Unipolar Depression Treatment: Therapy, Medication, Neuromodulation & Lifestyle

Evidence‑Based Management of Major Depressive Disorder

Treatment is individualized; combination approaches often yield best outcomes.

1. Psychotherapy (First‑Line for Mild‑Moderate)

• Cognitive Behavioral Therapy (CBT): Restructures negative cognitions/behaviors.
• Interpersonal Therapy (IPT): Addresses role transitions, grief, disputes.
• Behavioral Activation: Counters withdrawal; schedules rewarding activities.
• Acceptance & Commitment Therapy (ACT): Mindfulness + values‑based action.

2. Pharmacotherapy

• SSRIs (sertraline, escitalopram) – first‑line; favorable side‑effect profile.
• SNRIs (venlafaxine, duloxetine) – if SSRI inadequate; also for pain.
• Atypical (bupropion, mirtazapine) – specific symptom targeting.
• TCAs/MAOIs – reserved for treatment‑resistant cases; more side effects.

3. Combination Therapy

Medication + psychotherapy > either alone for moderate‑severe MDD.

4. Neuromodulation (Treatment‑Resistant)

• ECT: Gold standard for severe, psychotic, catatonic, or urgent suicidality.
• TMS: Non‑invasive; FDA‑cleared for TRD; 4‑6 week course.
• VNS/DBS: Investigational/surgical; highly selected.

5. Lifestyle Pillars

• Exercise (aerobic + resistance) – 150 min/week.
• Sleep hygiene (7‑9 hrs, regular schedule).
• Mediterranean diet; limit alcohol.
• Mindfulness/meditation.
• Social connection.

Monitoring & Adjustment

Use PHQ‑9 or similar at each visit. Adjust dose, switch, or augment at 4‑8 weeks if <50% symptom reduction. Continuation phase: 6‑12 months after remission. Maintenance for recurrent episodes.

Crisis: 988 Suicide & Crisis Lifeline (call/text 988).