Depression Treatment Options: Therapy, Medication, TMS, and SPRAVATO®
Several effective treatments are available for depression, including psychotherapy, medication, transcranial magnetic stimulation (TMS), and SPRAVATO®. Treatment recommendations depend on symptom severity, treatment history, and individual preferences.
What are the main treatment options for depression?
The main treatment options for depression include therapy, antidepressant medication, lifestyle support, and, for some people, advanced treatments such as transcranial magnetic stimulation (TMS) or SPRAVATO® (esketamine). Many people benefit from combining treatments, such as therapy and medication. The right approach depends on your symptoms, medical history, previous treatment experience, preferences, and how depression is affecting your daily life.
Key takeaways
- Depression is highly treatable using psychotherapy, medication, and lifestyle adjustments, often in combination.
- Therapy helps you identify negative thought patterns and build coping skills, while antidepressants can help reduce symptoms by affecting neurotransmitter activity in the brain.
- TMS and SPRAVATO® are FDA-approved options for treatment-resistant depression when standard approaches have not provided adequate relief.
- Finding the right treatment often involves working with a clinician to personalize your plan over time.
| Treatment | What it helps with | Often considered when |
| Therapy | Thought patterns, coping skills, stress, grief, trauma, relationships | Depression is mild to moderate, or as part of a combined plan |
| Medication | Mood, sleep, energy, appetite, concentration | Symptoms are moderate to severe, persistent, or affecting daily life |
| TMS | Depression symptoms that have not improved enough with standard care | Medication and therapy have not provided adequate relief |
| SPRAVATO® | Treatment-resistant depression | Two or more antidepressants have not provided adequate relief |
What are the main treatment options for depression?
Depression responds well to treatment, and most people improve with a combination of psychotherapy, medication, and lifestyle adjustments. The challenge is finding the right fit for you, which often takes some trial and adjustment with a clinician who can tailor a plan to your symptoms, history, and preferences.
Four main categories of treatment are available:
- Therapy (psychotherapy): Helps you recognize negative thinking patterns and develop healthier ways of coping with difficult emotions.
- Medication: Antidepressants can help reduce symptoms of depression by affecting neurotransmitters involved in mood and emotional regulation.
- TMS (transcranial magnetic stimulation): A non-invasive brain stimulation treatment that uses magnetic pulses, typically considered when therapy and medication have not worked well enough.
- Spravato (esketamine): An FDA-approved nasal spray administered in a clinical setting for treatment-resistant depression or major depressive disorder with suicidal thoughts.
If you want background on depression symptoms and how the condition is diagnosed, our depression resource page covers the basics.
How does therapy help treat depression?
Therapy, sometimes called talk therapy or psychotherapy, gives you a space to explore the thoughts, emotions, and behaviors that contribute to depression. Through regular sessions with a licensed therapist, you can start to see patterns you might not have noticed on your own and learn practical ways to interrupt them.
For mild to moderate depression, therapy alone can be effective. When symptoms are more severe, therapy often works alongside medication or other treatments. Mindpath Health’s therapy services connect you with psychologists and therapists trained in evidence-based approaches.
Cognitive behavioral therapy
Cognitive behavioral therapy, or CBT, focuses on the relationship between your thoughts, feelings, and actions. The idea is that how you interpret a situation affects how you feel about it, and CBT helps you identify distorted thinking and practice responding differently.
CBT is structured and goal-oriented. You and your therapist work on specific problems, and you practice skills between sessions. Many people find CBT helpful because it provides concrete tools for daily life.
Interpersonal therapy
Interpersonal therapy, or IPT, looks at how your relationships and life events affect your mood. If depression started after a major change, like a loss, a move, or a conflict with someone close to you, IPT can help you work through that connection.
The focus is on improving communication, resolving conflicts, and building stronger social support. IPT tends to be time-limited, usually lasting 12 to 16 sessions.
Psychodynamic therapy
Psychodynamic therapy explores how past experiences and unconscious thoughts shape your current mood and behavior. Rather than focusing on specific skills, this approach helps you uncover deeper patterns that may be contributing to depression.
Psychodynamic therapy often unfolds over a longer timeframe than CBT or IPT. It can be a good fit if you want to understand the root causes of your depression, not just manage symptoms.
How does antidepressant medication work?
Antidepressants work on neurotransmitters that help regulate mood and emotions. For many people, these medications can help reduce symptoms such as low mood, low energy, and difficulty focusing.
One thing to know: antidepressants do not work overnight. It often takes four to six weeks to notice improvement, and your clinician may adjust the dose or try a different medication if the first one is not a good fit. This process can feel frustrating, but it is a normal part of finding what works for you.
Medication is typically prescribed by a psychiatrist, psychiatric nurse practitioner, or physician assistant. At Mindpath Health, our psychiatry team provides evaluations and ongoing medication management.
Common medication classes include:
- SSRIs (selective serotonin reuptake inhibitors): Increase serotonin availability in the brain and are commonly prescribed due to their tolerability.
- SNRIs (serotonin-norepinephrine reuptake inhibitors): Target both serotonin and norepinephrine.
- Atypical antidepressants: Work through different mechanisms and may be considered when other options have not been effective.
- Tricyclics and MAOIs: Older medication classes that can be options when standard medications have not worked.
Your clinician will consider your symptoms, medical history, and any previous medication trials when recommending an approach.
Therapy vs. medication for depression: how do you choose?
Therapy and medication can both help treat depression, but they work in different ways. Therapy focuses on thoughts, behaviors, coping skills, relationships, and life stressors. Medication may help reduce symptoms related to mood, sleep, energy, appetite, and concentration.
Some people start with therapy alone, especially when symptoms are mild to moderate. Others may benefit from medication, particularly when symptoms are more severe, persistent, or affecting daily life. Many people use therapy and medication together. A clinician can help you decide which approach fits your symptoms, history, and preferences.
What is TMS for depression?
TMS stands for transcranial magnetic stimulation. It is an FDA-cleared treatment that uses magnetic pulses to stimulate nerve cells in areas of the brain involved in mood regulation. TMS is non-invasive, meaning it does not require surgery or anesthesia, and sessions take place in an office setting.
TMS is typically considered when therapy and medication have not provided adequate relief. You might hear this situation described as treatment-resistant depression. During a session, you sit in a chair while a device positioned near your head delivers targeted magnetic pulses. Most people describe the sensation as a tapping feeling on the scalp.
A typical course of TMS involves multiple sessions over several weeks. Some people notice improvement during the treatment course, while others see changes after completing the full series. Mindpath Health offers TMS at select locations. You can learn more on our TMS services page.
What is SPRAVATO® and who is it for?
SPRAVATO® is the brand name for esketamine, an FDA-approved nasal spray for adults with treatment-resistant depression. For treatment-resistant depression, it may be used on its own or with an oral antidepressant, depending on the treatment plan. It is approved for two specific situations: treatment-resistant depression and major depressive disorder with suicidal thoughts.
SPRAVATO® is also approved for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, when used with an oral antidepressant.
SPRAVATO® is not a replacement for emergency care. If someone is in crisis or at risk of self-harm, call or text 988 or seek emergency care.
Because of how SPRAVATO® works, it is administered in a certified healthcare setting rather than at home. After you take the nasal spray, you remain in the office for monitoring, typically for about two hours. Sessions are usually scheduled twice weekly at first, then taper to less frequent visits as you progress.
SPRAVATO® may be an option if you have tried multiple antidepressants without adequate improvement. Mindpath Health offers Spravato at select locations. Visit our SPRAVATO services page for details on availability.
What if depression treatment is not working?
If therapy or medication has not helped enough, that does not mean depression is untreatable. Your clinician may revisit your diagnosis, adjust your medication, combine treatments, or discuss advanced options such as TMS or SPRAVATO®.
Treatment-resistant depression generally refers to depression that has not improved enough after trying multiple standard treatments, such as antidepressant medication or therapy. Your care team can help determine whether additional options may be appropriate based on your symptoms, treatment history, and health needs.
- TMS: Brain stimulation using magnetic pulses, described in the TMS section above.
- Spravato: Nasal spray administered in a clinical setting, described in the Spravato section above.
- Medication adjustments: Switching medications, adjusting doses, or combining medications under clinician guidance.
- Combination approaches: Pairing medication with therapy or adding a brain stimulation treatment to your current plan.
Your clinician can help determine which next step makes sense based on your history and current symptoms.
How long does depression treatment take to work?
Timelines vary depending on the treatment type and your individual response. Patience is part of the process, and your clinician will monitor your progress and make adjustments as needed.
| Treatment | Typical timeline |
| Therapy | Benefits may emerge over several sessions; ongoing work deepens progress |
| Medication | May take 4 to 6 weeks before noticeable improvement; adjustments may be needed |
| TMS | Multiple sessions over several weeks; some notice changes during the course |
| Spravato | Administered in a series of sessions; response time varies by individual |
If you are not seeing improvement, let your clinician know. Sometimes a change in approach or adding another treatment can make a difference.
How to choose the right depression treatment
Choosing a treatment depends on several factors, and there is no single right answer for everyone. Your clinician will consider your symptoms, what you have tried before, and your preferences when making recommendations.
Factors that often guide treatment decisions include:
- Symptom severity: More severe symptoms may benefit from combining approaches, such as medication plus therapy.
- Previous treatment history: What has or has not worked informs next steps.
- Personal preferences: Your comfort with medication, therapy format, or in-office visits matters.
- Lifestyle and schedule: Availability for therapy sessions, TMS appointments, or Spravato monitoring can shape your plan.
Treatment can be adjusted over time. What works at one stage may evolve as your symptoms change or as you learn more about what helps you.
What to discuss with your clinician
Coming prepared to your appointment can help you get the most out of your time together. You do not need to have all the answers. Your clinician is there to guide you.
Topics worth bringing up include:
- Current symptoms and how long you have experienced them
- Treatments you have tried and how they affected you
- Concerns about medication side effects or time commitment
- Questions about therapy approaches, TMS, or Spravato
- How to coordinate care if you are also seeing another provider
Whether you are starting with psychiatry or therapy, your care team will work with you to build a plan that fits your needs.
Start your path to depression treatment at Mindpath Health
Support is available, and you do not have to figure this out alone. Mindpath Health offers psychiatry, therapy, TMS, and Spravato through in-person and online appointments across multiple states.
To get started, call 1-855-501-1004 or schedule an appointment. For more information about depression symptoms and diagnosis, visit our depression resource page.
Frequently asked questions about depression treatment
Yes. Therapy alone can be effective for many people, especially with mild to moderate depression. A clinician can help determine whether therapy, medication, or a combination makes sense based on your symptoms and preferences.
Research supports that online therapy can be as effective as in-person sessions for many people with depression. Mindpath Health offers online appointments for therapy and psychiatry across multiple states.
Yes. Combining therapy and medication is a common and often effective approach. Your care team can coordinate both and adjust your plan as you progress.
You sit in a chair while a device delivers magnetic pulses to your scalp. Sessions typically last under an hour, do not require anesthesia, and you can return to normal activities afterward.
Many commercial insurance plans cover depression treatment, including therapy, psychiatry, TMS, and Spravato. Mindpath Health is in-network with most major commercial plans. Visit our insurance page to check your coverage.
There is no single best treatment for everyone. The right treatment depends on your symptoms, medical history, previous treatment experience, preferences, and goals. Many people benefit from therapy, medication, or a combination of both.
Therapy and medication help in different ways. Therapy can help with thought patterns, coping skills, relationships, and stress, while medication may help reduce symptoms related to mood, sleep, energy, and concentration. Some people use one approach, while others benefit from combining both.
If antidepressants have not helped enough, your clinician may adjust the dose, switch medications, combine medications, add therapy, or discuss advanced options such as TMS or SPRAVATO®.
SPRAVATO® is esketamine, which is related to ketamine but is a specific FDA-approved prescription nasal spray administered in a certified healthcare setting. It is not the same as receiving ketamine outside of the SPRAVATO® treatment program.
Additional Sources
- National Institute of Mental Health: Depression
- National Institute of Mental Health: Mental Health Medications
- National Institute of Mental Health: Brain Stimulation Therapies
- FDA: SPRAVATO® Prescribing Information
- 988 Suicide & Crisis Lifeline: 988 Suicide & Crisis Lifeline