Depression presents one of the largest health burdens according to the World Health Organization.¹ It can descend upon anyone at any stage in life. 8% of Americans have experienced a major depressive episode over their lifetime.² Despite growing awareness of depression, it is still taboo to discuss as a personal or social issue.

What is depression?

Depression is a prolonged feeling of sadness, emptiness, or marked disinterest in life. It manifests differently in everyone. It can be mild and continuous or come in intense bursts. It can arise from a stressful event or present for seemingly no reason. Depressed individuals tend to have excessively negative or pessimistic thoughts, especially about themselves. As this website does not limit mental health to the medical model, it takes the broadest approach to depression, encompassing any sad or empty feelings that an individual feels has become excessive.
Depression can take hold even without noticeable feelings of sadness. There could be somatic symptoms like fatigue or pain anywhere in the body.³ Behavior may be affected. One may come across as ‘not himself lately’ or withdraw from social interactions. Many people are good at suppressing their unpleasant emotions, but rather than going away, the emotions manifest as physical or behavioral changes.

Prevention and Treatment

Prevention and treatment have no daylight between them in mental health. The self-help strategies used to prevent depression are the same ones used to treat it and prevent relapse. Professional services like counseling and prescription medication are also sometimes continued for months or years after recovery in order to lower the risk of relapse. Anti-depression strategies can be classified as lifestyle (or behavioral/environmental), cognitive, or medical.

Lifestyle factors greatly affect our ability to overcome or prevent depression. What we spend our time doing and what we put into our bodies can influence if we get depressed and how long we stay depressed.

The mechanisms by which lifestyle affects our mental health are many. Eating, sleeping, and exercise directly affect our physiology. Hormones and endorphins have a strong effect on how we feel physically and emotionally. Some activities make us feel happier than others, negating depression in a positive way.

When our minds are engaged in doing something pleasant, negative thoughts are less likely to attack us than if we are bored or doing something that we don’t like. Pleasant activities also benefit us when we are not doing them. They give us something to look forward to and provide us with pleasant memories that can displace negative memories and thoughts.

Any approach to depression (behavioral, cognitive, or medical) has the potential to rewire our brains. The neural pathways that facilitate depression break and are replaced with circuitry that is more conducive to mental wellness.

Hobbies and interests can be a source of self-esteem. How positively we feel about ourselves is closely related to how positively we feel in general. Activities which foster confidence, self-efficacy, and self-esteem are a natural defense against depression. Positive social interaction is in itself a mental health need and strong defense against depression. It can also be a source of relaxation and emotional support.

There is a substantial body of research demonstrating that exercise is an effective way of preventing and treating depression. A 2022 meta-analysis of exercise and antidepressants found them to have the same efficacy for non-severe depression.⁴

In 2020, a systematic review of 8 meta-analyses of exercise interventions for depression was published.⁵ It reported that 6 of the reviewed meta-analyses discovered a significant drop in depression. One meta-analysis factored in exercise intensity and determined that intensity was not related to the effects on depression. Another meta-analysis stated that low-intensity exercise can be beneficial. Interestingly, of the 134 studies included in the systematic review, the biggest drop in depression was observed in a study on weight training.

Exercise releases endorphins which increase feelings of vitality and well-being. If you exercise regularly, you will probably have higher endorphin levels and greater vitality much of the time. What matters is physical activity.⁵ It doesn’t have to be formal exercise. That could mean walking more or taking up physical hobbies. Increasing your activity level takes a lot of willpower in the beginning but it can quickly become habitual and easy to maintain.

For bright light devices, often called light boxes, higher intensity (e.g. 10,000 lux) output tends to provide better results, although lower brightness (e.g. 400 or 1,000 lux) can also provide some benefit.⁶ White light offers superior results to full-spectrum, blue, green, or red light.¹¹

Natural light therapy has not received as much research attention for depression as artificial light. However, Dr. Schwartz believes the two to be equivalent, especially when used in the morning. Lux is approximately 1,000 to 10,000 on a cloudy day and 50,000 on a sunny day.¹² Thus, spending half an hour in the backyard on a gray morning could provide enough light exposure to affect your depression.

Phototherapy clearly has many advantages over other forms of depression treatment. It is efficacious for both seasonal and non-seasonal depression.^{6,8,9,13,14,15} It has no side effects.⁷ After buying a light box, the only ongoing cost is the electricity to power it. Light therapy can be combined with any other form of treatment. You can have a light box at work, as well as one at home.

Natural light can also be a viable option. If winter mornings are too cold to spend time outside, you may be able to sit next to a large window in the direct sunlight or set up an outdoor heater on your patio, for example. Being outside on an overcast day is generally adequate to receive the mental health benefits.

Hobbies, or personal interests, play a large role in depression mitigation. It is easy to get into a downward spiral where you drift away from your hobbies because you are depressed… and you are depressed, in part, because you no longer spend time doing the things you like. To stem the cycle, it is important to make an effort to keep up your hobbies even though you may not feel like it.

Many people have no hobbies short of TV and social media. If you are one of them, it could be beneficial to experiment with different pursuits. It’s hard to know if you like something until you try it. Hobbies can be passive, like reading or listening to music, or active, like playing chess. They can have practical benefits, such as learning personal finance or cooking. Hobbies can be individual or group. Playing in a bowling league or golfing with coworkers are two examples of group hobbies.

Cognitive behavioral therapy (CBT) has been the most common form of psychotherapy for decades. It utilizes both cognitive and behavioral strategies to combat depression. The behavioral activation component involves intentionally spending your time doing things that (1) don’t trigger negative emotions, and (2) bring you happiness. Trials using separate groups for cognitive, behavioral, and combined (full CBT) have not found a significant difference in outcome.^16,17,18 Thus, changing how you spend your time can greatly affect your depression even when no cognitive techniques are employed.

Some counselors only practice behavioral activation with depressed clients. In their experience, adding cognitive techniques provides little benefit. In 2007, a meta-analysis of behavioral activation found that it resulted in a large decrease in depression. Moreover, there was little variation in studies — they all showed strong effects.¹⁹

In the 2001 booklet, Personalized Depression Therapy (PDT), Dr. James Herndon discusses how his research has found that depressed people spend under 20% of their spare time on their hobbies while people with good mental health devote over 90% of their spare time to hobbies. He states that people with excellent mental health have hobbies in 6 areas: objects, activities, places, people, skills, and beliefs.²⁰

Herndon theorizes that spending a large portion of our time on our hobbies reliably protects against depression by allowing us to exercise mastery and dominance. The premise is that people typically enjoy and excel at their hobbies, therefore spending considerable time doing them provides a sense of dominance. The more time we spend in that positive state, the less time we have for negative self-talk, which he regards as a type of submission. Not surprisingly, his recommended treatment for depression is to spend more time on our pastimes — preferably on multiple pastimes that traverse the six aforementioned areas.

Establishing (or re-establishing) a genuine connection with even one person, where you feel valued and understood, is often the lifeline out of a depressive episode.

Activities that induce a flow state make for some of the best pastimes. When in the flow state, you are immersed in an activity such that your mind stays centered on it and doesn’t wander. You are enjoying the activity, probably perform it fairly well, and find it highly rewarding even if it requires considerable effort. Time may appear to go by faster or (less commonly) slower than normal.

Researchers have found that flow state activities improve self-esteem, life satisfaction, and feelings of fulfillment.²¹ Flow state activities can be physical, intellectual, social, or passive. It can be watching sports, gaming, gardening, going for walks, affection… anything that fully captures your attention. Activities in which you are skilled, and those on the more active side, are more likely to provide an experience of flow.²¹

Don’t dismiss the importance of recreation as one of your biggest weapons against depression! It may not hold much appeal to your pride or intellect, but it is an important element in mental health well-backed by evidence. A large University College London study found that taking up a hobby lowered the risk for depression by 32% and improved the chances of overcoming depression by 272%.²²

Leisure activities are just as important for Type A folks. If you like to be productive, you can choose productive hobbies like learning new skills, watching documentaries, or beautifying your home. If you hate sitting still, there are no shortages of physical hobbies that also provide you with endorphin-boosting exercise. Don’t let your depression convince you that any interest of yours is stupid or futile. That’s your inner bully talking, not you.

Depression and social isolation have a bidirectional relationship.²³ For some people, inadequate socialization/connection is the main cause of their depression. For anyone, depression can breed self-isolation which, in turn, exacerbates the depression.

When it comes to socialization, quality is more important than quantity. Being around people that you like and who like you is what you want. It is easy to feel isolated even when you are around others if you have little affinity with them or are not treated well. The solutions to feeling isolated are not always easy to implement, but it is important to recognize that depression breeds in the absence of regular, positive social interaction.

Psychologists view connecting with others and receiving emotional support as essential elements in overcoming depression. It doesn’t matter how you became depressed. Perhaps you are blessed with a big, close family and social circle. You may not be used to discussing your feelings with others but now you have the need to do so.

You may continue to hang out with your friends but feel increasingly distant emotionally. Establishing (or re-establishing) a genuine connection with even one person, where you feel valued and understood, is often the lifeline out of a depressive episode. The person could be a friend, romantic interest, family member, or counselor.

Everyone has different social needs and preferences. Some sad people just need to go out more with their existing friends to return to mental health. They may even have a serious depression yet more time spent socializing is all they actually need to get out of their head and short circuit compulsive negative thinking. There are also people who ruminate little but feel intensely lonely and require a deep connection with one person to make them feel well again.

Social connection fights depression in a number of ways. Most obviously, it is a cure for loneliness. However, it works in many other ways as well. To one person with low self-esteem, going out more often will allay her thoughts of being a loser. To another person, the sensory and cognitive activity involved in conversation is enough to break him out of his negative internal dialogue. Others need to talk to someone about their problems and receive considerable empathy before they are ready to let go of their depressed state.

Socialization can also affect depression indirectly. For instance, stress is a contributor to depression for many people.²⁴ Being able to relax and laugh can provide considerable stress relief which indirectly mitigates their depression.

Diet and nutritional status are related to depression.^25,26,27,28 A number of nutrients are known to increase risk for depression when in deficiency: omega 3, vitamin D, vitamin B6, vitamin B9 (folate/folic acid), vitamin B12, zinc, magnesium, selenium, iron, and calcium.^27,28 Ensuring adequate intake of these nutrients can help in preventing and treating depression.

It may not surprise you to hear that depression is associated with a poor diet. While that association is predictable, the direction of causation is not. Diminished willpower comes with depression, so it isn’t hard to see how depressed people tend to favor comfort food. However, there have been a few studies in recent years suggesting that healthy diets can prevent or treat depression.

Current medical advice on diet typically recommends a ‘Mediterranean diet.’²⁹ This means a diet high in vegetables, fruit, whole grains, healthy, unsaturated fats, and possibly fish. It entails less processed carbs, meat (except fish), high-fat dairy, and saturated fats. A 2022 systematic review of depression and diet concluded that a healthy, vegetable-laden diet lowers the risk of developing depression compared to a less healthy, or pro-inflammatory (high in processed carbs, meat, and dairy) diet.²⁶

A 2015 review article in Cellular Physiology and Biochemistry cited 20 prospective studies which indicated that healthier, less processed diets lowered the risk of developing depression.³⁰ There is also some evidence that diet changes can reduce depression. A 12-week trial of people with clinical depression found that adopting a healthy Mediterranean diet lowered depression scores by 20 points, compared to 6 points in the control group which made no dietary changes.^30,31

It is very hard to be disciplined with your diet (or anything else) when you are depressed. But as with any lifestyle change, you can try taking one small step at a time. You can start off by no longer buying your least healthy staples. Then you can start buying more frozen vegetables and add a small amount to whatever you are already eating. Once you make a habit out of including more veggies, you can take further incremental steps to improve your diet.

A 2010 meta-analysis of 17 trials of massage therapy for depression found that all trials demonstrated efficacy. The authors concluded that massage significantly reduces depression with intervention groups having a 73% greater reduction in depression scores than control groups.³² A meta-analysis of massage therapy for pregnant women reported a moderate improvement in both depression and anxiety.³³

A number of theories speculate on the reasons for massage having an effect on depression. One theory postulates that a reduction in the hypothalamic pituitary adrenal axis is responsible for the improvement in mood. The reduction causes stress hormones, heart rate, and blood pressure to drop, which raises parasympathetic (your ‘calming’ nervous system) activity. Other possible mechanisms include the increase in oxytocin or serotonin caused by touch or the common factors between massage therapist and client — not unlike in counseling.³²

The evidence for massage therapy reducing depression has some caveats. Many studies used an intensive number of sessions (i.e., 3 per week) that is unrealistic in the real world due to cost and the inconvenience of going to a massage clinic. The studies also did not have follow-ups, so the duration of effects are unknown.³²

At least 80% of people with depression don’t get enough sleep. The link is likely bidirectional.³⁴ Depression causes people to lose sleep and lack of sleep is probably not good for your depression.

Good sleep hygiene can reduce preventable sleep loss. Going to bed around the same time everyday, no screens or big meals within an hour of bedtime, and limiting caffeine in the evening are examples of good sleep practices.

Unfortunately, improving sleep quality and quantity has limited tractability. Sleep hygiene practices often make little difference. Sleeping pills may work in the short-term but carry the problems of dependency and loss of effectiveness with time.

Thoughts and feelings form a cycle, with each affecting the other. When we think about unpleasant things, we often become angry, worried, or sad. When we think about positive things, we tend to feel more happy. Causation also works the other way. For instance, we may feel sad for no reason, with no negative thoughts present. That sad feeling will make it more likely for us to start thinking about depressing or unhappy things. Needless to say, once we delve into those depressing thoughts, our sad feelings will become even worse and a depressive cycle ensues.

Cognitive strategies aim to throw a wrench into the depressive thought-feeling gears. Since it is nigh impossible to forcibly make yourself feel or stop feeling an emotion by sheer willpower, cognitive strategies focus on the thinking portion of the thought-feeling cycle. Controlling what you think isn’t always much easier than controlling how you feel, but with experimentation and practice of the following strategies, many people have found that they have been able to lessen their depressing thoughts and reverse the depressive thought-feeling spiral.

Reframing is a form of harm reduction. We can’t stop those negative thoughts from popping up, but we can, hopefully, make those same thoughts less potent. Reframing is about looking at the same thing in a way that makes us hurt less.

Let’s say you keep thinking about how a bully at work insults you. Your hurt feelings stem from the injustice of being treated badly and worry that those insults could be true. Challenge them. Maybe none of the insults are true. Maybe your coworker just insults everyone because he likes how it makes him feel.

If you reframe the situation differently, it will hurt less when you think about it. In this instance, you may realize that you haven’t heard the same insults from others, so your coworker is just a bully who’ll say anything to hurt someone. Reframing it that way should make the thoughts of the insults hurt less when you think about them.

Continuing with the example, if you still feel hurt from the workplace abuse, you can further reframe the situation as being one of professionalism. You are much more professional than your coworker and won’t go down to his level when he harasses you. Now your thoughts about the situation center on how you are a good, professional worker — that should make you feel considerably better than the original narrative of inadequacy.

If negative thoughts about yourself have been bothering you, it can be immensely helpful to make a mental list of evidence against each criticism. For instance, if you sometimes feel like you ‘can’t do anything right,’ put some time aside to make a list of small things that you have accomplished and times when others have recognized them. Now whenever those thoughts of low self-efficacy arise, you can throw that list at them immediately and reclaim your power.

If we can short-circuit our mind running off with negative thoughts, we can put the brakes on the pain that comes with them. Make an effort to notice when you feel depressed. What are you thinking about? Probably something depressing. If it is not something that you need to think about at the time, then there will be no consequence to thinking about something else, correct?

Intentionally stopping negative thoughts and only thinking happy thoughts is next to impossible. What you can do is notice when your mind runs away with depressing thoughts and try to smash that snowball before it gets even bigger. There are a number of mental tricks that basically do that.

Deep breathing: Put your attention on your breath. Take slow deep breaths, with the exhalation longer than the inhalation: at least 4 seconds for the inhalation and 6 seconds for the exhalation. This often takes your attention away from your runaway thoughts while the breathing itself activates the parasympathetic nervous system, which has a calming effect, physically and mentally.

Getting results out of individual or group counseling is mostly about putting in the effort and having a good fit between you and the counselor or group members, respectively.

Focus on your senses: Your five senses provide an excellent way to redirect your thoughts. To get out of your head, focus on your hearing senses as much as you can. Identify the different sounds that you hear or home in on one in particular. By listening as carefully as you can, even if the only sound you hear is your refrigerator running, you can take your attention away from your negative thoughts. You can do a similar exercise for any sense. For example, you can look around you and visually identify five objects.

Om japa: Japa, or repetition of a mantra, can be an effective way to take your attention away from negative thoughts. “Om” is a mantra that has been used for thousands of years in India. When you feel a negative emotion, imagine a beam of healing love coming from in front of you into where you feel the emotion. Mentally chant “om” while this love beam goes into and dissipates the emotion. You can imagine the om beam as coming from God or the universe, as per your personal beliefs, but concentrate on how the beam is healing, unconditional love.

Redirecting your attention can be a double-edged sword. In order to practice a distraction or redirection technique, you need to notice that you are having negative thoughts. The problem is that if you monitor your thoughts too much, your problem thoughts often increase paradoxically. To demonstrate this concept, suppose I asked you not to think about how much tax gets taken off of your paychecks. You probably will think about how much money you pay in taxes more than usual, right?

It’s the same thing with thought monitoring. You want to be able to catch yourself in a negative thought episode before it drags on for hours, but you don’t want to be so eager to monitor for negative thoughts that you end up exacerbating them. Attention redirection is a delicate balancing act.

Counseling, or psychotherapy, has helped many people overcome depression. A very large meta-analysis from 2021 calculated a 41% rate of response to depression. The paper also estimated that 4 people needed to have psychotherapy for one person to have a 50% or more improvement in symptoms.^35,36

An interesting characteristic of counseling is that effectiveness is relatively unrelated to the type of counseling.³⁷ This peculiar finding has given birth to the common factors theory of counseling. According to this theory, success in psychotherapy is less about techniques and more about the factors that can be present in any type of counseling, such as developing a bond with the therapist or expressing one’s emotions.³⁸

This page lists many techniques that you may learn in counseling. Seeing a counselor is expensive with rates for counseling in high income countries averaging in the $100 to $200 range for a 50-minute session. If all you want is mental health knowledge, it is much cheaper to utilize free online resources and low-cost e-books. The power of counseling is not in the information imparted, but in the relationship with the therapist and commitment to the process.

Neither education nor experience are related to outcomes in psychotherapy.^39,40 A counselor with 6 months experience who has taken a week-long course produces as good outcomes as a Ph.D. in counseling psychology with 30 years experience.

Besides the lack of difference in the effectiveness of modalities (i.e., CBT, psychodynamic, expressive-supportive), this is another reason why many researchers feel that common factors are more important than techniques in psychotherapy. Getting results out of individual or group counseling is mostly about putting in the effort and having a good fit between you and the counselor or group members, respectively.⁴¹

Willfully stopping thinking thoughts that bother you and intentionally thinking only happy thoughts is not likely to work. If it were that easy, everyone would do it all the time and no one would ever feel unhappy. A somewhat less direct approach can be useful, though. If we don’t try to control our thoughts but are intentional about focusing on a few positive things, fewer negative thoughts are likely to arise.

For instance, you can select three things in your life for which you are really grateful. It could be a good quality that you have, someone awesome in your life, good fortune that you have experienced, or a future trip that you are excited about. Try to remind yourself of them a few times a day, and you may notice that your negative thoughts come up a little less.

Focusing on positive things involves recognizing cues that trigger your negative thoughts. When you are having a period of negative thoughts, think about what precipitated it. It could have been incited by your thoughts alone or it could have another cause. For example, social media companies are known to intentionally fill users’ feeds with negative content to make them miserable. Their analytics have revealed that the more miserable the person, the more time they spend on their platforms. The same tactic is used in the news industry. If you can identify a few mental health offenders, you can take steps to avoid them.

Another way to positively direct your mind is to intentionally notice positive things. If you are bogged down in traffic, for instance, it is easy to get stressed out. Take the time to notice the good things around. You may see some beautiful trees or elegant houses. You may check out a cool vehicle on the road or tell yourself how great that cool air conditioning coming out of your dashboard feels.

Due to biological evolution, humans are hardwired to notice and think extensively about the negative. Noticing and mitigating threats is how our species has survived since cavemen times. It therefore takes a bit of an internal push to get oneself to start noticing, and even focusing on positive, non-threatening things.

Positive orientating can be done in any circumstance. If you are at the gym and find yourself angry at someone with bad gym etiquette, take a moment to look at the others in the gym. Don’t many of them have great gym etiquette?

Your roommate may drive you mad by not picking up after herself, but maybe she is a model roommate in other ways. Rather than excessively thinking about her messy vice, you could take notice of how she makes so little noise in her room or how she never loses her temper. Notice an overlap with reframing? In this situation, your roommate problem is mentally mitigated by reminding yourself of the good aspects of having her live with you.

While stopping negative thoughts out of sheer will doesn’t often work, there are a few cognitive tricks that can stop a negative thought train. Mental distancing involves recognizing that your negative, destructive thoughts are invalid and don’t represent the real you. The negative inner voice is not you and you should not listen to it.

Psychologist Stephen Hayes, inventor of acceptance and commitment therapy, refers to this voice as the inner dictator. I call it the bully in the brain. When experiencing negative thoughts, remind yourself that those thoughts don’t come from the real you. You have a bully in your brain who loves to torment you, degrade you, and have you think about anything that makes you upset for as long as possible. Rather than listen to this devil on your shoulder, take a stand against him.

Ironically, refraining from getting mad at the inner bully tends to get the best results. Just say to the bully, “Thank you. Have a nice day.” politely and firmly like you are trying to get rid of a coworker who likes to bother you while you remain professional. By recognizing your negative thoughts as separate from you, you can distance yourself from them. When you distance yourself from an episode of troubling thoughts, those thoughts are more likely to dissipate.

In order for our species to survive, we have evolved strong skills to identify and focus on threats. When you have negative thoughts, there is nothing to worry about — your brain is working how it should from an evolutionary perspective. Hold this in mind when the bully in your brain bothers you. Knowing that your mind is working well aids in rejecting the inner bully’s words while not getting angry at him or her.

There are many techniques to distance yourself from negative thoughts. Recognizing bad thoughts as coming from your inner bully is one way. Each method has in common the recognition that the thoughts are harmful, unnecessary, and are not really from you. The thoughts are merely products of a human brain that has had to evolve to prioritize survival over mental well-being.

Your mind is like a Chinese finger trap. The more you struggle with it, the tighter its grip on you becomes.

In another distancing technique, relate to your bad thoughts as cars driving by or leaves floating down a stream. Imagine each car or leaf as a negative thought and watch them as they drive or float away, respectively. One simple but effective strategy is to say to yourself “I am having the thought that…”, for each negative thought. Just telling yourself that it is a thought spurs mental distancing.

Experiment and make some of your own. See which work the best. You don’t need an ability to visualize. Just think of the concept (e.g. of thought-cars driving by you). If your mind visualizes a little bit automatically, that is great but not necessary.

Many people have found that negative thoughts are more likely to drop away if they take a paradoxical accepting position about those thoughts. Of course, no one likes to be plagued with troubling thoughts. Don’t listen to the celebrity psychologists that seek to shame people into embracing and loving their negative thoughts. They are charlatans that have successfully used the same brainwashing techniques of cults and religions to become rich and famous. They do not care about you. They care about selling their overpriced books.

It happens to be the case that negative thoughts tend to increase the more we hate them and desire to be rid of them. Conversely, the less you care, the more likely they are to go away. Hence, putting in an effort to, not necessarily like, but accept negative thoughts makes it easier to get rid of them. It doesn’t need to be sincere. Everyone is bothered by bothersome thoughts and would like to be free of them.

Somehow applying a conscious effort to not react to your negative thoughts, but accept them and not feel desperate to be rid of them, tends to result in those thoughts decreasing in frequency and intensity. It is a skill you can practice and improve with time.

A few things can help with the acceptance approach to negative thoughts. Recognize that negative thoughts are natural. As previously mentioned, this is how our species has survived for hundreds of thousands of years. A caveman who never worried about anything wouldn’t have been diligent in avoiding threats and would be more likely to die younger.

Modern people need mental safeguards, too. If I have no fear of getting fired, it will be easy for me to not work hard enough, and I may end up getting fired as a result. Acknowledging your negative thoughts as demonstrating that your brain is working properly can help your mind accept, and consequently, release them.

Your mind is like a Chinese finger trap. The more you struggle with it, the tighter its grip on you becomes. Consider the metaphor of a struggle switch. When you feel a negative emotion, it is like a struggle switch or alarm is activated in your head. Your mind has identified a threat and immediately begins battling against it. When you struggle against your emotions or thoughts, you become angry, anxious, and ashamed as you inevitably lose the struggle.

Now your mental problems are multiplied. Besides the original negative feelings, you now also have meta-thoughts (thoughts about thoughts) and meta-feelings (feelings about feelings) that are often worse than the original negative thoughts and feelings. But if you turn off that struggle switch in your head, the negative metacognition will go away and most likely it will help the original offending emotion to go away as well.

Limited research suggests that it is easier to overcome your mental problems when you utilize your personal strengths.^42,43,44 How easy it is to forget you even have strengths or good qualities when you are in the grips of depression!

Utilizing strengths begins with giving yourself a thorough assessment of your strengths. Strengths include methods that you have successfully used to overcome mental and other problems in the past. They include positive qualities and skills that you have already developed or have the potential to develop. Situational or social resources can also be strengths.

A past coping method could be your good use of words to resolve a conflict you had with someone. Perhaps your current depression is related to a bad relationship. If you have the gift of gab, you could use that to resolve it.

A positive quality or skill of yours could be the ability to deeply engage in something you are doing. Depression tends to revolve around negative thinking, so if you have pastimes that get you into a flow state, they can help break the negative thinking cycle. A situational or social resource could be a fun friend of yours that you really like to hang out with. Maybe you haven’t seen her in a long time and seeing her again could lift your spirits.

Strengths don’t need to be pre-existing, although that is where you should start. You can develop skills and abilities at any age. Perhaps you are an introvert who is depressed due to social isolation. If you feel that lack of social skills is an impediment to your social life, working on your social skills could result in an improvement in your mental health.

Harnessing your personal strengths often entails a positive approach that doesn’t directly target your symptoms. However, the negative and positive approaches to depression are not mutually exclusive. You can use positive, personal strengths along with direct methods of dealing with negative emotions. Don’t let your depression convince you that you are weak and useless. With some self-assessment and self-prompting, you will realize that you are actually strong and resourceful.

Supernatural or religious beliefs have been a part of human society for possibly over ten thousand years.⁴⁵ Most people in the world today are religious.⁴⁶ Many people who identify as non-religious, or even atheist, also hold strong views about how the unseen universe works and what happens after we die.

Formal religions and informal personal supernatural beliefs are themselves psychosocial coping mechanisms. That’s why they have been so popular for thousands of years. Belief in justice in the afterlife helps us deal with the injustice we witness in our lives. Believing in a spiritual benefit to suffering and hardship helps people cope with their pain by injecting a dose of meaning.

Perhaps the belief or meaning isn’t real, making the benefit akin to placebo. Objective observation demonstrates that very few people are interested in the truth about anything. People are only interested in making their lives psychologically easier, whether by reality or fantasy.

If you are depressed, you may benefit from religion in a number of ways. Religions often focus on positive things like how much God loves you and how you have eternity in heaven to look forward to after death. By putting your attention on these positive, uplifting beliefs, you are taking attention away from your disturbing thoughts and feelings.

The more we love ourselves unconditionally like we love our children and romantic partners (in the best moments), the better will be our mental health.

Another way religion can aid depression is through imputing meaning. No one wants to think their suffering is for naught. It is human nature to want to believe that there must be some benefit to our pain. Most religions, therefore, apply a positive approach to suffering, such as the claim that it makes you a better person or reduces your bad karma so you can have a better afterlife. Telling yourself these things when dealing with negative emotions can bring significant relief.

You don’t need to be a card-carrying Christian or Muslim to take advantage of the benefits of religion to your mental health. You can come up with your own spiritual beliefs that help you cope or research what independent thinkers have written.

The lens of meaning can help with your depression whether it includes a supernatural component or not. For example, one could interpret the financial-related depression as a sign of being too money-focused or social isolation as an opportunity to spend time re-examining your life goals.

How good would everyone’s mental health be if they loved themselves like they loved their romantic partner or young daughter or son? Harsh, critical self-talk is a big contributor to depression. For whatever reason, it is very hard for people to love themselves as much as they can love someone else. The more we love ourselves unconditionally like we love our children and romantic partners (in the best moments), the better will be our mental health.

It is not uncommon for a depressed person to basically hate himself or herself. There may not even be logical reasons behind it. Depression can get a person thinking extremely negatively about himself, often to an unreasonable degree. Any negative thoughts about yourself you should challenge. Think about evidence and reasons to reject them. Often, they hold no basis.

You may think you are a loser when many things indicate that you are in fact a really good person that a lot of people respect. If the self-criticism doesn’t hold up to scrutiny, reject it and acknowledge that it is just nonsense from the bully in your brain.

With increased love and compassion for ourselves, we will be less critical of ourselves in our heads. We will also have greater acceptance for our mental state. If you love yourself, you won’t feel ashamed or inadequate because of the negative feelings you experience. As bad as they are, those negative feelings are natural. Everybody has them.

There are different ways to develop self-compassion. Visualization techniques and meditation exercises can be found online. One good technique is to imagine yourself as a young child. Imagine yourself walking up to her and talking to her. Notice how she is so innocent and precious. Think about how much you have suffered lately and how it is that little girl who is enduring it. Does she deserve it? Or will you forgive her for imperfections and want to protect her? Would you say to her the same harsh things that you say to yourself in your head?

Most important is not a specific technique but your attitude. Hold to the idea that you are a valid, special person who deserves to be happy as much as you have desired someone that you’ve loved to be happy. With that attitude, harsh thoughts and feelings about yourself should diminish.

Developing one’s curiosity has many potential advantages for someone dealing with depression. Withdrawal from social and leisure activity is common in depression. When interest in doing anything has waned, it can be very difficult to get it back through sheer willpower. However, curiosity may offer an easier alternative. While it is hard to make yourself feel like doing something, it may not be very hard to find a few things that at least spark your curiosity. If nothing currently interests you, take a few minutes to think about what you find intriguing or what you always wanted to try or learn.

You may be able to resume the same activities that you used to enjoy by finding something about each that makes you curious. For instance, you may not feel like going to the pub on the weekend anymore but end up going because you are curious if they still play the same music or have the same happy hour menu.

Curiosity can be just as advantageous cognitively. Being curious about what is happening around you at the moment is grounding and discourages runaway thoughts. Someone who is curious about many things, or considerably curious about just one subject, will tend to think about those interests frequently, leaving less time for the mind to wander.

Curiosity can also help manage negative thoughts. Shining an inquisitive light onto your thoughts like a researcher may make it easier to identify destructive thoughts and subsequently dissociate from them. Curiosity could potentially make it easier to test self-critical thoughts for validity and reframe negative memories. When feeling curious about your mind’s workings, you may be less inclined to take thoughts at face value and more easily recognize them as unconstructive and separate from yourself.

Improving mental health is necessarily an activity of experimentation. Since no single technique works for the majority of people, everyone must experiment with different methods and variations of a method. Being curious about how your mental health is affected could empower you to experiment with various ways of improving your well-being.

Identity is a fascinating concept. For some reason, human beings are obsessed with their self-image. Everything we think and do is driven by our self-concept. When depression becomes chronic or recurring, it often gets incorporated into our identity. This is something to avoid. The nature of identity is to self-perpetuate. Thus, if a mental issue is part of your identity, you will be inclined to perpetuate that issue, knowingly or unknowingly.

One way that happens is by the actions that we take. People tend to behave in ways that align with their identity. If you think of yourself as ‘someone with depression’, therefore, you will tend to act as you would expect a depressed person would act. For example, you may not try to rein in your depressive thoughts because you feel like you’re a depressed person and ruminate is what depressed people do. Believing depression is who you are will impede you in taking ownership of it.

A mind can become beholden to a destructive identity. What we think about throughout the day tends to serve our identity. If I think of myself as a funny guy, I will make jokes in my head frequently. If I think of myself as religious, I will think about my religion a lot. If I think of myself as a depressed person, I will likely have more depressing thoughts than if I did not think of myself that way.

It is normal to have emotional difficulties. People keep up a happy public face to avoid judgement but there are always other depressed or mentally troubled people in the room. Why should something common and temporary define you?

Above are a number of cognitive strategies to help with depression. You can combine cognitive strategies with each other and with lifestyle and medical strategies. Everyone’s path to emotional wellness is unique. The way you implement each strategy and how you combine strategies for optimal results will be different from others.

Experimentation is always required. You may find that certain techniques of redirecting attention work for you while others do not. For some people, lifestyle or medical methods work better than cognitive ones. Behavioral and cognitive methods may start working immediately, or they may require weeks or months of practice before getting results.

For a depressed person, it can be intimidating trying any one of these methods. If you walk your mental wellness journey slowly and make one small change at a time, you are more likely to keep up with it.

Disclaimer: Any medication, drug, herb, or medical procedure can have side effects. Psychelics carry major risks not mentioned in clinical trials including overdose, panic attacks, and nightmarishly bad trips. Do thorough research for yourself on the potential side effects for the specific product or procedure that you are considering. Do not rely on your doctor or pharmacist for informed consent. Effectiveness and side effects vary greatly from person to person.

The brain is indistinguishable from mental health and consciousness. Anyone who has taken a recreational drug, including alcohol, understands that firsthand. Even when the original cause of the depression is from a negative life experience or thinking pattern, those experiences and thoughts can alter the structure and activity of our brains for years.

The paths into and out of mental disturbances are many. The mysterious character of the brain and mind mean that the paths out are not necessarily the same as the paths in. It is not uncommon for people to have no success with cognitive and behavioral methods, but to see a meaningful difference with medical means. Sometimes, the cognitive and behavioral methods do work for an individual, but only when he or she is on a herb or medication. The medical intervention, in that case, improves the depression to a stage where it is more responsive to lifestyle and thought-based treatment.

Psychedelics have shown strong potential for mental health in recent years but have not yet become widely accessible.

Around 40% of people notice a benefit from the first antidepressant they try.

Prescription medication is a common form of treating depression. Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), collectively called antidepressants, are the most common. Many people have strong feelings for or against antidepressants whether they have tried them or not. Decisions regarding antidepressants, like all decisions, should not be based upon political correctness, but on an assessment of the benefits against the risks.

Meta-analyses have discovered that approximately net 20% of subjects on an antidepressant notice an improvement in their depression (40-60% of subjects receiving antidepressant vs 20-40% for placebo).⁴⁷ 20% to 30% of antidepressant users experience remission.⁴⁸ There is wide variation in effectiveness and tolerability among the individual drugs.^49,50 In general, the worse the depression, the better the results from taking an antidepressant.⁵¹ This class of drugs does relatively little for mild depression.⁴⁷

It takes about six weeks to receive the full effects of an antidepressant, although improvement is often seen in the first week.⁵² Around 40% of people notice a benefit from the first antidepressant they try.⁵³ Frequently, a depressed individual will try a few different antidepressants before she settles on one that helps her depression without excessive side effects. In clinical trials, combining medication with counseling generally has better outcomes than medication alone.⁵⁴

Antidepressants have many side effects. The most effective ones tend to have the worst side effects. Weight gain, drowsiness, nausea, and sexual downsides are among the most common side effects. Serious adverse reactions can also occur. Antidepressants are not considered addictive but many people use them for years at a time, even if they are not currently depressed. Risk of relapse is 27% lower when on antidepressants relative to placebo (50% vs 23%).⁵⁵

Side effects can last for many months after discontinuation. Withdrawal effects are also significant and long-lasting, especially after long-term (i.e., over 2 years) use. Approximately half of people who reduce or discontinue use of an antidepressant experience withdrawal effects.⁵⁶ In most cases, the effects last a number of weeks, but they can also last months or years.

Withdrawal effects may include the same ones experienced while on the medication. There are also many withdrawal-specific effects such as irritability, flu-like symptoms, and anxiety.⁵⁶ A 2025 survey of antidepressant discontinuation in primary care found that 79% of patients had withdrawal symptoms, one-fifth of whom experienced them for over 3 months.⁵⁷

Withdrawal was so significant in this survey that many people chose to resume their antidepressants than deal with their withdrawal symptoms. The survey researchers stated that 40% of patients who took antidepressants for 7-24 months and 80% of those who used them for over 2 years were ‘unable to stop the medication.’ Nearly one quarter of patients on antidepressants for 6 months or less were also unable to stop. Clearly, withdrawal symptoms and an inability to discontinue use should be taken into consideration before beginning a medication.

For the elderly as a class, antidepressants have lower efficacy and greater side effects than for younger adults.⁵⁸ In a 2019 meta-analysis of antidepressants in the elderly, researchers concluded that over the nine trials evaluated, the drugs did not statistically perform better than placebo.⁵⁹ A 2023 systematic review of antidepressants in seniors found that 4 of the 10 included studies showed no significant benefit for depression response or remission.⁵⁸ Thus, it is particularly important for seniors to experiment with cognitive, lifestyle, and herbal strategies for depression before taking the SSRI plunge.

This class of drugs is not good or bad. Despite the cost and side effects, many people find that SSRIs/SNRIs are worth taking. Antidepressants are usually administered by a primary care physician. Some depressed individuals find that the pills give them the boost they need to do other things to improve their mental health (i.e., counseling, lifestyle changes).

On the other hand, there are those who depend on antidepressants as their sole means of managing their depression. People in the latter group may be enduring side effects unnecessarily considering that they may be able to achieve equal results with herbs and/or cognitive-behavioral changes.

Depression has been linked to chronic, systemic inflammation. Depressed individuals are more likely to have indicators of inflammation than non-depressed individuals.⁶⁰

If inflammation is the cause of depression for an individual, the cure should theoretically involve treating the inflammation. While this cytokine hypothesis has been around since the 1980s, currently there is no established protocol to treat depression using anti-inflammatory medications.⁶¹

There have been at least 20 meta-analyses which have assessed trials of anti-inflammatories on depressed participants. In the majority of trials, the anti-inflammatory investigated (usually minocycline or celecoxib) had outperformed the placebo pill in improving depression symptoms.⁶² Anti-inflammatories have shown efficacy in trials whether taken alone or in conjunction with antidepressants. It must be noted that depressed individuals are only expected to see an improvement with an anti-inflammatory if they have systemic inflammation along with their depression.

A 2022 systematic review of meta-analyses on anti-inflammatories for major depressive disorder concluded that they were generally effective and well-tolerated as a treatment.⁶² In this sweeping paper, celecoxib performed particularly well, showing clear efficacy in every meta-analysis. This class of medication looks promising as both a depression monotherapy and an adjunct medication for antidepressants.⁶¹ However, anti-inflammatories are not commonly prescribed for this purpose nor included in major guidelines for depression.⁶³

Antipsychotic medication is sometimes prescribed for major depression. If you are still depressed after trying antidepressants, you may be prescribed an antipsychotic by itself or (more commonly) in conjunction with an antidepressant.

There is a growing body of evidence that antipsychotics can mitigate depressive symptoms even when no psychosis is present.⁶⁴ This drug class can have considerable side effects including weight gain, sedation, extrapyramidal symptoms (involuntary movements), cardiac irregularities, and an increased risk of developing diabetes.⁶⁵ Research each individual drug yourself before trying it.

Two trials on aripiprazole found that it improved remission rates over an 8-week period relative to placebo.⁶⁵ Remission in the intervention groups were 25.4% and 26.0%, respectively. The control arms had remission rates of 15.2% and 15.7%. A pooled analysis of extended-release quetiapine found the overall remission rate to be 46.3% with the placebo rate at 32.0%. Unlike antidepressants, the efficacy of the various antipsychotics used for depression seems to be similar across the board.^65,66

There is disagreement on the extent to which antipsychotic medication should be prescribed for depression. A 2017 review of clinical practice guidelines for major depressive disorder reported that 7 of the 14 guidelines recommended their use alongside antidepressants, 2 guidelines recommended against them, and the remaining 5 guidelines did not offer clear advice on their use.⁶⁷ A 2013 review of antipsychotics in depression recommended trying at least one alternative (i.e. cognitive or lifestyle) strategy for depression after the first antidepressant prior to considering adding an antipsychotic to the mix.⁶⁸ Usually, antipsychotics are not prescribed until at least two antidepressants have failed to manage depressive symptoms.⁶⁵

Herbs have been used effectively in the treatment of depression. A meta-analysis of individual herbs used in depression found that 45% of them conferred a good response while carrying less side effects than prescription antidepressants.⁹⁹ Herbs assessed in the paper included saffron, black cohosh, chamomile, lavender, chasteberry, and passionflower. In clinical trials for depression, the groups taking herbs did not report more side effects than the placebo groups, underscoring their high level of safety.

Some papers on herbs for depression have found the efficacy indistinguishable from prescription antidepressants, such as fluoxetine (Prozac).¹⁰⁰ Herbs are relatively cheap and easy to access over the counter. However, like antidepressants, they can take a few weeks to start working.

A 2022 review recommended that saffron should be used as a first line treatment for depression due to its efficacy approximating that of SSRIs while carrying higher rates of adherence than SSRIs.

St. John’s Wort

St. John’s Wort (Hypericum perforatum) has been studied and used for its antidepressant properties more than any other herb. It has very little side effects and many studies have found its efficacy on par with prescription antidepressants. Full effects take about 2 to 6 weeks to materialize.¹⁰¹

A 2016 systematic review concluded that St. John’s Wort was equally effective to antidepressants, but with less side effects.¹⁰² In the review, average response rates for SJW was 56%, with placebo rates at 35%. Remission rates versus an antidepressant were also calculated: 38% (SJW) vs 33% (SSRI) for follow up periods of 4 to 12 weeks.

A 2022 systematic review reported that most studies found SJW to have equal effectiveness to an SSRI (often fluoxetine), with some studies reporting SJW to have greater effectiveness.¹⁰³ The authors concluded that St. John’s Wort has similar effectiveness as fluoxetine (Prozac) in treating mild or moderate depression and likely has greater effectiveness than fluoxetine for major depressive disorder.

Considering the body of literature stating that this nearly side effect-free herb works as well as the most popular antidepressants, it is advisable to try it prior to prescription medications. In some countries, such as Germany, that has been common practice since the 1990s.¹⁰⁴ In fact, German doctors prescribe SJW for depression more often than any synthetic medication.¹⁰⁵ Don’t underestimate the power of the largest lobby in the United States to suppress natural health products!

Saffron

Saffron (Crocus sativus) is native to the Middle East, where it has been used in medicine for hundreds of years. There is clear evidence that saffron supplementation has a significant antidepressant effect. A number of trials have reported that participants taking saffron have experienced greater reductions in depression scores than those receiving a placebo.^106,107

Some studies have also included an arm receiving an SSRI and concluded that saffron reduced depressive symptoms to a similar degree as the SSRI.¹⁰⁸ Those studies had also noted that saffron’s antidepressant effects began after about one week, whereas the SSRI took at least 3 weeks to take effect. A 2022 review recommended that saffron should be used as a first line treatment for depression due to its efficacy approximating that of SSRIs while carrying higher rates of adherence than SSRIs.¹⁰⁸

Rhodiola rosea

Rhodiola rosea (RR), often called golden root or root, is commonly taken for mental health in Russia and China.¹⁰⁹ There are only a handful of peer-reviewed papers on the effectiveness of Rhodiola rosea for treating depression. Overall, they show that it has the potential to ameliorate depression symptoms modestly.

A 2020 systematic review of 5 studies on RR for depression concluded that it outperformed control groups. Of note, most of the gap between the control and treatment groups at the end of the studies were due to the control groups’ depression getting worse while RR groups’ symptoms remained about the same.¹⁰⁹ The authors stated that the results could mean that RR’s function in depression is largely one of prevention.

In 2009, a 6-week clinical trial of Rhodiola rosea for mild to moderate depression reported that subjects receiving RR had significant improvements in depression, insomnia, somatization, and emotional stability.¹¹⁰ The control group did not experience improvements in those areas. From these few studies, we can see that Rhodiola rosea supplements have the potential to modestly improve depression or prevent depression from getting worse.

Chinese Herbal Combinations

With a number of herbs reputed to have antidepressant properties (often through different mechanisms), it would seem plausible that combining them could have an additive or synergistic effect. In the West, research into the antidepressant effects of herbs has almost always investigated only one individual herb per trial. However in China, where medicinal herbal combinations have been used since ancient times, such trials have taken place.

A 2024 meta-analysis looked at 198 clinical trials on common Chinese herbal medicines for treating depression.¹¹¹ It found that they outperformed synthetic antidepressants in both efficacy and safety. Of the 17 combinations assessed, Chai Hu Shu Gan San, Xingnao Jieyu Decoction, and Xiaoyao Powder showed the largest reductions on the depression scale. This paper built upon a 2023 meta-review of five systematic reviews of clinical trials for Chinese herbal combinations.

That publication deemed the herbal preparations to have equal effectiveness to antidepressants, with fewer side effects.¹¹² A 2019 paper assessed 18 clinical trials of Chinese herbal preparations for depression in cancer patients. It found that the preparations were much more effective than placebo in relieving depression and borderline more effective than synthetic antidepressants.¹¹³ Studies have repeatedly found that adding Chinese herbal combinations to a prescription antidepressant regimen not only improved the antidepressant’s effectiveness, but also lowered its side effects.¹¹²

Almost all of the clinical trials on Chinese herbal combinations for depression have taken place in China. It is therefore possible that the researchers (and participants) had a bias for these traditional Chinese remedies over Western-developed synthetic drugs. However, Western pharmaceutical clinical trials have themselves been criticized for being manipulated by the pharmaceutical industry. Any study can be biased. Only by personally taking a substance can you know if it will work for you.

Psychedelics have emerged as one of the most promising developments in mental health over the past few years. Their use is still in its infancy, however. To the best of my knowledge, only ketamine is currently prescribed for mental health in Western countries. Other psychedelics have shown promise in the research phase.

A 2023 systematic review of psilocybin combined with counseling calculated a pooled remission rate of 45% compared to 22% for placebo groups.

Ketamine

In some ways, the use of ketamine in depression treatment represents a major breakthrough. Studies have consistently shown IV ketamine to have excellent efficacy in immediately alleviating depression that has not responded to prior pharmacotherapy or psychotherapy.^69,70 The effect begins within an hour of the infusion and peaks at around 24 hours.^71,72 Ketamine is very effective and has little side effects.^73,74,82 However, mainstream adoption is plagued by open questions such as duration of effects, ideal route, ideal dose, affordability, and availability.

Most studies on ketamine for depression have employed IV infusions on participants with treatment-resistant depression. Approximately half the people had experienced a significant relief in symptoms (46%), generally in about an hour or less after the ~5 minute infusion. 27% have had remission of their major depression.⁷⁵

Some research suggests that effectiveness declines with age and is lowest in those over 75.⁷⁶ Follow-up periods have mostly been in the 1-7 day period. Efficacy has generally held during this timeframe.⁷⁷ However, ketamine is very expensive and is only available to U.S. and Canadian consumers in physician-supervised clinics. Weekly sessions of 4+ hours each is obviously not practical for many people.

Some ketamine trials have had one-month follow-ups. Those studies have generally found the antidepressant effects to have been mostly sustained.^71,78 Monthly sessions are obviously more practical than weekly sessions but can still be inconvenient. Affordability is very low. Public or private insurance rarely covers IV ketamine and out-of-pocket costs are often ~$1,000-$2,500 per dose.

During a ketamine session, you lose consciousness and have a psychedelic trip in the clinic. You may come to face your worst fears and memories. It sounds scary, but people often report that it is a profoundly healing and meaningful experience. Some people get months of relief from depression after one dose, whereas others need a series of doses before they experience substantial relief for a few months.

A 2022 study had one of the longest follow-up periods. Among those who responded well to the initial 6-dose ketamine treatment, 46.4% maintained the improvement at the 9-month follow-up.⁷⁹ A 2023 trial with a 12-month follow up found that ketamine effects lasted for 3 months on average and were basically gone by 4 months.⁸⁰

One form of ketamine, esketamine, is available via nasal spray. It is FDA-approved, so it could be partially covered by insurance. Some systematic reviews have placed its effectiveness for depression as equal to that of IV ketamine while others have stated that it is considerably less effective.⁸¹ Oral and subcutaneous ketamine have demonstrated effectiveness in studies but may not yet be available to the public.^82,83 A 2015 study postulated that the antidepressant effects of ketamine could be independent of route.⁸⁴

There is no standard for ketamine treatment of depression at present. The administration route is IV or nasal spray (and potentially subcutaneous or oral). Initial treatment may consist of one dose or up to 8 doses. Frequency of initial doses can be multiple times per week to every few weeks. Maintenance treatment may be absent, annual, monthly, or more frequently.

Ketamine may be one of the most effective treatments developed for treatment-resistant depression with approximately half of users experiencing significant relief. However, it currently has limited availability, extremely high cost, and unpredictable duration of effects.

Psilocybin

Psilocybin is the psychoactive component of magic mushrooms. It is considered to be a safe, side effect-friendly substance with psychedelic effects lasting 2-6 hours.⁸⁵ A number of studies show that a single dose can provide significant relief for depression, possibly lasting for one year or more. However, there are also studies which have not found psilocybin to be more effective than placebo.⁸⁵

Psilocybin is taken orally. Antidepressant effects commence a few hours to a few days after administration.⁸⁶ It has been used in psychiatric practices in the 1950s and 1960s when it wasn’t strictly regulated.⁸⁷  Psilocybin is considered one of the safest recreational drugs with almost no potential for a fatal overdose.⁸⁸ It has less side effects and potential for physical dependence than ketamine.⁸⁵ Another advantage is that if you acquire the mushrooms themselves, you know you are getting the correct drug with no toxic additives.

Most studies have demonstrated considerable effectiveness. A 2023 systematic review of psilocybin combined with counseling calculated a pooled remission rate of 45% compared to 22% for placebo groups.⁸⁷ The review found psilocybin to be well tolerated with drop-out rates similar to control groups.

A 2024 review reported that psilocybin had greatly outperformed control groups in clinical trials with twice (2.17) the rate of significant response and three times (2.96) the rate of remission.⁸⁶

There is currently no protocol for psilocybin treatment of depression.⁸⁵ Most clinical trials used only one or two doses. Trials using a second dose had somewhat stronger, longer-lasting effects.⁸⁵ 25 mg doses usually resulted in greater improvements in symptoms than smaller doses.^85,88

Duration of effects has not been conclusively determined. One study showed that the improvement in depression was maintained 12 months after a 2-dose regimen.⁸⁹ Another trial found that it took one week for the effects to begin, which were still significant after 3 months.⁹⁰ Other studies have placed the duration of effects at 2 to 6 weeks.⁸⁹

A surprising feature of psilocybin is that it appears to work best in the elderly. Seniors report having the strongest euphoric experience on the medication and have the largest reductions in depressive scores. This contrasts with SSRIs which don’t work as well in seniors as in younger age groups.⁵⁸

Psychedelics are a promising nascent treatment for depression. However, they can be extremely expensive, difficult to access, and there is potential for abuse. Frequency of dosing and duration of antidepressant effects can range from days to over a year. Side effects are usually acceptable as seen from the very low drop-out rates in clinical trials.⁸⁷ If SSRIs haven’t given you good results, or you don’t want their side effects, this class of drugs could be worth investigating.

Electroconvulsive therapy (ECT) has been used in psychiatry since the 1930s.⁹¹
It is still used occasionally for treatment-resistant depression. An ECT session involves approximately 5 to 10 minutes of electric currents delivered to the brain while under general anesthesia.⁹² The shocks induce a seizure which is believed to diminish depressive activity by altering brain chemistry.⁹¹ There is no consensus on the precise mechanism of action.

ECT has always been controversial. It is inherently aversive to give someone electric shocks. Modern ECT is far more precise and controlled than it has been in previous generations.⁹² Many psychiatrists consider it to be the most effective, ‘last resort’ option for major depression. It has worked well for many people with the most severe, intractable forms of depression.

In a meta-analysis from 2008, trial participants receiving ECT were calculated to have five times the rate of positive response than to a simulated (fake) ECT.⁹³ In ECT trials using antidepressants as the control group, ECT was found to have four times the rate of response.

Despite being the gold standard for intractable depression,⁹¹ ECT has many drawbacks. Initial therapy consists of 2 to 3 sessions per week for 3 to 4 weeks. Six sessions are the minimum to start seeing results.⁹¹ That requires considerable time off work and subjection to side effects (i.e. nausea, drowsiness, dizziness).⁹¹

Remission is common and often occurs soon after the initial course of treatment.⁹¹ One study found that both ECT and antidepressant groups had a 6-month relapse rate of 37%.⁹¹ Ongoing monthly or as-needed sessions are often required to maintain the benefit. Often, individuals end up going back on antidepressants once the ECT effect wears off. The treatment is also expensive and difficult to access, making it impractical for most.

Transcranial magnetic stimulation (TMS) is a non-invasive intervention that targets areas in the brain associated with depressive symptoms. Magnetic pulses target the dorsolateral prefrontal cortex through a special cap.⁹⁴ Like ECT, it creates small electric pulses designed to reset dysfunctional brain activity. However, it is done while awake and does not induce a seizure. It is used in people who have not responded to mainline depression treatment.

Clinical trials have shown TMS to be an effective depression treatment. A review of TMS meta-analyses in 2023 determined that response and remission had improved in the range of 62% to 78%, but cautioned that it appears to worsen depression in some people.⁹⁵ It tends to work better the more severe the depression.⁹⁶

Researchers disagree on the duration of effects. One study found that 90% of people who responded well to TMS maintained the effect 6 months later.⁹⁶ However, another paper stated that relapse rates are up to 70%.⁹⁷

Having TMS along with SSRI antidepressants results in significant reduction in depression over SSRI therapy alone. Interestingly, adding TMS to SNRI treatment does not seem to give better results than SNRI therapy alone. A 2023 meta-analysis found that TMS along with antidepressants resulted in 36% remission compared to 8% in the control group.⁹⁸ The paper also found that 40% of people receiving TMS and antidepressants had a positive response compared to 10% in the sham control groups.

A typical TMS course of treatment involves daily sessions of under half an hour for 4-6 weeks. An accelerated form of TMS utilizing multiple sessions per day has been shown to have similar effectiveness and may bring results sooner.⁹⁶ However it is delivered, TMS is a very intensive and costly form of treatment. Nevertheless, it is an evidence-supported last line of defense for severe depression.

There are many ways to relieve depression. You need to experiment and see what works for you personally. Take the term “effective treatments” with a grain of salt. If a third of trial participants have a third of their depressive symptoms relieved, it will be labeled “significantly effective” in peer-reviewed papers. It means nothing. The state of your particular life and your brain are what determine which interventions will be effective for you.

It can be hard to take even one simple action to improve your mental health when you are depressed. Low willpower and pessimism are part of depression. However, small steps can start you on an upwards trajectory. Light cardio for 10 minutes twice a week or practicing a distancing technique when you catch yourself ruminating are two examples of small but potentially powerful steps.

Depression is not a medical disease that requires a particular medical treatment from a high-profit professional cartel. It is an enigmatic affliction with psychological, physical, and behavioral symptoms which usually resolves on its own within a few months. Fortunately, depression is amenable to cognitive, social, behavioral, medical, herbal, and environmental intervention.