Depression manifests as persistent low mood or sadness, disruptions in sleep and appetite, a loss of interest in things you once enjoyed, and a pervasive sense of worthlessness or hopelessness. If you’re living with depression, you already know how much it can affect your daily life. The good news is that depression is highly treatable, and most people find genuine relief through a personalized combination of therapy and medication.
If you’ve tried depression treatment before but haven’t found relief, switching to a different therapist or finding a psychiatric provider who’s a better fit could make a big difference. And if medication hasn’t been effective for you, you aren’t out of options. Alternative treatments like TMS and Spravato® offer a way forward when traditional approaches have fallen short.
Therapy for Depression
Therapists are equipped to help people work through depression, untangling the beliefs and behaviors that may be feeding symptoms and replacing them with healthier coping strategies. Simply being met with unconditional positive regard by a therapist can remind someone they’re not alone, and that sense of connection often becomes the foundation for healing.
Our therapists take a flexible, integrative approach, pulling techniques from multiple therapeutic modalities to fit each person’s specific needs. Depression treatment tends to work best as a genuine collaboration. You and your therapist will set shared goals, and your therapist will adjust their approach to best suit what you need in any given session to help you reach those goals.
Common therapy approaches for depression include:
- Cognitive behavioral therapy (CBT): CBT helps people recognize how their thoughts, feelings, and behaviors are connected, then use that awareness to shift patterns and improve mood. CBT techniques are often at the core of therapy for depression, whether or not these are integrated into a more eclectic approach.
- Interpersonal therapy (IPT): Depression frequently brings isolation and a sense of being misunderstood. IPT examines someone’s relationships and builds new communication skills, which can shift mood over time as someone starts to feel more supported.
- Dialectical behavioral therapy (DBT): A structured, skills-focused approach, DBT helps people distinguish between what they can change in their life (learning specific ways to do so) and what they need to accept as-is.
- Acceptance and commitment therapy (ACT): Involves learning to accept negative emotions and situations, then living into values to make desired changes.
- Mindfulness-based cognitive therapy (MBCT): Combining mindfulness with other coping tools helps people stay grounded in the present rather than getting caught in rumination about the past or anxiety about the future.
- Supportive therapy: Sometimes what someone needs most is simply to feel seen and heard. Supportive therapy is the heart of nearly every therapy approach, offering a nonjudgmental ear and reaffirming your core worth and value.
How Will I Know Therapy Is Working?
Progress in therapy tends to unfold gradually rather than all at once, with depression symptoms slowly shifting and lessening over time. Outside of sessions, you might notice yourself pushing back on negative thought patterns more naturally, feeling a bit more energy, or slowly returning to hobbies that depression caused you to push aside. You may also find it easier to identify and process your emotions as they come up with the tools you’ve learned in therapy.
Keeping an open conversation going with your therapist about your goals, what progress actually looks like, and what’s working (or not) is an important part of the process. If things feel stuck, you should say so. Your therapist may adjust their approach or refer you to someone else if that seems like the better path forward.
Medication for Depression
Antidepressant medications work by increasing the availability of key mood-related neurotransmitters, often serotonin, norepinephrine, or dopamine. A psychiatric provider can help determine whether medication makes sense for you, and which option fits best based on your symptoms, other medications, and potential side effects.
Common medications for depression include:¹ ² ³
- Selective serotonin reuptake inhibitors (SSRIs): SSRIs are generally well-tolerated with manageable side effects, making them the most frequently prescribed. They work by blocking serotonin reabsorption, leaving more of this neurotransmitter available for the brain to utilize.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs act on both serotonin and norepinephrine. While serotonin is tied directly to mood, norepinephrine influences focus and energy.
- Tricyclic antidepressants (TCAs): TCAs boost both serotonin and norepinephrine by working across multiple neurotransmitter receptors. Once a standard treatment, they’ve largely been replaced by SSRIs and SNRIs due to a higher risk of side effects, and are now typically reserved for cases where other medications haven’t worked.
- Monoamine oxidase inhibitors (MAOIs): MAOIs block the enzyme responsible for breaking down serotonin, norepinephrine, and dopamine, increasing their overall availability. Like TCAs, they carry more significant side effects and are generally used only after first-line treatments have failed.
- Other options: Providers may also consider medications like Wellbutrin (bupropion), Auvelity (dextromethorphan-bupropion), trazodone, or mirtazapine, depending on individual symptoms and reactions to other medications.
Finding the Right Depression Medication
Before prescribing any medication, your psychiatric provider will ask about your symptoms, whether family members have responded well to certain antidepressants, and which potential side effects you would prefer to avoid. They’ll also factor in other medications you’re taking, existing health conditions, and whether you’re pregnant, trying to conceive, or breastfeeding.
Most people start noticing effects within four to six weeks of consistent use.¹ Pay attention to any side effects you experience and share these with your prescriber so you can work together to find the right fit.
If a side effect becomes intolerable, contact your prescriber right away, but avoid stopping the medication on your own. Your provider will typically help you transition to something else or adjust your dosage until you land on the right solution.
Alternative Treatments for Depression
Most people start to feel better after a couple of months with therapy and medication.³ However, some people don’t see relief even after trying several medications. We refer to this as difficult-to-treat depression. Even then, you’re not out of options.
Many of our clinics offer both TMS and Spravato®, which are FDA-approved for depression that hasn’t responded to standard treatment:
- Transcranial magnetic stimulation (TMS): TMS is a noninvasive, low-risk procedure that uses magnetic pulses to stimulate underactive areas of the brain linked to depression. It’s a strong option for people who haven’t responded well to medication and generally comes with very few side effects.
- Spravato® treatment: Spravato® is the first FDA-approved esketamine nasal spray for difficult-to-treat depression. It works by increasing glutamate levels in the brain, boosting communication between nerve cells to improve overall function.
Other Ways to Cope with Depression
If you or someone you love is dealing with depression, professional support is the right first step. A therapist can help you process what you’re feeling and come up with strategies for moving forward, while a psychiatric provider can assess whether medication would help alleviate unwanted symptoms. Alongside professional care, changes to sleep, movement, and social connection can also support your recovery.
Here are a few coping strategies worth building into a broader depression treatment plan:
- Move your body: Physical activity releases endorphins, which naturally boost mood. Aim for around 150 minutes of moderate activity weekly, though even a 10-15 minute daily walk can make a difference.⁴
- Limit substance use: It might feel like alcohol or other substances bring relief in the moment, but they tend to impair brain function and slow down long-term healing.⁵
- Prioritize quality sleep: Improve your sleep quality by keeping a consistent bedtime routine, lowering your screen time before bed, and limiting caffeine and alcohol in the evening.⁶
- Practice mindfulness: Mindfulness helps redirect rumination and anxious thoughts back to the present, while also strengthening emotional regulation skills.⁷
- Stay connected: Depression can tend to isolate people, which makes it even more important to reach out to loved ones, even when you don’t feel like it. Let someone you trust know how you’ve been feeling so they can check in and consider scheduling a couple of weekly activities that get you out of the house.
- Eat well: Depression can sap appetite and motivation to eat nourishing foods, but getting enough nutrition (especially fruits and vegetables) supports both brain and body function.
- Consider light therapy: For seasonal affective disorder in particular, increasing sunlight exposure, whether outdoors or through a light therapy box, can boost mood and support healthy vitamin D levels.
How New Directions Mental Health Can Help with Depression
New Directions Mental Health is committed to providing compassionate, accessible mental health care for our neighbors in Pittsburgh and across southwest Pennsylvania in-clinic and over telehealth. Every clinic offers both therapy and psychiatric services, with care teams collaborating closely to build a treatment plan tailored to each person’s unique needs and goals. Several of our locations also offer alternative depression treatments, including TMS and Spravato®.
Ready to take the first step? Call 724.374.7414 or fill out a brief form to schedule your first appointment.
Sources:
- Antidepressants. (2025). Medline Plus. https://medlineplus.gov/antidepressants.html
- Commonly prescribed antidepressants and how they work. (2023). Medline Plus Magazine. https://magazine.medlineplus.gov/article/commonly-prescribed-antidepressants-and-how-they-work
- Antidepressants: Selecting one that’s right for you. (2022). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
- Depression and anxiety: Exercise eases symptoms. (2023). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495
- Finding Help for Co-Occurring Substance Use and Mental Disorders. (2025). National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
- Tompa, Rachel. (2025). How sleep affects mental health (and vice versa): What the science says. Stanford Medicine. https://med.stanford.edu/news/insights/2025/08/sleep-mental-health-connection-what-science-says.html
- Parmentier, F. B. R., García-Toro, M., García-Campayo, J., Yañez, A. M., Andrés, P., & Gili, M. (2019). Mindfulness and Symptoms of Depression and Anxiety in the General Population: The Mediating Roles of Worry, Rumination, Reappraisal and Suppression. Frontiers in psychology, 10, 506. https://doi.org/10.3389/fpsyg.2019.00506
