What Is the Best Therapy for Depression?

The best therapy for depression is the one that works

Depression can affect everything, which means many parts of a depressed person’s life need to be addressed. Because of this, many wonder what exactly is the best treatment for depression, whether short-term symptom-based relief like CBT (Cognitive Behavioral Therapy) or psychodynamic therapy that relates to depression as a symptom having meaning, one that indicates deeper, often historical issues. The answer is the one that works for each person, which could include multiple therapies over time or at once.

CBT was previously related to as the “gold standard” (And before that, SSRIs)

For about twenty years, roughly from 2000 to 2020, CBT was related to, in therapy circles and among psychiatrists, school counselors, and primary care doctors, as the “gold standard.” Behind the scenes, insurance companies were hugely influential in this distinction—developing criteria for standards (read: what kind of treatment they’ll pay for) and funding research and public relations to promote CBT. Why would insurance companies care? Because CBT casts itself as a short-term treatment, which saves money.

That roughly twenty-year period was preceded by a period when Prozac and similar SSRIs were related to as the “gold standard.” This shifted to CBT as the evidence stacked up that SSRIs were not magic pills. People still felt depressed (or had other problems in living that SSRIs could never promise to address) after taking them for years. Of course, insurance companies also supported this gold standard—pills are cheaper than therapy and short-term therapy is cheaper than long-term therapy.

Psychodynamic therapy addresses causes, not just symptoms

To be clear, CBT and similar therapies are useful for symptom relief and are often as helpful (or more so) than medication. Many psychiatrists recommend both as a “front line” treatment for depression. However, research shows that CBT and all short-term treatments are only effective as symptom relief and those effects are just that: short-term. 

For someone struggling with brief, mild, and perhaps a first episode of depression, this may be just what they need. But for most people seeking therapy for depression, their depression is neither brief nor recent—and it's often not mild. In these instances, therapy that addresses causes—not just symptoms—and relates to symptoms as having meaning is far more effective. This is psychodynamic therapy.

Psychoanalysis offers a language for articulating human struggles

The symptoms of depression are quite narrow. In contrast, the language of psychoanalysis offers the possibility of articulating human struggles that go beyond the language of diagnosis and medicine. This expands possibilities—not only to restore functioning like CBT but also to engage with larger questions of what it means to live a good life. With its language, we can experience angst, dread, and a lack of passion. We can be creatively stuck, spiritually blocked, and sexually bored. This complicates a narrative about our struggles rather than simplifying them to fit into a symptom checklist.

The best help is a relationship with a good therapist who can be flexible and open to multiple approaches

Research shows that the relationship between the therapist and patient is the most consistent indicator of efficacy regardless of treatment modality. No matter what treatment or combination of treatments, a person struggling with depression needs a therapist who can be flexible, take multiple approaches (perhaps even at the same time), and be open to evolving this approach over time. For example, a patient may need to start out with more concrete help (e.g. help getting out of bed) and move towards therapy that more deeply engages with the painful feelings of not just depression but those that underlie the depression (or feelings that the depression may be organized to avoid). What remains true is that in order to get better, we need to listen to our bodies, our pain, and our sadness. We just might need to understand what depression is trying to tell us.