Psychotherapy For Depression

Psychotherapy — or “talk therapy” — is an effective treatment for clinical depression. On its own, psychotherapy may not be enough to resolve severe depression. But it can play an important role when used with other treatments, including medications.

What can psychotherapy do to help with clinical depression?

The role of psychotherapy in treating clinical depression is to help the person develop good coping strategies for dealing with everyday stressors. In addition, it can encourage you to use your medications properly.

Many studies support the idea that therapy can be a powerful treatment for depression. Some, although not all, have also found that combining depression medicine with therapy can be particularly effective. A 2004 review published in the Archives of General Psychiatry, for example, concluded that therapy combined with antidepressants worked better than depression medicine alone. It also supported the idea that therapy can help people stay compliant with their drug treatment in the long term.

Although there are fewer studies of therapy for treatment-resistant depression specifically, many experts still recommend it. One 2007 study found that for people who didn’t respond to a specific drug treatment, cognitive behavioral therapy worked as well in reducing symptoms as switching to a different medication. On its own, therapy might work more slowly than medication, but it also causes fewer adverse reactions.

What are the benefits of psychotherapy with depression?

There are a number of benefits to be gained from using psychotherapy in treating clinical depression:

• It can help reduce stress in your life.
• It can give you a new perspective on problems with family, friends, or co-workers.
• It can make it easier to stick to your treatment.
• You can use it to learn how to cope with side effects from depression medication.
• You learn ways to talk to other people about your condition.
• It helps catch early signs that your depression is getting worse.

What are the different types of psychotherapy?

There are many different types of therapy. Here are some of the most common.

Cognitive therapy, behavioral therapy, and cognitive behavioral therapy all focus on how your own thoughts and behaviors contribute to your depression. Your therapist will help you learn new ways to react to situations and challenge your preconceptions. You and your therapist might come up with concrete goals. You might also get ‘homework’ assignments, like keeping a journal or applying problem-solving techniques in particular situations.

Interpersonal therapy focuses on how your relationships with other people play a role in your depression. It focuses on practical issues. You will learn how to recognize unhealthy behaviors and change them.

Psychodynamic therapy is a more traditional form of therapy. You and your therapist will explore the roots of your depression. You might focus especially on any traumas of your childhood.

Individual counseling is a one-on-one session with a professional therapist — who might be a PhD, DSci, CSW, NP, or PA — with experience in treating depression and other mood disorders. Your therapist can teach you more about depression and help you understand the diagnosis. You can discuss new strategies to manage stress and to prevent your depression from worsening or coming back.

One-on-one sessions can help you identify the specific stresses and triggers that worsen your depression. A therapist can help you work through issues at home or at work, and encourage you to maintain healthy connections with family and friends. Your therapist can also help you adopt good habits, like making sure you take your medicines, seeing your doctor regularly, and getting enough sleep.

Family counseling treats the entire family — because it’s not only the person with the diagnosis that is affected by depression. If you’re depressed, your family feels it too. And unfortunately, although family members might have the best of intentions, without professional guidance, they sometimes make things worse.

Family therapy is a great way for family members to learn about depression and the early warning signs of trouble. Studies suggest that family sessions might really help with treatment, too, improving a person’s lifestyle, compliance with medication, and sleep habits.

Family meetings also offer an opportunity for everyone — you and your family members — to talk about the stresses of life with depression. You may all feel more comfortable talking openly with a therapist there to guide the conversation.

Group counseling sessions give you a chance to meet other people who are struggling with depression just like you are. You can share your experiences and coping strategies. The give-and-take at group sessions is often a productive way of learning new ways to think about your illness.

How do I find a therapist?

You will want to find a qualified therapist — usually a psychiatrist, psychologist, social worker, psychiatric nurse, or counselor. If possible, find someone who has expertise in helping people with treatment-resistant depression. Ask your health care provider for recommendations. Or get in touch with an organization like the National Alliance on Mental Illness (NAMI) or the Depression and Bipolar Support Alliance (DBSA).

What is maintenance therapy for depression?

While some people only need therapy for short periods of time, people with treatment-resistant depression might need it for longer. This is called maintenance therapy. Studies show that maintenance therapy lowers your risk of relapse. You and your therapist can watch for signs that your depression might be worsening. Over time, you will also learn about the patterns in your life that lead to depression.

If you have treatment-resistant depression, you may have already tried therapy. Maybe you didn’t feel like it worked. But it may be time to give it a second chance. Here are some things to consider before you try again.

• Think about the reasons you didn’t like therapy before. Why didn’t it work? What did you need from therapy that you weren’t getting?
• Decide what you want out of therapy now. Do you want to tackle specific problems? Do you want to work through upsetting events from your past? Come up with goals.
• Consider going back to your old therapist. Even if therapy didn’t work last time, that doesn’t mean that the therapist was at fault. The experience may be different if you approach therapy with specific goals this time. Going back to a previous therapist may be easier, since he or she will already know your history and situation.
• Consider trying someone new. It’s very important that you like and respect your therapist. If you and your therapist didn’t “click,” therapy is unlikely to work. So you could try someone new. You might even want to meet with a few different therapists before choosing one. Ask about their approaches. Talk about your goals.
• Give it time. Once you have settled on a therapist, you need to give therapy a chance to work. Don’t give up after a few sessions. Like with depression medicine, therapy can require a little time before you feel the benefits

SOURCES:

National Institute of Mental Health: “What is Depression?”

FDA: “The Lowdown on Depression.”

Mental Health America: Mpower: “Facts about Depression and Suicide.”

Depression and Bipolar Support Alliance: “Psychotherapy: How it works and how it can help.”

American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R. Bipolar II, Rodale Books, 2006.

Little A, American Family Physician, July 15, 2009; vol 80: pp 167-172.

Reviewed by Brunilda Nazario, MD on October 30, 2009

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