Treatment helps most people with depression. Some may have more periods of depression after an initial episode has been treated.  Treatment for depression often includes:

1. Immediate treatment.
2. Continuing treatment to prevent relapse. This includes antidepressant drug therapy, usually lasting for about six months.
3. Maintenance therapy (longer-term therapy), if needed.

The following treatments, which may be used together, can help treat depression among older adults:

• Psychotherapy (“talk therapy”).
• Antidepressant medications.
• Electroconvulsive therapy.
• Light therapy during the winter months for people with seasonal affective disorder (SAD). This therapy may help restore normal sleep and decrease symptoms of depression.
• Some newer treatments can involve (non-invasive) surgery.  These treatments include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and the most recent, transcranial magnetic stimulation (TMS).

A person with severe depression needs a combination of medications and psychotherapy. This combination often works quickly and keeps depression from happening again.

Sometimes depression is so severe that a person can’t do daily activities, is suicidal, or isn’t safe in the community.  This means a person may need treatment in a psychiatric hospital.

A person needs treatment as long as their healthcare provider recommends it.

Psychotherapy

Psychotherapy is a safe and helpful way to treat a person who has depression.  People often also have therapy with antidepressant drugs (described below).

There are several useful psychotherapy techniques:

• Problem-solving therapy. A therapist helps a person figure out the parts of their life that are causing problems and helps them find solutions.
• Cognitive behavioral therapy (CBT). This helps a person understand how their thoughts and other things affect their depression. People also learn ways to deal with them. CBT therapy has a limited number of weekly visits. Visits may include helpful activities and assignments to do at home.
• Interpersonal psychotherapy. This therapy can treat minor depression, especially:
  • After the death of a close friend or relative.
  • For caregivers of older adults who develop depression.

This therapy helps a person deal with their relationships, grief, loss and coping with their role in life.

Antidepressant Medications

A person may need medication during treatment for depression. The choice of medication depends on:

• The medical problems a person has
• Side effects of the antidepressant
• Interactions with other medications

Steps the healthcare provider takes:

• Starts the person with a low dose of the antidepressant
• Increases the dose slowly and carefully until the medication takes effect
• Monitors the levels of the medication in the blood to make sure they don’t get too high, especially if the person has kidney or liver problems
• Changes medications or arrange psychotherapy

Other Treatments for Depression

Several newer treatments can help people with major depression.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy uses electric currents passed through the brain. It is a very effective, safe treatment if others haven’t helped. For most people, it’s the best treatment for life-threatening depression:

 when a person is suicidal, doesn’t take medications, or is at risk of starvation due to depression. Success rates are at least 80 percent in older adults.

Before ECT, a person gets anesthesia to make sure that they don’t have pain. Common side effects include:

• Short-term amnesia (forgetting things that happened very recently)
• A hard time learning new things for a while. This problem usually disappears quickly after the treatment stops.

ECT doesn’t cause long-term memory loss, and sometimes memory will get better. ECT usually happens twice a week for four weeks.

Note that a person with a recent heart attack or stroke may have a higher risk of side effects. ECT is not for older people with unstable heart problems or increased pressure in the brain due to a brain tumor or other medical problems.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. It is an option if ECT has already been tried and depression still causes problems. People receive TMS daily for 6 weeks or 30 treatments. Generally, TMS is less effective than ECT for older adults.

Last Updated February 2023