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    Depression treatments guide: therapy, antidepressants, esketamine, TMS

    Most depression is treated with talking therapy, medication or both; WHO puts psychological treatment first and adds antidepressants for moderate and severe depression.[1][2] For depression that has not responded to two antidepressants, options include esketamine nasal spray and brain stimulation such as ECT and rTMS, and zuranolone is approved specifically for postpartum depression.[3][4][5][6]

    Editor reviewedStrict sourcingUpdated ExplainerMental health, Health and medicine

    If you are struggling or thinking about suicide, help is available now. In the US, call or text 988 or chat at 988lifeline.org.[7] In the UK and Ireland, call Samaritans free on 116 123.[8] Elsewhere, find a local helpline at findahelpline.com.[9]

    This guide summarises the main evidence-based treatments for depression as described by WHO, NIMH and FDA labels, as of October 2026.[2][1] It is not medical advice and gives no dosing instructions. Treatment choices depend on a person’s needs, preferences and medical situation, and should be made with a doctor or other qualified clinician. NIMH notes that finding the right treatment can take trial and error.[1]

    Talking therapies

    Talking therapy, also called psychotherapy or counselling, helps people learn new ways of thinking, coping and relating to others. WHO lists four approaches that work for depression: behavioural activation, cognitive behavioural therapy (CBT), interpersonal therapy and problem-solving therapy.[10] Therapy can work in person or by video.[11] WHO says it is the first treatment to try, and the only one needed for mild depression.[2]

    WHO recommends psychological treatment as first line and says antidepressants are not needed for mild depression.[2] NIMH names CBT and interpersonal therapy (IPT) as the evidence-based psychotherapies and says telehealth delivery can be effective.[11] WHO adds behavioural activation and problem-solving therapy, delivered by professionals or supervised lay therapists, online or through guided self-help.[10] In practice access is a constraint: CDC data show that among people with depression in 2021–2023, 43.0% of females and 33.2% of males had received counselling in the past year.[12]

    Antidepressant medicines

    Antidepressants are common medicines for moderate and severe depression, often alongside therapy.[13] They usually take 4 to 8 weeks to work.[14] Some children, teenagers and young adults under 25 may have more suicidal thoughts in the first weeks, so the FDA advises close monitoring.[15] Never start or stop one without your clinician.[16]

    WHO says antidepressants such as SSRIs can be combined with psychological treatment in moderate and severe depression, and should not be used to treat depression in children; in adolescents they are not first line and need extra caution.[2][17] NIMH says onset typically takes 4 to 8 weeks.[14] FDA guidance summarised by NIMH flags a risk of increased suicidal thoughts or behaviour in people under 25, especially early in treatment or after dose changes, and advises monitoring patients of all ages.[15] About one in six US adults reported taking an antidepressant in a 2026 study.[18] In 2026, HHS launched an initiative to promote tapering when clinically appropriate; psychiatrists’ groups disputed its framing (see the new treatments analysis).[19][20]

    Treatment-resistant depression and esketamine

    NIMH defines treatment-resistant depression as no improvement after trying at least two antidepressants; one option is adding another type of medicine, such as an antipsychotic or anticonvulsant.[3] Another is esketamine, given as a nasal spray in a doctor’s office or clinic, which NIMH says typically acts within a couple of hours.[21]

    The Spravato (esketamine) label indicates it for treatment-resistant depression in adults, either alone or with an oral antidepressant; monotherapy was approved in January 2025.[4][22] Because of risks of sedation, dissociation, respiratory depression, abuse and misuse, it is available only through a restricted program and is given in certified settings.[23] It carries a boxed warning that also covers suicidal thoughts and behaviours.[24]

    Postpartum depression and zuranolone

    The FDA describes postpartum depression (PPD) as a major depressive episode that usually begins after childbirth but can start late in pregnancy.[25] In August 2023 the FDA approved Zurzuvae (zuranolone), the first oral medicine for PPD in adults; before that, PPD-specific drug treatment required an IV infusion in a health facility.[6] Approval rested on two randomised, placebo-controlled trials in women with PPD, which showed greater improvement than placebo at day 15, maintained at day 42.[26] The label has a boxed warning about impaired driving, and the FDA noted risks of suicidal thoughts and fetal harm.[27]

    Brain stimulation: ECT and TMS

    NIMH says brain stimulation is generally used after psychotherapy and medication have been tried, and the most used FDA-approved forms are electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).[5] ECT remains the “gold standard” for treatment-resistant depression, while strong clinical evidence supports rTMS.[28] The FDA cleared the first rTMS device for depression in 2008; unlike ECT, it does not need anesthesia.[29] For research on light-based brain tools, see optogenetics.

    What does not have FDA approval

    NIMH says the FDA has not approved any natural product, such as St. John’s wort or vitamin D, for depression, and some can interact with prescription medicines.[30] As of October 2026 no psilocybin treatment had FDA approval, although one candidate was under rolling review.[31][32] Read Depression explained for background, or the analysis of new treatments for the evidence on psychedelics.

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    Questions readers ask

    Is therapy or medication better for depression?

    WHO says psychological treatments are the first treatments for depression and that antidepressants are not needed for mild depression; they can be combined with therapy in moderate and severe depression. The right plan depends on the person and should be decided with a clinician.[2][13]

    How long do antidepressants take to work?

    NIMH says usually 4 to 8 weeks, and sleep, appetite and concentration often improve before mood does.[14]

    What is Spravato?

    Spravato is a nasal spray form of esketamine approved for treatment-resistant depression in adults, alone or with an oral antidepressant. It is available only through a restricted program and is given in certified healthcare settings.[4][23]

    Is there a pill for postpartum depression?

    Yes. In August 2023 the FDA approved Zurzuvae (zuranolone), the first oral medicine for postpartum depression in adults. Its label carries a boxed warning about impaired driving.[6][27]

    Can I stop my antidepressant on my own?

    NIMH advises talking to a health care provider before starting or stopping any medication.[16]

    Do supplements like St. John's wort treat depression?

    NIMH says the FDA has not approved any natural product for depression, and some, such as St. John's wort, can interact with prescription medicines.[30]

    Sources

    · 32 claims from 14 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      NIMH says depression treatment typically involves psychotherapy, medication or both, with brain stimulation therapy an option if these do not reduce symptoms enough; finding the best treatment may take trial and error. confirmedas of 2026-10-11

    2. [2]

      WHO says psychological treatments are the first treatments for depression and can be combined with antidepressants in moderate and severe depression, and that antidepressants are not needed for mild depression. confirmedas of 2026-09-11

    3. [3]

      NIMH defines treatment-resistant depression as not getting better after trying at least two antidepressants; one option is adding a different type of medication, such as an antipsychotic or anticonvulsant. confirmedas of 2026-10-11

    4. [4]

      The current Spravato (esketamine) label indicates it for treatment-resistant depression in adults, as monotherapy or with an oral antidepressant. confirmedas of 2026-10-11

    5. [5]

      NIMH says the most used FDA-approved brain stimulation therapies for depression are electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), generally used after psychotherapy and medication have been tried. confirmedas of 2026-10-11

    6. [6]

      On 4 August 2023 the FDA approved Zurzuvae (zuranolone), the first oral medication for postpartum depression in adults; before that, PPD-specific treatment was available only as an IV injection in certain health care facilities. confirmedas of 2023-08-04

    7. [7]

      The 988 Suicide & Crisis Lifeline provides free, confidential emotional support by call, text or chat to people in suicidal crisis or emotional distress 24 hours a day across the US and its territories, through a network of over 200 local crisis centers. confirmedas of 2026-10-11

    8. [8]

      In the UK and Ireland, Samaritans can be called free on 116 123, day or night. confirmedas of 2026-10-11

    9. [9]

      Find A Helpline lists free, confidential helplines verified with crisis centers in more than 175 countries. confirmedas of 2026-10-11

    10. [10]

      WHO lists behavioural activation, cognitive behavioural therapy, interpersonal psychotherapy and problem-solving therapy as effective psychological treatments for depression, which can be delivered in person, online, or through self-help manuals and apps. confirmedas of 2026-09-11

    11. [11]

      NIMH names cognitive behavioral therapy and interpersonal therapy as evidence-based psychotherapies for depression and says psychotherapy can be effective in person or via telehealth. confirmedas of 2026-10-11

    12. [12]

      Among people with depression in the NHANES data, 43.0% of females and 33.2% of males reported receiving counseling or therapy from a mental health professional in the past 12 months. confirmedas of 2025-04-30

    13. [13]

      According to NIMH, psychotherapy is often tried first for milder depression, while people with moderate or severe depression are usually prescribed medication as part of the initial treatment plan. confirmedas of 2026-10-11

    14. [14]

      NIMH says antidepressants usually take 4 to 8 weeks to work, and problems with sleep, appetite and concentration often improve before mood lifts. confirmedas of 2026-10-11

    15. [15]

      NIMH notes that some children, teenagers and young adults under 25 may have increased suicidal thoughts or behavior when taking antidepressants, especially in the first weeks or after a dose change, and that the FDA advises close monitoring of patients of all ages early in treatment. confirmedas of 2026-10-11

    16. [16]

      NIMH advises talking to a health care provider before starting or stopping any medication. confirmedas of 2026-10-11

    17. [17]

      WHO says antidepressants should not be used to treat depression in children and are not the first line of treatment in adolescents, in whom they should be used with extra caution. confirmedas of 2026-09-11

    18. [18]

      About one in six US adults (16.6%, per a 2026 study cited by the New York Times) report currently taking an antidepressant. confirmedas of 2026-07-02

    19. [19]

      In early May 2026 HHS Secretary Robert F. Kennedy Jr. announced policies to encourage clinicians to help patients taper off antidepressants such as SSRIs when appropriate, including new training, clinical guidance and changes to insurance billing. confirmedas of 2026-05-25

    20. [20]

      American Psychiatric Association leaders called the overprescribing framing an oversimplification and said the main problem is that many people cannot access timely mental health care. confirmedas of 2026-07-02

    21. [21]

      NIMH describes esketamine as an FDA-approved nasal spray for treatment-resistant depression, given in a doctor's office, clinic or hospital, that typically acts within a couple of hours. confirmedas of 2026-10-11

    22. [22]

      On 21 January 2025 Johnson & Johnson announced US approval of Spravato as a monotherapy for adults with treatment-resistant depression; it was previously approved for use alongside an oral antidepressant. confirmedas of 2025-01-21

    23. [23]

      Because of risks of sedation, dissociation, respiratory depression, abuse and misuse, Spravato is available only through a restricted program (the Spravato REMS) and can be administered only in certified healthcare settings. confirmedas of 2026-10-11

    24. [24]

      Spravato carries a boxed warning covering sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. confirmedas of 2026-10-11

    25. [25]

      The FDA describes postpartum depression as a major depressive episode that typically occurs after childbirth but can begin in late pregnancy. confirmedas of 2023-08-04

    26. [26]

      The FDA based the approval on two randomized, double-blind, placebo-controlled trials in women with PPD, in which zuranolone groups improved significantly more than placebo on the HAMD-17 scale at day 15, with the effect maintained at day 42. confirmedas of 2023-08-04

    27. [27]

      Zurzuvae's label has a boxed warning that it can impair the ability to drive or do other hazardous activities; the FDA also noted it may cause suicidal thoughts and behavior and fetal harm. confirmedas of 2023-08-04

    28. [28]

      NIMH says ECT is still considered the "gold standard" for treatment-resistant depression, while strong clinical evidence supports rTMS in reducing depressive symptoms. confirmedas of 2026-10-11

    29. [29]

      The FDA cleared the first rTMS device for depression in 2008, for people who had not responded to at least one antidepressant in the current episode; unlike ECT, rTMS does not require anesthesia. confirmedas of 2026-10-11

    30. [30]

      NIMH says the FDA has not approved any natural products for depression; products such as St. John's wort can interact with prescription medicines and should not be used without talking to a provider. confirmedas of 2026-10-11

    31. [31]

      As of October 2026 no psilocybin product had been approved by the FDA for depression; Compass described COMP360 as investigational and its approval as pending a completed NDA. confirmedas of 2026-10-11

    32. [32]

      In April 2026 the FDA granted Compass a rolling New Drug Application submission and review for COMP360; the company said some modules were submitted and it expected to complete all modules in the fourth quarter of 2026. confirmedas of 2026-08-05

    Revision history (1)
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    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Depression treatments guide: therapy, antidepressants, esketamine, TMS." ContentLora, updated Oct 11, 2026. https://contentlora.com/explain/depression-treatments-guide

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