Depression Treatment 2026 — Free PHQ-9 Test, Therapy & Medication Guide
Major depressive disorder (MDD) affects an estimated 280 million people globally (WHO 2024). Evidence-based treatments achieve full remission in 60–80% of cases when stepped care is followed: PHQ-9 screening → psychotherapy (CBT or IPT) → SSRI/SNRI antidepressants → augmentation → TMS or ketamine for treatment-resistant cases. This guide is reviewed by board-certified psychiatrists.
Take the PHQ-9 — Free Depression Screen
The PHQ-9 (Patient Health Questionnaire 9) is the most validated depression screening tool, used in primary care worldwide. Score interpretation:
- 0–4 — Minimal depression. Self-monitoring sufficient.
- 5–9 — Mild depression. Watchful waiting + lifestyle (exercise, sleep, social contact).
- 10–14 — Moderate depression. Psychotherapy +/- medication recommended.
- 15–19 — Moderately severe depression. Active treatment with medication AND psychotherapy.
- 20–27 — Severe depression. Immediate active treatment, may require psychiatry referral.
- Q9 (suicide ideation) ≥1 — Always triggers safety assessment regardless of total score.
Take the free PHQ-9 (2 minutes)
Antidepressant Comparison (2026, evidence-graded)
| Drug | Class | Effect Size (SMD) | Tolerability | Notes |
|---|---|---|---|---|
| Escitalopram (Lexapro) | SSRI | 0.32 (high) | Best | First-line by Cipriani 2018 meta. Few interactions. |
| Sertraline (Zoloft) | SSRI | 0.30 | Very good | First-line, safe in pregnancy. |
| Mirtazapine (Remeron) | Atypical | 0.37 (very high) | Good (sedating) | Best for insomnia + low appetite. Weight gain risk. |
| Bupropion (Wellbutrin) | NDRI | 0.29 | Very good | No sexual side effects, no weight gain. Avoid in seizure disorder. |
| Venlafaxine (Effexor) | SNRI | 0.33 | Moderate | Good for anxiety+depression. BP rise at high dose. |
| Duloxetine (Cymbalta) | SNRI | 0.30 | Moderate | Good for depression + neuropathic pain. |
| Vortioxetine (Trintellix) | SMS | 0.27 | Good | Cognitive symptoms preserved. Costly without insurance. |
Effect sizes from Cipriani 2018 (Lancet meta-analysis of 522 trials, 116,477 patients). SMD >0.30 considered high.
Psychotherapy — What Works
- Cognitive Behavioural Therapy (CBT) — Strongest evidence base. 12–20 sessions. Effect equal to antidepressants for mild-moderate depression, longer-lasting after treatment ends.
- Behavioural Activation — Simpler protocol focused on re-engaging with rewarding activities. Equal efficacy to full CBT in COBRA trial 2016.
- Interpersonal Therapy (IPT) — Addresses depression triggered by relationship transitions, grief, conflict. 12–16 sessions.
- Mindfulness-Based Cognitive Therapy (MBCT) — Best for relapse prevention after recovery. Reduces relapse 31% over 60 weeks (Kuyken 2016).
- Acceptance and Commitment Therapy (ACT) — Effective alternative to CBT, particularly when avoidance dominates.
Treatment-Resistant Depression
If 2+ adequate antidepressant trials (≥6 weeks at therapeutic dose) fail, evidence-based options include:
- TMS (Transcranial Magnetic Stimulation) — FDA-cleared. 50–60% response, 30–35% remission. Six weeks, daily 30-min sessions. Cost & provider guide.
- Esketamine nasal spray (Spravato) — FDA-cleared 2019. Acts in hours-days vs weeks. ~$700–$900/dose, twice weekly initially. Full guide.
- Augmentation — Add lithium, lamotrigine, T3, atypical antipsychotic (aripiprazole, quetiapine).
- ECT (Electroconvulsive Therapy) — Highest efficacy (~80% response) for severe, psychotic, or catatonic depression. Modern ECT is brief, anaesthetised, well-tolerated.
- Psychedelic-assisted therapy — Psilocybin, MDMA-assisted (Phase 3 trials, FDA Breakthrough Designation). Available legally in Oregon (US) since 2023, Australia since 2023, Switzerland (compassionate use), and several research clinics.
Frequently Asked Questions
How long do antidepressants take to work?
Initial improvement (sleep, energy) often appears at 1–2 weeks. Mood improvement takes 4–6 weeks. Adequate trial duration is 6–8 weeks at therapeutic dose before declaring "non-response". Stopping early is the most common cause of "failed" treatment.
Is therapy or medication better?
For mild depression: therapy alone is equal to medication. For moderate depression: combination beats either alone (38% additional remission, NICE 2022). For severe depression: medication should usually start first, with therapy added once functioning improves enough to engage.
Can I stop antidepressants once I feel better?
Continue at full dose for at least 6 months after full remission to lower relapse risk. For 2nd or 3rd episode, longer (1–2 years) or indefinite continuation is usual. Always taper gradually under clinical supervision — abrupt discontinuation can cause withdrawal-like symptoms.
Are antidepressants addictive?
No — they don't produce craving or compulsive use. However, abrupt discontinuation can cause "discontinuation syndrome" (flu-like symptoms, dizziness, brain "zaps") which is uncomfortable but not dangerous. Always taper.
If I'm in crisis, what do I do?
USA: Call or text 988 (Suicide & Crisis Lifeline). UK: Samaritans 116 123. India: iCall +91 9152987821, Vandrevala 1860-2662-345. Worldwide: findahelpline.com. If immediate danger to life, call your local emergency number (911, 112, 999, 102) or go to the nearest A&E.