Psychological therapies for major depression

For the indications for psychological therapy in major depression, see Principles of treating major depression in adults and young people or Principles of treating major depression in children.

If possible, use psychological therapy for all severities of major depression; for severe major depression and some cases of moderate major depression, psychological therapy is combined with an antidepressant.

Note: If possible, use psychological therapy for all severities of major depression.

For mild major depression , psychoeducation and simple psychological techniques such as structured problem solving or stress management are used. There is growing evidence for a range of internet-based structured psychotherapies (eg internet-based cognitive behavioural therapy [CBT]), particularly in milder cases. The strongest evidence supports internet-based CBT when there is online access to a clinician to supplement the therapy when needed. Although clinician-delivered CBT from an appropriately trained clinician (eg psychologist, psychiatrist, other mental health professional) is preferred, internet-based CBT may be more accessible.

For  moderate and severe major depression , referral to an appropriately trained clinician (eg psychologist, psychiatrist, other mental health professional) is recommended for psychological therapies, such as CBT, interpersonal psychotherapy (IPT) and brief psychodynamic psychotherapy. There is some evidence for mindfulness-based cognitive therapy. Internet-based CBT may be a useful adjunct but should not replace the supportive nature of the clinician–patient relationship.

Patients with severe persistent depressive symptoms despite treatment may benefit from psychosocial interventions for schizophrenia that focus on learning to adapt to the presence of ongoing symptoms (see Psychosocial interventions for psychoses including schizophrenia).

General practitioners trained in CBT can provide CBT to their patients. However, refer patients with more complex issues or patients not responding to treatment to an appropriately trained specialist (eg psychologist, psychiatrist, other mental health professional). Provide patients with information about the psychological therapy that will be used, as well as advice on less complex strategies (eg activity scheduling, relaxation strategies. If psychological therapy is provided by a psychologist, psychiatrist or other mental health practitioner, ensure a coordinated and collaborative treatment approach.

When using psychological interventions to treat major depression in children:

  • adapt the approach to the child’s developmental stage
  • identify and address factors that may contribute to the child’s depression (eg family conflict)
  • provide psychoeducation to the child as well as family, carers or significant others. Ensure parents or carers understand the importance of:
    • making the child’s home environment safe and secure to reduce the risk of suicide
    • taking immediate steps if suicidal thoughts or behaviour are identified
    • open and supportive communication with the child
  • first-line psychological therapies are CBT and IPT. Other interventions such as family therapy may also be considered.