Ways to Manage Depression in Senior Adults

Written By Julian/Yannick

Over 2 million Americans over the age of 65 experience depression. This doesn’t mean it’s inevitable in older age, however — far from it!

As an older adult, you may be experiencing new health concerns, adjusting to retirement, or even processing the loss of a loved one. Or, you may be thriving, but still coming to terms with your own mortality.

At any stage of life, it’s natural to feel sad as you accept losses along with time’s passage.

Sometimes though, sadness turns to hopelessness. It seems harder to reach out to people or to eat or sleep as you typically do. If symptoms persist daily for two or more weeks, you — or an older loved one in your life — may have depression.

Depression looks and feels different depending on the age group. In children, it may present as irritability or fatigue, while adults may have difficulties concentrating or lose interest in things they once enjoyed.

For seniors, symptoms of depression may be overlooked or simply considered a natural part of aging.

Also, other health concerns may mimic, cause, coexist with, or get mistaken for depression. A mental health professional can help determine this.

Here’s the good news: Depression is very treatable and you have options.

Depression types and symptoms

The National Institute on AgingTrusted Source outlines these different types of depression in older adults:

  • Major depressive disorder. If you’re unable to do daily chores or you experience disruptive symptoms for two or more weeks, it’s possible you may have major depressive disorder.

  • Persistent depressive disorder (dysthymia). You may have persistent depressive disorder, aka dysthymia, if you feel depressed (joyless, lethargic) for more than two years, but still accomplish your daily activities.

  • Substance/medication-induced depressive disorder. This type of depression may result from the prolonged use of alcohol or pain medication.

  • Depressive disorder due to a medical condition. Another health condition, such as dementia or heart disease, may be causing you to feel depressed.

Symptoms of depression

Depression in older adults may look similar to depression in younger adults. Only a mental health professional can diagnose depression, but it’s helpful to know what to look for.

It could be beneficial to consider changes in how you feel.

Are you:

  • fatigued?

  • disinterested in things you love?

  • overwhelmed by the thought of socializing?

  • feeling hopeless or worthless?

It’s also helpful to look at changes in how and what you’re thinking.

Do you:

  • believe there’s no point in doing anything?

  • rehash your mistakes?

  • contemplate death or even suicide?

Unexplained changes in behavior can also signal possible depression. If you have depression, you may be experiencing these symptoms:

  • sleeping too much or too little

  • eating too much or too little

  • decreased interest in getting dressed or bathing

  • communicating less with others

  • forgetting appointments

  • feeling pains that can’t be linked by doctors to a medical cause

Older adults and symptoms of depression

The American Psychological Association (APA) suggests that compared to younger adults, older adults experience some symptoms of depression more intensely, including:

  • higher rates of insomnia

  • higher rates of memory loss

  • slower than typical reaction times

  • difficulty making decisions or sustaining attention

You may wish to seek help if you notice that your symptoms start to interfere with tasks that require a little more concentration, such as:

  • cooking

  • driving

  • taking medications

Is it dementia or is it depression?

Apathy, forgetfulness, and confusion are hallmarks of dementia and depression. Sometimes dementia can trigger depression, and in some cases, the two can coexist.

It’s important to rule out depression before jumping to a diagnosis of dementia. The treatments for each will be different.

If you’re an older adult living with depression, you may notice — and feel distressed by — any new signs of forgetfulness.

A person with dementia, though, may be less likely to notice the changes. Only a mental health professional can diagnose depression and recommend medication and treatment, if necessary.

Cultural background

Cultural background can also impact how depression is expressed.

Older adults from some backgrounds may talk about their feelings of unhappiness. Others will express depression through physical symptoms, such as stomach issues or headaches.

Fact vs. myth regarding depression in seniors

According to the World Health Organization (WHO)Trusted Source, depression affects about 5% of the world’s older adult population.

  • A literature reviewTrusted Source suggests that 2% of adults aged 55 and over experience major depression, and 10% to 15% of older adults have symptoms of clinical depression, even without experiencing major depression.

  • The rate of depression goes up with increasing age.

  • Although adults aged 65 and older account for only 13% of the U.S. population, they account for 20% of all deaths by suicide.

The majority of older adults living in the community are not depressed, according to the Centers for Disease Control and Prevention (CDC)Trusted Source. The picture changes somewhat for older adults in living situations to accommodate advanced age or health concerns.

  • Only 1% to 5% of adults living in the community experience major depression.

  • Of adults who need home healthcare, 13.5% are depressed.

  • About 11.5% of hospitalized older patients have major depression.

What stops some depressed seniors from getting help?

In the 65 and older age bracket, only 38% of adults believe that depression is a medical problem, and only 42% say they would seek help from a medical professional, according to Mental Health America.

There are some myths that may inhibit older adults and their care providers from seeking help for depression. They include:

  • Prolonged sadness is inevitable because aging is hard.

  • Symptoms must be due to some other health problem, like dementia.

  • “I should be able to snap out of it.”

Cultural background can also be a driving force in whether older adults will seek help for mental health issues.

Mental Health America suggests Black Americans may not report symptoms if they view mental illness as weakness and treatment as a luxury.

Meanwhile, the suicide rate among white men 85 years old and older is the highest of any other demographic — nearly four times larger than that of the broader population. Some think this might be because older white males believe that reaching out for help is a sign of weakness.

Older adults who are religious may see depression as a lack of faith. This can prevent them from seeking mental health help for symptoms of depression.

Causes of depression in older adults

Depression is not connected to a lack of willpower. Life situations, medical conditions, and medications can all contribute to depression in older adults.

Situational causes

  • bereavement

  • elder abuse

  • isolation

  • changes in housing

  • changes in mobility

  • retirement

  • living with a lower household income

Medical causes

  • substance use

  • a family history or personal history of depression

  • low serotonin and norepinephrine levels

  • other medical conditions, such as Parkinson’s disease, stroke, dementia, heart disease, cancer, and arthritis

  • decreased folate levels

Medications contributing to depression

There are some medications that may also increase an older adult’s chance of depression, including:

  • beta-blockers for blood pressure

  • ACE inhibitors for blood pressure

  • protein pump inhibitors (PPIs) for acid reflux

Treatment for depression in older adults

If you’re an older adult and you’re experiencing symptoms of depression, consider reaching out to your medical doctor. They may be able to refer you to a mental health professional who can help.

You may be given a screening test — such as the Geriatric Depression Scale or the Mini-Mental State Examination — to help determine if you may have depression.

Treatment for depression in older adults is similar to that for any adult living with depression: medication, therapy, or a combination of both. However, there may be some special considerations.

Medication

  • Medications used to treat depression are called antidepressants.

  • Antidepressants don’t work overnight. You may notice a lightening of symptoms after two weeks.

  • Possible side effects can include intestinal distress, weight changes, and drowsiness.

  • If side effects worsen, you and your doctor can discuss changing your dose or medication.

  • Call your doctor immediately if you have dramatic mood changes or thoughts of suicide.

As an older adult, there are a few extra factors about medication you may want to consider:

  • If you take multiple medications, you may be at risk for more interactions.

  • If your medication can make you less alert, you may need a plan to reduce the risk of falls.

  • If your medication can cause forgetfulness, consider a plan so that you don’t miss doses.

  • It’s not safe to cut doses or stop medication without a doctor’s guidance.

  • A recent studyTrusted Source suggests that antidepressants may increase the risk of Alzheimer’s in older adults.

  • Some researchTrusted Source supports selective serotonin reuptake inhibitors (SSRIs) as the first pharmacological choice in treating both Alzheimer’s and depression, however.

Psychotherapy

Psychotherapy (or “talk therapy”) can help treat depression without medication. It encourages healthy ways to cope with stresses, including new:

  • thought and behavioral patterns

  • relational patterns

  • habits

  • problem-solving strategies

If your depression is severe, you may wish to consider both psychotherapy and medication.

Therapies focused on emotions, behaviors, and structured activities may help older adults with both Alzheimer’s and depression.

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Tips on managing depression in older adults

Depression cannot necessarily be prevented. However, some lifestyle changes can improve mental health, and complementary therapies may help aid medical and psychological treatments in easing depression.

Helpful actions to consider if you have depression include:

  • connecting with friends

  • joining a church, community center, or library program

  • adding exercising — such as dancing, swimming, yoga, or walking — into your daily routine

  • cutting back on alcohol

  • eating balanced, nutritious meals

  • maintaining a consistent sleep schedule

Ways to support someone with depression

If you know an older adult who is living with depression, or you’re a caregiver for an older adult having symptoms of depression, there are some ways you can help support and care for them.

  • Encourage conversations with healthcare professionals.

  • Be gentle when introducing new ideas.

  • Help research resources for recreation and socializing.

  • Offer assistance tracking medicines and appointments.

  • Assist with social media and virtual connections.

  • Offer rides and healthy meal preparation.

  • Help find low-cost healthcare. The National Institute for Mental Health suggests a nationwide directory of clinics.

Next steps

If you have symptoms of depression and they just don’t seem to go away, consider reaching out to a healthcare professional.

They can help determine if your symptoms are caused by another medical condition or if you may benefit from seeing a mental health professional.

They also may be able to recommend one that specializes in older adults. Our Find a Therapist tool may help, as well.

Here are some other resources specific to older adults that you may find helpful.

Need immediate help?

If you’re in crisis and need assistance right now, help is available:

  • Call the National Suicide Prevention Lifeline at 800-273-8255.

  • Text “HOME” to 741741.

If you’re a veteran, you can contact the Veteran’s Crisis Line 24-7:

  • Dial 800-273-8255 and press 1 to speak with someone by phone.

  • Send a text to 83825 to talk via text.

  • Visit the website to chat online any time.

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No matter what your age, help is available for depression and treatment is effective.

Last medically reviewed on September 23, 2021

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Medically reviewed by Kendra Kubala, PsyD, Psychology — By Karen Sosnoski, PhD — Updated on September 23, 2021

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Coping With Loneliness: Tips for Seniors

On the old television show “The Golden Girls,” four, over-60 widows live together, providing each other companionship, friendship and emotional support. Many seniors, however, lack this kind of social network. In fact, loneliness is a serious problem among elderly people. Fortunately, loneliness can be overcome, although doing so takes some initiative. You might find the following strategies and tips helpful.

Make friends

Make the effort to meet new people. At first, you may simply enjoy the companionship of a casual acquaintance. But over time, some of these relationships will grow into close friendships, the kind you can turn to for emotional support.

Your local senior center and area agency on aging are great resources, often organizing classes, outings and social functions for people who want to enjoy life with other seniors. Churches, health clubs, civic and service organizations, educational classes, travel clubs, and special interest groups are good places to meet people of all ages.

When you see an opportunity to introduce yourself, do so! Ask others about themselves and let people know something about you. Most people are happy to include newcomers, but growing new friendships requires ongoing contact.

Meanwhile, don’t forget old friends and neighbors. Invite a friend with whom you’ve lost touch for lunch or organize a neighborhood get-together. Someone always has to take the initiative-it might as well be you.

Volunteer

Volunteering your time and talents can help to put your own situation in perspective, bringing to light the positives and the things you can be thankful for. Check your local phone book under “volunteering” for organizations such as RSVP (Retired Senior Volunteer Program). You also can check with your local senior center, area agency on aging and hospital for volunteer opportunities.

Take up a hobby

Hobbies can keep you motivated and forward-thinking. Through hobbies, you can set goals, like finding that rare stamp to add to your collection or knitting a stocking for your grandson’s first Christmas. Plus, many hobbies are possible if your mobility is challenged. Here are some ideas:

  • gardening

  • model trains

  • arts and crafts

  • needlepoint

  • playing an instrument

  • reading

  • writing

  • puzzles

  • pen pals

Adopt a pet

Most people don’t feel so alone in the company of a pet. Why? Pets love unconditionally, they are accepting, they don’t criticize, they don’t judge, they forgive and they give pleasure. Plus, caring for a pet can renew meaning and purpose in your life.

Reminisce

Life review will help you recall the aspects of life and living that matter to you. Research shows that people who reminisce have enhanced emotional health and are less likely to be lonely or withdrawn.

If you are homebound

Meeting people can be particularly difficult if you are homebound. Call your area agency on aging or place of worship to inquire about home-visitation services as well as community transportation for elderly people. You also can contact Little Brothers-Friends of the Elderly, which serves lonely and isolated elderly in eight U.S. cities.

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Loneliness can indicate depression, a disease causing mental and physical deterioration. Feelings of sadness and despair, loss of appetite, apathy, reluctance to make decisions, suicidal thoughts, and trouble sleeping are signs of depression and should be discussed with your health-care provider.

Last medically reviewed on May 17, 2016

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Medically reviewed by Scientific Advisory Board — By Lynn Ponton, MD on May 17, 2016

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What to Know About Depression in Older Adults

Diagnosis, treatment, and lifestyle changes can help ease symptoms of depression in older adults and improve their quality of life.

It’s not uncommon for adults to begin experiencing symptoms of depression such as sadness or loss of interest in activities as they grow older.

Life changes, medications, or chronic health conditions can often trigger depressive symptoms in adults 65 years old and older. Symptoms can sometimes be overlooked because they can mimic the natural stages of life.

But depression is not a natural part of the aging process.

If you’re 65 years old or older, sharing your symptoms can be a crucial first step in getting an accurate diagnosis and a treatment plan that works best for you and any other conditions you may have.

How common is it? 

Depression is one of the most common mental health conditions. The National Institutes of Mental Health (NIMH)Trusted Source estimates that 21 million (8.4%) adults in the United States will have at least one major depressive episode.

It’s estimated that less than 1% to 5% of older adults live with major depression, according to the Centers for Disease Control and Prevention (CDC)Trusted Source. This number can increase to about 11.5% for hospitalized patients and about 13.5% for those who require home health assistance.

Symptoms of depression

If you or an older adult you know live with depression, they may experience symptoms such as:

  • loss of pleasure

  • changes in eating habits

  • changes in sleeping habits

  • not feeling “up” to seeing people

  • feelings of worthlessness

  • extreme fatigue

  • poor concentration

  • forgetfulness

  • suicidal thoughts

These symptoms can range in intensity, from mild to severe, and last 2 weeks or longer.

Does it look different in older adults?

While the symptoms of depression primarily look the same regardless of age, there are some differences.

According to the National Institute on Aging (NIA)Trusted Source, sadness may not be the primary symptom in older adults.

An older adult may say they “feel numb” or show a lack of interest in activities they once enjoyed. Some may not show symptoms at all.

The American Psychological Association (APA) suggests that older adults may experience some symptoms — such as indecisiveness, memory loss, and slowed responses — more intensely than younger people.

Because these symptoms can interfere with daily life skills such as driving, it’s crucial not to ignore them.

Cultural influences

Cultural influences can also affect how depression is expressed in older adults.

  • In some cultures, it’s more acceptable to talk about physical symptoms, such as stomach aches, than to share emotional ones.

  • According to Mental Health America, Black Americans may not report symptoms if they view mental health conditions as “a personal weakness.”

Depression vs. dementia

Symptoms of depression, particularly memory loss and lethargy, are also symptoms of dementia. Depression can also be an early sign of possible dementia.

If you or an older adult is experiencing any of these symptoms, having an evaluation by a healthcare professional is crucial to getting an accurate diagnosis and treatment.

Causes and risk factors

While there’s no exact cause of depression, there are factors that can contribute to the condition:

  • low serotonin and norepinephrine levels

  • traumatic childhood events

  • environmental triggers

  • genetics

  • family history

For folks 65 years old and over, the following factors may also play a role:

  • retirement

  • empty nest

  • isolation

  • decrease in physical strength or ability

  • bereavement or widowhood

  • substance use

  • low household income

Medical risks for seniors

People who also have chronic conditions such as heart disease or stroke have an increased chance of depression.

According to the National Council on Aging, about 80% of older adults have at least one chronic condition. Nearly 70% of those who receive Medicare — a government insurance provider — have two or more.

This makes older adults more likely to have symptoms of depression. Other contributing factors include:

  • decreased folate levels

  • specific heart medications such as beta-blockers and angiotensin converting enzyme (ACE) inhibitors

A 2022 study of people ages 55 to 75 years old found that long-term health conditions had a strong impact on depression in older adults and vice versa.

Researchers also found that a fear of worsening health associated with a long-term health condition decreased independence for some, making their depression symptoms even worse. Many reported withdrawing socially, which prevented them from seeking help and getting treatment.

This study was based on self-reporting so more research is needed.

Diagnosis

You’ll likely see a healthcare professional for an initial diagnosis. They may ask you about your medical history and symptoms and get a list of medications.

They may also do laboratory tests to determine any underlying causes of your symptoms, such as medication or another condition.

You may then be referred to a mental health professional for a psychological evaluation.

If you’ve experienced symptoms of depression every day for over 2 or more weeks, you might meet the criteria for a diagnosis of depression based on guidelines from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Symptoms can look different from person to person. You might not experience the same symptoms, or the same intensity of symptoms, as someone else.

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Treatment

Treatment for depression often involves a combination of medication and therapy.

  • Medications, such as antidepressants, may be recommended to help regulate mood. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for older adults. Research from 2019Trusted Source supports SSRIs for Alzheimer’s disease and depression if you have both conditions. A healthcare or mental health professional will work with you to monitor any side effects or possible interactions if you’re taking other medications.

  • Psychotherapy, or talk therapy, provides a safe space for you to talk through factors related to depression, including how you relate to others, how to manage negative thoughts, and ways to release your emotions safely. A 2017 reviewTrusted Source suggests that talk therapy can be adapted to meet the particular needs of older adults. Virtual therapies can be effective for older adults who find it difficult to leave home.

How to help an older adult with depression

As a caregiver or friend of an older adult with depression, you can be supportive by helping to facilitate a healthy lifestyle. You might try offering to:

  • take them to visit a healthcare professional

  • check out community centers for exercise programs geared toward older adults

  • keep track of medicines and medical appointments

  • ask them to go on a walk or a bike ride

  • facilitate virtual appointments and social gatherings

  • help with healthy meal prep

  • research ways to pay for healthcare

You may also find some helpful resources by checking out the following organizations:

You can also check out Psych Central’s hub on depression for more information and resources.

Let’s recap

If you or a senior adult you know is living with depression, you’re not alone. Help is available.

Sometimes, it’s easiest to talk with a trusted friend or caregiver about your symptoms and then seek an evaluation from a healthcare or mental health professional.

Treatment can ease symptoms of depression and improve your quality of life, no matter your age.

Last medically reviewed on April 29, 2022

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Medically reviewed by Danielle Wade, LCSW — By Karen Sosnoski, PhD — Updated on April 29, 2022

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How Loneliness Affects the Elderly

Most people know what it’s like to be lonely. Many of us have encountered life experiences that have left us yearning for more human interaction. Whether it’s the death of a loved one, moving to a new city, or simply spending a weekend indoors, the truth is that loneliness feels terrible. After all, it makes sense that the human brain has evolvedto become dependent on social interactions. Humans have an inherent desire to be with other people and feelings of loneliness or isolation has several detrimental effects on a person’s well-being.

Loneliness is a surprising epidemic that affects millions of people. Studies have shown that about one-fifth of Americans report feelings of loneliness. It’s something that affects people of every race, age, and gender, though senior citizens seem to have it the worst.

The loneliness epidemic is much worse than one might initially think. It might be tempting to say that loneliness is nothing more than a feeling, but researchers have found that it can be deadlier than obesity. (To be specific, lonely people have a 50% greater mortality rate than non-lonely people whereas obese people have an 18% greater mortality rate than non-obese people.)

One studyTrusted Source from Jama International Medicine observed the lifestyles and habits of about 45,000 people over a four year period. All participants either had heart disease or were at risk for it. During the follow up period, researchers recorded 4338 deaths and 2612 cardiovascular deaths. In both cases, lonely people were slightly more likely to die than non-lonely people.

In a follow-up studyTrusted Source, researchers looked at how loneliness affects people age 60 and up over a six year period. They found that loneliness has several adverse effects on the elderly population. First of all, seniors who reported loneliness also reported high levels of functional decline. Functional decline was measured using four different factors: ability to perform daily activities such as dressing and bathing, ability to perform upper extremity tasks, ability to walk, and ability to climb stairs. Lonely seniors reported increased difficulty in all four of these areas.

A comparative analysis of lonely and non-lonely seniors found that the lonely seniors also suffered from various medical conditions at a higher rate such as hypertension (3.1% difference), diabetes (2.4% difference), and heart conditions (5.3% difference). Not surprisingly, isolated seniors were also 27.6% more likely to suffer from depression and 8.6% more likely to die during the study period.

A study from the University of Chicago also found that loneliness can significantly affect someone’s blood pressure, particularly when they are older. Blood pressure differences between lonely and non-lonely people are less significant among people in their fifties, but the gap grows with age. In fact, loneliness can increase someone’s blood pressure by up to 30 points. Researcher Louise Hawkley noted that exercise and weight loss help reduce blood pressure by the same amount that loneliness increases it. In other words, a lonely person who exercises and diets is likely to have to same blood pressure as a non-lonely person who does neither of those things.

Another major reason loneliness can be deadly is the way that it affects your immune system. A study from psychologist Steve Cole and professionals from UCLA School of Medicine, University of California at Davis, and University of Chicago found something rather alarming. Loneliness causes abnormalities in the body’s monocytes, a white blood cell that helps defend the body against infection. Social isolation causes the monocytes to stay immature. Rather than helping the body fight infection, immature monocytes instead decrease immunization.

John Cacioppo, a professor of psychology at the University of Chicago, has been studying this subject in-depth for years. He says that part of the reason loneliness can be so deadly is because it creates a feedback loop that reinforces negative thoughts and feelings. Cacioppo recommends that elderly people can get out of this vicious cycle by staying in touch with friends and family and by attending family gatherings.

Senior man photo available from Shutterstock

Last medically reviewed on March 6, 2016

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Medically reviewed by Scientific Advisory Board — By Patrick W. Dunne on March 6, 2016

After Hip Fracture, Suicide Risk for Elderly Nearly Triples

A new South Korean study identifies that in the first six months following hip fracture elderly patients have a significant risk for suicide. The finding highlights the importance of addressing emotional and mental stress in addition to orthopedic care and musculoskeletal rehabilitation.

Researchers discovered the risk of suicide was nearly three times greater among patients who had sustained a hip fracture compared with a matched cohort of those who had not. The increased risk continued for up to a year.

The South Korean nationwide study was led by Yong-Han Cha, M.D., of Eulji University Hospital, Daejeon, and colleagues. Although subjects were Korean, researchers believe the need for improved mental health surveillance and care after hip fracture among the elderly should be applied universally.

The study appears in The Journal of Bone & Joint Surgery.

Said Cha, “So far, we have focused on the treatment of comorbidity and hip fracture itself in the management of elderly patients with hip fracture, but evaluation and management of their mental stress and emotional status are also important.”

With use of a national health-insurance database, the researchers identified 11,477 patients who underwent surgical repair of a hip fracture. Each patient was matched with two controls with similar demographic and health characteristics but without hip fracture.

The average age was 75 years, and nearly three-fourths of patients were women.

The researchers compared the suicide rates of the injured and uninjured cohorts over an average follow-up of about 4.5 years (total 158,139 person-years), identifying a total of 170 patients who died by suicide.

Through the first six months, there were 14 suicides among nearly 11,500 patients with a hip fracture compared with 10 suicides among nearly 23,000 matched controls. The cumulative rate of suicide was 0.13 percent among those with a hip fracture (incidence rate: 266.1 per 100,000 person-years) and 0.04 percent among the matched controls (incidence rate: 89.2 per 100,000 person-years).

Thus, older adults with hip fracture were about three times more likely to die by suicide within the first six months following surgical treatment.

The difference in suicide rates persisted through the first year but was not significant at longer follow-up intervals.

This may reflect the high risk of death and poor health among patients with a hip fracture, the researchers speculate: patients who survive beyond the first year may represent a cohort with higher levels of health and functioning.

The suicide rate during the first six months following surgical treatment was “remarkably high,” Cha and coauthors write, even compared with studies of older adults with cancer and other serious diseases. The findings are also consistent with data showing the “steadily increasing number of elderly suicides in South Korea.”

Hip fracture is a common and often catastrophic event in older adults, with a major impact on physical and mental health and functioning.

The authors note some limitations of their study, including a lack of data on fracture severity and on the causative factors leading to suicide. However, because it was based on a large national database, the findings “could be generalized to other populations.”

Meanwhile, the high suicide rate underscores the need to target mental health issues in older adults after surgical repair of a hip fracture.

Said Cha and colleagues, “These results imply the need for a new approach to psychiatric evaluation and management among elderly patients with hip fracture.”

Source: Wolters Kluwer Health/EurekAlert

Last medically reviewed on June 27, 2020

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Medically reviewed by Scientific Advisory Board — By Rick Nauert, PhD on June 27, 2020

Treating Depression: What Are My Options?

Therapy, medications, brain stimulation, and self-help strategies are just some of the many approaches to depression treatment.

There’s a wide variety of treatment options available for depression, but it can take some trial and error to find one — or a combo — that works for you.

While the cause of depression isn’t entirely known, it’s believed to be a blend of biological, social, and psychological factors. Treatment that focuses on only one of these factors may not be as helpful as an approach that addresses multiple aspects.

In fact, a combo of therapy and medication may lead to some of the best results.

Finding the right treatments can be tricky, though. Just because something works for some people, doesn’t mean it’ll work for you.

As you or a loved one seeks depression treatment, keep in mind that the first treatment isn’t always the right one. It’s normal for it to take some time to find the best treatment options.

Depression treatment is often a journey rather than a sprint. With patience and self-compassion, you can find methods that help you keep depression symptoms at bay.

Psychotherapy for depression

Many types of therapy can help you manage depression and its symptoms.

While some types have undergone more rigorous research than others, approaches that help you identify thoughts, behaviors, and beliefs that add to depression are often considered the most effective.

Some helpful forms of therapy for depression include:

Check out some more details on these therapy types below:

Cognitive behavioral therapy (CBT)

CBT is one of the most popular and commonly used therapies for depression. Hundreds of studies have verified its safety and effectiveness.

In CBT, the focus is on changing thoughts and behaviors that can worsen or encourage depression. These thoughts often contribute to:

  • feelings of worthlessness

  • frustration with yourself

  • hopelessness

  • feelings of being “stuck” or “in a rut”

A therapist will usually work with you one-on-one to help you learn to replace these thoughts with more realistic thoughts that support your well-being and goals.

You don’t usually focus on your past in CBT. Instead, you’ll focus on changing your thoughts, feelings, and behaviors right now.

Interpersonal therapy (IPT)

In IPT, you address your social relationships and how to improve them.

Stable social support is often considered key to overall well-being. When relationships falter, it can negatively impact the people in them.

The aim of IPT is to improve a person’s relationship skills, such as:

  • communicating effectively

  • expressing emotions clearly

  • being assertive in personal and professional situations

Like CBT, IPT usually takes place with a therapist one-on-one but also can be done in a group setting.

Behavioral activation therapy (BA)

BA therapy can help people change behaviors, which in turn may help change their moods.

Research has found BA to be just as effective as cognitive therapy in managing depression.

In BA, you might learn:

  • to identify when you start to feel depressed

  • how to engage in activities that line up with your beliefs and values

  • replace behaviors that contribute to depression with ones that don’t

A BA therapist can help you identify your goals and achieve them. Recent researchTrusted Source also suggests that BA for depression may be effective in a group setting.

Acceptance and commitment therapy (ACT)

In ACT, acceptance and mindfulness are key. One of the main goals of ACT is to help people live according to their values while coping with uncomfortable thoughts and feelings.

If you live with depression, ACT may help you:

  • focus on the present

  • observe and accept uncomfortable thoughts and feelings

  • identify what’s most meaningful and important to you

  • act on your values

One study found that ACT’s emphasis on value-based action helped people reduce symptoms of depression.

Problem-solving therapy (PST)

In some cases, depression can cause people to view problems as threats or believe they’re incapable of solving the problem.

In PST, your therapist may help you:

  • define the problem

  • brainstorm alternative realistic solutions

  • select a helpful solution

  • put that solution in place and evaluate it

ResearchTrusted Source suggests PST can help people with depression learn to cope with stressful problems in their daily lives.

Short-term psychodynamic psychotherapy (STPP)

STPP focuses on interpersonal relationships and unconscious thoughts and feelings.

The primary goal of STPP is to reduce your depression symptoms. The secondary goal is to decrease your vulnerability to depression and increase your resilience.

ResearchTrusted Source is currently underway to see how STPP could help people with different types of depression.

Family or couples therapy

Family or couples therapy can help if depression is impacting your family dynamic or the health of your relationships.

These therapies tend to focus on:

  • interpersonal relationships of family members

  • clear and straightforward communication

  • the roles of family members in managing your depression

  • education about depression and mental health

Therapy is an active collaboration between you and your therapist (and sometimes loved ones).

Whatever therapy you choose, taking a proactive approach can help. This means keeping up with assignments between sessions and letting your therapist know if you have any concerns.

Medications for depression

Antidepressants are the most commonly prescribed medications for depression.

Most antidepressants prescribed today are both safe and effective when taken according to your healthcare professional’s directions.

In the United States, antidepressants are often prescribed by family doctors or general practitioners. But many people find it most helpful to work with a psychiatrist or other mental health professional, as they may have extensive knowledge of medication types and side effects.

Your doctor will recommend a medication based on factors such as:

  • your past experiences with meds

  • side effects you experienced with any other medications

  • co-occurring medical or mental health conditions

  • any other meds you’re taking

  • your personal preference

  • the medication’s short and long-term side effects

  • the toxicity of overdose

  • any history your relatives have had with the medication

  • financial constraints

It can take up to 6 to 8 weeks to start getting results with most antidepressants, so you may need to give it some time. If you experience side effects, many will go away before this point.

Keep in mind that you might not feel better with the first medication you try — sometimes you might need to try a few different types before finding the meds that work for you.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are some of the most prescribed antidepressants for depression.

SSRIs increase the amount of serotonin in the brain. Researchers aren’t exactly sure why an increase in serotonin helps relieve depression, but decades’ worth of studiesTrusted Source suggest these medications help improve mood.

Some of the most common SSRIs are:

While SSRIs are usually well-tolerated, most people experience some side effects while taking them. These might include:

  • nausea

  • diarrhea

  • agitation

  • insomnia

  • headache

  • lowered sex drive

  • weight gain

For most people, these initial side effects dissipate within 3 to 4 weeks. Some side effects, such as tremors cause by serotonin syndrome or weight gain, are long-term side effects of taking SSRIs.

Serotonin syndrome

Serotonin syndrome occurs when you have too much serotonin in your body. This can cause mild to severe side effects and can be fatal if you don’t receive quick treatment.

If you take an antidepressant and notice symptoms like tremors, rapid heartbeat, or hallucinations, it’s important to let your doctor know right away.

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Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs work by boosting the levels of two neurotransmitters — serotonin and norepinephrine — in your brain. These chemicals play an essential role in your mood.

Some commonly prescribed SNRIs include:

SNRIs can cause many of the same side effects as SSRIs.

They can also cause:

  • anxiety

  • constipation

  • lack of energy

If an SSRI isn’t working for you, your doctor might prescribe an SNRI. If you also have anxiety, an SNRI may be a better option since some are used to treat anxiety disorders.

Tricyclic antidepressants (TCAs)

TCAs are older antidepressants, and while they’re not prescribed as often as SSRIs and SNRIs, they still help some people manage depression.

Some common TCAs include:

Some common side effects of TCAs include:

  • drowsiness

  • weight gain

  • constipation

  • dizziness

  • heart problems

  • blurred vision

  • confusion

Since TCAs generally cause more side effects than newer antidepressants, they’re usually considered an option only if newer antidepressants don’t work for you.

Monoamine oxidase inhibitors (MAOIs)

MAOIs aren’t prescribed as frequently as other types of antidepressants anymore. This is because they’ve been known to cause severe side effects and have unwanted interactions with many foods and other drugs.

A few examples of MAOIs include:

  • tranylcypromine (Parnate)

  • phenelzine (Nardil)

  • isocarboxazid (Marplan)

Side effects of MAOIs include:

  • dry mouth

  • nausea

  • diarrhea

  • constipation

  • insomnia

  • drowsiness

  • dizziness

MAOIs can interact with other drugs and antidepressants, some supplements and herbs, and certain foods (especially those that contain high levels of tyramine).

Your doctor may only prescribe an MAOI if other types of medications aren’t working for you.

Atypical antidepressants

Atypical antidepressants don’t fall into any of the other antidepressant classes. They’re often prescribed when a person hasn’t improved with a common SSRI.

Examples of atypical antidepressants include:

Sometimes these meds are prescribed when others cause severe side effects, or in combination with other antidepressants.

Mood stabilizers and antipsychotics

Your doctor might also prescribe an atypical antipsychotic to boost the effectiveness of your antidepressant.

The following atypical antipsychotics are sometimes used to add to your treatment:

Lithium, a mood stabilizer commonly used to treat bipolar disorder, is also sometimes used to treat major depressive disorder.

Ketamine

Ketamine is one of the newest treatments for severe forms of depression.

In 2019, the FDA approved a prescription nasal spray called esketamine (Spravato). It’s a fast-acting drug derived from ketamine and can be taken along with an antidepressant to treat severe depression.

Spravato must be taken at a doctor’s office or clinic. Because Spravato can have severe side effects, including sedation and dissociation, people are monitored by their doctor for 2 hours after taking the med.

While apparently effective for many people who try it, the long-term effects of ketamine haven’t been studied yet. Since it’s so new, it may also be harder to obtain and is only recommended for treatment-resistant depression.

Brain stimulation therapy for depression

Brain stimulation therapies help treat depression with electricity acting on the brain.

While therapy and meds are used much more often than brain stimulation therapies, they may be effective for reducing depression in some people.

Electroconvulsive therapy (ECT)

ECT is considered an effective treatment option for severe, chronic, or treatment-resistant depression.

ECT isn’t typically an initial treatment for depression, though. This is because you’re placed under general anesthesia, may need to take time off work or school, and it can come with side effects like memory loss.

Still, current researchTrusted Source supports its effectiveness for treating depression. But questions regarding memory loss and ECT have yet to be fully answered.

Repetitive transcranial magnetic stimulation (rTMS)

rTMS is a newer type of brain stimulation that may be an alternative to and more accessible than ECT.

In rTMS, a technician places an electromagnet on the scalp that generates magnetic field pulses roughly to the strength of an MRI scan. These pulses pass readily through the skull and may stimulate the cerebral cortex.

Potential benefits of rTMS that have been observed include:

  • no systemic side effects such as: weight gain, sexual dysfunction, sedation, nausea, or dry mouth

  • no adverse effects on concentration or memory

  • reduced risk of device-drug interactions

Seizures are also much less likely to occur as a side effect compared to other brain therapies.

The most common adverse event related to treatment was mild to moderate scalp pain or discomfort during treatments, which lessened after the first week of treatment.

Hospitalization for depression

In some cases, hospitalization may be the best way to keep someone safe if their depression is severe. But hospitalization is typically only necessary if someone poses a danger to themselves or others.

Hospitalization for depression requires a lot of care. It’s usually best when someone can check themselves into a hospital. This way, they’re able to give their full consent to treatment.

Involuntary hospitalization to a psychiatric hospital is fairly rare, and there are legal requirements involved. In order for someone to be placed in hospitalization against their will, it typically has to be very clear that it’s the best way to help that person.

Hospitalization is usually relatively short — often until you’re stabilized and have a treatment plan. In some cases, you may only need a partial hospitalization plan.

Are you or a loved one in crisis?

If you believe you or a loved one is in crisis and may need hospitalization, there are many options available for immediate help:

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Self-help strategies

A variety of self-help strategies, including home remedies and lifestyle changes, can empower you with tools to manage your depression.

Home remedies

It’s not uncommon to want to try home remedies — such as supplements and teas — either before starting prescription meds or in combination with your current treatment.

While some of these remedies can be helpful, before you start anything, reach out to a healthcare professional. Some remedies interact with antidepressants or other meds, or may only work for mild symptoms.

Like anything else, home remedies may or may not work for you, but most are generally safe to try.

St. John’s wort

St. John’s wort is a popular herbal remedy for depression — though it does come with its fair share of interactions.

Research suggests that St. John’s wort can help people with mild and moderate depression. A 2017 meta-analysisTrusted Source found it comparable in safety and effectiveness to SSRIs.

However, St. John’s wort interacts (sometimes dangerously) with several medications:

  • antidepressants

  • birth control pills

  • warfarin, a blood thinner

  • other medications for the heart, HIV, or cancer

It may also make you more sensitive to sunlight, and cause interactions with certain foods.

Saffron

Recent research has found some evidence that saffron may be effective in treating mild to moderate depression.

According to this studyTrusted Source, saffron was better than the placebo at reducing the severity of depression symptoms.

Green and black tea

Tea contains compounds — L-theanine and catechins, to name a couple — that may have antidepressant effects.

ResearchTrusted Source suggests that regularly drinking a cup of green or black tea could reduce some depression symptoms.

Omega-3 fatty acids

Omega-3 fatty acids are essential fats found in many fish, nuts, and seeds. ResearchTrusted Source suggests that omega-3s may help reduce symptoms of depression.

To get more omega-3s in your diet, you can add foods rich in them like salmon, mackerel, and chia seeds. You might also take a supplement if you’re not getting enough from diet alone.

Vitamin D

Most people are lacking in vitamin D, and some researchTrusted Source suggests that vitamin D deficiency is connected to depression.

While more research is needed to understand the link between depression and vitamin D, most doctors will support supplementing with vitamin D to help with mood and depression symptoms.

Probiotics

Probiotics often bring to mind gut health — but depression doesn’t just affect your thoughts. Some researchTrusted Source suggests that probiotics could help people reduce depression by improving gut health.

A 2019 reviewTrusted Source also found that while prebiotics didn’t have any noticeable effect on depression, probiotics yielded promising results.

Lifestyle changes

In many cases, making lifestyle changes can help you reduce and manage depression symptoms. ResearchTrusted Source supports the idea that diet and exercise, for example, can impact the severity of your symptoms.

While the ways you might choose to adjust your lifestyle are endless, below are a few tried-and-true strategies that have been used to help with depression.

Support groups

For some people, one of the most effective strategies is to join a depression-focused support group.

You can find a variety of depression support groups online. These groups may give you the opportunity to:

  • socialize

  • develop healthy relationships

  • talk with people who have similar experiences and feelings

Mental Health America has a popular support group for people with depression, and the Depression and Bipolar Support Alliance has an online support group for people with depression and bipolar disorder.

Workbooks

Another excellent strategy is to read self-help books or workbooks on overcoming depression. Some examples include:

Some books emphasize a cognitive behavioral approach, which is similar to those used in many types of therapy. So these books can be helpful whether or not you’re currently working with a therapist (or in between sessions if you can’t access one frequently).

Exercise

Engaging in physical activity and getting outdoors can be incredibly helpful in improving mood. Both sunlight and exercise have been well-established to boost mood and reduce depression symptoms.

If you’re currently not experiencing much sunshine where you live, consider trying a light therapy box. This can especially help if you experience seasonal symptoms of depression, like in seasonal affective disorder.

While saying that exercise can help with depression is one thing, actually doing it is another.

Depression often causes fatigue or lack of motivation — so be gentle with yourself. You don’t need to join a gym or start a daily workout program. Any movement and time spent outdoors can be a step in the right direction.

Diet

One way or the other, food affects mood. ResearchTrusted Source looking into the link between diet quality and depression found that higher quality diets were connected to a lower risk of depression.

In particular, people who ate higher amounts of fish (omega-3s!) and veggies were less likely to have depressive symptoms.

So if you want to give your mood a boost, try adding some more foods that support well-being into your diet.

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Next steps

If there’s one thing you can take away, let it be this: You’ve got endless options when it comes to managing your depression.

While it can feel overwhelming to some people, the more options means better opportunities to find the right treatments that work for you.

Depression treatment is often determined by how severe your symptoms are. One question you might ask yourself is, “How much does depression affect my everyday life?”

If your depression is severe — you find it hard to do much at all — talking with a doctor is a good first step. In many cases, a doctor will refer you to a mental health specialist who can connect you with treatments, like therapy or medication, to manage your symptoms.

If you consider your depression mild, it might help to start by implementing some lifestyle changes or home remedies to see if they work for you. Keep in mind that if you need it, more help is available.

Last medically reviewed on February 23, 2021

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