Depression Therapy and Treatment

---

What Is Depression?

Depression is a medical illness that affects both the mind and body. It can change how you feel, think and behave. Depression is more than just a case of the blues. For some people it is a recurring condition that needs ongoing treatment. When feelings of extreme sadness or despair last most of the day, nearly every day, for more than two weeks and begin to interfere with normal living, it could indicate depression (American Psychiatric Association, 2024).

Depression is not just “sadness” or feeling down. Depression can make you feel helpless and hopeless. You may feel guilty or blame yourself for feeling this way. Depression can interfere with your ability to function in your daily life, hold a job, or maintain a relationship. Some people with depression may even have thoughts of suicide or death.

The good news is most people with depression feel better with medication, psychological counseling, or another form of treatment. Understanding the signs and symptoms of depression can go a long way in finding the most effective treatment option for you. Once you recognize the signs of depression, you can seek the treatment you need to find relief and start to feel like yourself again.

What Causes Depression?

There is no single cause. Depression usually comes from a mix of factors, including differences in brain chemistry, genetics (depression can run in families), personality traits such as low self-esteem or being easily overwhelmed by stress, and ongoing stress such as violence, neglect, abuse or poverty (American Psychiatric Association, 2024).

Signs and Symptoms of Depression

• A persistent feeling of deep sadness, anxiousness and worry, or emptiness that you just can’t shake regardless of what you try.
• Feelings of hopelessness and helplessness. A belief that nothing will ever get better and there’s nothing you can do.
• Strong feelings of worthlessness, guilt, or being overly self-critical.
• Low tolerance for daily frustration, generally feeling irritable, restless, or agitated.
• An overall loss in the ability to feel pleasure or joy, no longer being interested in former hobbies, pastimes, social activities, or sex.
• Feeling physically drained or an overall sense of sluggishness. Your whole body may feel heavy, and completing a small task seems exhausting and overwhelming.
• Difficulty remembering details, making decisions, or focusing on a single activity or topic.
• Insomnia, early-morning wakefulness, or oversleeping (also known as hypersomnia).
• Overeating or loss of appetite resulting in significant weight gain or loss.
• Thoughts of suicide, or suicide attempts.
• Persistent, unexplained aches and pains such as headaches, muscle aches, cramps, or digestive problems.
• Social isolation, not wanting to be with other people, or feeling like you are alone in the world.
• Lack of motivation to complete even the simplest tasks like getting out of bed, bathing or brushing your teeth.
• Not being able to keep up with responsibilities like work, preparing meals, or caring for your family.

Types of Depression

Your doctor or therapist can make an assessment based on the severity and duration of your symptoms.

The most common types of depression are:

Major Depressive Disorder

Major depression is diagnosed when five or more symptoms of depression, including low mood or loss of interest, last for at least two weeks and significantly interfere with a person’s ability to enjoy life and experience pleasure (Bains & Abdijadid, 2023). Symptoms can range from mild to severe, and without treatment an episode can last for months. Major depression typically interferes with a person’s ability to carry out their normal daily activities. While an episode of major depression may occur only once in a person’s life for a certain time, it is often a recurring issue for many people. Major depression, while debilitating, is also treatable so that people who have this condition can restore their quality of life and feel like themselves again.

Persistent Depressive Disorder

Persistent depressive disorder, also called dysthymia, is a type of low-grade depression lasting at least two years. While the symptoms may not be as severe as major depression, dysthymia can prevent a person from fully enjoying life or feeling well. In addition, people with dysthymia often experience one or more episodes of major depression in their lifetime.

People who have dysthymia often feel like they’ve always been depressed, or that being low is “just who they are.” However, dysthymia is treatable, allowing people with the disorder to live significantly improved lives, even if the symptoms have gone unrecognized and untreated for years.

There are several less common forms of depressive disorders that exhibit slightly different characteristics or are triggered by specific events.

Less common types of depression include:

Seasonal Affective Disorder (SAD)

SAD is characterized by the onset of depression during fall and winter. The depression generally lifts during spring and summer when there is more exposure to natural sunlight. SAD is more common in women. People who live farther from the equator are more likely to develop this type of depression. That is because the daylight hours are shorter. SAD begins in young adulthood, in most cases. For some people, light therapy (exposure to artificial sunlight) can help relieve their symptoms. Others require treatment with antidepressant medication and psychotherapy during the months they are affected. Learn more in Understanding and Coping with Seasonal Affective Disorder.

Postpartum Depression

Postpartum depression, also called perinatal depression, is a type of depression that can start during pregnancy or after having a baby. Initially, postpartum depression may appear to be the “baby blues” or be caused by the lack of sleep and stress that accompanies having a newborn. However, the symptoms are more intense, longer lasting and interfere with daily tasks and the ability to care for the baby. Postpartum depression is a serious condition that requires active treatment and emotional support for the new parent. Left untreated, postpartum depression can last for a year or longer. Postpartum depression symptoms can range from mild to severe and add complexity to a new marriage or relationship.

Atypical Depression

This is a common subtype of major depression or dysthymia. It is characterized by temporary “mood lifts” in response to a positive event. However, the benefits are fleeting and the depression returns. Other symptoms include increased appetite and weight gain, marked fatigue, excessive sleeping or sleepiness, an increased sensitivity to criticism or rejection, and moods that are heavily influenced by environmental factors.

Psychotic Depression

Psychotic depression is characterized by major depression accompanied by some form of psychosis, such as breaks in reality, hallucinations, and delusions. Individuals with psychotic depression may need to be hospitalized due to the severity of the symptoms.

Depression in bipolar disorder: Bipolar disorder also includes periods of depression, along with periods of mania or hypomania. It is treated differently from depression alone, so it’s important to mention any past periods of unusually high energy or very little need for sleep to your doctor.

How Is Depression Diagnosed?

A good place to start is with your primary care physician. They may want you to get testing done to determine if the symptoms could be caused by another medical condition like an underactive thyroid or changes in your hormone levels. After doing a medical exam and asking you some questions about your symptoms, your doctor may refer you to a mental health specialist such as a therapist, psychologist, or psychiatrist who can help you further.

It can be hard to talk to your doctor about depression. However, it’s important to bring it up if you are experiencing the depression symptoms listed above. Advocating for your mental health is a key step in feeling better.

Treatment Options for Depression

The specific treatment approach used will depend on the type of depression, its severity, and personal preferences. In general, most depressive disorders are treated with psychotherapy or counseling, medication, or some combination of the two. For adults, the American Psychological Association’s (2019) treatment guideline recommends either psychotherapy or an antidepressant as a first treatment, and combining therapy with medication is also an option.

Psychotherapy for Depression

Several types of psychotherapy have strong research support for depression (American Psychological Association, 2019), including:

• Cognitive behavioral therapy (CBT): This form of therapy focuses on helping people change negative styles of thinking and behaving that may contribute to their depression and correcting or re-purposing the thinking process toward a more positive response. CBT challenges the automatic internal beliefs a person has about themselves and teaches people to view themselves through a more realistic and positive lens.
• Dialectical behavior therapy (DBT): DBT was first developed for people who feel emotions very intensely, and it can help when depression comes with self-harm or overwhelming emotions. It teaches people how to regulate strong emotions and cope with stress. It can also help people with depression improve their relationships.
• Interpersonal therapy (IPT): This form of therapy focuses on helping people understand and work through troubled personal relationships that may cause their depression or make it worse. Addressing issues in past and current relationships can be useful in helping a person remove themselves from toxic situations that may make their depression symptoms worse.
• Behavioral activation: This therapy helps you slowly add back activities that matter to you or used to bring you joy, which can lift mood even before motivation returns.
• Mindfulness-based cognitive therapy (MBCT): This approach combines mindfulness practice with CBT skills and is often used to help prevent depression from coming back.
• Psychodynamic therapy: This therapy explores how past experiences and patterns you may not be aware of shape your mood and relationships today.

Online Therapy for Depression

Therapy for depression doesn’t have to happen in an office. Many therapists offer online therapy by video, and research on internet-based CBT for depression finds it helps, especially when a therapist guides the program (Karyotaki et al., 2021). You can search TherapyTribe for a therapist who offers online sessions.

Medication for Depression

For many people, medication works best alongside therapy. A large analysis of treatment studies found that combining the two worked better than either one alone (Cuijpers et al., 2020). Medication will not cure depression but can help keep symptoms under control while the person receives counseling. With treatment, many people with depression lead healthy and fulfilling lives.

There are many antidepressant medications available to treat depression, including:

• Selective serotonin reuptake inhibitors (SSRIs): These increase serotonin levels in the brain. Common SSRIs include Prozac, Zoloft, Celexa, Lexapro and Paxil.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These medications act on both serotonin and norepinephrine. Brand names include Effexor, Pristiq and Cymbalta.
• Atypical antidepressants: These include Wellbutrin, Viibryd, and Remeron. Atypical antidepressants have different mechanisms of action.

There are a wide variety of antidepressants available and a person may have to try several types before they find the right medication for them. Your doctor will guide you through finding the medication, or combination of medications, that are right for treating your depression.

Sometimes people feel they have “failed” at therapy or that treatment didn’t work. However, it is important to be patient and give adequate time to a treatment plan to truly gauge its success. Many medications can take six to eight weeks before they fully begin to work and psychotherapy typically requires ongoing sessions before a person with depression begins to see an improvement in how they’re feeling. In many cases, individuals may need to try several different treatment combinations before they find the right one for them.

People with depression commonly struggle with additional mental or physical illnesses, including anxiety, anger problems, eating disorders or substance use, which can raise the risk of suicide. Depression is also linked to physical health conditions such as heart disease and diabetes (National Institute of Mental Health [NIMH], n.d.), and depression and obesity often occur together (Milaneschi et al., 2019). The earlier treatment can begin, the more effective it will be and the greater the likelihood of preventing complications from co-existing mental or physical illnesses.

Antidepressant Side Effects and Monitoring

Antidepressants can cause side effects such as stomach upset, headaches, sleep changes, weight changes or sexual side effects (Chu & Wadhwa, 2023). Tell your prescriber about any side effects, since a dose change or a different medication often helps. Psychiatrists usually recommend staying on an antidepressant for six months or more after symptoms improve, so talk with your prescriber before stopping (American Psychiatric Association, 2024).

Antidepressants carry an FDA warning about a possible increase in suicidal thoughts in children, teens and young adults up to age 25 (Chu & Wadhwa, 2023). Family members and prescribers watch closely for mood changes, especially in the first weeks. Medication management can help with monitoring and managing side effects.

Treatment-Resistant Depression

When depression hasn’t improved after trying several treatments, doctors may call it treatment-resistant. Other options include electroconvulsive therapy (ECT), which is considered the gold standard for treatment-resistant depression, and repetitive transcranial magnetic stimulation (rTMS), which doesn’t require anesthesia (NIMH, 2024). Some newer medications are also available under close medical supervision, and they vary by country. A psychiatrist can explain which options are approved where you live.

Psychedelic-assisted therapy is also being studied. In this approach a substance is administered under medical supervision as part of a structured course of psychotherapy, with preparation sessions beforehand and integration work afterward.

The research is still early. The US National Institutes of Health has summarized work on how these compounds may affect mood, including effects on neuroplasticity and brain connectivity. A 2024 Cochrane systematic review of six randomized trials found possible reductions in anxiety and depressive symptoms among people with life-threatening illness, but rated the certainty of that evidence as low to very low, citing small sample sizes and the difficulty of blinding participants in this kind of study (Schipper et al., 2024).

These treatments are not generally available, and no psychedelic therapy is FDA-approved for depression yet. One psychedelic treatment for treatment-resistant depression is under FDA review. In Canada, access runs through clinical trials, individual exemptions, and Health Canada’s Special Access Program, which considers case-by-case requests from healthcare practitioners for patients with serious conditions where other treatments have not worked. Availability elsewhere varies, and any course of treatment is arranged and supervised by a qualified prescriber.

Coping Skills and Self-Help for Depression

Besides medical treatments, there are a number of steps that you can take to manage your depression symptoms.

Social Support Network

A compassionate and understanding social support network can be instrumental in the recovery of a person with depression. Close personal relationships with family, friends, and the community are directly linked to a person’s general sense of well-being. Positive feedback and support can help motivate a person to stay on the course of treatment.

In addition, many people with depression benefit from joining a support group or online support community. Swapping stories of success and failure can lead to some very important self-awareness improvements and inspiration. Since many people with depression isolate themselves from others, having someone they can reach out to who understands their struggles can be very beneficial. However, advice from friends or support groups should never be used as a substitute for care from a psychologist or mental health counselor.

Healthy Lifestyle Changes

Eating well, avoidance of drugs and alcohol and getting plenty of regular exercise can ease depression symptoms. A large 2024 review of exercise trials found that walking or jogging, yoga and strength training all reduced depression, with more vigorous exercise helping more (Noetel et al., 2024). A person’s physical well-being is directly linked to their mental and emotional well-being. Making the effort to get fresh air, drink water, eat well, and do light exercise like walking or stretching can make an impact on symptoms, even if it’s only for a short period of time. For people with depression, even a small break from their symptoms can be a tremendous relief.

Small Steps That Help on Hard Days

When you’re in a depressive episode, it can help to:

• Keep a simple routine: get up, eat and go to bed around the same times each day
• Set one small goal: a shower, a short walk or one task, and count it as a win
• Get outside: daylight and fresh air, even for 10 minutes
• Reach out to one person: a text or call to someone you trust
• Limit alcohol: it can deepen low mood and interfere with sleep and medication

If these feel impossible right now, that’s a sign of how heavy depression can be, not a personal failure, and a good reason to reach out to a therapist or your doctor.

Depression Therapy FAQs

What is the best type of therapy for depression?

There’s no single best therapy for everyone. CBT, behavioral activation, interpersonal therapy, psychodynamic therapy and MBCT all have research support (American Psychological Association, 2019). The best fit depends on your symptoms, your preferences and how well you connect with your therapist.

Can depression go away with treatment?

Yes, for most people. Depression is among the most treatable mental health conditions, and 70% to 90% of people eventually respond well to treatment (American Psychiatric Association, 2024). Some people need to try more than one approach before finding what works.

What’s the difference between sadness and depression?

Sadness is a normal response to loss or disappointment and usually eases with time. Depression lasts more than two weeks, affects most of the day, and makes it hard to work, sleep or enjoy things you used to. With grief, painful feelings tend to come in waves and self-esteem usually stays intact, while depression often brings feelings of worthlessness (American Psychiatric Association, 2024).

Can online therapy help with depression?

Yes. Many people get therapy for depression by video, and guided online CBT programs have been shown to reduce depression symptoms (Karyotaki et al., 2021).

If you’re in crisis or thinking about suicide, call or text 988 (US and Canada), or see our crisis helplines for other countries.

Find a Therapist for Depression

Search TherapyTribe for a therapist who specializes in depression, in your area or online.

This article is for information only and is not a substitute for professional medical advice, diagnosis or treatment. Talk with a qualified health professional about your symptoms and treatment options.

References

American Psychiatric Association. (2024, April). What is depression? https://www.psychiatry.org/patients-families/depression/what-is-depression

American Psychological Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline

Bains, N., & Abdijadid, S. (2023). Major depressive disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Chu, A., & Wadhwa, R. (2023). Selective serotonin reuptake inhibitors. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554406/

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://doi.org/10.1002/wps.20701

Karyotaki, E., Efthimiou, O., Miguel, C., Maas genannt Bermpohl, F., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., & the Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. https://doi.org/10.1001/jamapsychiatry.2020.4364

Milaneschi, Y., Simmons, W. K., van Rossum, E. F. C., & Penninx, B. W. J. H. (2019). Depression and obesity: Evidence of shared biological mechanisms. Molecular Psychiatry, 24(1), 18–33. https://doi.org/10.1038/s41380-018-0017-5

National Institute of Mental Health. (n.d.). Depression. https://www.nimh.nih.gov/health/topics/depression

National Institute of Mental Health. (2024). Brain stimulation therapies. https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies

Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S., & Lonsdale, C. (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

Schipper, S., Nigam, K., Schmid, Y., Piechotta, V., Ljuslin, M., Beaussant, Y., Schwarzer, G., & Boehlke, C. (2024). Psychedelic-assisted therapy for treating anxiety, depression, and existential distress in people with life-threatening diseases. Cochrane Database of Systematic Reviews, 2024(9), Article CD015383. https://doi.org/10.1002/14651858.CD015383.pub2

U.S. Preventive Services Task Force. (2023). Screening for depression and suicide risk in adults: US Preventive Services Task Force recommendation statement. JAMA, 329(23), 2057–2067. https://doi.org/10.1001/jama.2023.9297