What to Expect from Therapy for Depressionand How to Start The Process

By Ashley Abramson

Medically reviewed by Ryan Howes, Ph.D.

Starting therapy for depression is really crucial for so many people, because the mental health condition goes far beyond your typical bouts of sadness. Depression can swallow your life with feelings of hopelessness, pessimism, and irritability. It’s totally normal to feel low at times—we’ve all struggled to get out of bed at some point—but it becomes debilitating when these feelings don’t seem to have an end in sight. That’s why finding the right treatment, which often includes therapy, can be life-changing.

You may find some comfort in knowing that you’re not alone if you are feeling this way. Depression is relatively common, affecting nearly 8% of adults in the U.S., according to 2019 figures from the National Institute of Mental Health. “Depression is a complex disease, and like almost all chronic diseases, there are multiple causes,” Anne H. Gilbert, M.D., a clinical psychiatrist at Indiana University Health, tells ishonest.

But discovering the root cause of your symptoms will ultimately help pave a path for brighter days, and a mental health expert can help you do that. If you’ve been considering therapy for depression, here’s your sign to go for it. Working with a therapist can help you bring buried feelings to the surface, so you can confront them, begin to understand them, and ultimately address them in a safe space.

Ahead, ishonest asked experts to explain the ins and outs of getting diagnosed with depression, and what you need to know about therapy before you get started. (Keep in mind that some of the following information may be triggering if you’re seriously struggling. If you feel like you need immediate help, you can contact your local hospital or the confidential National Suicide Prevention Hotline.)

What are the symptoms of depression?

Depression can be an insidious condition that looks and feels different for everybody. It may present as feelings of hopelessness for one person and irritability or overwhelming fatigue for someone else. If you experience at least five of the following signs of depression for most of the day, nearly every day, for at least two weeks, your physician or therapist might diagnose you with some form of depression:

• Feeling hopeless, pessimistic, sad, or empty
• Feeling worthless or guilty
• Lost interest in favorite hobbies or activities
• Eating more or less than you typically do
• Unexplained weight fluctuations
• Sleeping more or less than you usually do
• Fatigue or loss of energy
• Irritability
• Trouble concentrating
• Thoughts of suicide
• Unexplained physical aches, pains, or digestive issues

How is depression diagnosed?

Getting an official depression diagnosis happens at different times for different people. For some, a diagnosis comes when they bring up symptoms with their primary care doctor, who then refers them to a therapist. For others, a depression diagnosis isn’t discovered until therapy has already started to unpack unresolved feelings. There’s no wrong time to receive a diagnosis, but getting one can help shed a light on what you’ve been experiencing.

If your physician or a mental health professional suspects your symptoms are signaling depression, they’ll refer to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which experts view as the bible of mental health conditions.

When you discuss your symptoms with your provider, they’ll ask you about your medical history, as well as your family’s medical history. (Depression tends to run in families, suggesting the condition has a genetic component, per the U.S. National Library of Medicine.) Your primary care doctor may also order lab tests to rule out other health conditions that can mimic depression’s effects. For example, thyroid disorders can cause irritability, fatigue, and really low moods. Or, you may feel really tired and apathetic because of a vitamin or mineral deficiency, according to the Mayo Clinic.

If your symptoms aren’t caused by other health issues and ultimately point to depression, there are different forms of the condition you may be diagnosed with, according to the Cleveland Clinic. This commonly includes, but is not limited to, the following:

• Major depressive disorder means your symptoms are really distressing and they last longer than two weeks.
• Bipolar depression is specific to people with bipolar disorder who have alternating periods of low (depressive) and extremely high (manic) moods.
• Perinatal or postpartum depression means you’re depressed during pregnancy or up to one year after having a baby, which may be caused by a combination of factors including stress and hormonal changes.
• Persistent depressive disorder (PDD) means your depression symptoms are less severe than major depressive disorder but last for at least two years.
• Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual disorder, or PMS, that causes low moods in the days or weeks leading up to your period.
• Psychotic depression is characterized by delusions, meaning you think things that aren’t necessarily true, or hallucinations, in which you may see or hear things that aren’t actually there. These symptoms occur in addition to the depression symptoms mentioned above.
• Seasonal affective disorder (SAD) means you have the common depression symptoms during the late fall or early winter, which goes away in the spring or summer. Experts don’t know what specifically causes SAD, but believe a lack of sunlight changes brain chemicals and hormones that affect mood and sleep patterns.

What to expect from a depression treatment plan

During your first few appointments, your therapist will want to get to know you, how you’ve been feeling, and what your goals are with counseling. Heidi L. Combs, M.D., a clinical psychiatrist and director of inpatient psychiatry at UW Health Harborview Hospital, says she develops a depression treatment plan with input from her patients based on their medical history and whether they have other health conditions or mental health disorders (like anxiety or OCD), individual needs based on symptoms, and personal preferences.

For example, some people prefer to try talk therapy before they try medication, while others are open to including both in their treatment plan. Or, if you’ve had depression in the past and benefited from a particular medicine or type of therapy, it might be worth trying the same course of action if it’s already been successful for you.

Essentially, your treatment might include therapy for depression, medications for depression, or both. For people with really severe symptoms, a combination of the two can be helpful because the benefits of antidepressants can start to take effect in as little as two months for some people, according to the Cleveland Clinic. Of course, anyone can benefit from therapy, but the skills you learn are an ongoing process that may take some time to stick.

What types of therapy help relieve depression symptoms?

Psychotherapy, or talk therapy, can be a game changer for people who struggle with depression. A therapist can work with you to identify things that contribute to your symptoms, from grief to stress to buried traumas, and help you find actionable ways to change or adapt your thoughts and behaviors around those circumstances, among other practices.

Showing up for therapy to help treat your depression is a commitment: The conversations you’ll have with your trusted provider can be tough, messy, uncomfortable, and very emotional. But over time, you may find that talking to your therapist becomes easier, enlightening, and extremely rewarding.

There are two major ways to approach therapy for depression: individual therapy and group therapy. Individual psychotherapy is just what it sounds like: a one-on-one session with a trained mental health professional, which can take place at a hospital, medical clinic, therapist’s office, or your own home via telehealth. If you’re new to therapy, you might feel most comfortable with individual sessions since they’re private. Plus, your therapist can get to know you on a deeper level this way and tailor their treatment recommendations to fit your particular situation.

Group therapy, on the other hand, involves more than two people in a therapy session with at least one mental health professional. (Some group therapists may also ask that you get individual counseling too.) According to psychiatrist Michelle Durham, M.D., M.P.H., clinical associate professor of psychiatry at Boston University School of Medicine, group therapy allows you to explore perspectives or advice from other people who understand some of what you’re feeling beyond what a therapist notices or shares during group therapy.

It can also help you feel less alone. “People are often very isolated with their mental health struggles,” Dr. Combs says, “so seeing there are other people out there who struggle can be very empowering.”

With this framework in mind, there are various types of therapy for depression that can occur in a one-on-one or group setting.

What it is: Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps you identify negative or unhealthy thought patterns and behaviors so you can replace them with more positive ones, according to the American Psychological Association. CBT not only helps relieve depression symptoms but it can also be effective in preventing depression relapse. Some people with mild- to-moderate depression may feel better just with cognitive behavioral therapy, but others may benefit from trying cognitive therapy in combination with antidepressants.

What to expect: In a CBT session, a therapist will help you make connections between your thoughts, actions, and how you feel overall. For example, if you’re always dwelling on mistakes you made at work, your therapist might help you develop strategies to reframe those challenges as learning opportunities for growth.

With CBT, you can also develop a skill called behavioral activation, which encourages you to do activities that make you feel good. For example, you may not feel like you have the energy to go for long runs like you used to. A therapist can help you work on an actionable plan that helps your work back up to running, even if that means just starting with a short walk.

Sometimes, CBT also involves “homework,” such as journaling or meditation, to help you tune into your thoughts and develop coping skills.

What it is: Dialectical behavior therapy combines elements of behavior therapy, CBT, and mindfulness. The goal is to help you accept your life and your actions while also helping you learn how to change any behaviors that could be contributing to your depression. With this method, you’ll ideally learn how to validate your emotions and to also control them, per the National Alliance on Mental Illness (NAMI).

What to expect: During your session, your therapist will help you come to terms with your emotions, and whether or not they are driving you to do things that might make you feel worse (for example, eating a large quantity of food when you’re stressed). Many DBT therapists will also help you figure out how to create an environment that you feel good in. For example, if you drink a lot because it temporarily makes you feel better, your therapist can help you come up with a plan about what to do if you’re at parties that include alcohol.

What it is: Interpersonal therapy focuses on how your relationships with other people influence your behaviors and emotions. This form of therapy helps you understand how interpersonal problems may contribute to your depression as well as how you can address and resolve those conflicts. Generally, you may find this type of therapy helpful if you are experiencing depression due to loss of a loved one, family problems, or other distressing events connected to your relationships.

What to expect: Interpersonal therapy is typically brief, so you may go to a weekly session for three to four months. During that time, your therapist will talk to you about the relationships in your life and help you identify pain points that are affecting your mood. Depending on your particular situation, you may learn how to communicate your feelings to other people, set personal boundaries, or develop coping skills.

What it is: Psychodynamic therapy is based on the idea that you may become depressed because of unresolved conflicts that you’re not even aware of, such as your parents’ divorce. By reflecting on those events, you can better understand your behaviors and how to make changes that are positive for your mental health. “Psychodynamic therapy really helps the person reflect on how they got here,” Dr. Durham says. While CBT is more focused on the here and now, she says psychodynamic therapy dives deeper into your history and how it may contribute to your depression today.

What to expect: In a session, you’ll take a closer look at your past so your therapist can help identify the events and beliefs that may be tied to your depression. For example, if you’re always drawn to avoidant partners who don’t want a committed relationship, your therapist might ask more questions about that, like who else in your life may have acted this way. The conversations are usually very open, so you will talk about a variety of experiences as they come up. As the therapy continues, you’ll dig deeper into your emotions as you become more aware of past events and reflect on how they might be affecting you now.

What it is: If your depression is linked to problems you’re having with your partner, or if a person is in a relationship with someone who is depressed and needs help, couples therapy is an option. With the help of a trained professional, partners open up about their relationship in order to figure out how a person’s depression may overlap with their relationship. According to Dr. Combs, couples therapy tends to focus on the couple’s dynamic rather than individual problems, so if you’re in this situation, you may benefit from couples therapy and individual therapy.

What it is: Family therapy is a form of group therapy that focuses on supporting relatives through difficult issues. Often, people choose this route to work through conflicts that stem from the family unit. “It’s really hard for an individual therapist to work with just one individual if most of the problems they’re describing have to do with another person or their family,” Dr. Durham says.

What to expect: Every family has their own issues to work through, so the specifics of what you’ll talk about really depends on your particular situation. But if you, or someone in your family, is depressed, then you might discuss what’s causing that and how everyone can be more supportive. For example, if someone in your family is depressed due to years of childhood abuse that they never addressed, that may be something they need help working through even as an adult. Of course, asking your family to go to therapy together and open up about these sensitive subjects can be really difficult, but these tips on how to talk to a reluctant family member about therapy might make the process feel less daunting.

How to find the best therapist for you

If you’re ready to talk to a therapist about your depression, you’re headed in a good direction—but it’s important to keep in mind that finding the best therapist for you might take some time, and that’s totally normal. Lots of factors, such as insurance coverage, where you live, the hours you work, the type of therapy practiced, and your overall experience with a therapist, can contribute to finding “the one.”

If you don’t have a physician you feel comfortable talking to about your depression and you have insurance, then you can start by contacting your insurance company to ask about mental health coverage. Once you find out what types of services are covered, you can start making a list of potential therapists to reach out to by browsing your insurance company’s directory or another online directory, like this one from the Anxiety & Depression Association of America. Then, when you have some promising names, you’ll want to reach out to them for a preliminary call or consultation. Make sure you create a list of questions you’d like answered before you commit to an appointment, including whether or not they take your insurance to verify coverage.

If you don’t have great insurance coverage (or no coverage at all), you can look for therapists who offer reduced fees based on your income. The Substance Abuse and Mental Health Services Administration (SAMHSA) directory of mental health providers includes whether a provider accepts sliding scale fees. You can also search for providers who offer sliding scale sessions on Psychology Today, Thero, and Inclusive Therapists, the latter of which allows you to find therapists based on your cultural or sexual identity.

Still have questions? ishonest’s Guide to Caring for Your Mental Health has tons of resources on how to make the most of therapy, including:

• 7 Ways to Find an Actually Affordable Therapist
• How to Find a Culturally Competent Therapist Who Makes You Feel Heard
• How to Decide Between Seeing a Therapist or a Counselor
• 8 Things You Should Know Before Your First Therapy Appointment
• 13 Tips for Getting the Absolute Most Out of Therapy
• Here’s How to Actually Give Your Therapist Feedback

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