Depression

Psychological therapy for depression: recovering activity, working on thoughts and preventing relapse, with individualised treatment and clear objectives.

How it is recognised

Depression is not simply feeling sad for a few days. It is a condition that can persist for weeks and affect mood, interest in activities, energy levels, sleep, concentration, and the way we relate to ourselves and our environment.

Some common signs include:

• Persistently low mood for a large part of the day.
• Loss of interest or pleasure in activities that were previously rewarding.
• Tiredness, lack of energy, or a feeling that any activity requires excessive effort.
• Changes in sleep or appetite.
• Difficulty concentrating, thinking clearly, or making decisions.
• Feelings of guilt, worthlessness, or hopelessness.

When thoughts related to death, not wanting to carry on, or self-harm appear, it is important to seek professional help as soon as possible. In the event of an emergency or immediate risk, urgent care services should be contacted. In Spain, the 024 helpline for suicidal behaviour is also available.

What therapy does

Depression can create a cycle in which low mood and lack of energy lead to reduced activity and less contact with things that previously provided well-being or a sense of purpose. In turn, this reduction in activity can contribute to maintaining isolation, the loss of positive reinforcers, and distress.

Intervention aims to break this cycle progressively and tailored to each individual. Behavioural activation can be an important part of treatment, helping to gradually restore activity, routines, relationships, and meaningful experiences, even when motivation is initially lacking.

When present, negative thought patterns, guilt, self-criticism, hopelessness, high self-expectations, and personal or contextual difficulties that may be contributing to maintaining the problem are also addressed.

Treatment is planned with specific, reviewable goals, adapting to the progress of each individual.

Therapy, medication, or both

The choice of treatment depends on the characteristics of the condition, its severity, duration, personal history, and individual circumstances.

Psychological treatment can be used as the primary intervention or combined with pharmacological treatment when indicated. In such cases, coordination with Psychiatry allows for the joint assessment of different treatment options.

Medication and psychotherapy are not mutually exclusive alternatives. In certain situations, they can complement each other within an individualised approach.

What to expect

Improvement is usually progressive and may have ups and downs. Restoring sleep, energy, activity, relationships, or the ability to concentrate does not necessarily happen all at the same time.

For this reason, treatment is oriented towards specific, gradual goals, reviewing progress and adjusting the intervention throughout the process.

In addition to working on symptom improvement, attention is paid to factors that may encourage a recurrence of the problem, and strategies are developed to prevent relapse.