Anyone who’s been depressed knows how hard it can be just to keep up with daily responsibilities. Trying to figure out the best way to treat the depression can present a whole other level of challenge: What works? Should I try medication or therapy? What about alternative treatments? What’s the role of lifestyle factors like diet and exercise?

For this reason I’ve collected 12 of the most reliable research findings about depression treatment, and presented them in an easily digested format.

For the most part I’ve chosen facts that are supported by meta-analyses, which combine results from many studies to determine the current state of the science.

As with any scientific data, research in these areas is ongoing.

  1. Cognitive behavioral therapy (CBT) and medication are equally effective in treating depression. Medication can help with severe depression even as much as CBT. The selective serotonin reuptake inhibitors (SSRIs; e.g., Zoloft, Lexapro) are the most widely prescribed medications for depression. While they’re generally no more effective than older drugs like the tricyclic antidepressants (e.g., Tofranil), they tend to produce fewer side effects and so are easier to tolerate.
  2. Chronic and more severe depression responds better to a combination of medication and therapy. Medication plus CBT is more effective than meds alone, and medication adds additional benefit for those receiving CBT. Thus it may be worth the extra time, effort, cost, and potential side effects to get two treatments. Although received wisdom says that two treatments are always better than one, a single treatment typically works as well as a combination for mild, non-chronic depression.
  3. Other kinds of talk therapy in addition to CBT can work well in treating depression. The Society of Clinical Psychology keeps a list of treatments that are supported by research. While the majority of the treatments are forms of CBT, studies that compare two forms of therapy head-to-head generally don’t find an advantage for CBT. And while some CBT advocates like to beat up on psychodynamic therapy—which is based on a Freudian understanding of the mind—there’s growing evidence that short-term psychodynamic therapy can be helpful.
  4. Exercise can be a powerful antidepressant. There’s something about simply moving our bodies that can boost our mood, especially when we do it regularly. Research studies have shown benefits of resistance training, walking, running, and other activities; more intense exercise generally leads to greater depression relief.
  5. Improving one’s diet may relieve depression. Learning about better eating habits led to substantial reductions in depression for many people in a study published earlier this year. The average participant in the diet education group had a 43% reduction in depression symptoms, versus 17% for a control group that received general social support. Dietary recommendations included increased consumption of vegetables, whole grains, legumes, healthy fats, and lean proteins; and reducing heavily processed and sugary foods, as well as alcohol. In contrast, the addition of omega 3 fatty acids to one’s diet provides minimal benefit over placebo, based on a recent meta-analysis. Bear in mind, though, that placebo is not the same as “no treatment,” given the very strong placebo effect in depression treatment; the average person in a clinical trial sees a 40% reduction in symptoms on placebo, compared to 48% for medication.
  6. Self-directed CBT can be an effective treatment for depression. Not everyone has easy access to a specialist in CBT, and the cost of the treatment can be considerable. Fortunately even without a therapist, the approach can provide relief, though typically a bit less than from partnering with a therapist. You can find a list of self-help books that use evidence-based techniques here; Internet-based CBT can also be effective, and some of the programs are available to the public for free (e.g., MoodGYM). For both books and web-based programs, some input from a professional generally leads to better outcomes, even matching face-to-face therapy for many people. Self-directed CBT is probably appropriate for those with mild to moderate depression.
  7. “Positive psychology interventions” can relieve depression symptoms. These approaches are “aimed at cultivating positive feelings, positive behaviors, or positive cognitions”; for example, one of the interventions involves writing down 3 things that went well each day, and an explanation for why they went well. While there isn’t enough data to suggest that these techniques are sufficient by themselves in treating depression, they may be incorporated into evidence-based approaches.
  8. One of the simplest treatments for depression is also among the most powerful. It’s a type of CBT called “Behavioral Activation,” and focuses on increasing the rewarding activities in our lives. By doing more of the things we care about we can have more fun, enjoy greater connection, and experience a greater sense of accomplishment—all things that are good for our mood. The benefits of Behavioral Activation tend to last well after treatment has ended.
  9. Positive changes in our relationships with others can lead to big boosts in our mood. For better or worse, relationships affect our well-being. When we’re stuck in disappointing modes of interacting with the people in our lives, our mood often suffers. Interpersonal Therapy is one well-tested approach for “improving problematic interpersonal relationships or circumstances that are directly related to the current depressive episode.” It has strong research support, and can help prevent relapse.
  10. Hypericum perforatum: St. John’s wort
    St. John’s wort can be an effective treatment for depression. It’s better than placebo in treating mild to moderate depression, and equally effective as medication—with fewer side effects.
  11. CBT is better than medication at protecting against depression relapse after treatment. Nevertheless, nearly one in three individuals will relapse within a year after receiving CBT. Relapse was much less likely for those who received additional CBT sessions, which highlights the need to continue practicing the skills learned in treatment. The risk of relapsing after switching from medication to placebo was about 40% over the course of 4 to 36 months; that risk was reduced to 18% among those who stayed on medication.
  12. Mindfulness-Based Cognitive Therapy (MBCT) prevents depression relapse. The preventive effect is most evident for people who’ve had 3 or more depressive episodes. MBCT led to a 34% lower risk for relapse—comparable to staying on medication for depression.

Major depression can be a devastating conditions. Thanks to the efforts of clinicians and researchers throughout the world, we have a good idea about how best to treat it.

It’s not easy to escape depression’s grasp, but there’s reason for hope: With the right treatment, most people can feel better.

If you’ve been battling depression, now is a good time to take a step toward getting help. Consider doing one of the following today:

  • Call your doctor or check with your insurance to start the process of finding treatment.
  • Visit the ABCT website and choose a self-help book for depression (including my own, Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks). 
  • Talk with a loved one about how you’ve been feeling and how you might find relief.
  • Make small dietary changes that can boost mood, like eating fewer processed foods.
  • Look into whether St. John’s wort might be a good option for you.
  • Start an online CBT course like MoodGYM

If you have a loved one who’s been struggling with depression, consider talking with that person about looking into treatment options.

The information here is not intended as medical advice—talk to a healthcare professional you trust if you or a loved one needs help with depression.

2 thoughts

  • Hi Dr. Gillihan, i just read your article about 12 findings on the best ways to treat depression. I have a question: how can one exercise when we feel so much
    fatigue and lack of energy? Since my depression hit me hard about 1 year ago i had to stop exercising because i can’t. I don’t have the energy. In some periods during the last year i could’t even walk for 100 metres without having my heart beating really fast and being extremely fatigued. How can we exercise when the fatigue and lack of energy is so everwhelming? Maybe there are several types of depression but in my case it’s impossible. I wish i could exercise and have a normal life again. Thank you very much for your article, it was really helpful.
    Carla, Portugal

    • Thanks for your question, Carla — what an important issue in trying to manage depression. How can I benefit from a treatment that I don’t have the energy or motivation to do? Assuming there are no medical restrictions on physical activity, one of the most important approaches is to start small. Very small if necessary. Maybe it means walking 50 meters today and working up to 100. Whatever the steps are, we make them small enough so they’re manageable and not too intimidating. We do what we know we can do now, so that over time we can work up to what we can’t do right now.

      Often we’ll discount the little we can do, telling ourselves not to bother since it’s so insignificant anyway. But that way of thinking will prevent us from doing what we’re capable of today, which we could build on over time.

      If exercise is physically impossible, thankfully there are other ways to improve our mood. Thank you again for your comments and I wish you all the best through this time.

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