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Depression

Depression is common and treatable. This hub explains what depression can look like and how care plans are built.

Use the medication roadmap to compare common first-line options and adjuncts, then print handouts for shared decision-making.

Understanding depression

Depression is more than sadness—it is persistent low mood and/or loss of interest that affects daily life.

  • Common symptoms include low mood, reduced motivation, sleep and appetite changes, poor concentration, and feelings of hopelessness or guilt.
  • Depression severity varies. Some people have milder symptoms with preserved function, while others have severe symptoms that impair work, school, relationships, and self-care.
  • Depression often overlaps with anxiety and insomnia; addressing sleep and worry directly can improve outcomes (see the anxiety hub and insomnia hub).

If you feel unsafe or in crisis, use the crisis banner (988 in the U.S.) or seek emergency care.

Evaluation and diagnosis

A careful evaluation helps match treatment to the right diagnosis and improves safety.

  • Screen for bipolar symptoms (mania/hypomania) before changing antidepressants; antidepressants can worsen mood instability in bipolar disorder (see the bipolar disorder hub).
  • Review medications and substances that can worsen mood (alcohol, cannabis, stimulants, steroids, withdrawal states).
  • Consider medical contributors when symptoms are new or severe (thyroid disease, anemia, sleep apnea, chronic pain).
  • Track symptoms with a simple weekly check-in (sleep, appetite, energy, functioning, and safety concerns).

First-line: psychotherapy and supports

For many people, therapy is core treatment—often with or without medication.

  • CBT and behavioral activation help reduce avoidance and rebuild daily routines that support recovery.
  • Interpersonal therapy can be helpful when depression is tied to relationship stress, grief, or role changes.
  • Sleep, exercise, and structured routines can reduce symptom burden and improve resilience alongside therapy and medication.
  • If anxiety is prominent, pair depression treatment with anxiety-focused skills (see the anxiety hub).

Medication options (overview)

Medication choices depend on symptoms (sleep vs activation), medical comorbidities, prior responses, and side-effect preferences.

  • First-line options often include SSRIs/SNRIs such as sertraline, escitalopram, venlafaxine, and duloxetine.
  • Bupropion can be a good fit when fatigue or sexual side effects are key concerns; it can feel activating for some people.
  • Mirtazapine is often chosen when insomnia or low appetite is prominent; sedation and weight gain are common trade-offs.
  • Some people benefit from newer options such as vortioxetine or vilazodone when tolerability or cognitive symptoms drive choice.
  • For treatment-resistant depression, options may include esketamine (specialized settings), ketamine protocols, or augmentation strategies (e.g., aripiprazole, brexpiprazole, quetiapine, or lithium)—monitor metabolic and sedation risks when combining agents.
  • MAOIs (e.g., phenelzine, tranylcypromine) are often reserved for refractory cases because of diet/drug interaction complexity.

Antidepressant benefit often builds over several weeks; early side effects commonly improve with time.

If suicidality, severe agitation, or mania emerges, seek urgent clinical support and reassess the diagnosis and treatment plan.

Medication roadmap for teams

Use compare presets to align options with goals (sleep vs activation, side effects, interactions).

Use the Share button in Compare to keep a stable link for follow-ups.

Monitoring, side effects, and safety

Depression improves fastest when treatment plans include safety monitoring and follow-up.

  • Discuss activation vs sedation effects and how they fit work, school, driving, and sleep.
  • Review interactions with alcohol, cannabis, and other sedatives.
  • Plan for discontinuation symptoms when stopping or switching antidepressants; avoid abrupt changes without clinical guidance.
  • If symptoms worsen, suicidal thoughts appear, or mania emerges, seek urgent clinical support.

Staying current with evidence

Use evidence filters to keep pace with new trials and guidelines.

Medication index

Browse all medication pages covered by this hub. Use Compare for side-by-side decisions and Evidence for curated studies.

Antidepressants (33)
Ketamine & rapid-acting antidepressants (2)
Common augmentation agents (4)

Frequently asked questions

What is usually tried first for depression?

Many people start with therapy (often CBT and behavioral activation) and/or a first-line antidepressant such as an SSRI or SNRI. The best first choice depends on symptom pattern, prior responses, and side-effect preferences.

How long does it take antidepressants to work?

Side effects can show up in the first days, while mood benefits often build over several weeks. If there is no improvement after an adequate dose and duration, clinicians may adjust dose, switch, or add an augmenting medication.

How often is this hub updated?

We refresh medication summaries, monitoring notes, and evidence links when labeling or guidelines change. The Evidence Library and Updates pages provide the quickest view of recent refreshes.