Depression Treatments for Adults

Introduction to behavioral therapy

Behavioral therapy focuses on having the person re-engage more frequently in activities they once found pleasurable. The person and therapist work together to identify short-term and long-term goals specific to the individual. During the course of behavioral therapy, the person identifies their behaviors and reactions to difficult situations that might be unhelpful in moving forward in life. Instead, the person learns to engage in behaviors that are more likely to reverse the negative patterns. As the individual increases participation in pleasurable activities and changes those behavioral patterns, their mood is expected to improve. On average, adults receive 20-24 weekly sessions of behavioral therapy.

Behavioral therapy is recommended for the treatment of depression in adults.

How behavioral therapy can help treat depression in adults

Individuals with depression often disengage from their relationships and usual activities, perhaps because they perceive themselves as incompetent or as a burden to others. This self-perception and subsequent behavioral withdrawal can negatively influence their mood and lead to a confirmation bias (e.g., an individual feels incompetent and withdraws from task, and by not completing or fully engaging in the task, confirms their prior feeling of incompetence). Behavioral therapy can help address the negative perception of one’s ability to engage in activities of daily living by having the person reverse current patterns and actively participate in pleasurable activities, despite their current depressed mood. The active participation is presumed to increase their mood over time and improve functioning.

Using behavioral therapy to treat depression in adults

Treatment usually begins with the therapist providing an overview of the behavioral theory of depression and explaining how actively engaging in pleasant activities and reducing avoidance/withdrawal in difficult situations can improve one’s mood over time. The therapist and patient work collaboratively to define treatment success and goals. They identify problematic behaviors that impede the patient from experiencing the quality of life they desire (e.g., patient avoids going to work due to feeling guilty or ashamed after receiving a critique of a work assignment) and develop alternatives for coping with such situations.

The patient completes behavior monitoring logs outside of session, where the patient identifies their reaction and coping mechanisms used in difficult situations. This helps the patient and therapist work together to identify behaviors and activities that they will begin to re-engage in to enhance positive, adaptive behavior and reverse patterns of problematic behaviors that have likely contributed to the ongoing depression.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). Treatment: Behavioral activation for depression. https://www.div12.org/treatment/behavioral-activation-for-depression/

Dimidjian, S., Martell, C.R., Addis, M.E., & Herman-Dunn, R. (2008). Behavioral activation for depression. In D.H. Barlow (Ed.) Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed., pp. 328-364). Guilford Press. https://psycnet.apa.org/record/2008-00599-000

Hopko, D.R., Ryba, M.M., McIndoo, C., & File, A. (2015) Behavioral activation. In A.M. Nezu and C.M. Nezu (Eds.), The Oxford Handbook of Cognitive and Behavioral Therapies (pp. 229-263). Oxford University Press. https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199733255.001.0001/oxfordhb-9780199733255

Kanter, J.W., Busch, A.M, & Rusch, L.C. (2009). Behavioral activation: Distinctive features. Routledge. https://www.crcpress.com/Behavioral-Activation-Distinctive-Features/Kanter-Busch-Rusch/p/book/9780415446549

Kanter, J.W., Santiago-Rivera, A.L., Santos, M.M., Hurtado, G.D., West, P., Nagy, G., & Lopez, M. Behavioral activation for Latinos: Treatment manual [Unpublished manuscript]. University of Washington. https://www.div12.org/wp-content/uploads/2014/11/Behavioral_Activation_for_Latinos_Manual.pdf (PDF, 765KB)

Lejuez, C.W., & Hopko, D.R. (2013). Behavioral activation (BA) program treatment manual [Unpublished manuscript]. https://www.div12.org/treatment/behavioral-activation-for-depression/

Martell, C.R., Addis, M.E., & Jacobson, N.S. (2001). Depression in context: Strategies for guided action. W.W. Norton. https://psycnet.apa.org/record/2001-06573-000

Martell, C.R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A clinician's guide. Guilford Press. https://www.guilford.com/books/Behavioral-Activation-for-Depression/Martell-Dimidjian-Herman-Dunn/9781462510177/authors

Introduction to cognitive therapy

The cognitive therapy model proposes that holding negative views (also known as “schemas”) of the self, the world, others and the future are likely to lead to the development of unhelpful thinking patterns that play a role in the biological and emotional symptoms of depression. Cognitive therapy for depression emphasizes modifying these unhelpful thinking patterns. On average, adults receive eight to 28 weekly sessions of cognitive therapy.

Cognitive therapy is recommended for the treatment of depression in adults.

How cognitive therapy can help treat depression in adults

People with depression often look for evidence that confirms their negative perceptions of themselves. These perceptions are often learned earlier in life from their family members, friends and school. People may develop beliefs such as “the environment is dysfunctional or unsafe” or “receiving criticism means one is not worthy of love.” Those beliefs can be triggered when encountering a stressful situation. Cognitive therapy seeks to identify and alter negative schemas that have undue influence in how one feels and behaves in a situation.

Using cognitive therapy to treat depression in adults

Treatment usually begins with the therapist presenting a cognitive model of depression. This involves describing how early thinking patterns can shape the way we view and interpret the present. When those patterns are negative and unquestioned, they can lead to the development of depressive symptoms. A cognitive therapist works with the patient to identify those schemas and unhelpful thinking patterns that drive their own experience of depression. The therapist uses a strategy of Socratic questioning along with other approaches to help the patient arrive at different understandings of situations and events that are personally compelling.

An important component of treatment is completing homework assignments outside of session. The patient learns to identify and record the unhelpful thoughts that trigger negative emotions and then utilizes the Socratic method to analyze and refute those thoughts. These thought records are used in sessions to work together to identify and address root beliefs. By addressing the underlying negative beliefs about the self, the world, others and the future, depressive symptoms are then presumed to subside.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). Treatment: Cognitive therapy for depression. https://www.div12.org/treatment/cognitive-therapy-for-depression/

Gilson, M., Freeman, A., Yates, M.J., & Freeman, S.M. (2009). Overcoming depression: A cognitive therapy approach (2nd ed.). Oxford University Press. https://global.oup.com/academic/product/overcoming-depression-9780195371024?cc=us&lang=en&

Young, J.E., Rygh, J.L., Weinberger, A.D., & Beck, A.T. (2008). Cognitive therapy for depression. In D.H. Barlow (Ed.) Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed., pp. 250-305). Guilford Press. https://psycnet.apa.org/record/2008-00599-000

Introduction to CBT

CBT focuses on how thoughts, feelings and behaviors are intertwined in everyday functioning and how changes in any one domain can lead to improvement in the others. The way we view ourselves, the world around us (including other people), and our futures plays a role in how we feel and act in any given situation. CBT aims to modify the unhelpful thinking and behavioral patterns that impair one’s functioning. These changes can lead to healthier behaviors and improved emotion regulation. CBT targets current problems and symptoms and is typically delivered in six to 20 weekly sessions.

CBT is recommended for the treatment of depression in adults.

How CBT can help treat depression in adults

CBT can teach people how to differentiate between their thoughts and feelings and regulate their feelings by questioning their assumptions and beliefs. This is done through identifying and labeling the types of negative thinking patterns described in sessions and in the various exercises the individual completes (e.g., mood log). CBT might also address behavior patterns that contribute to withdrawal and lack of enjoyment with strategies such as helping people identify activities they have enjoyed in the past and planning to engage in them regularly.

Using CBT to treat depression in adults

Treatment begins with the therapist educating the patient about how thoughts, feelings and behaviors interact with each other to influence mood and well-being. The therapist introduces the idea that there are ways to modify thinking and behavioral patterns that could have a positive benefit on emotions and behaviors. Therapists teach patients how to use a variety of techniques to reduce symptoms and improve functioning.

The patient might be encouraged to complete a “mood diary” outside of sessions, noting the situations that triggered the thoughts that then influenced feelings and behaviors in the moment. The patient and therapist then work together to identify common themes that influence the unhelpful thinking and behavior patterns in a particular situation.

The therapist might have the patient challenge their beliefs about themselves (or others), the world, and the future by exposing the patient to a fearful situation (for example, talking to their boss about whether the feedback he/she received was intended as a criticism).

Patients are often encouraged to complete homework assignments to fully develop new skills and build confidence to work through stressful situations.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). What is cognitive behavioral therapy? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.pdf (PDF, 244KB)

Beck, J.S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press. https://beckinstitute.org/product/basics-and-beyond/

Craske, M.G. (2017). Cognitive-behavioral therapy (2nd ed.). American Psychological Association. https://www.apa.org/pubs/books/4317445

Muñoz, R.F., & Miranda, J. (1996). Individual therapy manual for cognitive-behavioral treatment of depression. https://www.rand.org/content/dam/rand/pubs/monograph_reports/2005/MR1198.6.pdf (PDF, 2.29MB)

Persons, J.B., Davidson, J., & Tompkins, M.A. (2001). Essential components of cognitive-behavior therapy for depression. American Psychological Association. https://www.apa.org/pubs/books/431758A?tab=2

Introduction to IPT

IPT aims to improve the person’s relationships with others by learning strategies to effectively communicate emotions and needs as well as problem-solve within a significant relationship. Therapists using IPT emphasize a biopsychosocial explanation of depression, in that negative or distressing events people experience within their lives can exacerbate feelings of sadness and worthlessness. As relationships with others improve, the depressive symptoms may subside, and the person will hopefully experience improved functioning in multiple areas of their life. On average, adults receive 16 to 20 weekly sessions of IPT. If medication is being considered, the panel recommends augmenting IPT with a second-generation antidepressant.

Interpersonal psychotherapy is recommended for the treatment of depression in adults.

How IPT can help treat depression in adults

IPT conceptualizes depression as consisting of three components:

• Depression symptoms: Symptoms are seen as having both biological (e.g., sleep/wake functioning, eating patterns) and psychological (e.g., sadness; feelings of guilt) underpinnings.
• Social functioning: The way one interacts with significant others and responds to social situations. Difficulties in social interactions can lead to or exacerbate depression symptoms.
• Personality difficulties: Individual characteristics that may be consistent across situations such as difficulty with anger expression, self-esteem and communication. These characteristics can play a role in a person’s response to a social situation which in turn can increase vulnerability to developing symptoms of depression.

While IPT is not expected to have an impact on personality due to the short treatment duration, the interpersonal communication skills attained in treatment may mitigate the impact of one’s personality difficulties on their relationships. In addition, the new social skills can hopefully prevent the development of future episodes of depression by improving coping skills.

Using IPT to treat depression in adults

Treatment begins with a comprehensive evaluation of the person’s social and emotional functioning along with educating the patient about the biopsychosocial model of depression, emphasizing that the illness does not define the person. Next, the therapist will ask questions about their relationships and how he/she interacts within those relationships. This comprehensive review allows the therapist to identify and work with one of the four problems areas that are commonly noted in adults with depression: grief (e.g., long periods of sadness after losing a loved one), role disputes (e.g., not feeling understood), role transitions (e.g., recent move to a new city) and interpersonal deficits (e.g., socially withdrawn).

In the middle stages of treatment, the therapist and patient identify strategies to ameliorate the chosen problem area and improve the patient’s relationships, with the goal of reducing depressive symptoms. The therapist then reviews the interpersonal skills (specifically, perspective-taking and effective communication) that the patient has learned and emphasizes use of these skills outside the office. The therapist might also offer “booster sessions” for the patient to help solidify the skills and possibly prevent future episodes.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). Treatment: Interpersonal psychotherapy for depression. https://www.div12.org/treatment/interpersonal-psychotherapy-for-depression/

Bleiberg, K.L., & Markowitz, J.C. (2008). Interpersonal psychotherapy for depression. In D.H. Barlow (Ed.) Clinical handbook of psychological disorders (4th ed., pp. 306-327). Guilford Press. https://psycnet.apa.org/record/2008-00599-000

Frank, E., & Levenson, J.C. (2011). Interpersonal psychotherapy. American Psychological Association. https://www.apa.org/pubs/books/4317234

Pettit, J.W., & Joiner, T.E. (2006). Chronic depression: Interpersonal sources, therapeutic solutions. American Psychological Association.

Ravitz, P., Watson, P., & Grigoriadis, S. (2013). Psychotherapy essentials to go: Interpersonal psychotherapy for depression (P. Ravitz, & R. Maunder, (Eds.)) W.W. Norton https://books.wwnorton.com/books/978-0-393-70829-5/

Weissman, M.M. (1995). Mastering depression through interpersonal psychotherapy: Patient workbook. Oxford University Press. https://global.oup.com/academic/product/mastering-depression-through-interpersonal-psychotherapy-9780195188479?cc=us&lang=en&

Weissman, M.M., Markowitz, J.C., & Klerman, G. L. (2017). The guide to interpersonal psychotherapy: Updated and expanded edition. Oxford University Press. https://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780190662592.001.0001/med-9780190662592

Introduction to MBCT

MBCT for depression uses methods from cognitive therapy (CT) with strategies such as mindfulness meditation. MBCT’s aim is to teach people how to recognize intrusive/unhelpful thoughts as mere mental events and view them objectively in a way that is loving and kind to oneself. On average, adults receive eight weekly two-hour sessions of MBCT in a group format. A full-day retreat between the sixth and seventh sessions and post-intervention booster sessions may also be included.

MBCT is recommended for the treatment of depression in adults.

How MBCT can help treat depression in adults

Several theories suggest how depression develops and recurs in adults. People with depression often hold rigidly negative views of themselves, the larger world (including other people), and their futures. They may also form comparisons about how things “should be,” versus how things are. People are also likely to confirm their negative perceptions by focusing on negative aspects instead of viewing events from a more positive perspective. Mindfulness training teaches people how to pay attention to and refocus their thoughts despite the inevitable ways their minds will wander. Through practice, people can develop the ability to alter thoughts, keep themselves in the present moment, and not become stuck in negative thoughts.

Using MBCT to treat depression in adults

MBCT is typically conducted in a small-group format that meets once a week for two hours for eight weeks. The first two sessions consist of educating the group on the theory of mindfulness and how ruminating on stressful situations contributes to the development of depression. Exercises that teach people how to attend to and be “in the moment” include body scanning, mindful eating, breathing and sitting practice. Cognitive exercises such as “affect labeling” are integrated with the mindfulness exercises.

In sessions three and four, group members are taught to remain in the present moment through the practice of “sitting” (focusing on the breath and body) and, at the same time, to identify alternative ways of responding to a stressful situation. Group members continue in sessions five and six with the practice of mindful breathing as well as learning that “thoughts are not facts” and that people have choices in how to respond to a situation.

Homework is assigned after each session and consists of practicing various mindfulness meditation exercises as well as completing brief worksheets on how to accept and acknowledge negative emotions. The group typically participates in a retreat or day-long session that goes over all of the mindfulness and cognitive skills they acquired throughout the course of treatment.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). Treatment: Mindfulness-based cognitive therapy. https://www.div12.org/treatment/mindfulness-based-cognitive-therapy/

Kuyken, W., & Evans, A. (2014). Mindfulness-based cognitive therapy for recurrent depression. In R.A. Baer (Ed.) Mindfulness-based treatment approaches (2nd ed.). Academic Press. https://www.elsevier.com/books/mindfulness-based-treatment-approaches/baer/978-0-12-416031-6

Segal, Z.V., Williams, M., & Teasdale, J. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). Guilford Press. https://www.guilford.com/books/Mindfulness-Based-Cognitive-Therapy-for-Depression/Segal-Williams-Teasdale/9781462537037

Teasdale, J., Williams, M., & Segal, Z.V. (2014). The mindful way workbook: An 8-week program to free yourself from depression and emotional distress. Guilford Press. https://www.guilford.com/books/The-Mindful-Way-Workbook/Teasdale-Williams-Segal/9781462508143

Williams, M., Teasdale, J., Segal, Z.V., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. Guilford Press. https://www.guilford.com/books/The-Mindful-Way-through-Depression/Williams-Teasdale-Segal-Kabat-Zinn/9781593851286

Introduction to psychodynamic therapy

Psychodynamic therapists encourage the individual to freely explore their current mood and thinking to begin to recognize patterns of behavior and unexpressed feelings. The therapeutic relationship is often used to identify the individual’s common verbal and nonverbal patterns and nuances that negatively impact their other important relationships as well as view of self. The individual can apply lessons learned in the therapeutic relationship to issues he/she is currently experiencing in their personal relationships. Adults generally receive three to 80 weekly sessions of psychodynamic therapy, although the studies the APA guideline development panel reviewed consisted of short-term psychodynamic therapies.

Psychodynamic therapy is recommended for the treatment of depression in adults.

How psychodynamic therapy can help treat depression in adults

A psychodynamic therapy approach to depression treatment frequently emphasizes the role that early experiences, especially experiences of loss, play in the development of vulnerability to abandonment, self-criticism, hopelessness and other interpersonal challenges that can lead to depressive symptoms. Consequent goals of psychotherapy are to develop greater tolerance for uncomfortable feelings and greater reliance on the self, rather than looking to others, to feel good and to handle inevitable disappointments. Psychodynamic therapy, overall, may provide not only relief from suffering but may also help increase people’s self-awareness and appreciation of who they are.

Using psychodynamic therapy to treat depression in adults

There are very different models of psychodynamic therapy. Variations (often integrated in treatment) are based on drive/conflict, interpersonal/relational, or attachment theories. Depending on the patient’s preference, psychodynamic therapy can be either short-term or long-term.

Short-term psychodynamic therapy is time-limited and focuses on one major problem area contributing to the current depression (or other presenting concern). The initial phase of therapy typically involves promoting a supportive environment and providing education about depression. People with depression are often preoccupied with negative, hopeless thoughts, and experience neurovegetative signs and symptoms that are understood as stemming from earlier traumatic events and unresolved feelings.

Although patients are encouraged to engage in external activities that they identify as important and rewarding, the therapy focuses on in-session work to identify core conflicts or maladaptive patterns in the patient’s life. These often involve themes of abandonment and loss and subsequent negative feelings about the experiences. Facilitating increased self-awareness and self-expression, as well as encouraging new behaviors, are essential aims of treatment.

The therapeutic relationship is often used as ground to explore feelings and to provide a corrective experience. The therapist helps patients consolidate their new understandings to better distinguish older conflicts and feelings from current situations. Ending therapy carefully is important, as those patients with core themes of loss may re-experience those emotions as they say goodbye to the therapist. Still, this can be a valuable process for realizing new perspectives and strengths as a result of therapy.

References and resources

American Psychological Association, Div. 12: Society of Clinical Psychology. (n.d.). Short-term psychodynamic therapy for depression. https://www.div12.org/treatment/short-term-psychodynamic-therapy-for-depression/

Barber, J. P., Muran, J. C., McCarthy, K. S., Keefe, J. R., & Zilcha-Mano, S. (2021). Research on dynamic therapies. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 387-420). Wiley. https://www.wiley.com/en-af/Bergin+and+Garfield's+Handbook+of+Psychotherapy+and+Behavior+Change,+6th+Edition-p-9781118415924

Busch, F.N., Rudden, M., & Shapiro, T. (2016). Psychodynamic treatment of depression (2nd ed.). American Psychiatric Publishing. https://www.appi.org/Psychodynamic_Treatment_of_Depression_Second_Edition

Driessen, E., Hegelmaier, L.M., Abbass, A.A., Barber, J.P., Dekker, J.J.M., Van, H. L.,…Jansma, E. P. & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review, 42, 1–15. http://dx.doi.org/10.1016/j.cpr.2015.07.004  

Eppel, A. (2018). A manual for short-term psychodynamic psychotherapy. In Short-term psychodynamic psychotherapy (pp. 133-168).
Springer. https://www.springer.com/us/book/9783319749945

Gabbard, G.O. (2017). Long-term psychodynamic psychotherapy: A basic text (3rd ed.). American Psychiatric Publishing. https://www.appi.org/Long-Term_Psychodynamic_Psychotherapy_Third_Edition

Haggerty, J. (2018). Psychodynamic psychotherapy. https://psychcentral.com/lib/psychodynamic-therapy/

Messer, S.B., & Warren, C.S. (1998). Models of brief psychodynamic therapy: A comparative approach. Guilford Press. https://psycnet.apa.org/record/1995-98730-000

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist 65(2), 98-109. https://psycnet.apa.org/fulltext/2010-02208-012.pdf

Summers, R.J. & Barber, J.P. (2009). Psychodynamic psychotherapy: A guide to evidence-based practice. Guilford Press. https://www.guilford.com/books/Psychodynamic-Therapy/Summers-Barber/9781462509706/reviews

Introduction to supportive therapy

Supportive therapy emphasizes the therapeutic relationship between the person and therapist as the foundation of the treatment of depression in adults. The therapist shows genuine care for the well-being of the person by listening with empathy as well as being flexible in having the person define what successful treatment looks like. Therapists focus on the individual’s current stressors and provide affirmation and support for what the person is currently experiencing to facilitate effective coping. In an environment free of judgment and interpretation, the person shares difficult situations and how they felt about them. On average, adults receive four to 20 weekly or bi-weekly sessions of supportive therapy.

Supportive therapy is recommended for the treatment of depression in adults.

How supportive therapy can help treat depression in adults

Supportive therapy can be helpful for people who are, for example, currently struggling to find meaning in their life or cope with events and situations effectively. People with depression may interpret certain situations with more negativity but can learn to adapt and hold more positive views of themselves. Supportive therapy strives to achieve this via the unconditional support and regard the therapist provides the individual and the flexibility to explore different perspectives. Over time, the individual incorporates the therapist’s empathic perspective of the self into their self-concept. Supportive therapy also helps people better understand their current situations and strengthen their ability to face challenges despite difficulties.

Using supportive therapy to treat depression in adults

Techniques that are foundational to supportive therapy include showing empathy and unconditional positive regard toward the individual’s current struggle by normalizing their feelings, as well as providing suggestions for how to deal with whatever difficult situations the individual might be experiencing. Supportive therapists might also include exercises from a range of therapeutic orientations, such as diaphragmatic breathing or problem-solving. In experiencing the therapist’s empathic listening and unconditional positive regard, the individual will generally feel “heard” and understood and learn to internalize the therapist’s accepting view of the individual, ideally leading to improved self-esteem. The flexibility to explore different perspectives strengthens an individual’s inner resilience and capacity to cope.

References and resources

Cain, D.J. (2010). Person-centered psychotherapies. American Psychological Association. https://psycnet.apa.org/record/2009-18997-000

Misch, D.A. (2000). Basic strategies of dynamic supportive therapy. The Journal of Psychotherapy Practice and Research, 9(4), 173-189. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330607/

Pinsker, H. (2013). A primer of supportive psychotherapy. Routledge. https://www.routledge.com/A-Primer-of-Supportive-Psychotherapy-1st-Edition/Pinsker/p/book/9781315803296

Werman, D.S. (1984). The practice of supportive psychotherapy. Brunner/Mazel. https://www.crcpress.com/Practice-Of-Supportive-Psychotherapy/Werman/p/book/9781138869004#googlePreviewContainer

Introduction 

Second-generation antidepressants (selective serotonin reuptake inhibitors — SSRIs, serotonin-norepinephrine reuptake inhibitors — SNRIs or norepinephrine/dopamine reuptake inhibitors — NDRIs) are recommended but the evidence base is insufficient for recommending any specific medication over another.

Please see Table 3 in the full guideline document (PDF. 1.15MB) as well as the evidence grid located in the supplement for more information.

What are second-generation antidepressants?

Second-generation antidepressants include SSRIs, SNRIs and NDRIs. These drugs regulate the neurotransmitters serotonin, norepinephrine and dopamine, which are involved in brain functions related to mood and behavior.

SSRIs help regulate the amount of serotonin that is active in the synapses between neurons. SNRIs address levels of both serotonin and norepinephrine. NDRIs help regulate both norepinephrine and dopamine levels.

The following are common dosage ranges of SSRIs, SNRIs and NDRIs for adults with depression. Shared decision-making between the provider and patient is recommended as individual patients may have different responses to the medications or be concerned about different side effect profiles.

• bupropion (Wellbutrin): 150-450 mg once daily
• citalopram (Celexa): 20-40 mg daily
• desvenlafaxine (Pristiq): 50 mg daily
• duloxetine (Cymbalta): 40-60 mg 1-2 times daily
• escitalopram (Lexapro): 10-20 mg daily
• fluoxetine (Prozac): 10-80 mg daily
• fluvoxamine (Luvox): 50-300 mg daily
• levomilnacipran (Fetzima): 40-120 mg daily
• mirtazapine (Remeron): 15-45 mg daily
• paroxetine (Paxil): 20-40 mg daily
• sertraline (Zoloft): 50-200 mg daily
• trazodone (Desyrel): 150-400 mg once daily
• venlafaxine (Effexor): 75-300 mg once daily
• vilazodone (Viibryd): 20-40 mg daily
• vortioxetine (Brintellix): 10-20 mg daily

Side effects and frequency of prescriber visits

Side effects of second-generation antidepressants are generally mild to moderate side effects that can be tolerated or managed with over-the-counter remedies (e.g., headaches, nausea, drowsiness). Upon initially being prescribed medication, the patient will likely see the prescriber at least a few times within the first eight weeks to check whether he/she is taking the medication as prescribed, as well as to determine whether the dose is optimal and whether the patient is experiencing any adverse side effects.

Once the patient has a stable medication dosage and reports a decrease of symptoms, visits to the prescriber will likely be less frequent. It is generally recommended that medication be continued at the same dose after remission of symptoms, in order to facilitate recovery and to prevent relapse.

References and resources

Gartlehner, G., Gaynes, B.N., Amick, H.R., Asher, G., Morgan, L.C., Coker-Schwimmer, E., Forneris, C., Boland, E., Lux, L. J., Gaylord, S., Bann, C., Pierl, C. B. & Lohr, K.N. (2015). Nonpharmacological versus pharmacological treatments for adult patients with major depressive disorder (RTI International-University of North Carolina Evidence-based Practice Center Contract No. 290-2012-00008-I). U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/pubmed/26764438 

Kaiser Permanente. (2018). Adult & adolescent depression screening, diagnosis, and treatment guideline. https://wa.kaiserpermanente.org/static/pdf/public/

Before taking any medications, over-the-counter drugs, supplements or herbs, consult a health care provider for a thorough evaluation. American Psychological Association (APA) does not endorse any medications, vitamins or herbs. A qualified health care provider should make a decision based on each person's medical history and current prescriptions. The medication summaries provided do not include all of the information important for patient use and should not be used as a substitute for professional health care advice. The prescribing professional should be consulted concerning any questions that you have.