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According to a recent study by Blue Cross Blue Shield, cases of major depression are on the rise all across the United States. As more people seek treatment for depression symptoms, they may be puzzled by the variety of care options available.

Common treatments range from the most common antidepressants to new therapies like transcranial magnetic stimulation (TMS) to natural supplements for depression. Moreover, it can be hard to tell which of these are backed by scientific evidence and research and which are not.

At our practice, we encourage our patients to take an active role in their health by researching their treatment options and speaking with us about their needs and concerns. 

We choose to specialize in providing TMS therapy because it has been proven time and again to be effective in treating symptoms of major depression. But it’s also true that any single treatment may not work for everyone. Further, the path to full remission from depression can involve several different therapies.

Decisions about depression treatment should always be made with your doctor, but we encourage you to take a look so that you can remain informed about the options available.

The most common treatments for depression

In the section below, we’ve compared some of the most common treatments for depression:



Medication Therapy

The scientific basis for treatment

Antidepressants treat the symptoms of depression by affecting how the neurotransmitters of the brain behave. This ultimately determines how the nerve cells in the brain communicate. This can have an impact on mood.

Unfortunately, there is no way to predict whether antidepressants will be effective in treating a particular individual. Further, some side effects can motivate patients to discontinue their use.1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/

FDA Approved? 

Yes1

Side effects

Common side effects include nausea, vomiting, weight gain, diarrhea, sleep disturbances, sexual problems, and more.1

Length of treatment

If symptoms persist (and as time goes on), the dosage of the medication may need to be increased to maintain effectiveness. Patients must continue with medication daily until full remission is sustained for more than 6 months.

When a patient is determined ready to discontinue treatment by their psychiatrist, they must also undergo a gradual weaning period.2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181183/

Contraindications

MAOI (monoamine oxidase inhibitor) antidepressant medications are not recommended for people with a cerebrovascular defect, cardiovascular disorder, pheochromocytoma, in combination with tyramine-containing food, and in combination with some other medications.3https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ad-adult-factsheet.pdf

Some pregnant women are not comfortable taking antidepressants because they have not been proven to be fully safe during pregnancy.



Talk Therapy

 

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Photo source: iStock

The scientific basis for treatment

Talk therapy, also known as psychotherapy, has been proven to be an effective way of alleviating the symptoms of depression.4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/ While working with a mental health professional, patients develop strategies for identifying depressive thoughts, as well as coping mechanisms to combat them.

Psychotherapy alone may not work for all depression sufferers, especially in severe cases or when there is a biological factor in the brain (such as a neurotransmitter imbalance) contributing to symptoms.

FDA Approved?

No

Side effects:

There are few side effects, however, more study is needed.5https://psychcentral.com/blog/harmful-side-effects-of-psychotherapy/

Length of treatment

Patients should attend regular (often weekly hour-long) sessions as long as symptoms persist. They must also commit to actively participating in their therapy and to continue using the strategies learned throughout their daily life.

Contraindications

Psychotherapy is not contraindicated for any particular group. However, certain people may find the cost or inconvenience associated with weekly treatment prohibitive (especially in the long term). Many others may find that talk therapy alone does not sufficiently control their symptoms.



Transcranial Magnetic Stimulation (TMS)

The scientific basis of treatment

Transcranial magnetic stimulation involves regular sessions with a TMS technician as well as check-ins with a supervising psychiatrist. Each session consists of placing a safe metal coil over targeted parts of the brain to stimulate pleasure centers and alleviate depressive symptoms. Over 30 clinical trials with 2,000 patients have shown TMS to be effective for treating depression.

FDA approved?

Yes 

Side effects

Side effects are very rare, with the most common being minor headaches. The relative lack of side effects can make it a great alternative for people who struggle with the side effects of antidepressants, as well as those who didn’t see results from talk therapy.6https://neurostar.com/neurostar-tms-depression-treatment/side-effects/

Length of treatment

9 weeks of 19-minute treatment sessions, at a physician’s office. Patients can come unaccompanied and may drive or return to work immediately after.

Contraindications

Not recommended for patients who have a seizure disorder or a history of seizures. Nor for those who have a metal implant in the head. Other conditions in a patient’s medical history can also affect TMS therapy results.7https://www.madisonavetms.com/what-is-tms/

Due to the potential risk associated with taking antidepressants during pregnancy, many women may choose TMS while they are expecting.



Electroconvulsive treatment (ECT)

The scientific basis of treatment

Electroconvulsive therapy (ECT) can alleviate symptoms of depression by sending powerful electrical impulses into the patient’s brain producing a short seizure. ECT is proven to be effective in treating depression.

It is not a first line approach to treating depression. It carries substantial risks for cognitive impairment during the time of treatment and can interfere with a patient’s occupational or academic pursuits.

Also, ECT must be performed in a hospital setting with anesthesia, increasing the likelihood of complications and risks to the patient.8https://www.ncbi.nlm.nih.gov/pubmed/18580559 It also requires either an in-hospital stay or for patients to be picked up by a companion after each treatment.

FDA approved?

Yes

Side effects

Disorientation, loss of memory, nausea, headaches, migraines, and potentially more serious complications like heart problems.9https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

Length of treatment

During treatment, electrical pulses are applied to the skull which causes a mild seizure. These sessions are performed as long as symptoms persist but usually, patients receive treatment several times a week for around 6 weeks. Some continue to receive treatment after 6 weeks, depending on results.10https://www.healthline.com/health/electroconvulsive-therapy#the-procedure

Contraindications

ECT is usually considered only for severe depression. The interference in one’s daily activities by the treatment must outweigh the severe impact of the depression on the patient’s life.

It is usually not recommended for patients with mild to moderate depression.

Certain patient populations may require additional monitoring during ECT. Others may not experience the same level of relief from symptoms.11https://emedicine.medscape.com/article/1525957-overview



Exercise

close up running shoes treadmill 848x565 pxThe scientific basis of treatment

Exercise has been proven to provide relief from the symptoms of depression. It elevates the patient’s mood temporarily. Also, the sense of well-being can increase over time.

Unfortunately, most patients will not achieve remission from depression through exercise alone. It is considered a great supplement while patients continue taking their regular medication or undergoing other treatment programs like TMS. However, patients should not replace their current depression treatment program with an exercise program without speaking with their psychiatrist. 

FDA approved?

No (not applicable)

Side effects

Exercise has many health benefits. People who are not accustomed to it should start slowly and speak with their doctor before beginning a regular exercise regimen.

Length of treatment

Requires regular commitment to exercise as long as symptoms persist, but recommended as a daily habit for life.

Contraindications

May not be recommended for some patients whose medical history makes intense physical activity unadvisable. Additionally, someone who is physically disabled may not be able to participate in a physical exercise program.



Acupuncture

The scientific basis of treatment

Acupuncture is a form of traditional Chinese medicine that involves placing needles at specific points on the body. This is thought to bring balance to the body’s energies and stimulate blood flow.

While there is not enough scientific evidence to prove that acupuncture is effective on its own for treating depression, treatments like acupuncture and other “self-care” activities can provide a temporary mood boost to those suffering from depression.

FDA Approved?

No

Side effects

Slight pain and bleeding, nausea, vomiting, and headaches.12https://www.webmd.com/fibromyalgia/qa/what-are-the-side-effects-of-acupuncture

Length of treatment

Sessions vary in length but can last as long as two hours each. Treatment would involve regular sessions for as long as symptoms persist.

Contraindications

Not recommended for people with bleeding or blood clotting disorders, or people taking medications that interfere with blood clotting. Should be used with caution on pregnant women.13http://apps.who.int/medicinedocs/en/d/Jwhozip56e/4.2.1.html



St. John’s Wort

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Photo source: iStock

The scientific basis of treatment

St John’s Wort is an herbal supplement that, according to some studies, may be effective in treating mild depression. However, the evidence is slim and more research is needed. Most psychiatrists would not recommend using St. John’s Wort in lieu of other, more researched forms of treatment, like TMS or antidepressants.14https://www.webmd.com/depression/guide/st-johns-wort

FDA Approved?

No15 https://www.psychologytoday.com/us/blog/reading-between-the-headlines/201308/st-johns-wort-and-depression

Side effects

Tiredness, feelings of restlessness, high blood pressure, sun sensitivity, and gastrointestinal issues.

Length of treatment

Requires taking a supplement containing St. John’s Wort daily, as long as symptoms persist.

Contraindications

St. John’s Wort is not recommended for patients being prescribed antidepressants. It is also not recommended for those who are allergic to St. John’s Wort, pregnant women, children, or older adults. It should be used with caution by people with certain medical histories/conditions. Ask your doctor before taking St. John’s Wort.



Vitamins (such as Folic Acid and SAM-e)

The scientific basis of treatment

While there is some evidence that certain vitamins can have an effect on depression symptoms, the effects appear to be minimal. More research is needed.

Most psychiatrists would not recommend a treatment plan for depression based solely on vitamins and supplements.16https://www.psychologytoday.com/us/blog/the-integrationist/201310/depression-wont-go-away-folate-could-be-the-answer 17https://www.webmd.com/vitamins/ai/ingredientmono-786/same

FDA approved?

No

Side effects

Gastrointestinal issues (including nausea, constipation, and diarrhea), sleeplessness, dizziness, mood changes or irritability, anxiety, excessive perspiration, and others depending on what is being taken.18https://www.mayoclinic.org/drugs-supplements-same/art-20364924 19https://www.mayoclinic.org/drugs-supplements-folate/art-20364625

Length of treatment

Requires taking a recommended dosage or certain vitamins or supplements (as instructed by your doctor) as long as symptoms persist.

Contraindications

Not recommended for those with allergies to a particular supplement. You should be evaluated by a doctor before starting to take vitamins and/or supplements. This is so they can evaluate the safety of their use given your particular medical history/medications/conditions.19



Solar lamps

The scientific basis of treatment

Solar lamps have been proven to be effective for treating seasonal affective disorder (SAD). SAD can cause depression in some people during the cold weather months of the year or when not exposed to sunlight. There is no scientific consensus on the effects of solar lamps treating non-seasonally related depression.20 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004050.pub2/full 21https://www.sciencedirect.com/science/article/pii/S0165032707003369?via%3Dihub

FDA approved?

No

Side effects

Added strain on eyes, migraines or headaches, nausea, psychological symptoms like hyperactivity, irritability, and mania.22 https://www.mayoclinic.org/tests-procedures/light-therapy/about/pac-20384604

Length of treatment

Use is recommended as long as symptoms persist but typically only during winter months

Contraindications

It is not recommended for those who have any kind of light sensitivity or are at risk for light sensitivity, those with a manic disorder or symptoms of mania, those taking a medication or supplement that increases light sensitivity, and those considered at risk for eye damage or melanoma (as determined by their doctor).23 http://www.health.am/psy/more/light_therapy1/

The bottom line

There are a variety of treatments for depression. Some are supported by scientific evidence but others are not. It is important to consult with your physician to get help choosing which treatment might be best for you.



  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181183/

3. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ad-adult-factsheet.pdf

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/

5. https://psychcentral.com/blog/harmful-side-effects-of-psychotherapy/

6. https://neurostar.com/neurostar-tms-depression-treatment/side-effects/

7. https://www.madisonavetms.com/what-is-tms/

8. https://www.ncbi.nlm.nih.gov/pubmed/18580559

9. https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

10. https://www.healthline.com/health/electroconvulsive-therapy#the-procedure

11. https://emedicine.medscape.com/article/1525957-overview

12. https://www.webmd.com/fibromyalgia/qa/what-are-the-side-effects-of-acupuncture

13. http://apps.who.int/medicinedocs/en/d/Jwhozip56e/4.2.1.html

14. https://www.webmd.com/depression/guide/st-johns-wort

15. https://www.psychologytoday.com/us/blog/reading-between-the-headlines/201308/st-johns-wort-and-depression

16. https://www.psychologytoday.com/us/blog/the-integrationist/201310/depression-wont-go-away-folate-could-be-the-answer

17. https://www.webmd.com/vitamins/ai/ingredientmono-786/same

18. https://www.mayoclinic.org/drugs-supplements-same/art-20364924

19. https://www.mayoclinic.org/drugs-supplements-folate/art-20364625

20. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004050.pub2/full

21. https://www.sciencedirect.com/science/article/pii/S0165032707003369?via%3Dihub

22. https://www.mayoclinic.org/tests-procedures/light-therapy/about/pac-20384604

23. http://www.health.am/psy/more/light_therapy1/


Related reading:

Tips for Parenting with Depression

How to Deal with Infertility and Depression

Distinguishing Grief, Loneliness, and Depression in Seniors

David Woo, MD
David Woo, MD is certified in Psychiatry and Geriatric Psychiatry by the American Board of Psychiatry and Neurology. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He is one of the few providers offering TMS in NYC’s Midtown Manhattan area. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive-compulsive disorder.

2 COMMENTS

  1. Worried about too many meds and “collateral damage” I will have a try, as long as my insurance helps me. Not sure about that though.
    Thanks for bringing this up.

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