Patients and Families — Understanding the Guideline for Treatment of Depression

Depression for patients and families

What Is Depression?

We all feel sad, low or “have the blues” sometimes. We also might experience periods of grief or heartbreak. Depression is different. It’s a common but serious mood disorder that can negatively affect your feelings, thoughts and daily functioning. Adults with depression may experience persistent sadness or despair, lose interest in activities they once enjoyed, and have trouble eating, sleeping and concentrating. Children and adolescents with depression may be excessively irritable. Depression is the second-leading cause of disability both in the United States and worldwide*.

For some people, depression means feeling sad or not feeling pleasure from activities that once used to be enjoyable. For others, depression can involve a lot of negative self-talk (like your inner voice telling you that you’re terrible). Depression can make people believe that they will never find happiness again or that they aren’t worthy of feeling good.

Depression can interfere with your ability to work, maintain relationships or feel hopeful about the future. It can impact your physical health, too. For some people, it’s a chronic—but manageable—condition.

Biochemical, genetic, environmental and other factors may raise a person’s risk for developing depression. But no matter the cause, depression is treatable. Many people who seek treatment are able to reduce or totally resolve their symptoms. Learning more about your options is the first step.

*Please refer to the full guideline document (PDF, 890KB)opens in new window for more information on the prevalence rates of depression.

How Can I Tell if I’m Depressed?

Depression affects people differently. Symptoms can range from mild to severe, and people with depression may not experience all of the symptoms listed below. You may have major depressive disorder if you have experienced five or more symptoms for at least two weeks, including a depressed mood (or irritability in children), a loss of pleasure or interest, and at least three additional symptoms.

These are the most common symptoms of depression:

  • Low mood.
  • Loss of pleasure or interest in activities once enjoyed.
  • Increased irritability (especially in children and adolescents).
  • Weight loss, weight gain or change in appetite.
  • Sleeping too much or too little.
  • Feeling hopeless.
  • Low self-esteem.
  • Lethargy or listlessness.
  • Increased agitation.
  • Fatigue or loss of energy.
  • Excessive or inappropriate feelings of guilt or worthlessness.
  • Indecisiveness and trouble thinking or concentrating.
  • Recurrent thoughts of death or suicide.
  • Planning or attempting suicide.

What Is the Clinical Practice Guideline for Depression?

The information on this website is based on the "American Psychological Association’s Clinical Practice Guideline (CPG) for the Treatment of Depression Across Three Age Cohorts." It was published in 2019.

The guideline is intended to help mental health professionals treat depression in their patients, but you can benefit from learning about the guideline, too.

APA developed the guideline by reviewing the scientific literature about the evidence for various treatments for depression. The guideline makes treatment recommendations based on an analysis of the evidence along with other factors.

Together, you and your health care provider can use the guideline to discuss which treatment, or combination of treatments, will work best for you.

Depression Is Treatable

A wide variety of treatment options are available for people with depression. Typical treatments include psychotherapy, medication or some combination of the two.

Several different kinds of psychotherapy and several different medications are used to treat depression. Alternative or complementary treatments, like exercise and some herbal therapies, are also available.

These treatments work differently for different people, and each have their pros and cons. Your experience of a particular treatment, and its effectiveness for you, may be influenced by factors such as your age, gender, race or ethnicity, socioeconomic status, or other health conditions you may have.

You can learn more about the different treatment options in the “Treatments” section below.

Getting Help for Depression

Depression can leave you feeling hopeless, exhausted and like there’s no way out. If you’re depressed, seeking treatment can feel like a pointless or impossible task. But you can take just a few steps toward feeling better.

You might begin by talking to a trusted friend or family member about what you’re feeling. But if you aren’t comfortable with that, that’s okay. Another option is to raise your concerns with a health care professional, such as your primary care provider. They will be able to direct you to a mental health professional who can help.

Alternatively, you can look online to find a mental health professional directly. Many of them take insurance or have sliding fee scales. Some online search tools, like APA’s Psychologist Locator feature, are available below in the “Finding Help” section.

If you are having suicidal thoughts or are thinking about harming yourself, call or text 988 or chat with the Suicide and Crisis Lifelineopens in new window.

Treatments

These are the treatments for depression that the APA clinical practice guideline found to be most effective for certain age groups. This is not an exhaustive list of treatments available for depression, but it does include those that have been shown to work. Keep in mind that your health care provider may recommend a combination of these treatments for you. For additional information about each treatment below, please refer to the treatment descriptions page on this website.

For children and adolescents

Psychotherapies

  • Cognitive-behavioral therapy (CBT)
    CBT is a type of therapy in which patients learn to identify and manage negative thought and behavior patterns that can contribute to their depression. CBT helps patients identify unhelpful or negative thinking, change inaccurate beliefs, change behaviors that might make depression worse, and interact with others in more positive ways.
  • Interpersonal psychotherapy for adolescents (IPT-A)
    IPT-A is a form of therapy in which patients learn to improve their relationships with others by better expressing their emotions and solving problems in healthier ways. IPT-A helps patients resolve or adapt to troubling life events, build social skills and organize their relationships to increase support for coping with depressive symptoms and life stressors.

Medications

  • Fluoxetine
    Commonly known as Prozac, fluoxetine is a medication recommended to treat depression in adolescents. It’s a type of medication known as a selective serotonin reuptake inhibitor (SSRI).

For adults

Psychotherapies

  • Behavioral therapy
    Behavioral therapy focuses on having the person re-engage more often in activities he/she once found pleasurable in order to shift mood and behavioral patterns away from depression, negativity and avoidance.
  • Cognitive therapy
    Cognitive therapy focuses on changing unhelpful thinking patterns that play a role in the development of depressive symptoms so that the person has a more balanced and adaptive view of themselves and the world.
  • Cognitive-behavioral therapy
    CBT is a type of therapy in which patients learn to identify and manage negative thought and behavior patterns that can contribute to their depression. CBT helps patients identify unhelpful or negative thinking, change inaccurate beliefs, change behaviors that might make depression worse, and interact with others in more positive ways.
  • Mindfulness-based cognitive therapy (MBCT)
    MBCT combines strategies of cognitive therapy with mindfulness meditation to modify unhelpful thoughts and develop a loving and kinder self-view.
  • Interpersonal psychotherapy (IPT)
    IPT is a form of therapy in which patients learn to improve their relationships with others by better expressing their emotions and solving problems in healthier ways. IPT helps patients resolve or adapt to troubling life events, build social skills, and organize their relationships to increase support for coping with depressive symptoms and life stressors.
  • Psychodynamic therapy
    Psychodynamic therapy focuses on unconscious thoughts, early experiences and the therapeutic relationship to understand current challenges, improve self-awareness and support the patient in developing more adaptive patterns of functioning.
  • Supportive therapy
    Supportive therapy offers a supportive relationship that focuses on helping people explore and understand their experience in their current situation. The focus is on strengthening a person’s ability to make choices that help them cope effectively with life stressors, from a stance of genuine empathy and supportive listening.

Medications

  • Second-generation antidepressants
    nded for treating depression in adults. Currently, there is not enough evidence to recommend one specific medication over another. These medications include selective-serotonin reuptake inhibitors (SSRIs), selective-norepinephrine reuptake inhibitors (SNRIs) and norepinephrine-dopamine reuptake inhibitors (NDRIs).

For older adults (ages 60 and over)

Psychotherapies

  • Group life-review/reminiscence therapy
    In group life-review/reminiscence therapy, participants reflect on and discuss the events of their lives to achieve a sense of peace or empowerment. The goal of this treatment is to help put life in perspective.
  • Group cognitive-behavioral therapy
    This therapy utilizes behavioral and cognitive strategies in a group setting to address behaviors, thoughts and emotional reactions, and the ways in which they interact and contribute to depression.

Medications

  • Second-generation antidepressants
    This is a class of medications that are recommended for the treatment of depression in older adults. They include SSRIs, SNRIs and NDRIs. If medication is being considered for older adults, it is recommended that it be combined with IPT.

Barriers to Treatment

There are a number of obstacles that might make it difficult for you to seek treatment for depression. Some might be practical factors that you have limited control over, such as the availability of treatment, financial strain, scheduling issues, and transportation problems. But there may be treatments and resources available to you that you are not aware of. (You can learn more about these resources in the “Finding Help” section below.)

You might also be stuck because of your ideas about treatment. You might feel like you can or should “fix” your depression on your own. You may feel alienated by or dissatisfied with your health care provider. Or you might be afraid to admit you need treatment for a mental health issue.

These barriers can be tough to overcome. But many people have experienced these feelings and gone on to find help for their depression. Trained health care professionals can assist with logistical problems like identifying the right provider for you, or helping problem-solve scheduling and transportation issues. They can also address the feelings, perceptions, or fears that may be preventing you from committing to treatment (or point you toward another provider who can).

Finding Help

You can talk to your primary care provider or another health care provider about finding a mental health professional who can evaluate and treat you for depression. 

There are a number of tools that can help you with this, too:

If you are having thoughts of suicide or self-harm, call or text 988 or chat with the Suicide and Crisis Lifelineopens in new window.

Last updated: December 2022Date created: 2019