Approaches to therapy

While therapy can be done in different formats -- like family, group, and individual, there are also several different approaches that mental health professionals can take to provide them. After talking with the patient about depression and conducting a complete assessment, the therapist will decide which approach to use based on the suspected psychological or social causes.

Psychodynamic therapy

Psychodynamic therapy is based on the assumption that a person experiences depression as a result of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by re-experiencing them through talking about them. Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years.

Interpersonal therapy

Interpersonal therapy is a treatment that focuses on the behaviors and social interactions a patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and interpersonal therapies help patients resolve depression caused by:

• Loss (grief)
• Relationship conflicts
• Role transitions

Cognitive-behavioral therapy

Cognitive-behavioral therapy helps people with depression to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps the patient establish new patterns of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.

Cognitive-behavioral therapy is recommended for patients:

• Who think and behave in ways that trigger and perpetuate depression.
• With mild-to-moderate depression as a sole treatment or as adjunctive treatment with antidepressant medication
• With depression who refuse or are unable to take antidepressant medication.
• Of all ages who have depression that causes suffering, disability or interpersonal problems.

How do I seek therapy?

Seeking treatment for depression is difficult for most. Some may feel that taking the advice of a mental health professional makes them something other than normal, or that they have given up the battle to be in control of their emotions. This is simply not so. Maintaining good mental health is just as important as maintaining good physical health. Good mental health allows you to take on life's challenges with a better perspective and experience each day with a sense of fulfillment.

If you are experiencing the symptoms of depression, see your primary care physician for an initial evaluation. Sometimes general modifications to your lifestyle that include a healthy diet, exercise, and seeking the support of family and friends can be enough to help mild depression without further treatment. For moderate to severe depression, however, your physician can either prescribe antidepressant medication or refer you to a mental health professional for further evaluation and treatment. (more: How to Find A Therapist Who's Right For You")

Therapy tips

Therapy works best when you attend all of your scheduled appointments. The effectiveness of therapy depends on your active participation and working together with your therapist to effectively deal with your depression. It requires time, effort and regularity.

As you begin therapy, establish some goals with your therapist. Then spend time periodically reviewing your progress with your therapist. If you don't like your therapist's approach or if you don't think the therapist is helping you, talk to him or her about it and seek a second opinion if both you and your therapist agree, but don't discontinue therapy abruptly.

Tips to help you get started

• Identify sources of stress: Try keeping a journal and note stressful as well as positive events.
• Restructure priorities: Emphasize positive, effective behavior. Make time for recreational and pleasurable activities.
• Communicate: Explain and assert your needs to someone you trust; write in a journal to express your feelings.
• Try to focus on positive outcomes and finding methods for reducing and managing stress.

Remember, therapy involves evaluating your thoughts and behaviors, identifying stresses that contribute to depression, and working to modify both. People who actively participate in therapy recover more quickly than those who aren't motivated and have fewer relapses. Therapy is treatment that addresses specific causes of depression; it is not a "quick fix." It takes longer to begin to work than antidepressants, but there is evidence to suggest that its effects last longer. Antidepressants may be needed immediately in cases of severe depression, but the combination of therapy and antidepressant medicine is very effective. Treatment is best determined on an individual basis.

next: NIMH: Psychotherapy and Antidepressant Medications Work Best