Overcoming depression
The research on the efficacy of different depression treatments is only moderately strong. Our remarks below reflect our attempt to come to the best conclusion possible with the evidence available: we're not confident in our assessments, but they represent a reasonable best guess using the evidence available.
Cognitive behavioral therapy
Our top recommendation for overcoming depression is cognitive behavioral therapy (CBT). According to The empirical status of cognitive-behavioral therapy: A review of meta-analyses, there's a strong base of evidence that CBT has a large effect of reducing depression on average. There's evidence that the benefits extend beyond the duration of the treatment. Studies generally seem to show that CBT is as effective as antidepressants at reducing depression (some find that CBT is more effective, but the evidence is unclear).
CBT has the advantage that one can learn to do the exercises on one's own, without the expense of a therapist or a psychiatrist. It's also superior to anti-depressant medications in that it doesn't have negative side effects. In particular, it probably doesn't increase risk of suicide in young people as antidepressants do.
Our recommendation for learning CBT on your own is Feeling Good: The New Mood Therapy by David Burns
Talk therapy
Talk therapy has been shown to reduce depression on average. However:
- It's expensive, costing on the order of $120/week if one's insurance doesn't cover it.
- Anecdotally, highly intelligent people find therapy less useful than the average person does, perhaps because there's a gap in intelligence between them and most therapists.
Antidepressants
The Cochrane Review Newer generation antidepressants for depressive disorders in children and adolescents found that anti-depressants increased recover rates from 38.0% to 44.8% (over a specified duration) relative to a placebo. This understates the capacity for anti-depressants to reduce depression, because placebo treatment is also better than no treatment, and if one anti-depressant doesn't work, one can try another one.
The case for using an antidepressant if you're an adolescent is weakened by the fact that in the Cochrane review antidepressants increased suicide rates from 2.5% to 4%. The Food and Drug Administration requires that manufacturers of antidepressants include a warning that antidepressants can increase the risk of suicide in children, adolescents and adults under age 25. See Antidepressants and suicide risk The increased suicide risk may not be worth the potential benefits.
In particular cases the prospects for recovery vs. suicide might be much better than those suggested by the figures above, but for young people, CBT seems superior to antidepressants as a first line treatment for depression.