Options for Depression

You Have More Influence Over Depression Than You Think — Here’s What the Research Says

Many people living with depression have been told, in one way or another, that it’s something that simply happens to them. A chemical imbalance. The luck of the draw. Something to be managed with a prescription and endured.

That story can leave you feeling stuck, as if there’s nothing you can do except wait and hope. The research tells a more hopeful story. Not that depression is easy, and certainly not that it’s your fault. It isn’t. But that you likely have more influence over it than you’ve been led to believe, and more options than whatever you’re doing right now.

Rethinking the “Chemical Imbalance”

For decades, the popular explanation for depression was low serotonin. In 2022, a team led by Professor Joanna Moncrieff at University College London reviewed the major bodies of serotonin research and found no consistent evidence that depression is caused by low serotonin [1]. Some researchers have pushed back on parts of that review, and it is worth being clear that whether serotonin causes depression is a different question from whether antidepressants help.

But the shift in thinking matters. If depression were purely a fixed chemical fault, medication would be the only lever available. When we understand that depression is shaped by many things, including our patterns of thinking, attention and behaviour, a lot more levers come into view. And many of them are within reach.

What Medication Can and Can’t Do

The largest analysis of antidepressant trials ever conducted, covering more than 116,000 people, found that all 21 antidepressants studied did better than placebo, though the advantage was mostly modest [2]. That advantage also isn’t the same for everyone. Medication’s benefit over placebo grows with the severity of depression, and for people with mild or moderate symptoms, it may be small on average [3]. A 2022 analysis of more than 73,000 trial participants found that around 15% of people had a large benefit from medication that they wouldn’t have had from placebo, though there’s no way yet to predict who those people will be [4].

In plain terms: medication is a valuable tool, and for some people, especially those with more severe depression, it makes a big difference. But it’s one tool, not the whole toolkit.

The Levers You Can Pull

Talk therapy. A 2020 analysis in World Psychiatry, pooling 101 trials, found that psychotherapy and medication worked about as well as each other, people were more likely to stick with therapy, and combining the two worked best of all for moderate depression [5]. A 2021 analysis focused on GP-based care found the same pattern [6]. Therapy also works on something medication doesn’t: the skills and patterns you carry with you after treatment ends.

This isn’t a fringe view. Australia’s own psychiatric guidelines, from the Royal Australian and New Zealand College of Psychiatrists, recommend lifestyle changes and psychological therapies as first-line actions for depression, with medication becoming more important as severity increases [7].

Movement. A 2024 analysis in the BMJ, led by Dr Michael Noetel at the University of Queensland, pooled 218 trials involving more than 14,000 people with depression. Walking or jogging, yoga and strength training all produced moderate reductions in symptoms, and the authors suggested exercise could sit alongside therapy and medication as a core treatment [8]. That’s a lever many people can start pulling today, in small ways.

Where Strategic Hypnotherapy Fits

If depression is shaped by patterns of thinking, attention and response, then working with those patterns directly makes sense. That’s the territory strategic hypnotherapy works in.

The approach traces back to psychiatrist Milton H. Erickson, widely regarded as the father of modern clinical hypnosis, who worked with a client’s own patterns and resources rather than applying generic techniques. Bill O’Hanlon, who trained under Erickson, developed this into Solution-Oriented Hypnosis, focused on shifting the pattern underneath a problem rather than managing symptoms indefinitely [9].

Clinical psychologist Michael Yapko has spent decades applying this specifically to depression. He describes how hypnosis can build hope and positive expectancy, interrupt rumination, and shift the thinking styles that keep depression going [10]. Here in Australia, Gordon Young, the trainer behind my own qualification, has developed this further through Strategic Hypnosis, which identifies the specific unconscious patterns underlying a problem and addresses them directly [11].

Does It Actually Work? What the Data Shows

A 2019 meta-analysis in the American Journal of Clinical Hypnosis found hypnotic interventions significantly reduced depressive symptoms compared with control conditions, with improvements comparable to established psychotherapies [12].

Two trials stand out:

•          Hypnosis alongside talk therapy. In a randomised trial of 84 people with depression, adding hypnosis to CBT produced greater reductions in depression, anxiety and hopelessness than CBT alone, and those gains held at 6 and 12 months [13].

•          Hypnotherapy compared with talk therapy. A German trial of 152 people with mild to moderate depression compared hypnotherapy with CBT, the gold-standard talk therapy, over six months. Hypnotherapy performed as well as CBT [14].

The research base is smaller than it is for medication and CBT, and more large trials are needed. But the evidence is real, controlled and growing.

Getting Curious About Your Options

You don’t need to overhaul everything at once. Sometimes the most useful step is simply getting curious. Is what I’m doing now working as well as I’d like? Have I tried a psychological therapy, or only medication? What small changes are within my control this week?

If you’re taking an antidepressant, curiosity doesn’t mean stopping. Coming off antidepressants can cause withdrawal symptoms, and current thinking favours slow, gradual tapering under medical supervision [15]. Any change to medication should be a conversation with your GP or prescriber. Exploring other options alongside your current treatment is often where the real gains are.

I work alongside GPs and other medical and allied health professionals so clients get the care that fits their situation. If you’re curious about hypnotherapy as part of your recovery, talk it over with your GP or mental health professional, and reach out to me for a chat. As I’m not a medical professional, I can only work with clients with diagnosed severe mental health conditions on referral.

If you need support right now, please contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.

Conclusion

The idea that depression is a fixed chemical imbalance, managed only with medication, doesn’t hold up against current research. Medication helps some people significantly, particularly in more severe depression, but it’s one option among several. Talk therapy works as well as medication for many people, movement is a real treatment in its own right, and hypnotherapy has a growing body of controlled evidence behind it, both alongside talk therapy and compared with it. Depression is serious and real, but it is also something you can influence. Getting curious about your options is a powerful first step.

References

1.        Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28(8), 3243–3256. https://doi.org/10.1038/s41380-022-01661-0

2.        Cipriani, A., Furukawa, T. A., Salanti, G., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7

3.        Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA, 303(1), 47–53. https://pubmed.ncbi.nlm.nih.gov/20051569/

4.        Stone, M. B., Yaseen, Z. S., Miller, B. J., Richardville, K., Kalaria, S. N., & Kirsch, I. (2022). Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: Individual participant data analysis. BMJ, 378, e067606. https://doi.org/10.1136/bmj-2021-067606

5.        Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92–107. https://pubmed.ncbi.nlm.nih.gov/31922679/

6.        Cuijpers, P., Oud, M., Karyotaki, E., Noma, H., Quero, S., Cipriani, A., Arroll, B., & Furukawa, T. A. (2021). Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis. Annals of Family Medicine, 19(3), 262–270. https://www.annfammed.org/content/19/3/262

7.        Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A. B., & Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry, 55(1). https://www.ranzcp.org/getmedia/a4678cf4-91f5-4746-99d4-03dc7379ae51/mood-disorders-clinical-practice-guideline-2020.pdf

8.        Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J. J., et al. (2024). Effect of exercise for depression: Systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. https://doi.org/10.1136/bmj-2023-075847

9.        O’Hanlon, W. H., & Martin, M. (1992). Solution-Oriented Hypnosis: An Ericksonian Approach. W.W. Norton. https://www.billohanlon.org/aboutbill

10.    Yapko, M. D. (2001). Treating Depression with Hypnosis: Integrating Cognitive-Behavioral and Strategic Approaches. Brunner-Routledge. https://yapko.com/about-michael/

11.    Young, G. — Strategic Hypnosis and the Gordian Pillars of Psychotherapy. https://gordonyoung.com.au/about-us/

12.    Milling, L. S., Valentine, K. E., McCarley, H. S., & LoStimolo, L. M. (2019). A meta-analysis of hypnotic interventions for depression symptoms: High hopes for hypnosis? American Journal of Clinical Hypnosis, 61(3), 227–243. https://doi.org/10.1080/00029157.2018.1489777

13.    Alladin, A., & Alibhai, A. (2007). Cognitive hypnotherapy for depression: An empirical investigation. International Journal of Clinical and Experimental Hypnosis, 55(2), 147–166. https://doi.org/10.1080/00207140601177897

14.    Fuhr, K., Meisner, C., Broch, A., Cyrny, B., Hinkel, J., Jaberg, J., Petrasch, M., Schweizer, C., Stiegler, A., Zeep, C., & Batra, A. (2021). Efficacy of hypnotherapy compared to cognitive behavioral therapy for mild to moderate depression: Results of a randomized controlled rater-blind clinical trial. Journal of Affective Disorders, 286, 166–173. https://doi.org/10.1016/j.jad.2021.02.069

15.    Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6, 538–546.