Depression afflicts an estimated 16 million Americans every year, many of whom go to their doctors in despair, embarking on an often stressful process about what to do next. These visits may entail filling out forms with screening questions about symptoms such as mood changes and difficulty sleeping. Doctors may ask patients to share intimate details about such issues as marital conflicts and suicidal urges. Some patients may be referred to mental-health specialists for further examination. Once diagnosed with depression, patients frequently face the question: "Are you interested in therapy, medications or both?" As a resident physician in psychiatry, I've seen many patients grapple with this question; the most frequent answer I've heard from patients is "I'm not sure." Deciding between different types of medical treatment can be challenging, especially amid the fog of depression. Moreover, patients rely on doctors to help guide them, and we're often not sure ourselves which is the best approach for a specific patient. People commonly associate psychotherapy with Freud and couches, but newer, evidence-based treatments such as cognitive behavioral therapy have become prominent in the field. CBT helps patients develop strategies to address harmful thoughts, emotions and behaviors that may contribute to depression. There are many proposed explanations for how specific psychotherapies treat depression. These possibilities include giving patients social support and teaching coping skills, and researchers are using neuroimaging to study how these treatments affect depressed patients' brains. Antidepressant medications are thought to work by changing chemical signaling in our brains. For example, one class of commonly used drugs - selective serotonin reuptake inhibitors - is designed to alter levels of the neurotransmitter serotonin in the brain. These antidepressants may be effective for treating depression in some patients, but the neurochemistry of depression remains poorly understood, and we're still not entirely sure how these drugs alleviate depressive symptoms. A number of recent studies highlight the uncertainty involved with these treatment decisions.