Mood · Treatment guide
Major Depressive Disorder
Persistent low mood, anhedonia, and behavioral withdrawal; thinking turns rigid and self-critical.
In this guide
Overview
Depression responds to multiple evidence-based therapies. Choice depends on severity, recurrence history, interpersonal context, and client preference. For 3+ prior episodes, relapse prevention (MBCT, maintenance IPT) becomes central. Severe presentations usually benefit from combined therapy + medication.
First-line treatments
- CBT — Cognitive Behavioral Therapy
Largest evidence base; thought records + behavioral activation are the workhorses.
- IPT — Interpersonal Psychotherapy
Equally effective; especially when depression is tied to grief, role disputes, or transitions.
- MBCT — Mindfulness-Based Cognitive Therapy
First-line for relapse prevention after 3+ episodes (NICE guideline).
Also consider
Cautions
- In severe depression, lead with behavioral activation; cognitive work lands once activation lifts. Always assess suicide risk and safety plan.
Worked cases
- Major depressive disorder, recurrent, moderate
High-achieving professional in a third depressive episode; perfectionism and overwork mask collapsing functioning.
- Major depressive disorder secondary to chronic low back pain
Chronic back pain × 4 years; opioid taper completed; depressed, withdrawn, identity collapsed around 'disabled.'
- Postpartum depression with anxious features
First-time mother at 4 months postpartum; tearful, intrusive harm thoughts toward infant, sleep-deprived, partner overwhelmed.
- Major depressive disorder, late-life onset
Widower 14 months; first depressive episode; medical comorbidities; cognitive complaints requiring differential workup.