Best depression medications | Side effects of depression | Depression home remedies | FAQ | Resources

Depression is a serious medical illness that affects 7.1% of adults, which is over 17 million people in the United States, according to the National Institute of Mental Health. Children can also have depression, with 3.2% of children in the U.S. having a diagnosis of depression, according to the Centers for Disease Control and Prevention (CDC).

What is depression?

According to the American Psychiatric Association (APA), 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

Depression is one of the most common mental illnesses, but it is also treatable. Almost all people receive some relief with treatment, and between 80 and 90% eventually respond well to treatment, according to the APA. Treatment typically includes a combination of prescription drugs and psychotherapy. Cognitive-behavioral therapy, a type of psychotherapy, is effective in treating depression. Electroconvulsive therapy (ECT) is sometimes used for those who have not responded to other treatments.

Researchers continuously look for improved methods of understanding and treating depression. For example, a five-year study found that using a vagus nerve stimulation device can help improve the quality of life in those with treatment-resistant depression. You can find ongoing clinical trials on the website CenterWatch.com.

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 that 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.

Your answers on these screening questionnaires help your doctor understand the severity and type of depression you have. A diagnosis requires symptoms to be present most of the day, more days than not, and for over two weeks.

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, endocrine disorders and vitamin deficiencies can cause symptoms like those seen in depression.

During your doctor’s appointment, make sure your physician is aware of all medications you are taking, as some drugs can cause symptoms of depression. If you are diagnosed with depression, you could 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?

You should also talk to your doctor about a plan for an emergency. Many people with depression are suicidal or have thoughts of harming themselves. You should know what steps you, and your loved ones, should take if you feel you might hurt yourself, such as calling the National Suicide Prevention Lifeline at 1-800-273-8255.

Depression treatment options

One of the main symptoms of depression is feeling hopeless, which can make the prospect of treatment seem useless. There is no complete cure for depression; however, there are many effective treatments to reduce or eliminate symptoms.

Most people with depressive symptoms find that a combination of psychotherapy and medication is the most effective. For treatment-resistant depression, brain stimulation therapies might provide relief. 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. 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 negative 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. These frequently take two to four weeks for you to begin to feel better and can take up to 12 weeks 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 are:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs target serotonin and are the most widely used medications for depression, and can also be used for bipolar disorder. Common SSRIs include:

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs increase the brain chemicals serotonin and norepinephrine. They might also be used for bipolar disorder. Common SNRIs include:

Serotonin modulators

Serotonin modulators are a class of drugs used as antidepressants as well. They work to increase serotonin, norepinephrine and dopamine. 

Atypical antidepressants

Atypical antidepressants are a class of drugs that affect multiple neurotransmitters, including serotonin, dopamine and norepinephrine. These may also be used for bipolar disorder. The most commonly used atypicals are:

Tetracyclic & tricyclic antidepressants

Tetracyclic antidepressants 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 may 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:

Monoamine oxidase inhibitors

MAOIs can have severe side effects, so they are rarely used. They should never be taken in combination with SSRIs, and many other medications, as this can cause various drug interactions. These include:

While antidepressant medications help many people, approximately 30% do not improve or improvement is short-lived. The classes of drugs available today have been available for many years. Researchers have been working with the medication ketamine, according to Time Magazine. This medication has been used as an anesthetic and as a psychedelic drug that causes hallucinations. But researchers have found it quickly helps 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 according to Yale Medicine. However, using this drug carries unique risks so the U.S. Food and Drug Administration (FDA) created a Risk Evaluation and Mitigation Strategy (REMS) for this drug. A REMS is a drug safety program which 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. Note that all antidepressants carry a Boxed Warning, often called a “black box warning” which is designed to call attention to serious or life-threatening risks. The specific Boxed Warning is about suicidal thinking and behavior in children, adolescents and young adults with major depressive disorder and other psychiatric disorders.

Best medications for depression
Drug name (generic) Drug type Methods of use Standard dosage Common side effects
Prozac
(fluoxetine)
SSRI Capsule 20 mg/day to start, max of 80 mg/day, 90mg for weekly capsule Insomnia, headache, drowsiness, anxiety, nausea, diarrhea, dry mouth, restlessness
Zoloft
(sertraline)
SSRI Tablet, Oral suspension 25 to 50 mg/day to start, max of 200 mg/day Dizziness, indigestion, loss of appetite, decreased sex drive, insomnia
Paxil, Pexeva
(paroxetine)
SSRI Tablet,
Oral suspension
20 mg/day to start, max of 50 mg/day Decreased sex drive, headache, dry mouth, trouble sleeping, drowsiness, loss of appetite
Effexor XR
(venlafaxine)
SNRI Tablet,
Capsule
75 mg/day to a max of 225 mg/day Headache, sweating, trouble sleeping, weight loss, upset stomach, dizziness, dry mouth
Cymbalta
(duloxetine)
SNRI Capsule 40 mg/day to 60 mg/day Trouble sleeping, dry mouth, headache, weight loss, dizziness, upset stomach
Serzone
(nefazodone)
Serotonin modulator Tablet 200-600 mg/day Dizziness, headache, upset stomach, feeling hungry, dry mouth, trouble sleeping
Wellbutrin
(bupropion)
*Wellbutrin has been discontinued in the US, but generics are available
Atypical antidepressant Tablet 200 mg/day to a max of 450 mg/day Insomnia, weight loss, dizziness, headache, upset stomach, dry mouth, muscle or joint pain
Remeron
(mirtazapine)
Atypical antidepressant Tablet 15 mg/day to max of 45 mg/day Constipation, drowsiness, weight gain, dry mouth
Norpramin
(desipramine)
TCAs Tablet 100 mg/day to max of 300 mg/day
Low dose suggested for teens and elderly
Headache, dizziness, nausea, dry mouth, change in taste, mouth sores
Nardil
(phenelzine)
MAOI Tablet 15 mg, 3 times per day up to a max of 90 mg/day Dizziness, trembling, upset stomach, weight gain, insomnia, headache
Marplan
(isocarboxazid)
MAOI Tablet 10 mg/day up to max of 60 mg/day Dizziness, headache, constipation, dry mouth, nausea

What are common side effects of depression medications?

All medications have side effects. These are unwanted adverse reactions when taking medication. Often, side effects disappear within a few weeks, but some linger.

The following are side effects of common classes of drugs used to treat depressive symptoms. It is not a complete list. It is essential to speak with your doctor about the risks and benefits of the 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), approximately listed from more to less common, include:

  • Sexual dysfunction
  • Drowsiness
  • Weight gain
  • Insomnia
  • Anxiety
  • Dizziness
  • Headache
  • Dry mouth
  • Blurred vision
  • Nausea
  • Rash or itching
  • Tremor
  • Constipation
  • Stomach upset

Common side effects of serotonin and norepinephrine reuptake inhibitors (SNRIs), approximately listed from more to less common,  include:

  • Nausea
  • Dry mouth
  • Headache
  • Dizziness
  • Sweating
  • Insomnia
  • Constipation or diarrhea
  • Fatigue
  • Increased heart rate
  • Erectile dysfunction
  • Decreased appetite

Common side effects of atypical antidepressants, approximately listed from more to less common, include:

  • Dry mouth
  • Drowsiness
  • Sedation
  • Nausea
  • Insomnia
  • Increased appetite
  • Weight gain
  • Dizziness
  • Anxiety
  • Dyspepsia
  • Sinusitis
  • Tremor

Tetracyclic and tricyclic antidepressants side effects include:

  • Dry mouth
  • Constipation
  • Headache
  • Feeling nervous
  • Mouth sores
  • Changes in taste
  • Weight gain or loss
  • Excessive sweating
  • Heart palpitations

Monoamine oxidase inhibitors (MAOIs) side effects include:

  • Sleepiness during the daytime
  • Dizziness
  • Low blood pressure
  • Dry mouth
  • Headache
  • Upset stomach
  • Back pain
  • Constipation or diarrhea
  • Difficulty urinating

Esketamine side effects, approximately listed from more to less common, include:

  • 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, you should be aware of a condition called serotonin syndrome, which occurs when serotonin rises to a dangerous level. It is rare and typically happens when you combine SSRIs and SNRIs or if you add a second antidepressant. The supplement, St. John’s Wort, can also cause it if taken while you are taking another antidepressant. Symptoms of serotonin syndrome include

  • Anxiety
  • Confusion
  • Agitation
  • Sweating
  • Muscle twitching or spasm
  • Shivering, shaking, or trembling
  • Diarrhea
  • Fever
  • Increased heart rate
  • Rapid eye movements
  • Vomiting

Should you experience these symptoms, you should immediately seek medical attention.

What are the best home remedies for depression?

Exercise

There are things you can do to treat your depression naturally. One is exercise. Besides the physical benefits of exercise—protecting against heart disease and diabetes, improving sleep and lowering blood pressure—it helps with emotional and mental health. When you participate in high-intensity exercise, your brain releases endorphins, which are considered the feel-good chemicals, according to Harvard Health. Low-intensity activity sustained over time also offers benefits. When you exercise, your body releases neurotrophic or growth factor proteins, which cause nerve cells in your brain to grow and make new connections, which improves brain function and makes you feel better.

Meditation

Meditation helps decrease depressive symptoms, according to John Hopkins Medicine. Madhav Goyal, MD, 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, where you focus on the present moment, was found to be most effective. Goyal believes that regular meditation can stop the worries and fears that accompany depression.

Diet

What you eat can 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 30% of those who ate healthily achieved remission from major depression. Only 8% of those in the control group indicated depression symptoms had decreased.

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 may be as effective as antidepressant medication for people with mild to moderate depression. You need to speak with your physician before taking this supplement. It can interfere with other drugs and increase your risk of developing serotonin syndrome.

Chamomile: A small study in 2012 found that chamomile provided more relief from depression than a placebo. However, this study was small, with only 57 participants, and further studies are needed before determining its benefit when treating depression.

Saffron: Saffron might be an effective way of managing symptoms of depression, according to a review of studies published in 2018. However, it is not known if there are possible adverse effects of using saffron for depression.

Frequently asked questions about depression

What are the different types of depression medications?

There are three main classes of medication used as first-line treatments for depression today. They are SSRIs, SNRIs, and atypicals. Older antidepressants, which tend to have more side effects, include tetracyclic antidepressants, tricyclic antidepressants, and MAOIs. Esketamine is a new medication that was approved by the FDA in 2019 and that may relieve symptoms more quickly than other antidepressants.  

Are stimulants used to treat depression?

Stimulant medications such as Ritalin or Adderall, are not considered a first-line treatment for depression but might be prescribed as an add-on treatment for people who have not had an adequate response to antidepressants alone, according to a report published in 2019. Stimulants might help with depressive symptoms such as fatigue, loss of energy and impaired concentration. 

What is the most popular antidepressant? What are the common antidepressants?

SSRIs are the most commonly prescribed types of antidepressants. Some common SSRIs include Prozac, Celexa, Zoloft, Paxil, and Lexapro. 

What is the best depression medication without side effects?

There is no “best” medication for depression. Everyone reacts to medication differently, so what works for one person might not work for another. The same is true for side effects; not everyone will experience side effects, and those that do can experience them differently.

What is the best natural antidepressant?

The best natural antidepressant is exercise. Studies have found that regular exercise might decrease symptoms of depression as much as antidepressants.

How do antidepressants work?

Antidepressants work by balancing the chemicals in your brain. For example, people with depression might have low levels of serotonin in their brains. SSRIs work by increasing serotonin levels to help you feel better.

Which type of therapy is often used to treat depression?

Cognitive behavioral therapy (CBT) is a common type of psychotherapy used to treat depression. This therapy focuses on decreasing negative thought patterns and replacing them with healthy, balanced thought patterns. CBT also provides practical solutions to problem-solving and creating steps to take when you notice early warning signs of a depressive episode.

Do I need a psychiatrist or psychologist?

Some people are treated for depression by their primary physician. However, some primary physicians might not feel comfortable addressing it and could refer you to a psychologist or psychiatrist.

What do doctors do for anxiety?

Anxiety treatment is similar to depression treatment. Many antidepressants also help reduce feelings of anxiety, and CBT is a common type of psychotherapy for anxiety.

Related resources for depression