When you first look into depression treatment, the choices can feel like an overwhelming wall of names. In practice there are a handful of well-established options, and each one fits a different situation. Here is an honest, plain-language rundown of the main ones, what they involve, and who they tend to suit. Which of these is right for you is a decision to make with a clinician, not a website.
Talk therapy (psychotherapy)
Therapy is a structured conversation with a licensed professional aimed at changing patterns of thought and behavior that feed depression. Cognitive behavioral therapy, or CBT, is one of the most studied forms and is often a first step. For depression tied to trauma, trauma-focused therapies are the core of care.
Tends to fit: almost everyone, either on its own for milder depression or alongside medication for more severe symptoms.
Honest tradeoffs: it takes time and effort, results build gradually, and finding a therapist you click with can take a few tries.
Antidepressant medication
Antidepressants, including the common SSRIs and SNRIs, adjust brain chemistry to ease symptoms. For many people they make a real difference, and they are often the first medication a doctor suggests. They usually take a few weeks to show their full effect.
Tends to fit: moderate to severe depression, or milder depression when therapy alone has not been enough.
Honest tradeoffs: finding the right medication and dose can involve trial and error, and some people notice side effects. If two or more have not worked, that is worth flagging to your doctor rather than simply giving up.
TMS (transcranial magnetic stimulation)
TMS is a non-invasive, drug-free treatment that uses focused magnetic pulses to stimulate regions of the brain involved in mood regulation. It is FDA-cleared for depression and typically delivered in a series of short in-office sessions. You stay fully awake and can drive yourself home and return to your day.
Tends to fit: people with treatment-resistant depression, or those who want to avoid or reduce medication.
Honest tradeoffs: it requires a course of repeated visits, and results vary from person to person.
Spravato (esketamine)
Spravato is an FDA-approved nasal spray, derived from ketamine, for treatment-resistant depression. Because it is given under medical supervision, you receive it in a certified clinic and are monitored for a period afterward before going home. For some people it can help when other treatments have not.
Tends to fit: adults with treatment-resistant depression, used along with an oral antidepressant, under a doctor's supervision.
Honest tradeoffs: it must be given in a certified setting with monitoring, so it involves scheduled clinic visits rather than something you take at home.
How to think about choosing
A useful way to picture it: therapy and first-line antidepressants are where most journeys begin. If those have not worked after a fair trial, TMS and Spravato are established next steps designed specifically for that situation. See our Spravato vs TMS comparison for how those two differ, and our guide to what to do when antidepressants have not worked. None of these is a magic switch, and a good provider will be upfront about what to realistically expect.
The single most powerful thing you can do is have a specific, honest conversation with a qualified clinician about your history and your goals. Bring notes. Ask what they would try first and why. Ask what they would do if it does not work.