Depression & Mood Disorders
Depressive Disorders / Bipolar and Related Disorders (DSM-5-TR)
Persistent low mood, loss of interest, fatigue, sleep/appetite disruption, and cognitive changes. Includes major depressive disorder, persistent depressive disorder (dysthymia), bipolar depression, and perinatal mood disorders. One of the most common reasons people seek therapy.
Prevalence: ~8% of US adults had a major depressive episode in the past year (NIMH, from NSDUH 2021); ~21% lifetime prevalence of major depressive disorder (NESARC-III, Hasin et al., 2018)
Clinical Picture
Depression is not one thing. The flat, leaden immobility of melancholic depression is neurobiologically and experientially different from the agitated, ruminative quality of anxious depression or the irritable emptiness of what's sometimes called 'male-type' depression. Treatment selection depends on which depression you're actually looking at. Behavioral activation works well for the withdrawal-and-avoidance pattern. Cognitive restructuring targets the ruminative loop. Psychodynamic approaches may be essential when depression is rooted in unprocessed grief, chronic self-attack, or relational templates established in childhood. Somatic approaches become relevant when the body itself seems to carry the depression: when the client can articulate no thoughts but reports heaviness, constriction, or numbness.
Treatment Considerations
For mild-to-moderate depression, differences between bona fide evidence-based approaches are small next to the contribution of the therapeutic alliance. For severe or treatment-resistant depression, combined approaches (therapy plus medication) consistently outperform either alone. Suicide risk is the standing question in any depressive presentation: ask directly, and ask again, rather than treating intake screening as settled. When depression co-occurs with trauma history, treating the depression alone often fails because the depressive symptoms are maintained by unresolved traumatic material. The vignettes on this site illustrate how different modalities formulate the same depressive presentation in genuinely different ways.
81 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.