Depression can make the simplest steps feel heavy — including the step of looking for help. If you are reading this for yourself or for someone you love, it is worth knowing that depression is one of the most studied conditions in mental health, and there are several well-researched treatments that help many people feel like themselves again.
This guide walks through what those treatments are, how therapy and medication fit together, what a course of treatment usually involves, and how to find a provider whose training matches what the research supports.
If you are thinking about suicide or feel unsafe right now, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day. If you are in immediate danger, call 911 or go to the nearest emergency room.
Several therapies have strong support
In 2019 the American Psychological Association published a clinical practice guideline for treating depression, built on a series of systematic reviews. For adults, the guideline recommends offering either psychotherapy or a second-generation antidepressant as a first step, chosen together with the person through shared decision-making. Because studies found broadly similar effects across several therapy models, the guideline does not single out one “best” therapy. The models it names include:
- Behavioral therapy, including Behavioral Activation. Depression tends to shrink a person’s world: less activity leads to fewer rewarding moments, which deepens low mood. Behavioral Activation works on that cycle directly, helping you schedule and gradually rebuild activities that matter to you, even before motivation returns.
- Cognitive and cognitive-behavioral therapy (CBT), including mindfulness-based cognitive therapy. CBT looks at the links between thoughts, feelings, and actions, and teaches practical skills for noticing and testing the harsh, hopeless thinking depression produces.
- Interpersonal psychotherapy (IPT). IPT focuses on relationships and life transitions — grief, conflict, role changes, isolation — and how they connect to mood.
- Psychodynamic therapies. These explore patterns, emotions, and earlier experiences that may be shaping how you feel now.
- Supportive therapy. A structured, collaborative relationship focused on coping and problem-solving in the present.
For adults whose depression is tied up with relationship distress, the guideline also suggests problem-focused couples therapy as an option. For older adults, it highlights group CBT and group life review.
The APA guideline found that comparative research generally shows similar effects across the major therapy models for adults, which is why it recommends choosing among them based on the person’s preferences, history, and what is available — rather than ranking them.
Behavioral Activation is a good example of how practical these approaches can be. In the COBRA trial, published in The Lancet in 2016, 440 adults with depression in the UK were randomly assigned to Behavioral Activation or CBT. Behavioral Activation, delivered by junior mental health workers, was not inferior to CBT delivered by specialist psychotherapists, and it cost less to provide.
Therapy, medication, or both
Therapy and antidepressant medication are both recommended starting points for adults, and the APA guideline found insufficient evidence to say one should be offered over the other as a first step. When people choose combined treatment, the guideline recommends pairing a second-generation antidepressant with CBT or interpersonal psychotherapy. For people who have not responded, or only partly responded, to an antidepressant, it suggests adding psychotherapy (IPT, CBT, or psychodynamic therapy) as one option.
Decisions about medication belong with a prescribing clinician such as a psychiatrist, psychiatric nurse practitioner, or primary care provider. Clinicians who specialize in depression are used to coordinating with prescribers, so you do not have to carry information back and forth on your own.
What a course of treatment looks like
A careful assessment
The first sessions cover your symptoms, history, sleep, health, substance use, safety, and what you hope will change. Clinicians trained in depression also ask about past episodes and any periods of unusually elevated mood, since that history can shape the treatment plan.
A shared plan with clear goals
You and your provider agree on an approach and on what progress would look like in daily life — getting back to work, reconnecting with friends, sleeping better, enjoying things again.
Regular measurement
Many providers use a brief questionnaire such as the PHQ-9, a nine-item measure of depression symptoms, every few sessions. Scores of 5, 10, 15, and 20 roughly mark mild, moderate, moderately severe, and severe symptoms. Tracking scores over time shows whether treatment is working and when the plan needs adjusting.
Practice between sessions
Most structured therapies include small between-session tasks, such as an activity plan or a thought record. The real change tends to happen in daily life, not only in the therapy room.
Planning for the long run
As symptoms ease, treatment turns to preventing relapse: recognizing early warning signs and knowing what to do if they appear.
When to seek help right away
Reach out for urgent help if you or someone you care about is having thoughts of suicide or self-harm, cannot keep up with basic needs like eating or sleeping, or is experiencing a sudden, sharp change in mood or behavior. You can call or text 988 at any hour, or chat at 988lifeline.org. Clinicians who treat depression ask about suicidal thoughts routinely, so you can bring them up plainly; it is a normal and important part of care.
What to look for in a provider
Look for a licensed mental health provider with specific training in at least one of the approaches above, who can explain how their method works and how you will both know whether it is helping. It is also reasonable to ask how they handle safety concerns and how they work with prescribers.
Questions worth asking a provider
- “Which approach do you use for depression, and where did you train in it?”
- “How will we measure progress? Do you use a tool like the PHQ-9?”
- “What happens if I am not improving after several weeks?”
- “How do you coordinate with a psychiatrist or primary care provider if I take medication?”
- “How do you handle a crisis between sessions?”
- Several therapies have strong research support for depression, including Behavioral Activation, CBT, and interpersonal psychotherapy.
- Therapy and medication are both recommended first steps for adults; when combined, CBT or IPT plus an antidepressant is recommended.
- Good treatment is measurable: brief tools like the PHQ-9 show whether the plan is working.
- If you are thinking about suicide or feel unsafe, call or text 988 any time.
The specialists listed below are mental health providers whose depression training Tandem has reviewed. Reaching out to one is a meaningful first step.
References
- American Psychological Association. (2019). Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. https://www.apa.org/depression-guideline
- Richards, D. A., et al. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A randomised, controlled, non-inferiority trial. The Lancet, 388(10047), 871–880. https://eprints.whiterose.ac.uk/105790/
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://pmc.ncbi.nlm.nih.gov/articles/PMC1495268/
- 988 Suicide & Crisis Lifeline. https://988lifeline.org