Depression: How effective is psychological treatment?

Photo of patient and psychotherapist (PantherMedia / Stratos Petrakogiannis) Besides medication, psychological treatment plays a key role in treating depression. Its effectiveness has been proven in many studies. The success of treatment depends on factors like the severity of the symptoms, the relationship between the person and their therapist, and their personal circumstances.

Psychological treatment is about helping someone out of the emotional depths of depression and keeping them from becoming depressed again. The therapy sessions are used to teach strategies designed to help people better cope with negative thoughts or process difficult experiences. Seeing a therapist regularly can also provide valuable emotional support and help to find out what is causing the depression.

What types of psychological treatments can be used for depression?

Psychological treatment can be given in an outpatient setting or – in more severe cases of depression – in the hospital. The treatment is offered by therapists in practices, specialized psychiatric and psychosomatic clinics, and rehabilitation facilities. The sessions are most often one-on-one, but group therapy or a combination of individual and group sessions is also possible. Family members might also participate in the therapy if needed.

In Germany, statutory health insurers cover the costs of cognitive behavioral therapy, depth psychotherapy and analytical psychotherapy for the outpatient treatment of depression. All three approaches are offered by trained psychotherapists with a background in psychology or medicine. There are more types of treatment recognized by the psychological community, but they are not currently covered by insurers. These include interpersonal psychotherapy, person-centered therapy and systemic therapy. Sometimes elements of different treatments are combined.

Cognitive behavioral therapy aims to change behaviors and attitudes, work on current problems, and find concrete solutions. Treatments based on depth psychology or psychoanalysis involve dealing with past experiences. They attempt to find possible causes of the person's psychological problems and, for example, overcome problematic relationship experiences.

Person-centered therapy, interpersonal psychotherapy and systematic therapy are similar to cognitive behavioral therapy in that they focus more on finding solutions concerning current problems and experiences.

How effective is psychological treatment?

Many studies have shown that people with depression benefit from psychological treatment. It is not possible to tell for sure which of these methods is most effective in which situation, though.

Psychological treatment can help to relieve the symptoms of depression and lower the risk of becoming depressed again. How well it works will depend on the approach used, the type and severity of depression, how long the patient has had depression, and whether he or she has other psychological problems too. Also, not everyone responds to psychological treatment in the same way: In some people it starts helping quite quickly, after just a few sessions, while it takes longer in others. Further factors that play a role include the sometimes very diverse symptoms, the patient’s personality, life experiences, and current circumstances.

The relationship between the patient and therapist is also a crucial factor. It is important for the therapist to be attentive, respectful, open-minded and empathetic – and the "chemistry" has to be right. The patient's expectations of therapy have to be realistic.

How effective is psychological treatment compared with antidepressants?

Previous research supports the idea that psychological treatment and medication can effectively relieve moderate and severe cases of acute depression. Severe depression is often treated with a combination of psychological therapy and medication. This combination can help more than just taking antidepressants on their own. Some people don't start psychological treatment until they have had acute treatment with medication. Psychological treatment aims to offer long-term stability and keep the depression from returning.

Chronic and recurrent depression are also often treated with both antidepressants and psychological therapy.

Can psychological treatment have side effects?

Like medication, psychological treatment can also have side effects and other repercussions. The difference is that antidepressants are more likely to have physical side effects than psychological ones. As a result, treatment with antidepressants is stopped more often than psychological treatment. But there's a general lack of research on the side effects of psychological treatment.

Psychological treatment also involves dealing with topics that may be unpleasant and upsetting. That can sometimes get to be too much for the patient, making them doubt themselves even more and possibly feel worse for a while. But facing these issues can also be an important step towards getting better.

Psychological treatment can affect relationships with partners, friends and co-workers. Psychological treatment usually helps people to deal with conflicts. If someone changes their usual behavior as a result of psychotherapy, though, it may lead to tension too. The patient might also become dependent on their therapist, or conflicts between the patient and therapist may arise.

Before starting therapy, it is important to openly discuss what you expect from treatment and what is actually possible. If the therapist warns you about how the treatment might affect you, you may be better prepared, helping you to handle more difficult phases of treatment.

Should you think the treatment isn't going well, it's always good to let your therapist know that you feel that way. If things don't improve, you can switch to a different therapist. For therapy to be successful, the patient needs to feel they are in good hands. You can have trial sessions before the actual therapy starts in order to find out whether that is the case.

What determines what treatment you should start with?

In Germany, people with mild depression are currently advised to wait and see whether their symptoms improve without antidepressants or psychological treatment. But waiting doesn't mean not doing anything about the problem. When someone is depressed, it's very important that they receive support and help from family and friends, as well as have consultations and regular contact with doctors or therapists. Different types of self-help can be used as well. Treatment is a good idea for more severe and persistent depression – either with psychological therapy or antidepressants, or both together. When deciding on a suitable treatment approach you can go to a doctor's practice or psychotherapist's practice for advice.

In Germany, outpatient psychotherapy practices also offer special initial consultations ("psychotherapeutische Sprechstunde"). Adults can have up to six of these 25-minute consultations without having to wait a long time to get an appointment, and children and teenagers can have up to ten of them (together with their parents if needed). These sessions can be used to assess the symptoms and to see what further treatments and forms of help are possible.

People who would like to have more long-term outpatient psychological treatment may have to wait a while before it starts, depending on what part of Germany they are in. But those with severe depression can always go to a walk-in clinic without an appointment. If someone is feeling suicidal, immediate inpatient treatment is possible too. The special initial psychotherapy sessions described above may help people find a suitable therapy for more long-term treatment.

Many people take antidepressants until they can start their long-term therapy. But people who don't have to wait a long time to start their long-term therapy may not have to take antidepressants if the therapy soon leads to an improvement.