How is depression treated?

Photo of a woman and a psychotherapist

There are various treatment options for . They include psychological treatments, medication and general measures such as relaxation techniques or the use of sports and exercise. Different treatment options are often combined.

Depression is one of the most common mental illnesses. People who have acute feel like they're in a deep, dark pit, and often can't see any way out. If this feeling lasts several weeks or months, the medical term is a “depressive episode.” In chronic , the symptoms last for years. Treatment can shorten depressive episodes and relieve the symptoms.

Does depression always need to be treated?

People with moderate or severe can have very serious symptoms that don’t get better quickly. So it’s particularly important they get psychotherapy or antidepressant treatment as soon as possible. This is also true if they have chronic or are thinking of harming or killing themselves (committing suicide).

If the is minor or just starting, it's possible to try other approaches first and see if they help. It is important to stay in touch with the doctor and have regular appointments to discuss how you're feeling and how you can cope with the situation. Some people find it helpful to spend more time doing things like sports and hobbies – even if they have trouble motivating themselves because they don't feel like it. Others take (online) courses to learn how to deal with their symptoms better. If it helps, they can also talk to a psychiatrist or psychotherapist.

It is also important for people to be able to talk with others. Partners, friends and family play a key role here. Support and information centers can offer help and guidance too. Sometimes it can help to talk to people who have gone through similar experiences, for example in a support group.

If your mood doesn't improve within a few weeks – or if it gets even worse – then help from a therapist may be a good idea.

What are the psychological treatment options?

Psychological treatment usually involves talking about things in depth and doing behavioral exercises. Cognitive behavioral therapy (often called “CBT” for short) is often used to treat . Statutory health insurance companies in Germany cover the costs of CBT as well as other outpatient treatments, including depth psychology, analytical psychotherapy and systemic therapy. They are often offered by specially trained therapists.

If someone is going through an acute depressive episode, they can usually get short-term psychological support, sometimes together with medication. They can start by seeing their family doctor or organizing an appointment with a therapist. Then they can apply for a full course of outpatient psychological treatment.

Cognitive behavioral therapy

In , negative thought patterns such as self-doubt and feelings of guilt often make the problem worse. Cognitive behavioral therapy aims to break these patterns bit by bit, so that people feel better about themselves. The first step is for them to form a clear idea of their own thoughts, attitudes, and behavioral patterns so that they can recognize and change false and distressing beliefs.

For example, people who have developed depressive thoughts often tend to become withdrawn and give up their hobbies. As a result, they feel even more unhappy and isolated. Cognitive behavioral therapy can help them realize what's happening. Then they can work with their therapist to find ways to become more active again.

Psychoanalytic approaches: analytical psychotherapy and depth psychology

Psychoanalytic approaches include analytical psychotherapy and depth psychology. They are based on the belief that unresolved, unconscious conflicts or losses can cause . They use therapy to identify and work through previously unknown issues, the aim being to change attitudes and behaviors that are causing problems. People who have psychoanalytic therapy have to be prepared to face potentially painful past experiences.

Psychoanalysis usually takes longer than approaches based on depth psychology.

Systemic therapy

Systemic therapy places a lot of importance on the relationships between people – for instance, within your family, your group of friends or at work. These relationships can play a role in the development of . The therapy might involve trying to improve communication within the family, for instance. The aim is to use the strengths and resources of the people involved to change problematic attitudes and behaviors and find solutions to conflicts. This can help to reduce the symptoms of . The therapy sessions are typically one-on-one, but other people, like family members, can also be included.

For more information on whether therapy can help and how to get treatment, take a look at the information “How effective is psychological treatment?

When are the different medications considered?

Depression is treated with medications called antidepressants. They can have a mood-lifting effect and increase motivation. Antidepressants are often used in combination with psychological treatment. Medication is hardly effective in mild , and sometimes not at all. It is only prescribed for people with mild in certain situations, like if the symptoms don't go away or are likely to get worse.

The symptoms sometimes get better without antidepressants after a short while. The possible side effects will also play a role when deciding whether or not to take antidepressants.

But it usually takes several days or weeks for antidepressants to start working. In acute they have to be taken every day for several weeks or months before they start having a noticeable effect. This is often followed by continuation treatment, which lasts several months, and sometimes long-term therapy as well in order to prevent the from coming back.

The possible side effects of antidepressants include a dry mouth, headaches and feeling faint, restlessness and a decreased sex drive. These usually arise within the first few weeks of taking antidepressants. Whether or not someone has side effects, which side effects they have, and how frequent the side effects are will depend on the specific drug and dose that is used.

And everyone reacts slightly differently to drugs too. That’s why it’s important to see a doctor regularly while on medication, so they can see how things are going and adjust the treatment if necessary. Towards the end of the treatment, the dose of antidepressants is gradually reduced over the course of several weeks. If someone stops taking antidepressants suddenly, they might (temporarily) have problems sleeping, feel nauseous or restless. Stopping taking the medication as soon as you start to feel better without consulting your doctor can increase the risk of returning.

There's more information about how antidepressants work and what side effects they can have in the information “How effective are antidepressants?

How long does treatment last?

Acute treatment usually lasts six to eight weeks. The aim is to

  • ease the symptoms enough to enable the person to lead a normal life again, and
  • shorten the depressive episode.

The next phase of treatment is called continuation treatment. This usually lasts four to nine months. The aim of continuation treatment is to

  • further relieve the symptoms, until they go away, and
  • sustain the progress made through treatment.

Some people have depressive episodes on a regular basis, which has a major impact on their lives. Long-term treatment is a possible option for them. It can last several years and the aim is to prevent the from coming back (relapse). People who have chronic also often take medication for many years and need psychological treatment for a longer time as well. This eases persistent symptoms.

Doctors check regularly to see whether the treatment is working properly. If necessary, they make adjustments.

What other kinds of medication are there?

The most common and best-known herbal medicines for the treatment of are made from St. John’s wort. These products can provide relief from the symptoms of mild and moderate . Omega-3 fatty acids, on the other hand, are not effective for treating . A number of studies have come to this conclusion. Herbal products can have side effects and interact with other medications too, so it’s important to consult a doctor before taking things like St. John’s wort.

Even though lots of people with have trouble sleeping, doctors tend not to recommend sleeping pills or sedatives for them. They're only an option for people whose is moderate to severe and whose insomnia or restlessness is causing major problems that can't be helped with other methods (like changes to their bedtime habits) Sleeping pills and sedatives that have to be prescribed shouldn't be taken for longer than two to four weeks because they can lead to dependence. They are not recommended for people who've had problems with addiction in the past.

The doctor might prescribe antipsychotics (usually in combination with antidepressants) if the person has psychosis too. The symptoms of psychosis include hallucinations, delusional thoughts, and an urge to move about without any particular purpose. Antipsychotics can also be an option when antidepressants aren't having the necessary effect and need to be backed up with additional medication.

What is psychoeducation?

Psychoeducation involves providing information about what causes , how it progresses, what treatments are available, and strategies for coping with the illness. It's intended to improve the person's knowledge of their illness and point them to ways of changing their attitude and behavior. Ultimately, the aim is to help them develop the skills they need to deal with the illness.

The information is typically provided by a doctor or therapist, in information material, or on courses. Most of these courses take place in clinics. They're offered for individuals or groups. Online programs sometimes include a psychoeducation component too.

How can online programs help people with depression?

A number of web-based tools are available to help people with . Most of them are apps that can be downloaded. Some are free, some have to be paid for. They're designed to help people cope better with . They include things like information on psychotherapy techniques and symptom diary tools.

They can be helpful for people with minor and as additional support for people being treated for more severe . Experts recommend that people who use these online programs should talk to a therapist about them.

In Germany, some apps can be prescribed by a doctor or therapist. They're referred to as "Digital Health Applications" (DiGAs) and they’re covered by statutory health insurance. DiGAs are assessed and certified by Germany’s Federal Institute for Drugs and Medical Devices (BfArM). This means they meet certain requirements to do with things like data privacy and content quality.

The BfArM can supply a list of all DiGAs that deal with . The list contains additional information on the content of each app and what it does.

Are there other treatment options?

A lot of other treatments and strategies are offered to people with . But many of these haven't been clearly proven to help reduce the symptoms. Some can be a useful addition or alternative to other treatments in certain situations.

Relaxation techniques and yoga

There is some that relaxation techniques can help relieve mild to moderate . These include approaches such as progressive muscle relaxation, autogenic training, music therapy and yoga. But they aren't as effective as other treatments, such as cognitive behavioral therapy. Psychotherapists sometimes teach relaxation techniques as part of the therapy, though.

Sports and exercise

Sports and exercise – such as Nordic walking, jogging, cycling, swimming or hiking – are often recommended for the relief or prevention of . Many people find that physical activity improves their mood and gives them more energy. Often, sports and exercise aren't enough on their own but they can be useful as a way of backing up other treatment.

The most suitable activity will depend on the person’s symptoms and situation. For instance, people who have severe are often not capable of doing intensive exercise. People with milder are more likely to be able to. But just going for regular walks in the fresh air or for bike rides can help if it's difficult to find the motivation to go for a jog or to the gym.

Light therapy

This form of affects some people during the darker months of the year. Light therapy, also known as phototherapy, is used in the treatment of seasonal affective disorder (SAD). Treatment with artificial light is an option here if the lack of natural bright daylight is thought to be affecting their mood. Light therapy involves sitting in front of a special bright light (a light therapy device) for about half an hour every morning.

Sleep deprivation therapy

This treatment involves temporarily depriving the patient of sleep. They stay awake for a whole night and only go to sleep the following night. It is thought that sleep deprivation changes the metabolism in the brain, and that this might lead to an improvement in mood. Sleep deprivation therapy only aims to improve the symptoms temporarily. It can be used in addition to other treatments.

Electroconvulsive therapy

Electroconvulsive therapy is usually only considered as a treatment option for people with severe if other treatments haven't helped. Electroconvulsive therapy is usually carried out in a hospital, under general anesthetic. Electrodes are placed on the patient’s head and a short burst of electric current is passed through the brain, inducing a seizure. The patient can’t feel anything because the procedure is carried out under general anesthesia.

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation is also only considered when other treatments haven’t been effective enough. It involves a coil being placed on the person's head to produce magnetic fields that stimulate the nerve cells in their brain. The aim is to relieve the symptoms by changing the brain’s activity.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 15, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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