Evidence-based depression treatments

It only makes sense to employ a multifaceted treatment approach since depression impacts so many aspects of our daily lives.

It influences our motivation, sleeping patterns, thoughts, mood, etc. Thus, we must attack this mental illness from several angles by combining multiple treatment options, in my opinion.

I know that I had absolutely no motivation to do anything when I was depressed. Not to exercise, shower, work, never mind getting out of bed.

How to care for depression depends on individual circumstances and the severity. The more depressed you are, the larger the combination of approaches is typically necessary.

These are the most common techniques that are typically employed:

1. Psychotherapy (professional talk therapy)

• • Cognitive behavioral therapy (CBT)

CBT is effective at handling depression by identifying negative behaviors in addition to incorrect thinking patterns. It then rephrases these flawed actions and opinions into more accurate, positive notions. In short, unhelpful performances are stopped or changed to benefit the individual.

This is, in my opinion and experience, the most helpful form of psychotherapy there is. It helped me alter both unhelpful thoughts and actions that were influencing my life for the worse, improving my quality of life once again.

• • Psychodynamic therapy (PDT)

Explores unconscious patterns, behaviors, and past experiences that can negatively affect our lives without our knowledge.

Although it can be helpful, one glaring disadvantage of PDT is that it can be hard to isolate the effectiveness of the therapy because of the constraints of measurable interventions, since it focuses on unconscious patterns and past experiences.

• • Interpersonal therapy (IPT)

Focuses on improving relationships and communication with friends, family, and acquaintances.

This is important because people are social animals who need social stimulation to be and remain content and healthy.

This meta-analysis shows its effectiveness both as a standalone treatment and in combination with others.

• • Mindfulness-based cognitive therapy (MBCT)

Combines CBT techniques with mindfulness exercises to prevent relapses in recurrent depression.

It’s been shown to be notably effective for those with a history of multiple depressive episodes.

• • Behavioral activation therapy

Encourages engagement in activities that bring joy or a sense of accomplishment.

This is helpful since motivation and positive emotions tend to drop when depressed, meaning we need every optimistic experience we can get to keep us going.

It also breaks the cycle of inactivity and withdrawal.

• • Acceptance and commitment therapy (ACT)

Focuses on accepting negative thoughts and feelings rather than avoiding them and committing to actions aligned with personal values.

I think this works because avoiding things and events that you know you should tackle might reduce feelings of anxiety in the short term, but it doesn’t eliminate those emotions. Thus, the issues grow larger over time, and the mental strain remains present unconsciously.

This study suggests that ACT aids in reducing depressive symptoms in the short term and in those who are mildly depressed. Still, more research is necessary for moderate to severe depression and a longer follow-up period.

It’s effective for mild to moderate depression, especially when accompanied by chronic stress or anxiety. It helps lower avoidance behaviors and enhances psychological flexibility.

• • Dialectical behavior therapy (DBT)

DBT was originally developed for borderline personality disorders and includes mindfulness, emotional regulation, and distress tolerance.

It’s beneficial for depression in individuals with co-occurring emotional dysregulation or self-harming behaviors.

• • Problem-solving therapy (PST)

Problem-solving therapy is a structured approach that aims to help people develop coping skills to tackle specific problems and stressors they experience. In return, reducing feelings of helplessness and improving your overall mood due to having less tension.

Problem-solving therapy is just as effective as other medications and psychosocial interventions, and much more beneficial than receiving no treatment.

• • Exposure therapy

Gradual exposure to avoided situations or stimuli that maintain the depression.

It’s most effective for depressive symptoms related to avoidance behaviors or simultaneous anxiety disorders.

2. Positive lifestyle changes
   

• • Exercise

Physically exerting ourselves aids in improving our mood because it releases endorphins, which can be considered our “happiness” hormones. It also helps to clear our minds of negative thoughts and the more stressful parts of life.

This systematic review states that exercise has a clear therapeutic effect on depression in people of all ages, making it a great natural way to stave off and treat mental illnesses.

I enjoy a combination of lifting weights and kickboxing to get a good mix of resistance training and cardiovascular exercise.

• • Sleep hygiene

One of the most critical things we can do to improve our mood is get our much-needed, uninterrupted hours of sleep.

Many people, even those who are not suffering from depression, don’t realize just how sleep-deprived they are. Yet, it’s essential to establish a regular sleep schedule to help regulate our mood and overall health.

Impaired sleep can be a symptom of depression, but also be a risk factor. This can make it hard in some cases to decipher whether it caused the mental disorder or if it’s merely a result of the issue.

• • Healthy diet

Our diet not only has a significant influence on our physical appearance, but it also impacts our mental health.

That’s why we should aim to limit unhealthy, pro-inflammatory foods such as greasy, processed foods, and liquids such as soda.

A Mediterranean-style diet, with an emphasis on fruits, vegetables, whole grains, and lean proteins, has shown promise in reducing depression symptoms.

• • Avoid alcohol and drugs

Drugs such as alcohol can make depression worse, especially the day after consuming them when the effects wear off.

There is even research that suggests the possibility that drugs can cause depression, although the evidence is suggestive and not conclusive.

Yet, many people suffering from a mental disorder turn to these substances unconsciously in an attempt to self-medicate. And while this can make them feel better in the present, it will end up having a negative effect in the end.

My desire to drink alcohol heightens the more depressed I become. That’s probably because my body and mind are trying to self-medicate in an attempt to feel better and forget about my problems.

• • Stress reduction

Practices like yoga, meditation, and breathing exercises are extremely useful mindfulness-based techniques to lower stress and reduce depressive symptoms.

3. Medication
   

• • Antidepressants

There are many different types of antidepressants.

Antidepressants such as SSRIs (Prozac, Zoloft) and SNRIs (Effexor, Cymbalta) can be used to help regulate brain chemistry since depression involves a problem with dopamine and serotonin.

Multiple studies have shown that the effectiveness of antidepressants depends on the severity of the depression. The more severe, the better the results typically are.

Never start using medication without consulting a doctor, since you need a prescription for most and because some can potentially be dangerous when misused or abused.

• • • Selective serotonin reuptake inhibitors (SSRIs)

Medications like Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro) are regularly used as a first-line treatment for moderate to severe depression.

They’re effective with relatively few side effects.

• • • Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs such as Venlafaxine (Effexor) and Duloxetine (Cymbalta) are useful for depression with co-occurring anxiety or chronic pain.

• • • Atypical antidepressants

Antidepressant drugs like Bupropion (Wellbutrin) and Mirtazapine (Remeron) are helpful for specific symptoms such as low energy (bupropion) or insomnia (mirtazapine).

• • • Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)

Amitriptyline (TCA) and Phenelzine (MAOI) are both valuable but typically reserved for treatment-resistant cases due to side effects.

• • • Adjunctive medications

Lithium, atypical antipsychotics (aripiprazole), and thyroid hormones are frequently used in combination for treatment-resistant depression.

• • • Mood stabilizers and antipsychotics

Sometimes used and necessary for more severe cases or in combination with antidepressants when at risk for self-harm or when the symptoms are too harsh to function properly.

4. Support networks

• • Social support networks (family and friends)

Sharing your struggles with trusted individuals such as your family and best friends can make you feel supported and understood, which can aid in reducing feelings of isolation as a result.

From personal experience, it’s important not to try carrying the burden and pain of your illness alone, since we all go through bad experiences at some point during our lives. That’s why we must assist each other when the time calls for it.

A sense of social connectedness has been shown to protect adults from depressive disorders and symptoms.

• • Support groups

Connecting with peers who have similar experiences can provide comfort and understanding since it’s typically difficult for people who have never experienced depression to fully comprehend the depth and pain that it can produce.

Peer support groups lessen the symptoms typically associated with depression.

5. Stress reduction
   

• • Mindfulness

Mindfulness can help us to live in the moment instead of worrying about the past and future. That can go a long way to reduce negative thoughts and self-talk.

Mindfulness is effective at treating depression and anxiety. It performs comparably to cognitive behavioral therapy (CBT) and outperforms non-evidence-based treatments.

• • Meditation

Meditation can help focus and calm the mind.

Meditation-type therapy can create moderate to substantial reductions in depression symptoms in people suffering from acute major depressive episodes and lingering subacute clinical symptoms.

• • Yoga

This practice combines physical activity with relaxation techniques.

As some of you may already know, exercise is a great natural antidepressant since it releases dopamine and serotonin, which makes us feel better and allows us to clear our minds.

There is currently a medium amount of evidence for positive short-term effects of yoga in patients with elevated levels of depression and established depressive disorders.

• • Exercise and physical activity

Exercising is important not only to stay physically healthy, but for our mental state as well.

Especially aerobic exercise like running, swimming, or even simply walking, has been shown to reduce symptoms of depression significantly. That’s because it boosts the mood through the release of endorphins, improving our mental health in the process.

Some studies even suggest that exercising might be as effective as antidepressants to relieve symptoms and improve mental health.

6. Self-care and coping strategies

• • Set small and realistic goals

It’s better to set small, realistic goals because achieving small tasks can build a sense of accomplishment, while failing because of large, hard-to-accomplish goals can lower our morale.

This research shows that failing to attain a specific, high goal can damage self-related aspects such as motivation and self-esteem. Not to mention the later behavioral outcomes.

This is something we can miss since these things are already commonly impacted negatively when depressed. These temporary consequences may lead to major long-term consequences, particularly when repeatedly failing to hit goals, and when the person has no resources to offset the effects.

Just because you start small doesn’t mean that they’re insignificant either. These tiny increments will compound and pay off in the future.

• • Journaling

Expressing your thoughts and feelings by writing them down can help you to understand yourself better, but it can also assist you in relaxing because you can pen down your bottled-up frustrations and emotions.

It’s also a convenient way to track how your mood and progress are evolving. The data shows that journaling as an intervention results in a higher discount of negative mental health symptoms.

Unfortunately, the number of high-quality studies is still lacking. Nevertheless, it’s a low-risk and convenient treatment option. So, I would advise everyone to try it out for themselves.

• • Avoiding isolation

No matter how introverted you might be, that still doesn’t change the fact that we’re social animals. Thus, everyone should make it a point to avoid prolonged isolation by interacting with one another.

The ideal would be to meet in real life since it’s the most natural and stimulating way of keeping in touch. But if that isn’t possible, or if you don’t want to leave the house since you’re so depressed, then calling a friend, or talking with your loved ones via a program like Skype can be decent alternatives to get some much-needed social stimulation.

Social isolation is a strong predictor of poor physical and mental health. It has been shown that social support protects our overall well-being.

Levels of depression and anxiety are typically significantly higher among socially isolated people. Interestingly, the type of support that socially isolated people receive can be important in reducing depression and anxiety.

7. Hospitalization or intensive outpatient programs

In severe cases where there is a risk of harm to oneself or others, more intensive treatment settings may be necessary, such as hospitalization or intensive outpatient programs.

Just because you may need to go through such an intervention doesn’t make you any less of a person, nor does it make you weak. If anything, it makes you a strong, reasonable person because you recognize and admit to yourself and others that you have an issue that needs to be sorted out to start living again.

Studies show that both inpatient and outpatient complex treatment programs are effective at treating depression. Outpatient groups show a higher response rate, although not clinically significant.

Outpatient treatment programs can be an attractive alternative for individuals needing more than one treatment session per week, but not necessarily as many as a day clinic or inpatient program.

8. Light therapy

Light therapy can provide solace when you’re affected by seasonal affective disorder (SAD), such as winter depression.

It involves exposure to bright light, typically from a lightbox, to mimic natural sunlight and regulate mood.

This can be particularly helpful during the winter periods when there’s less natural sunlight and daylight to simulate a similar experience. It’s not something I have used, but it’s worth considering.

Bright light therapy has shown promise for disorders that have seasonal variations in symptoms, depressive symptoms, and a delayed circadian phase.

9. Bibliotherapy
   

Reading self-help books and therapeutic literature can be beneficial since we must first know how to solve our issues before we can treat them. Especially articles based on CBT principles since that’s a proven method to cure and improve depression.

Bibliotherapy is an effective way of treating mild to moderate depression or subthreshold depressive symptoms.

Nevertheless, I think it’s optimal to combine it with other practices rather than employing it as your sole treatment option. It might not be as effective in treating severe depression since more professional guidance may be in order. Still, it won’t harm you, and it’s better to be informed rather than ignorant! Great as a low-entry alternative.

I like reading because it distracts me from my struggles (and because I need to research studies to get the right data).

10. Digital and online therapies

Online programs and apps that provide guided therapy or support, such as mood tracking, CBT exercises, or mindfulness training, can help treat mental disorders. They’re a particularly interesting alternative for those with limited access to in-person therapy.

This meta-analysis shows that internet-based cognitive behavioral therapy is more effective when guided by a professional rather than doing so all by yourself.

Unguided online therapy is best reserved for mild depression, while guided digital therapy is more appropriate for moderate to severely depressed individuals.

11. Gratitude practice

It’s good practice to reflect regularly on and note things you’re grateful for. This can shift your focus away from negative thoughts and self-talk and help improve your mood.

Humans always want more. And those who have the most are frequently not happy while lamenting what they don’t possess.

There seems to be a direct correlation between practicing gratitude and experiencing fewer depressive symptoms. Positively reframing, in addition to experiencing positive emotions, also has positive effects on depressive symptoms.

12. Animal-assisted therapy

Interacting with animals such as dogs or horses in a therapeutic setting has been shown to lessen symptoms of depression and anxiety.

Those with pets will surely know how they can cheer you up even on the most terrible days, just with their presence and unconditional love.

Dog-assisted therapy is effective in reducing symptoms of depression in institutionalized elderly. Possibly because the dog stimulates social interaction and positive emotions.

More studies in a younger, non-institutionalized population are required to determine its effectiveness for all age groups.

13. Creative therapies
    

Art, music, and drama therapies provide alternative ways to express emotions and work through complex feelings. This can aid those who typically have trouble admitting, showing, or discussing their feelings with themselves and others.

The current meta-analysis indicates that music therapy can provide short-term benefits in depressed people. It also aids in decreasing anxiety and improving the overall functioning of depressed individuals. It seems more effective to combine music therapy with other, more conventional treatment options.

Future trials with a larger sample of adults and youth will be necessary to attain conclusive evidence regarding its effectiveness.

14. Biofeedback and neurofeedback

These are techniques that teach you how to control bodily functions, such as heart rate or brain waves.

Studies have shown that engaging the parasympathetic nervous system can help reduce stress and improve mood.

15. Brain stimulation therapies

Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)

These are typically used for severe depression that hasn’t responded to other treatments. Several studies about ECT show favorable results for treating severe and treatment-resistant depression.

Vagus nerve stimulation (VNS)

Involves implanting a device to stimulate the vagus nerve.

It’s approved for treatment-resistant depression but is less commonly used.

I don’t have real-life experience with these regimens, but they might be worth exploring, especially for treatment-resistant depression.

16. Alternative treatments

• • Acupuncture

Some find acupuncture helpful for reducing symptoms, which helps make the suffering more bearable.

This meta-analysis showed major clinical drops in the severity of depression compared to usual care.

There seems to be a positive correlation between the number of acupuncture treatments received and the reduction in depression. Nevertheless, it should be noted that there’s a high risk of personal biases in these studies!

• • Herbal supplements

St. John’s Wort and other supplements may help if you’re suffering from mild to moderate depression.

However, it’s a supplement, and thus, it will usually not be sufficient as a stand-alone treatment.

Omega−3 Polyunsaturated Fatty Acids (PUFA), probiotics, and vitamin D can be beneficial dietary supplements to manage depression.

• • Psychedelic-assisted therapy

Modern research is exploring the use of psychedelics like psilocybin and MDMA in a therapeutic setting for treatment-resistant depression. These are still experimental and tightly regulated, so employ these options at your peril.

My advice would be not to try anything too risky or untested, since there can be hidden and undiscovered dangers.

This systematic review implies a reduction of depressive symptoms in both the short and long term after being administered LSD, ayahuasca, or psilocybin with psychological support. Symptom reduction was significant for various time points, including 1 day, 1 week, and 3-5 weeks, except the 6-8 weeks follow-up point, which was less conclusive.

Conclusion

A large variety of evidence-based treatment options exist these days to deal with depression. I’ve listed the most helpful and common ones to help you get started on your way to recovery.

Perhaps my best tip would be to not limit yourself to just one form of therapy. A combination of multiple approaches is always better than putting all your eggs in just one basket concerning depression.

Please consider joining our forum and Facebook if you enjoyed reading this and would like to chat with like-minded peers about anything depression related.

It would certainly go a long way toward my dream of creating a thriving, supportive community!