A woman holds out her hand to feel the rain coming down.

Depression is one of the most common mental disorders in the United States. The symptoms range from mild to severe and can disrupt a person's ability to carry out everyday activities.

The prevalence of major depressive episode was higher among adult females (10.3%) compared to males (6.2%). The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (18.6%). While depression affects millions of Americans, effective treatments are available that can help people recover and regain their quality of life.

NIMH is funding and conducting research to learn more about what causes depression, how it affects the brain, and how to treat it effectively. We're working to improve existing treatments like medications, talk therapy (including telehealth and online options), and brain stimulation therapy. With help from a mental health professional and the right treatment approach, recovery from depression is possible.

Table of Contents

  • What to Expect in Depression Therapy
  • Types of Psychotherapy for Depression
  • Medication for Depression
  • Complementary and Alternative Medicine
  • Lifestyle Changes to Help Depression
  • Telehealth and Online Therapy Options
  • Hospitalization for Depression
  • Overcoming Stigma and Barriers to Treatment
  • Depression Therapy Case Examples
  • Frequently Asked Questions
  • How Therapy Can Help / Find a Therapist

What to Expect in Depression Therapy

In a typical first therapy session for depression, a therapist will conduct a comprehensive evaluation to assess your symptoms, goals, and any co-occurring physical or mental health factors. This initial assessment helps determine the most appropriate treatment approach for your specific situation.

During therapy, you can expect:

  • A non-judgmental, supportive environment where you can discuss your experiences openly
  • Collaborative goal-setting to address your specific concerns
  • Evidence-based techniques tailored to your needs
  • Regular monitoring of your progress
  • Adjustments to treatment as needed

Among adolescents and adults with depression, 87.9% reported at least some difficulty with work, home, or social activities due to their depression symptoms. Among adolescents and adults with depression, a higher percentage of females (43.0%) than males (33.2%) reported receiving counseling or therapy in the past 12 months.

Common therapy goals include:

  • Reducing depressive symptoms
  • Improving daily functioning
  • Strengthening relationships
  • Building self-esteem and self-worth
  • Developing healthy coping strategies
  • Preventing future depressive episodes

Types of Psychotherapy for Depression

Research shows several types of psychotherapy are effective for treating depression:A young girl lays her head in her mother's lap. The mother rests her hand on the child's head.

Cognitive Behavioral Therapy (CBT)

Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry. (2023) 22:105–15. CBT helps identify and change negative thought patterns and behaviors that contribute to depression. Results differ from previous NMA findings in suggesting that (a) antidepressants do not show evidence of an effect against pill placebo in less severe depression; (b) group CBT may be the most effective treatment for less severe depression; (c) the mode of delivery (individual versus group) appears to impact on CBT effectiveness.

Interpersonal Therapy (IPT)

IPT focuses on improving interpersonal relationships and social functioning to relieve depressive symptoms. It addresses four main problem areas: grief, role disputes, role transitions, and interpersonal deficits.

Behavioral Activation

For more severe depression, efficacious classes versus pill placebo (reference treatment for this population) included combined individual CT/CBT with antidepressants [-1.18 (-2.07; -0.44)], individual behavioural therapies [-0.86 (-1.65; -0.16)]. This therapy focuses on helping people engage in activities that bring a sense of accomplishment or pleasure.

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT combines mindfulness meditation practices with cognitive therapy techniques to prevent depression relapse.

Medication for Depression

Antidepressants can be effective for treating moderate to severe depression. In 2021, an estimated 61.0% of U.S. adults aged 18 or older with major depressive episode received treatment in the past year. Among those individuals with major depressive episode with severe impairment, an estimated 74.8% received treatment in the past year.

Types of Antidepressants

The main classes of antidepressants include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs): Often the first-line treatment due to their effectiveness and relatively mild side effects
  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Effective for both depression and anxiety symptoms
  • Tricyclic Antidepressants (TCAs): Older medications that are effective but often have more side effects
  • Atypical Antidepressants: Including medications like mirtazapine and bupropion

Effectiveness and Considerations

The outcomes were the 6-month relapse rate (primary outcome, efficacy), all-cause discontinuation (acceptability), discontinuation due to adverse events (tolerability), and the incidence of individual adverse events. The risk ratio with a 95% credible interval was calculated. The meta-analysis comprised 34 studies (n = 9384, mean age = 43.80 years, and females = 68.10%) on 20 antidepressants.A man in a suit sits on the ground, covering his head with his hands. He is very wet.

Important considerations when taking antidepressants:

  • It typically takes 4-8 weeks to see full benefits
  • Side effects often improve after the first few weeks
  • Never stop taking antidepressants suddenly without medical supervision
  • Regular monitoring by a healthcare provider is essential

A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. (2020) 19:92–107.

Complementary and Alternative Medicine

Many people with depression use complementary and alternative medicine (CAM) approaches alongside conventional treatment. Globally, depression is one of the ten most leading indications for seeking CAM treatment (22). Furthermore, the use of CAM is more common among individuals with psychiatric complaints than the rest of the population (19).

Evidence-Based CAM Approaches

Acupuncture

Other treatments such as manual acupuncture, aromatherapy, biofeedback, herbs (crocus sativus, curcuma longa, traditional Chinese herbs, lavandula angustifolia, echium amoenum and rhodiola rosea), homoeopathy, hypnosis, bright light therapy, massage, meditative movement therapies (dance therapy, Qi Gong, Tai Chi and yoga), whole-diet interventions, fasting and supplementation with inositol, magnesium, omega-3 fatty acids, probiotics, tryptophan, B and D vitamins and zinc were based on very low quality of evidence or no level 1 evidence.

Massage Therapy

Studies have shown massage to be helpful in the short-term relief of pain, anxiety, depression, fatigue, and stress in cancer patients, but there is no scientific support for claims that massage slows the growth or spread of cancer.

The literature search detected no meta-analysis of massage therapy in patients with a primary depression. However, massage therapy appeared to be effective in decreasing depressive symptoms in mixed samples of physically ill patients and healthy adults.132 Future research will show whether these results may be transferable to primary depressed cases.

St. John's Wort This herbal supplement may help with mild to moderate depression, but it can interact dangerously with many medications. Always consult with your healthcare provider before taking St. John's Wort.

Mind-Body Practices

A survey covering 6,618 adults in Australia indicated that self-help strategies including CAM were very commonly adopted to cope with depression, with meditation, music therapy, and massage often being used to address mild depression, and St John's Wort, aromatherapy, nutritional supplements and yoga often being used to address moderate depression (23).

Important Considerations

Increasing mainstream use of complementary and alternative medicine (CAM) supports this trend, particularly for different physical conditions with comorbid affective disorders.23–27 The NIH defines CAM as therapeutic approaches that are usually not included in conventional Western medicine systems.28 CAM therapies used in combination with conventional care are considered as complementary, those used instead of conventional care as alternative practices.

Always discuss CAM approaches with your healthcare provider to ensure they're safe and won't interfere with other treatments.

Lifestyle Changes to Help Depression

Research shows that certain lifestyle modifications can significantly help manage depression symptoms:

Exercise

In more severe depression, combined group exercise with antidepressants emerged as efficacious versus pill placebo (albeit based on a more limited evidence base than other efficacious classes in this population), whereas light therapy combined with antidepressants failed to show efficacy as in the original analysis, which is likely attributable to its limited evidence base, which apparently could not ensure stability in the results. Regular physical activity has been shown to:

  • Release endorphins and other mood-boosting chemicals
  • Reduce stress and anxiety
  • Improve sleep quality
  • Increase self-esteem

Sleep Hygiene

Maintaining regular sleep patterns is crucial, as depression often disrupts sleep. Tips include:

  • Going to bed and waking at consistent times
  • Creating a relaxing bedtime routine
  • Limiting screen time before bed
  • Avoiding caffeine and alcohol in the evening

Nutrition

While no specific diet cures depression, eating a balanced diet rich in:

  • Omega-3 fatty acids (found in fish, walnuts, flax seeds)
  • Whole grains
  • Fruits and vegetables
  • Lean proteins

can support overall mental health.

Social Connection

Gallup's 2025 data shows 33% of lonely adults have depression vs. just 13% among non-lonely adults. About 21% of Americans now experience significant daily loneliness—up from 17-18% in 2022-2023. Maintaining social connections and engaging in meaningful activities can help combat depression.

Telehealth and Online Therapy Options

The expansion of telehealth services has made mental health treatment more accessible than ever. 54% of Americans have had at least one telehealth visit by early 2024. Nearly 38% of Americans have used telehealth services for medical or mental health needs. 60% of survey respondents would consider using teletherapy for mental health services.

Effectiveness of Telehealth for Depression

Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups.

Depression: Meta-analysis of 12 studies (n=1,876) comparing telehealth to face-to-face treatment for depression showed no significant difference in effectiveness (SMD = -0.03, 95% CI [-0.15, 0.09], p = 0.62, I2 = 32%). This suggests non-inferiority of telehealth interventions for depression.

Benefits of Telehealth

  • Increased accessibility, especially for rural or mobility-limited individuals
  • Greater scheduling flexibility
  • Reduced travel time and costs
  • Comfort of receiving treatment from home

Telehealth was shown to improve overall patient attendance at appointments and lower cancelation rates.

Considerations for Telehealth

  • Requires reliable internet connection and device
  • Privacy concerns in shared living spaces
  • May not be suitable for severe depression or crisis situations

Therefore, access barriers to telehealth also encompass challenges to being of low-income status such as affordability costs, insurance, and availability of technological services. Ownership of technological devices such as a mobile phone or computer was required,16,17,19 and this was a significant barrier to internet access and, thus, effective therapy for depression and anxiety.

Hospitalization for Depression

In some cases, hospitalization may be necessary to ensure safety and provide intensive treatment. Of the 18.2 percent of individuals (52.6 million) who needed substance use treatment in 2024, only 3.5 percent (around 10.2 million individuals) received treatment. Additionally, 4.4 percent of adults (1.8 million) and 6.7 percent of adolescents (111,000) with a SUD who did not receive treatment thought they should have been able to.

When Hospitalization May Be Needed

  • Active suicidal thoughts or attempts
  • Severe symptoms preventing self-care
  • Risk of harm to self or others
  • Need for medication stabilization under close supervision
  • Lack of adequate support system during acute crisis

Types of Hospitalization

Inpatient Hospitalization: 24-hour care in a psychiatric unit, typically lasting 3-7 days for stabilization.

Partial Hospitalization Programs (PHP): Intensive day treatment (4-8 hours) while returning home at night.

Intensive Outpatient Programs (IOP): Several hours of treatment multiple days per week while maintaining regular activities.

What to Expect

During hospitalization:

  • Comprehensive psychiatric evaluation
  • Medication management
  • Individual and group therapy
  • Safety monitoring
  • Discharge planning for continued care

Overcoming Stigma and Barriers to Treatment

Stigma, characterized by societal prejudice and discrimination, profoundly influences psychiatric care, creating barriers to the timely recognition and treatment of mental health disorders [1]. Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of psychiatric care, leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.

Types of Mental Health Stigma

Public Stigma: Public stigma reflects negative attitudes, beliefs, and stereotypes that are directed toward people with mental illnesses by the public. Second, internalized stigma reflects the stigmatized person's own internalized negative beliefs, attitudes, and stereotypes that had been previously placed on them by society.

Self-Stigma: When individuals internalize negative beliefs about mental illness, leading to shame and reduced self-esteem.

Structural Stigma: Finally, structural stigma reflects laws, policies, and practices that result in unfair treatment of people with mental illnesses (Price & Hollinsaid, 2022).

Strategies to Combat Stigma

Substantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.

Personal Strategies:

  • Educate yourself and others about depression
  • Use person-first language ("person with depression" not "depressed person")
  • Share your story when comfortable
  • Join support groups

Make sure you get treatment. Don't let fear keep you from getting help. Treatment can help you find out what's causing your symptoms and lessen those that are leading to difficulties in your life.

Community Approaches:

Social marketing campaigns can also be effective. For example, a research study looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019).

  • Contact-based interventions showing real stories
  • Mental health literacy programs
  • Workplace mental health initiatives

Common Barriers and Solutions

Financial Barriers: Income is one of the strongest predictors of depression. 35.1% of low-income adults (<$24K/year) have depression—up from 22.1% in 2017. People below the poverty line are 3x more likely to experience depression than those with higher incomes.

  • Solutions: Sliding scale fees, community mental health centers, insurance coverage expansion

Geographic Barriers: Limited providers in rural areas

  • Solutions: Telehealth services, mobile crisis units, integrated primary care

Cultural Barriers: The studies reviewed reveal that mental illness stigma is influenced by cultural beliefs, attitudes, and values, and can manifest in different ways across cultures. It is important to understand these cultural differences to develop more effective interventions to reduce mental illness stigma and improve outcomes for individuals living with mental illness.

  • Solutions: Culturally competent providers, community-based interventions, multilingual services

Depression Therapy Case Examples

Case 1: Young Adult with First Episode

Sarah, 22, college student experiencing her first major depressive episode after a breakup. Initially reluctant to seek help due to stigma, she started with campus counseling services. Through 12 sessions of CBT and lifestyle changes (regular exercise, improved sleep schedule), she identified patterns of negative self-talk and developed healthier coping strategies. She recovered without medication and learned skills to prevent future episodes.

Case 2: Middle-Aged Professional with Hidden Depression

Marcus, 45, successful executive who hid his depression for years. Despite career achievements, he felt empty and disconnected from family. Started with telehealth therapy due to busy schedule. Combination of individual therapy, antidepressant medication (SSRI), and couples counseling helped him address perfectionism and improve relationships. After 6 months, reported significant improvement in mood and life satisfaction.

Case 3: Older Adult with Late-Life Depression

Elena, 68, developed depression after retirement and spouse's death. Initially dismissed symptoms as "normal aging." Primary care physician screening identified depression. Treatment included antidepressant medication, grief-focused therapy, and joining a senior center for social connection. Group therapy particularly helpful in reducing isolation. Significant improvement after 4 months of treatment.

Frequently Asked Questions

How do I know if I need professional help for depression?

During August 2021–August 2023, the prevalence of depression in the past 2 weeks was 13.1% in adolescents and adults age 12 and older (Figure 1, Table 1). Depression prevalence decreased with increasing age. Overall, prevalence was highest in adolescents ages 12–19 (19.2%) and lowest in adults age 60 and older (8.7%). Seek help if you experience persistent sadness, hopelessness, changes in sleep or appetite, difficulty concentrating, or thoughts of death lasting more than two weeks.

What's the difference between therapy and medication for depression?

Therapy is as effective as drugs in the short term, but more effective in the long term. Combined treatment is better than drugs or psychotherapy alone. Both can be effective; therapy addresses thought patterns and behaviors while medication targets brain chemistry. Many people benefit from combining both approaches.

How long does depression treatment take?

Treatment duration varies by individual. Although depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated. The aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment. Many people see improvement within 6-12 weeks, but full recovery may take several months. Some may need longer-term maintenance treatment.

Will my insurance cover depression treatment?

Most insurance plans cover mental health treatment, including therapy and medication. The Mental Health Parity Act requires equal coverage for mental and physical health. Check your specific plan for details about copays and covered providers.

Can I get better without medication?

Results differ from previous NMA findings in suggesting that (a) antidepressants do not show evidence of an effect against pill placebo in less severe depression; (b) group CBT may be the most effective treatment for less severe depression. Many people with mild to moderate depression improve with therapy alone. Lifestyle changes and support systems also play important roles. Severe depression often benefits from medication combined with therapy.

What if the first treatment doesn't work?

Further research is needed to help improve both the standard of care and the outcome for patients with treatment-resistant depression. A particularly critical evidence gap exists with respect to whether pharmacological or non-pharmacological augmentation is superior to antidepressant switch, or vice-versa. It's common to try different approaches. Your provider can adjust medication doses, switch medications, try different therapy approaches, or combine treatments.

How Therapy Can Help / Find a Therapist

Depression is highly treatable, and seeking help is a sign of strength, not weakness. 23.4% of U.S. adults experienced mental illness in 2024 (61.5 million people). 53% of U.S. LGBTQ+ young people ages 13-24 reported experiencing recent symptoms of depression in 2023. With proper treatment, most people with depression can achieve significant improvement and return to fulfilling lives.

Benefits of Professional Treatment:

  • Evidence-based approaches proven to reduce symptoms
  • Personalized treatment plans
  • Professional support during difficult times
  • Skills to prevent future episodes
  • Improved relationships and functioning

How to Find Help:

1. Start with your primary care provider - They can provide initial screening and referrals

2. Use insurance provider directories - Find in-network mental health professionals

3. Contact community mental health centers - Often offer sliding-scale fees

4. Explore telehealth options - Increased accessibility and convenience

5. Ask for referrals - From trusted healthcare providers or friends

Crisis Resources:

  • 988 Suicide & Crisis Lifeline: Call or text 988 (available 24/7)
  • Crisis Text Line: Text HOME to 741741
  • Emergency Services: Call 911 for immediate danger

Remember, If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

To find a qualified therapist in your area, visit the GoodTherapy directory at www.goodtherapy.org/find-therapist.html

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