When you're low and exhausted, a long list of depression treatment options can feel like one more thing to carry. Therapy, medication, exercise, apps: which of them actually work, and which should come first? This guide explains the options in plain language, using Canada's own clinical guideline for adults as the main source. It's for learning, not for deciding on your own, and a free conversation with us can help you sort out what fits you.
This article is general education. It isn't medical advice, and it can't tell you what to do about your own care.
First, what depression means here
Depression is more than a bad week. The WHO describes it as a depressed mood or loss of interest that lasts most of the day, nearly every day, for at least two weeks, along with other symptoms like poor concentration, guilt or hopelessness. CAMH adds that depression can be treated so that people recover and keep up their daily functioning.
Depression ranges from mild to severe, and only a qualified professional can diagnose it. Our psychologists can assess and diagnose, and our Nurse Practitioners can assess, diagnose and prescribe. If you're not sure what you're feeling, our post on the symptoms of depression is a good place to start.
How the guideline approaches treatment
The Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes a guideline for treating major depression in adults. The 2023 update was published in The Canadian Journal of Psychiatry in 2024, and you can read the full text here.
Three ideas from it are worth knowing:
Treatments are ranked in lines, based on the strength of the evidence and on safety and practicality. First-line options are the ones to consider first.
The guideline stresses shared decision-making, which means your values, preferences and past experience count.
Choices depend on how severe the depression is.
The guideline is written for clinicians. Use it as background, not as a to-do list.
It also helps to know what "works" means. Research looks at groups of people and asks how many improve on average. That tells us which options have the best track record. It can't tell you for certain how you will respond, which is why the fit with you matters as much as the ranking.
Talk therapy, what has the strongest evidence
CANMAT says the evidence continues to support three psychological treatments as first-line for adults:
Cognitive behavioural therapy (CBT). It focuses on how thoughts, feelings and actions affect each other, and helps you test and change patterns that keep you low. The guideline says CBT appears to work across formats, including individual, group and digital delivery.
Interpersonal therapy (IPT). It looks at how your relationships and big life changes, like loss or conflict, connect to your mood.
Behavioural activation (BA). It helps you rebuild routines and take small steps toward things that matter, even when you don't feel like it, because action can lift mood.
For mild depression, the guideline says a first-line psychotherapy is the preferred choice when it's readily accessible. For moderate depression, it describes psychotherapy and antidepressant medication as the two treatments with the most robust evidence. In the short term they're about equally effective, and the guideline notes CBT does better at 6 to 12 months of follow-up.
Other therapies you may come across
CANMAT places several other approaches as second-line, including mindfulness-based therapies such as mindfulness-based cognitive therapy, problem-solving therapy and short-term psychodynamic therapy. Acceptance and commitment therapy is listed as third-line for depression, mainly because the evidence base is smaller.
That doesn't mean these can't help. A lower line reflects the strength of the research, not whether a method will suit you. The guideline also says the evidence doesn't support mixing and matching pieces of different therapies at random, so a clear, structured approach matters.
Our clinicians will talk through approaches with you in your first conversation. We don't promise that any one method will work for you.
Medication, in plain terms
Antidepressants are one tool. The guideline notes there are many first-line options and that the choice depends on things like side effects, your history and your preferences. For moderate depression, it says combining medication with therapy should also be considered.
We won't name drugs or doses here, because a prescriber needs to make those choices with you. If you take medication now, raise any questions with your prescriber or ask about our Nurse Practitioners, and don't stop anything on your own. You can learn how we approach this on our page about diagnosing and prescribing.
Exercise, sleep and everyday habits
CANMAT supports supervised exercise as a first-line treatment on its own for mild depression, and as a second-line add-on for moderate depression. In the guideline, that meant low to moderate intensity activity for 30 to 40 minutes at a time, 3 to 4 times a week, for at least 9 weeks.
That's a big ask on a low-energy day. Aim for smaller, kinder steps. A ten-minute walk counts. CAMH also notes that being active, eating well, sleeping and spending time outdoors can help recovery, though they work best alongside professional care.
The guideline also lists guided online CBT programs as an option for mild depression, and describes other approaches, like light therapy and some complementary treatments, at lower levels of evidence. Ask a clinician before relying on any of these on their own.
How severity and history change the picture
Mild. Psychotherapy is usually the preferred starting point, and exercise or guided online programs may also be considered.
Moderate. The choice is mainly between structured therapy and medication, and a combination can be considered.
Severe. The guideline recommends combining medication with therapy, and describes other treatments for the most severe or hard-to-treat cases, which need specialist attention.
Your history matters too, such as whether this is a first episode or a return, and how earlier treatments worked. If depression is severe or your safety is at risk, getting help quickly matters more than choosing the perfect option.
What the first three months of therapy can look like
The guideline says most improvement comes in the early sessions of psychological treatment, with smaller gains later. It describes 12 to 16 sessions as the optimal dose for most people, but needs vary a great deal and it isn't a promise.
In general, you can expect:
The first sessions. Getting to know you, what's happening and what you want to change.
Early skills. Small tools you can try between sessions.
Check-ins. Looking at what's working and adjusting the plan.
There's no quick fix, and some weeks will feel better than others. Showing up consistently tends to matter more than doing it perfectly. Our page on how long counselling takes gives more detail.
If the first approach doesn't help enough
Sometimes the first plan isn't the right fit. That's information, not failure. The guideline describes steps for when the response is not enough, such as adjusting the plan, adding another treatment or changing to a different one. It also says first-line psychological treatments should be considered early on, because they are effective and have a low chance of side effects.
If you're a few weeks in and nothing has shifted, say so. Honest feedback helps your clinician change course sooner.
Questions worth asking about any option
Before you start any treatment, it helps to ask:
What is the evidence for this, and how strong is it?
What will a typical week look like?
How will we know whether it's working?
What are the risks or side effects, if any?
What happens if it doesn't help enough?
You have every right to ask. A good clinician will welcome these questions.
If you are thinking about suicide
If you're thinking about ending your life, please reach out now. You can call or text 9-8-8 any time. In Waterloo Region and Wellington, call Here 24/7 at 1-844-437-3247. If you're in immediate danger, call 911 or go to the nearest emergency department.
Starting with one conversation
Individual sessions with our clinicians are $130 to $200, and student therapists offer sessions for $0 to $80. New clients pay a one-time $50 setup fee, which isn't charged for the free consultation. Depending on your plan, your insurance may cover the full session fee. We don't have a waitlist. You can read more about our depression counselling.
You don't need to pick a treatment before you call. Book a free 15-minute consultation and talk through your options. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario. No referral is needed.
Last reviewed: October 2026
Sources
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults (Canadian Journal of Psychiatry, 2024), peer-reviewed, via NIH PubMed Central
Depressive disorder (depression) fact sheet, World Health Organization
Depression, CAMH