For weeks you have been waking up tired even after a full night's sleep. Things you used to enjoy no longer mean anything, it is hard to concentrate and every task feels like an uphill climb. You keep telling yourself it is a rough patch and it will pass. Maybe it will, but maybe it will not, and perhaps you have been wondering for a while whether you should talk to someone.

Looking for therapy for depression is one of the decisions people put off the longest. The NHS puts it plainly: many people wait a long time before seeking help, but it is best not to delay, because the sooner you start, the sooner you can be on the way to recovery. This guide explains when it is worth seeking help, which therapies clinical guidelines recommend, how many sessions it usually takes, what role medication plays and how to choose a professional.

When to see a psychologist for depression

Depression is not the same as a bad day. The NHS points out that most people go through spells of stress, anxiety or low mood during difficult times, and that low mood can improve after a short while without being depression. What sets depression apart is that sadness or hopelessness persists, you lose interest in things you used to enjoy and other symptoms appear, such as constant tiredness, poor sleep, loss of appetite or aches and pains. Many people with depression also have symptoms of anxiety.

It is worth seeking help if:

  • Low mood or loss of interest has lasted for weeks and is not improving.
  • Working, studying or looking after yourself is getting harder.
  • You are withdrawing from people or giving up things that used to matter to you.
  • You feel nothing will get better.

If you have thoughts of harming yourself or that life is not worth living, do not wait: in immediate danger, call 112 or your local emergency number, and in Spain the 024 line is free and available at any time.

If you are not sure whether what you are going through is depression, the Depression Test can help you put a name to it before your appointment, and if you are torn between anxiety and depression, Anxiety or depression: how to tell them apart and what to do if you have both may help.

Which therapies work for depression

The NICE guideline on depression in adults recommends choosing treatment according to severity and each person's preferences, and reaching the decision together. These are the most common psychological therapies, with the number of sessions the NHS usually gives:

Therapy What it involves Usual number of sessions
Cognitive behavioural therapy (CBT) Understanding how thoughts, feelings and behaviour interact, and learning to challenge hopelessness 8 to 16, weekly or every two weeks
Behavioural activation Linking activities with mood and planning practical changes to break out of inactivity 12 to 16
Interpersonal therapy Working on relationships, communication or bereavement 8 to 16
Guided self-help A workbook or online course based on CBT, with support from a therapist 6 to 8

The first is the best known; we explain it in depth in Cognitive behavioural therapy: what it is, how it works and what it treats.

If depression is mild

For less severe depression, the NICE guideline considers all of its options suitable as a first choice, but advises starting with the least intensive, such as guided self-help, and not routinely offering antidepressants first unless that is the person's informed preference. The NHS adds that exercise is one of the main treatments for mild depression and that, if it does not improve, a talking therapy may help.

If depression is moderate or severe

For more severe depression, the first option in the NICE guideline is a combination of individual CBT and an antidepressant, followed by individual CBT on its own, of about 16 sessions, and individual behavioural activation, of 12 to 16. The NHS sums it up: a combination of an antidepressant and CBT usually works better than either on its own. A meta-analysis by Cuijpers and colleagues, covering 52 studies and more than 3,600 patients, found that adding psychotherapy to medication clearly improved results compared with medication alone in major depression, with effects lasting up to two years.

Antidepressants are prescribed and monitored by a doctor; the psychologist handles the therapy and can coordinate with them.

What therapy for depression is like

The first session is about understanding what is happening to you: since when, how it affects your life, what you have tried and what you want to achieve. From there, a plan is agreed. Therapy is usually structured and focused on the present, and CBT involves tasks between sessions, something the NICE guideline mentions explicitly.

In behavioural activation, for example, the starting point is not your thoughts but what you do: you identify activities that give you some satisfaction or meaning and gradually bring them back, starting with small things. The NICE guideline considers it especially helpful when depression has led to social withdrawal, doing fewer things or inactivity.

Woman watering a plant in her bedroom in the morning, a small activity of the kind brought back through behavioural activation for depression

To check whether things are on track, it helps to review progress every so often; we give you some pointers in How to know whether therapy is working (and what to do if it is not).

Does online therapy work for depression?

There is evidence to support it. A meta-analysis by Andersson and colleagues compared therapist-guided internet CBT with face-to-face CBT across 13 studies and more than 1,000 participants, two of them on depressive symptoms, and found equivalent effects. The authors call for more studies for each specific problem, but the overall result is clear. The NHS also allows for guided self-help to be delivered in person, by phone or online.

How to choose a psychologist for depression

These checks help you choose well:

  • Licensing and registration. That comes first, whatever the approach.
  • Evidence-based therapies. CBT, behavioural activation or interpersonal therapy.
  • A clear plan. They should explain what you will work on and roughly how many sessions they expect.
  • They involve you. The NICE guideline stresses shared decision-making about treatment.
  • Coordination with your doctor if you take or plan to take medication.
  • Reviewing progress. Measuring how you are doing helps adjust therapy in time.

A psychologist for depression

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. Among the areas she treats at her practice in Igualada and through online therapy are anxiety and depression, with an integrative, evidence-based approach that tailors each process to the person. On her website she explains that the therapeutic relationship is the basis of any process of change and that her aim is for you to leave therapy with practical tools. Sessions last an hour and are available in English, Spanish or Catalan, the first contact is a free, no-commitment information session by phone, and she herself points out that in a serious crisis what is needed is immediate in-person care.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: