Psychotherapist for Depression

Depression is a mood disorder in which symptoms that impair everyday functioning persist for at least two weeks: depressed mood and/or a marked loss of interest, accompanied by cognitive, somatic and behavioural changes.

According to international diagnostic criteria (DSM-5/ICD), diagnosis is based on a combination of signs: changes in sleep (insomnia/hypersomnia), appetite and weight, decreased energy, psychomotor retardation or agitation, feelings of guilt/worthlessness, difficulty concentrating, thoughts of death/suicide.

Depression is often comorbid with anxiety disorders, pain syndromes, and somatic diseases — and this influences the choice and sequence of treatment.

Emotional: persistent sadness, emptiness, hopelessness, irritability, increased shame and guilt, reduced satisfaction with life and relationships.

Cognitive: negative automatic thinking (catastrophising, “black-and-white” thinking, devaluing oneself and one’s achievements), difficulty concentrating and remembering, slowed thinking, pessimistic forecasts.

Physical: sleep disturbances (trouble falling asleep, early awakenings), changes in appetite and weight, low energy, psychomotor slowing, bodily pains, headaches, GI disturbances, lowered libido.

Behavioural: avoiding activity and socialising, procrastination, lower productivity at school/work, self-medication with alcohol/sleeping pills, dropping hobbies, neglecting self-care.

In adolescents irritability, anger outbursts, somatic complaints are more noticeable — in older adults cognitive “fading”, apathy, and masking as somatic complaints are more typical.

Any statements about not wanting to live are a reason for immediate risk assessment and a safety plan.

In the development of depression, biological factors (vulnerability, hormones, stress axis), psychological factors (perfectionism, negative schemas, lack of self-regulation) and social factors (chronic stress, losses, loneliness) all play a role.

Protective factors include supportive relationships, access to therapy, regular activity, sleep.

The specialist’s task is to assess your exact profile and build a realistic plan.

Without treatment, depression lowers quality of life and affects every domain:

A “vicious circle” often forms: the less activity and contact, the stronger the apathy and emptiness.

Suicidal risk increases when depression is combined with hopelessness, substance use, severe insomnia, isolation — that’s why we prepare a safety plan and a map of support resources in advance.

Breaking this circle alone is difficult — support and structured work with a professional are important.

At the first session we clarify complaints, symptom history, possible triggers, family history, lifestyle, sleep, medications and illnesses.

Validated questionnaires are used (for example, PHQ-9 to assess symptom severity and monitor dynamics, GAD-7 for comorbid anxiety).

It is important to rule out medical causes (anemia, thyroid dysfunction, vitamin D and B12 deficiency, side effects of medications) — if needed, I recommend seeing a physician and basic labs.

We also do differential diagnosis with bipolar disorder, PTSD, grief, personality disorders.

Together we formulate goals and metrics (for example, PHQ-9 reduction by ≥5 points within 4–6 weeks, sleep restored to 7–9 hours, return to 3–5 meaningful activities).

The optimal strategy is stepped and combined.

Psychotherapy:

Pharmacotherapy (by a psychiatrist):

Antidepressants (SSRIs, SNRIs, NaSSAs, etc.) are indicated for moderate–severe and severe depression, pronounced functional impairment, suicidal risk, recurrences. Effect develops over 2–6 weeks — it’s important to monitor tolerability and interactions and not to stop prematurely once you feel better.

Physiological and neuromodulation methods:

Lifestyle:

Regular physical activity, sleep hygiene, nutrition, reducing alcohol, structuring the day — all are mandatory modules.

Important: strategies are selected together with the specialist — there are no universal “home recipes”.

1. Assessment and goal-setting

Symptom, trigger and resource map, agreeing on realistic goals and improvement criteria.

2. Individual plan

We choose evidence-based approaches (CBT, IPT, MBCT, etc.) to fit your pace, considering comorbidities, work, family.

3. Behavioural activation — together

We bring manageable activity back into the day with support: you don’t “do it all yourself”, we agree on steps one by one, collect feedback and adjust.

4. Sleep, energy, rhythm

Not a “do-it-yourself” checklist, but setting up the regimen in therapy: how to even out sleep, reduce overloads, distribute workload.

5. Communication and boundaries

We practise safe wording and agreements with loved ones/work so that support actually holds.

6. Monitoring and relapse prevention

We regularly evaluate dynamics by questionnaires and wellbeing, and there is an early-response plan. If needed — coordination with a doctor.

Result — stable changes, not one-time “heroic efforts”.

Myth 1: “You just have to pull yourself together.”

Fact: depression is a medical condition — effort matters, but self-control alone is often not enough.

Myth 2: “Antidepressants cause addiction.”

Fact: antidepressants do not cause euphoria or substance-like dependence — what matters is proper selection and gradual tapering under medical supervision.

Myth 3: “If you start therapy, it’s forever.”

Fact: most CBT protocols are short-term (8–20 sessions) and teach self-help skills.

Myth 4: “Depression is forever.”

Fact: with proper treatment, remission is possible and quality of life returns.

Early referral improves prognosis.

1. Initial meeting

Assessment, goal-setting, choice of metrics.

2. 6–8 sessions of the basic protocol

CBT + behavioural activation + sleep/stress hygiene.

3. As indicated

Coordination with a doctor (pharmacotherapy).

4. Advanced modules

Interpersonal skills, mindfulness, work with self-worth and shame.

5. Consolidation and relapse prevention

3–6 month plan, occasional maintenance sessions.

Between-session steps are short and realistic, agreed on in therapy.

How long does therapy take?

For mild–moderate depression — 8–16 sessions; for severe/recurrent — longer, with a doctor involved.

Does online work?

Yes. If privacy is ensured, effectiveness is comparable.

Can I be treated without medication?

For mild–moderate depression — often yes (psychotherapy + lifestyle). For severe — we discuss a combined approach.

What if I don’t even have the energy to come?

We start with “micro-steps” and supportive sessions — your task is not to “do everything perfectly”, but to show up and stay honest with yourself.