Therapy for Depression

How therapy helps depression

Therapy can help you understand what contributes to depression, re-engage with activities that bring meaning, challenge harsh or hopeless thinking, and improve relationships and support.

Approaches with good evidence

• Cognitive behavioral therapy (CBT): identifies and changes unhelpful thinking and behavior patterns.
• Behavioral activation: gradually increasing rewarding and meaningful activities to counter withdrawal.
• Interpersonal therapy (IPT): focuses on relationships, role changes, grief and conflict.
• Problem-solving therapy: builds structured ways to tackle practical difficulties.
• Mindfulness-based cognitive therapy (MBCT): often used to prevent relapse.
• Psychodynamic therapy: explores underlying patterns and past experiences.

Therapy and medication

For mild depression, guidelines often suggest starting with therapy or guided self-help. For more severe depression, combining therapy with antidepressants is common. A clinician can help you weigh the options.

If you are in therapy and want to discuss medication, you can see a separate prescriber. For example, Lemonaid Health offers antidepressant prescribing, and PlushCare offers both therapy and a prescribing doctor in one service.

What therapy for depression involves

Depression pulls people into a cycle: low mood reduces activity and contact, which removes sources of pleasure and meaning, which lowers mood further, while harsh self-critical thoughts add to the weight. Therapy works on several parts of this cycle. Depending on the approach, your therapist may help you notice patterns, schedule rewarding or meaningful activities, challenge hopeless or self-critical thinking, strengthen relationships and solve practical problems. Sessions are usually weekly, last about 50 minutes and include tasks between meetings.

The approaches in more detail

• Behavioral activation (BA) is a straightforward and effective approach. You and your therapist identify activities that matter to you, plan small steps and track how they affect mood. It is based on the idea that action can come before motivation.
• CBT adds a focus on thoughts, helping you spot patterns such as “I’m a failure” and test them against evidence. See CBT.
• Interpersonal therapy (IPT) looks at the links between mood and relationships, grief, role changes and conflict. It typically runs for 12 to 16 weeks.
• Mindfulness-based cognitive therapy (MBCT) combines mindfulness with cognitive skills and has good evidence for preventing relapse in people who’ve had several episodes.
• Problem-solving therapy helps when practical difficulties feed low mood.
• Psychodynamic therapy explores longer-standing patterns and may be chosen when depression is tied to long-standing relationship themes.
• Couples and family approaches help when relationships are central; see couples therapy.

How effective is therapy?

Studies show that psychotherapy is effective for mild to moderate depression and is comparable to antidepressants for many people, with a lower risk of relapse after treatment ends in some trials. For severe depression, combining therapy and medication often works better. Response varies: some people feel better within weeks, others need more time or a change of approach. Because effects of therapies are broadly similar, personal preference, availability and fit often guide the choice.

Starting when motivation is low

Depression makes it hard to begin, which is exactly when help is most needed. Some ideas that can make it easier:

• Ask a friend or family member to help you search, book or attend the first session.
• Use online or phone options if leaving home feels too hard; see online therapy.
• Tell your doctor; they can help arrange care and check for medical contributors.
• Plan the first session to be about getting to know each other, not solving everything.
• Start with small steps outside therapy, such as a short walk or a call to someone.

Recognizing that it is working

You might notice better sleep, more energy, small returns of interest or humor, greater ease with routines and less harsh self-talk. Often these show up before you’d describe your mood as “good.” Tell your therapist about progress and about setbacks; they are common and don’t mean treatment has failed. For more on spotting depression, see signs of depression.

When therapy alone may not be enough

Seek medical advice if depression is severe, if you can’t function day to day, if you have lost a lot of weight or can’t sleep for long periods, or if you have symptoms such as psychosis or thoughts of suicide. A prescriber can discuss antidepressants, and specialist services can help when depression hasn’t responded to initial treatment. If you are having thoughts of ending your life, please contact a crisis line or emergency services now; see Get Help Now.

Related reading

For an overview of the condition, see depression, and for options and costs, see depression treatment and our guide to online depression treatment.

Getting started

Look for a licensed therapist experienced in treating depression. If motivation is low, it can help to ask someone you trust to support you in making the first contact.

Questions people often ask

Will therapy work if I don’t feel motivated? Yes. Approaches such as behavioral activation are designed for low motivation, and starting small is part of the method. Do I have to talk about my childhood? Not necessarily. Many effective therapies focus on the present, while others explore the past; ask your therapist how they work. How will I know it’s helping? You may notice small changes in sleep, energy or interest before mood lifts, and short questionnaires can track progress over time.