Best Way to Cure Depression

Takeaway: Depression Recovery Is a Process — Not a One-Step Fix

When I work with patients struggling with depression, I often start by prescribing a first-line antidepressant. But here’s the reality: most patients don’t spontaneously say whether it's helping. I have to ask — repeatedly. And the data backs this up. The largest study on the subject found that only about 33% of people experience significant relief from their first antidepressant.

So what happens next?

We try something else. Typically, I recommend adding cognitive behavioral therapy (CBT) or trying a different medication. CBT alone helps about 1 in 4 people who didn’t respond to their first medication. Personally, I always encourage CBT early in the process — it's just as effective as many medications and comes with fewer side effects. (Keep in mind: medications can take 5 to 12 weeks to stabilize in your system.)

If that still doesn’t work, we may add a second medication — a process called combination therapy. That helps about 1 in 10 patients who are still struggling.

Still no improvement? You’re not alone — and we’re still not out of options. The next step is to switch the medication class entirely, which helps another 10% of patients at this stage.

In other words: it’s a process, but it’s a process that works. With time and persistence, I’ve seen most patients find a treatment or combination that helps them feel better — often significantly so.

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Why Should You Care?

If you’re on an antidepressant and it’s not working, talk to your psychiatrist. This is common —

in fact, 77% of people don’t respond to the first medication they try.

But that’s not the end. There’s a well-studied path forward.

There’s a plan. And there’s hope.

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The STAR*D Trial is the Landmark study on depression, which studied >4,000 individuals.

Most of our knowledge today on depression is based on the findings from the STAR*D trial, the largest trial done on depression patients ever. In this blog, we break down what the data says, and what it means for treating depression today.

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The Clinical Data:

The STAR*D trial followed over 4,000 adults with major depressive disorder who didn’t respond to the first antidepressant (citalopram). The findings revealed important results:

_{In Step 1: 33% of patients showed significant improvement with citalopram(a classic antidepressant), meaning they no longer experienced the full range of depressive symptoms.}

_{In Step 2, switching to another antidepressant or adding CBT (cognitive behavioral therapy) improved remission rates by another 24–30%.
*CBT was shown to be as effective as switching or augmenting with another medication — with fewer side effects.}

_{In Step 3: Around 10–20% more patients improved when a second agent was added.}

_{In Step 4: A final 13–16% of patients improved after trying a combination of two antidepressants or switching to another class of antidepressants (monoamine oxidase inhibitors).}

Study Design: How They Figured This Out

• Population: 4,041 adults aged 18–75 with non-psychotic major depression
• Setting: 41 clinics across the U.S. (23 psychiatry, 18 primary care)
• Duration: Each of four levels lasted up to 14 weeks
• Assessment Tools: Depression was tracked using validated symptom scales (QIDS-SR16 and HAM-D17)
• Patient Choice: People could switch medications or augment their current one based on preference and tolerability

CBT was introduced at Level 2 as both a standalone treatment and an augmentation strategy, giving patients a non-medication route to continue treatment. This flexibility mirrors modern, collaborative care approaches.

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Why This Study Changed My Practice:

As a psychiatrist, I always hear patients say, “This medication didn’t work — something must be wrong with me.” STAR*D changed how I talk about expectations. One med isn’t always enough, and that’s not a failure — that’s the norm. More importantly, this trial validated therapy, especially CBT, as an essential option when medications alone aren’t enough.

Now, I emphasize the process:

• We start with one treatment — then we adapt, build, and personalize. STAR*D made it clear that persistence, flexibility, and patient-centered care lead to results.      
• CBT is a powerful clinical tool — particularly for those sensitive to side effects, or hesitant about more meds.

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What Patients Should Know:

• Don’t give up if the first medication doesn’t work — you’re not alone.
• CBT is as effective as a second medication, and it’s often better tolerated.
• Each step you take increases the chance of remission — even if it feels slow.
• STAR*D proves that healing isn’t linear, but it is achievable.

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Final Thought:

The STAR*D trial reshaped how we understand and treat depression. It proved that recovery often takes multiple steps — and that’s okay. If you’re stuck or frustrated, it doesn’t mean you’re out of options. It just means you haven’t reached the step that’s right for you… yet.