Depression Treatments & Therapies
Understand the major approaches used to treat depression—from psychotherapy and antidepressant medication to TMS, ECT, ketamine and SPRAVATO®. Compare how treatments work, when they may be considered, and the questions worth discussing with a qualified clinician.
What treatments are used for depression?
Depression treatment commonly includes psychotherapy, medication or both. When symptoms are severe, persistent or have not improved enough with earlier care, clinicians may consider additional options such as TMS, ECT, SPRAVATO® or off-label ketamine. The appropriate approach depends on diagnosis, symptom severity, safety, medical history, previous treatment and individual preferences.
Depression Treatment Is Not One-Size-Fits-All
Two people with depression may receive very different treatment plans—and both plans may be clinically reasonable.
The National Institute of Mental Health describes psychotherapy, medication and brain stimulation among the established approaches to depression care. Treatment selection depends on a person's needs, preferences and medical situation.
Some people begin with psychotherapy. Others may receive medication and therapy together. People with severe symptoms, urgent clinical needs or depression that has not improved after appropriate treatment attempts may be evaluated for additional interventions.
Explore Depression Treatments & Therapies
Each guide explains what the treatment is, how it is used, what the evidence shows, potential risks and limitations, and questions to discuss with a healthcare professional.
Psychotherapy
Talk therapies such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) can help address patterns in thoughts, behavior, relationships and coping. Psychotherapy may be used alone or alongside other treatments.
Explore psychotherapy →Antidepressant Medication
Antidepressants include SSRIs, SNRIs and other medication classes. Response, side effects and treatment timelines vary, so medication decisions require individualized prescribing and follow-up.
Explore antidepressant medication →Transcranial Magnetic Stimulation (TMS)
TMS is a noninvasive brain stimulation treatment that uses magnetic pulses. It is commonly considered for certain people whose depression has not improved adequately with medication.
Explore TMS →Electroconvulsive Therapy (ECT)
ECT is performed under anesthesia and uses controlled electrical stimulation to produce a therapeutic seizure. It may be considered for severe, urgent or difficult-to-treat depressive episodes.
Explore ECT →Ketamine
Ketamine is FDA-approved as an anesthetic but not specifically for psychiatric disorders. Some clinicians administer ketamine off-label for depression after individual screening and informed consent.
Explore ketamine →SPRAVATO® (Esketamine)
SPRAVATO® is an FDA-approved esketamine nasal spray for specific adult depression indications. It is administered under healthcare supervision and is subject to a restricted safety program.
Explore SPRAVATO® →Light Therapy
Light therapy uses controlled exposure to bright light and is most closely associated with seasonal patterns of depression. Timing, intensity and eye or medication considerations can affect appropriate use.
Explore light therapy →Supportive & Lifestyle Approaches
Sleep, physical activity, social support, nutrition and other behavioral strategies may support a broader treatment plan. They should not be presented as substitutes for needed clinical care.
Explore supportive approaches →Need immediate help?
If you or someone else is in immediate danger, call 911. For crisis support anywhere in the United States, call or text 988.
Depression Treatments at a Glance
This comparison is designed for orientation, not to determine which treatment is appropriate for an individual.
| Treatment | Type | What it involves | When it may be considered |
|---|---|---|---|
| Psychotherapy | Psychological treatment | Structured sessions with a trained mental health professional | Across a range of depression severity; alone or combined with other care |
| Antidepressants | Medication | Prescription medicines including SSRIs, SNRIs and other classes | Commonly used for moderate or severe depression and recurrent or persistent symptoms |
| TMS | Brain stimulation | Noninvasive magnetic stimulation delivered over a treatment course | Often when medication has not provided adequate relief or has not been tolerated |
| ECT | Brain stimulation | Controlled electrical stimulation under anesthesia | Severe, urgent or treatment-resistant depressive episodes in appropriate patients |
| Ketamine | Off-label medication | Clinically administered ketamine; protocols vary by setting | Selected patients with difficult-to-treat depression after clinical evaluation |
| SPRAVATO® | FDA-approved medication | Esketamine nasal spray administered under healthcare supervision | Adults meeting FDA-labeled indications and safety requirements |
| Light therapy | Light-based treatment | Scheduled exposure to a therapeutic light source | Most established for depression with a seasonal pattern |
| Supportive approaches | Adjunctive care | Sleep, exercise, social support and other health behaviors | May complement clinical treatment based on individual needs |
How a Treatment Plan Is Usually Evaluated
Choosing care is generally a process of evaluation, shared decision-making, monitoring and adjustment rather than a one-time selection.
Clarify the diagnosis
Review symptoms, duration, severity, functioning, medical history and whether another condition could be contributing.
Review previous care
Document prior therapies, medications, doses, duration, adherence, benefits and side effects.
Compare appropriate options
Discuss evidence, potential benefits, risks, practical requirements, alternatives and personal preferences.
Monitor and adjust
Track symptoms, safety and everyday functioning, then modify the plan when response or circumstances change.
When Depression Has Not Improved With Initial Treatment
A disappointing response to treatment does not by itself identify the next treatment—or mean that additional care will not help.
Treatment-resistant depression is commonly used to describe major depression that has not improved adequately after multiple appropriate antidepressant treatment attempts. Before labeling depression as resistant, clinicians may review the diagnosis, medication dose and duration, adherence, psychotherapy, medical conditions, sleep, substance use and other factors.
Depending on the clinical situation, next steps may include changing or combining medications, modifying psychotherapy, treating contributing conditions, or evaluating options such as TMS, ECT, SPRAVATO® or off-label ketamine.
Authoritative Treatment Resources
These government resources provide additional information about depression treatment, medications, brain stimulation and current regulatory requirements.
Depression Treatment
Overview of psychotherapy, medication, brain stimulation and other depression treatment considerations.
Visit NIMH →Psychotherapies
Plain-language information about psychotherapy, evidence-based approaches and treatment planning.
Visit NIMH Psychotherapies →Brain Stimulation Therapies
Information about ECT, repetitive TMS and other brain stimulation approaches.
Visit NIMH Brain Stimulation →Mental Health Medications
Information about antidepressant classes, treatment timelines and medication safety considerations.
Visit NIMH Medications →SPRAVATO® Prescribing Information
Current FDA labeling for indications, administration, monitoring, warnings and dosing.
View FDA labeling →Crisis Support
Free, confidential crisis support is available in the United States by call, text or chat.
Visit 988 Lifeline →Frequently Asked Questions About Depression Treatments
Quick answers to common questions about treatment options and how they may fit into a broader care plan.
What is usually the first treatment for depression?
There is no universal first treatment. Psychotherapy and antidepressant medication are common approaches. NIMH notes that psychotherapy may be tried first for milder depression, while medication is often included in initial treatment for moderate or severe depression. Individual circumstances can change that plan.
Can depression be treated without medication?
For some people, psychotherapy or another non-medication treatment may be appropriate. The choice depends on diagnosis, severity, safety, medical history, prior response and preferences. Some treatments that differ from conventional antidepressants—such as ketamine and SPRAVATO®—are still medications.
What happens if antidepressants do not work?
A clinician may first review whether the medication was taken at an appropriate dose and duration, whether side effects or adherence affected the trial, and whether the diagnosis or another health condition needs reassessment. Options may include changing medication, combining treatments, psychotherapy, TMS, ECT, SPRAVATO® or off-label ketamine depending on the clinical situation.
Are TMS and ECT the same treatment?
No. TMS uses magnetic pulses to stimulate targeted brain regions and does not generally require anesthesia. ECT is performed under anesthesia and uses controlled electrical stimulation to induce a therapeutic seizure. Their procedures, risks and clinical uses differ.
What is the difference between ketamine and SPRAVATO®?
Ketamine and esketamine are related but distinct. Ketamine is FDA-approved as an anesthetic and may be used off-label for depression. SPRAVATO® is the brand name for esketamine nasal spray and has specific FDA-approved depression indications, administration requirements and monitoring safeguards.
Is SPRAVATO® only used with an oral antidepressant?
Not in every FDA-labeled use. Current FDA prescribing information allows SPRAVATO® for treatment-resistant depression in adults as monotherapy or together with an oral antidepressant. For depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, the labeled use is in conjunction with an oral antidepressant.
How long does depression treatment take?
Timelines vary considerably. Psychotherapy generally involves multiple sessions, antidepressant medications often require several weeks to evaluate, and TMS is delivered as a treatment course. ECT, ketamine and SPRAVATO® follow different schedules. Treatment duration should be based on response, tolerability and clinical guidance rather than a fixed universal timeline.
How do I compare depression treatment options?
Useful comparison points include the strength of evidence for the person's diagnosis, expected benefits, risks and side effects, medical contraindications, treatment setting, time commitment, prior treatment response, insurance or access considerations and personal preferences. A qualified clinician can help interpret these factors for an individual case.
Learn About Your Options. Then Find Care Near You.
Use the treatment guides to understand the major approaches to depression care, then explore state and local resources when you are ready to look for treatment providers.
DepressionTreatment.info provides educational information and does not diagnose medical conditions, recommend treatment for individual readers or replace care from a qualified healthcare professional. Treatment indications, safety information and regulatory requirements can change. Confirm current information with an appropriate clinician and official sources.