Estimated reading time: 9 minutes

By: Dr. Dennis London

When is the ‘right’ time to start therapy for depression? It’s sooner than you might think.

According to one study, individuals waited an average of about eight years after the development of a clinically significant mood or anxiety disorder before seeking treatment. This means for eight years, these individuals lived with symptoms that could have benefited from therapy and an evidence-based treatment. 

Research suggests psychotherapy is an effective treatment for depression, and guidelines endorse psychotherapy as a first-line treatment for outpatients with depression. If therapy is so effective and recommended as an initial treatment option, why do some wait? 

Reasons people might delay depression therapy: 

• Stigma or feeling ashamed for needing therapy
• Negative attitudes from family members or others about attending therapy
• Feeling hopeless that nothing will make things better 
• Nervousness 
• A previous negative experience in therapy 
• Ambivalence, or having mixed/contradictory ideas about something 
• Avoidance of addressing uncomfortable thoughts and feelings

Making the decision to attend therapy is not a minor decision. One of the first questions I ask new clients when I meet them is, “How do you feel about being here today?” More often than not, they say ‘nervous’ or ‘anxious.’ 

Why might you feel unsure about starting therapy?

Firstly, it’s important to recognize that seeking therapy for depression is a brave and proactive step towards improving your mental health. Depression can be a difficult and overwhelming condition to manage on your own. 

Depression clouds our thinking, and it can be difficult to know when it’s time to reach out for help. We think less clearly, our thoughts are slower, and we don’t make as clearly thought out decisions when we are depressed. Additionally, depression onset tends to be gradual. Little decisions that impact our mood build up over time. Although it might start out as skipping the gym, turning down social invitations, or sleeping in a little bit extra, pretty soon this can become the ‘new normal.’ You might find yourself thinking, “How did I get here?”

Fortunately, therapy can provide you with the tools, skills, and support you need to manage your symptoms and live a more fulfilling life.

That being said, I also understand that therapy can feel intimidating or daunting, especially if you’ve never been to counseling before. It’s normal to have concerns or doubts about whether therapy will work for you or if you’ll be able to open up to a therapist.

To help resolve your feelings of ambivalence, I encourage you to think about what’s holding you back from starting therapy. 

1. Are you worried about the cost? The time commitment? Or the stigma surrounding therapy? 
2. Do you have doubts about whether therapy can really help you? 

Once you’ve identified your concerns, you can work together with a therapist to address them and find solutions that work for you.

It can also be helpful to remind yourself of the potential benefits of therapy. Therapy can help you better understand your depression and the factors that contribute to it, teach you coping strategies for managing symptoms, and provide a safe and supportive space to express your thoughts and feelings. 

You don’t have to face depression alone, and therapy can provide you with the guidance and support you need to overcome it.

What is Depression? 

It’s important to note that depression can also present differently across individuals, and not everyone fits neatly into these categories. A mental health professional can help assess symptoms and determine the most appropriate treatment plan.

What might depression look like? 

Younger adults with depression are more likely to be irritable, complain of weight changes and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, and substance use disorders.

Middle-aged adults with depression may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning awakening. They also may more frequently report having gastrointestinal symptoms such as diarrhea or constipation.

Older adults with depression commonly experience sadness or grief or may have other less obvious symptoms. They may report a lack of emotions rather than a depressed mood. Older adults also are more likely to have other medical conditions or pain that may cause or contribute to depression. In severe cases, memory and thinking problems (called pseudodementia) may be prominent.

Types of Clinical Depression 

To meet criteria for a clinical depression diagnosis, it requires more symptoms than just sadness. You must have evidence of functional impairment. What does this mean? It means that depression and other symptoms interfere with your daily functioning and ability to complete your activities. 

Here are 5 signs that it’s time to consider seeking therapy for depression:

1. Persistent sadness or feelings of hopelessness: If you’ve been feeling down for an extended period of time, and it’s affecting your ability to enjoy life or engage in your daily activities. Additionally, isolation and increased time alone or at home may be a sign as well.
   
2. Loss of interest in things you used to enjoy: Losing pleasure in activities that you once enjoyed, or no longer doing those things, can be a sign of depression. Therapy can help you identify any underlying issues and work to regain your sense of enjoyment.
   
3. Increased irritability or anger: If you’ve noticed that you’re more easily agitated or quick to anger than usual, this can be a sign of depression or other mental health concerns (such as anxiety).
   
4. Difficulty sleeping or sleeping too much: Changes in your sleep patterns can be a sign of depression, and a therapist can help you identify strategies to improve your sleep and manage any underlying mental health issues.
   
5. Thoughts of suicide or self-harm: If you’re experiencing thoughts of suicide or self-harm, it’s important to seek help immediately. Therapy can be a crucial step in managing these feelings and getting the support you need to stay safe.

Common symptoms of depression:

1. Feelings of worthlessness or excessive guilt 
2. Significant changes in appetite or weight that isn’t intentional 
3. Feeling tired or lethargic 
4. Concentration difficulties 

Common depression diagnoses:

1. Major depressive disorder (MDD): This is the most common depression diagnosis. It is characterized by discrete periods (at least 2 weeks or longer) of depressed/sad mood or lack of interest in usual activities and other symptoms. It is considered “episodic,” because symptoms usually only last for a discrete period of time and then wane. Some people might only experience 1 episode in their entire life; others may experience multiple/repeat episodes throughout their life. 
   
2. Persistent Depressive Disorder (PDD): This diagnosis was previously known as dysthymia. It typically presents with many of the same symptoms as MDD, but the severity and course of symptoms are different. Symptoms usually present as milder and less intense than in MDD. The distinctive factor though is the course of symptoms, which tend to last much longer than in MDD. To meet criteria, symptoms are required to be present for at least 2 years or longer. People with PDD often report they “have been this way forever.” 
   
3. Seasonal Affective Disorder: This is a type of depression that occurs during specific seasons, typically the winter months, and is thought to be related to reduced exposure to sunlight.
   
4. Postpartum Depression: This is a type of depression that can occur after giving birth, and is thought to be related to hormonal changes and the stresses of caring for a newborn.

As with other mental health conditions, it is important to rule out medical or other causes of depression. A check-up with your doctor to rule out medical causes like hypothyroidism, low vitamin D, or hypoglycemia is a good place to start. Women can also experience recurrent, brief depression exclusively around their menstrual cycle, so talking to your OBGYN is also advisable. 

What are your depression treatment options?

1. Psychotherapy: Psychotherapy also known as talk therapy, or just therapy can be very effective for treating depression. Different types of therapy, such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and acceptance and commitment therapy (ACT) can help individuals identify and respond differently to negative thoughts, improve coping skills, and address underlying emotional issues.
   
2. Medication: Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), can help alleviate symptoms of depression. It’s important to work with a doctor to find the right medication and dosage, as different people may respond differently to different medications.
   
3. Lifestyle changes: Making changes to lifestyle habits can also help alleviate symptoms of depression. This might include getting regular exercise, eating a healthy diet, reducing stress, and getting enough sleep.
   
4. Brain stimulation therapies: For severe or treatment-resistant depression, brain stimulation therapies such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) may be recommended. Talk to your psychiatrist or medical provider about these.
   
5. Complementary therapies: Alternative or complementary therapies such as acupuncture, meditation, or massage therapy may also be helpful for some individuals with depression. It’s important to talk to a healthcare provider before starting any complementary therapies.

It’s completely normal to feel ambivalent or unsure about starting therapy, and here at the Psychology Group, we’re available to help you explore those feelings and make a decision that is right for you. 

If you’re unsure if therapy for depression might be beneficial for you, we’d like to hear from you. Call us today for a complimentary 15 minute phone consultation to speak with one of our expert depression therapists.

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