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Main article: Clinical depression

• Depression - Clinical guidelines
• Depression - Clinical protocols
• Depression - Cognitive analytic therapy
• CBT for depression
• Human Givens treatment of depression
• Psychotherapy for depression
• Psychoanalytic treatment of depresssion
• REBT treatment of depression

Psychotherapy

Psychotherapy can be delivered, to individuals or groups, by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, counselors, and psychiatric nurses. With more complex and chronic forms of depression, the most effective treatment is often considered to be a combination of medication and psychotherapy.^[1] In people under 18, medication is usually offered only in conjunction with psychotherapy, not as a first line treatment.^[2] Psychotherapy has been shown to be effective in older people. ^[3][4] Successful psychotherapy appears to prevent the recurrence of depression even after it has been terminated or replaced by occasional booster sessions. The same degree of prevention can be achieved by continuing antidepressant treatment.^[5]

The most studied form of psychotherapy for depression is cognitive behavioral therapy (CBT), thought to work by teaching clients to learn a set of useful cognitive and behavioral skills. Earlier research suggested that cognitive-behavioral therapy was not as effective as antidepressant medication; however, more recent research suggests that it can perform as well as antidepressants in patients with moderate to severe depression.^[6] Overall, systematic review reveals CBT to be an effective treatment in depressed adolescents,^[7] although possibly not for severe episodes.^[8] Combining fluoxetine with CBT appeared to bring no additional benefit^[9][10] or, at the most, only marginal benefit.^[11]

A review of studies on the effectiveness of Mindfulness-based Cognitive Therapy (MBCT), a recently developed class-based program designed to prevent relapse, suggests that MBCT may have an additive effect when provided with the usual care in patients who have had three or more depressive episodes, although the usual care did not include antidepressant treatment or any psychotherapy, and the improvement observed may have reflected non-specific or placebo effects.^[12]

Interpersonal psychotherapy focuses on the social and interpersonal triggers that may cause depression. There is evidence that it is an effective treatment. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT, however the focus is on relationships with others. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress.^[13]

Psychoanalysis, a school of thought founded by Sigmund Freud that emphasizes the resolution of unconscious mental conflicts,^[14] is used by its practitioners to treat clients presenting with major depression.^[15] A more widely practiced, eclectic technique, called psychodynamic psychotherapy, is loosely based on psychoanalysis and has an additional social and interpersonal focus.^[16] In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression.^[17]

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