The steps of care for depression

Depression isn't one size fits all. Some people feel better with self-help and support. Others need therapy, medicine, or both. Doctors often call this "stepped care": you start with the kind of help that fits how you're doing now, and move up a step if it isn't helping enough.

Our check-in suggests a step based on your answers. It isn't a diagnosis. A clinician can help you decide what's right for you.

If you're thinking about ending your life, you don't need to find a step first. Call or text 988 any time. In immediate danger, call 911.

The steps

Keep an eye on it

For mild or few symptoms. Symptoms like these often ease on their own. Checking in again in a few weeks helps you notice if they don't. Support and self-help can make the time easier.

Self-help and support

For mild symptoms. Guided self-help and online CBT programs help many people. They work best with some support from a person, like a coach, a group or a clinician. Peer support groups can help too.

Talk therapy

For moderate symptoms. Several kinds of talk therapy work about equally well. Choosing one you're comfortable with matters more than the type. Medicine through your primary care doctor is another option if you prefer it.

Therapy and medication

For more severe symptoms. Therapy and medicine together tend to work better than either alone. A primary care doctor or a psychiatrist can prescribe.

Specialist treatment

When two or more medicines haven't helped enough. Other treatments work for many people, such as TMS, esketamine and ECT. A psychiatrist can help you choose.

Crisis care sits outside the steps. Anyone can use it at any time, whatever step they're on.

What can change your step

How you've been feeling is only part of the picture. A few other things can change what fits best:

• Depression that has lasted more than 2 years, or has come back after better times, often needs more support than a first episode.
• Times of feeling unusually high or energetic, or needing much less sleep, for several days in a row. It's important to check for bipolar disorder before starting an antidepressant, so a psychiatric evaluation comes first.
• Pregnancy or a new baby. Specialists in pregnancy and postpartum care can help. See postpartum depression.
• Alcohol or drug use. Care that treats both at once tends to work best.

When to step up

Treatment takes time. Therapy and medicine usually need several weeks before you can tell whether they're helping. If you've been in treatment for 6–8 weeks and aren't feeling better, it may be time to talk with your clinician about stepping up.

Stepping up doesn't mean you've failed. It can mean adding therapy to medicine, trying a different medicine, or seeing a specialist. See when treatment hasn't worked.

A good way to tell if things are changing is to answer the same questions again every few weeks. Many clinicians use a short questionnaire called the PHQ-9 for this. Our check-in uses it too, and offers a recheck after you start care.

Where the steps come from

The steps follow published clinical guidelines, including those from the UK's National Institute for Health and Care Excellence (NICE) and the American Psychological Association. Our full rules are open for anyone to read on how this works. They are waiting for review by our clinicians.

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