Getting treated for depression usually starts with a single appointment, either with your primary care doctor or a mental health professional. Both can screen you, make a diagnosis, and begin treatment the same day. You don’t need a referral to see a psychiatrist in most cases, though many people find it easier to start with the doctor they already have.
The bigger challenge isn’t finding a door to walk through. It’s knowing what happens once you do, what the treatment options actually look like, and how long each one takes to work. Here’s what to expect at every stage.
What Happens at Your First Appointment
Your doctor or therapist will likely have you fill out a short questionnaire called the PHQ-9. It’s nine questions about how you’ve been feeling over the past two weeks, scored on a 0 to 27 scale. A score of 5 to 9 suggests mild depression, 10 to 14 moderate, 15 to 19 moderately severe, and 20 or above severe. This gives your provider a quick, standardized snapshot of where you are, and it’s often repeated at future visits to track whether treatment is working.
Beyond the questionnaire, they’ll ask about the specific symptoms you’re experiencing. A clinical diagnosis of major depression requires at least five symptoms lasting two weeks or more, and at least one of those symptoms must be either a persistently low mood or a noticeable loss of interest in things you used to enjoy. The other symptoms they’ll ask about include changes in sleep, appetite, energy, concentration, feelings of worthlessness or guilt, physical restlessness or slowness, and thoughts of death or self-harm. They’ll also want to rule out other causes, like thyroid problems or medication side effects, which can sometimes mimic depression.
You don’t need to hit some threshold of suffering before seeking help. If your symptoms are interfering with your work, relationships, or daily functioning, that’s enough to warrant treatment.
Starting With Therapy
Cognitive behavioral therapy (CBT) is the most studied form of talk therapy for depression, and it works well for mild to severe cases. It focuses on identifying thought patterns that keep you stuck and replacing them with more accurate, less destructive ones. A typical course runs 11 to 20 sessions, usually weekly, meaning you’re looking at roughly three to five months of treatment. Meta-analyses show medium to large effects across that range, and CBT alone performs nearly as well as therapy combined with medication.
Other approaches include interpersonal therapy, which zeroes in on relationship problems and life transitions that fuel depression, and behavioral activation, which focuses on gradually reintroducing activities that give you a sense of accomplishment or pleasure. Your therapist will recommend an approach based on your specific situation, but the most important factor is finding someone you feel comfortable being honest with.
Therapy sessions typically cost $80 to $150 out of pocket, depending on your location and provider. Many therapists accept insurance, and community mental health centers offer sliding-scale fees. Online platforms have expanded access significantly, with some offering sessions for less than in-person visits.
Starting With Medication
SSRIs are the most common first-line antidepressants. Your primary care doctor can prescribe them; you don’t necessarily need a psychiatrist. Response rates for SSRIs sit between 40 and 60 percent, meaning roughly half of people see at least a 50 percent reduction in symptoms. Full remission, where symptoms essentially disappear, happens in 30 to 45 percent of people on the first medication they try.
Those numbers might sound modest, but they improve with adjustment. If the first medication doesn’t work, your doctor can change the dose, switch to a different drug, or add a second one. The key is giving each trial enough time and communicating honestly about what you’re experiencing.
How Long Medication Takes to Work
There’s an old belief that antidepressants take six to eight weeks to kick in, but the data tells a more encouraging story. Most of the improvement people experience actually happens within the first two weeks. A meta-analysis of over 5,800 patients found that measurable differences between antidepressants and placebo showed up by week one, and patients on active medication were twice as likely to have a sustained response by week two.
This has a practical flip side: if you’ve seen zero improvement after two to three weeks (less than a 20 percent reduction in symptoms), that’s a signal to contact your doctor about adjusting the plan rather than waiting it out. Most providers will schedule a follow-up around the two- to four-week mark for exactly this reason.
Combining Therapy and Medication
For moderate to severe depression, combining therapy with medication tends to produce the best outcomes. The two work through different mechanisms. Medication addresses the biological side, helping stabilize mood, sleep, and energy. Therapy gives you tools to change the thinking and behavior patterns that maintain depression over time. Together, they reduce the risk of relapse more than either one alone.
If your depression is mild, starting with therapy alone is reasonable. If it’s severe enough that you’re struggling to function day to day, medication can take the edge off quickly enough to make therapy productive.
The Role of Exercise
Exercise is not a substitute for professional treatment in moderate or severe cases, but the evidence for its antidepressant effects is strong enough that clinical guidelines in the US, UK, and Australia all recommend it as part of a treatment plan. A large systematic review published in the BMJ found that the benefits scaled with intensity: vigorous exercise like running or interval training produced the largest effects, but even light activity like walking or yoga made a clinically meaningful difference.
There’s no single magic dose. Benefits appeared across different weekly amounts, and shorter programs (around 10 weeks) worked somewhat better than longer ones, possibly because people were more likely to stick with them. The most practical takeaway: any regular physical activity helps, and more intense activity helps more. If you can manage two to three sessions per week of something that gets your heart rate up, you’re in the range that the research supports.
What to Do if Treatment Isn’t Working
Depression is classified as treatment-resistant when it hasn’t responded adequately to at least two different antidepressant trials given at proper doses for a sufficient duration. If you’ve been through multiple medications and therapy without meaningful improvement, your doctor will likely refer you to a psychiatrist if you haven’t seen one already.
At that point, several additional options open up. Transcranial magnetic stimulation (TMS) uses magnetic pulses targeted at areas of the brain involved in mood regulation. It’s noninvasive, performed in an office setting, and typically involves daily sessions over several weeks. Electroconvulsive therapy (ECT) remains one of the most effective treatments for severe, treatment-resistant depression, despite its outdated reputation. It’s done under general anesthesia, and modern protocols cause far fewer side effects than older versions.
Ketamine-based treatments are a newer option. In one study of patients who hadn’t responded to ECT, a course of six infusions over two weeks produced a meaningful improvement in over half of participants, with about a third achieving a full response and one in five reaching remission. Results varied widely between patients, from rapid remission to minimal change, so it’s not a guaranteed fix. But for people who’ve exhausted other options, it represents a real possibility.
Where to Start Right Now
If you have a primary care doctor, call and schedule an appointment. Tell them you want to be evaluated for depression. They can diagnose you, prescribe medication, and refer you to a therapist, all in one visit. If you’d rather start with therapy, you can search your insurance provider’s directory for in-network therapists, or use platforms like Psychology Today’s therapist finder to search by location, insurance, and specialty.
If you don’t have insurance, community mental health centers provide treatment on a sliding scale based on income. The SAMHSA National Helpline (1-800-662-4357) is free, confidential, and available around the clock. It connects you to local treatment services and support groups. Many university training clinics also offer low-cost therapy with supervised graduate students, which research shows is similarly effective to more experienced providers for common conditions like depression.
The single most important step is the first one. Depression makes it harder to do exactly the things that would help, including picking up the phone. If scheduling an appointment feels overwhelming, ask someone you trust to help you make the call or sit with you while you do it.