Depression Treatment

Signs and symptoms of depression

You do not need to have every symptom for it to be clinical depression: a persistent group of them that affects your daily life is enough. These are the most frequent:

• Sadness, emptiness or irritability most of the day, nearly every day.
• Anhedonia: loss of interest or pleasure in activities you used to enjoy (hobbies, sex, seeing friends).
• Unintended changes in appetite or weight (in either direction).
• Sleep disturbances: insomnia (especially waking up early) or hypersomnia (sleeping more than usual without feeling rested).
• Fatigue or loss of energy: small tasks feel enormous.
• Feelings of guilt, worthlessness or disproportionate self-criticism.
• Difficulty concentrating, making decisions or thinking clearly.
• Slowed movement or physical agitation that other people notice.
• Recurrent thoughts about death, suicidal ideation or suicide attempts.

How we approach depression in therapy

For clinical depression, the approaches with the strongest evidence are Cognitive Behavioral Therapy (CBT) and, within it, Behavioral Activation, a particularly powerful component for moderate and severe depression. The central idea: depression creates a cycle where less energy → less activity → less positive reinforcement → more depression. To break it, you do not wait to "feel like it" before acting; you act first, in small planned steps, and the motivation comes as a consequence.

In the first sessions we carry out a complete clinical assessment, provide psychoeducation about the condition and put together an activation plan adapted to your case. In the following sessions we work on cognitive restructuring (identifying and changing the negative thinking bias typical of depression), emotional regulation, managing rumination (those repetitive mental loops that keep depression going) and, when relevant, addressing unresolved grief or underlying trauma.

A CBT process for moderate depression usually takes between 16 and 24 sessions (4 to 6 months, meeting weekly). This is an approximate range taken from the protocols with the strongest evidence, not a prognosis for your case: how long it takes depends on your history, the condition and how the work progresses. It is discussed in the first session and reviewed as you go. For severe or recurrent depression it may take longer, and it usually benefits from a complementary psychiatric evaluation.

When it is important to act soon

Untreated depression tends to become chronic: each episode increases the risk of the next one, and the neurobiological circuits of the condition become consolidated over time. The earlier the intervention, the better the prognosis.

There are signs that it is time to ask for help: if the sadness lasts more than two weeks and you cannot "get out" of it; if you stopped enjoying what you used to enjoy; if your tiredness is out of proportion to the effort of the day; if you have withdrawn socially; if there are marked changes in sleep, weight or appetite; if self-criticism has become constant.

If there is suicidal ideation (thoughts about taking your own life), planning or attempts, it is urgent to act. Suicidal ideation does not go away on its own and is not a sign of weakness: it is a symptom of depression. If you are having these thoughts right now, call 168 (Santa Cruz medical emergencies, they send an ambulance) or go to the emergency department of the nearest hospital, with no appointment and no need to be registered with the SUS (Bolivia's Unified Health System). If what you need is to talk to someone, Familia Segura listens free of charge and in confidence at 800 11 3040, every day from 6:00 a.m. to midnight. Between midnight and 6:00 a.m. there is no emotional support line open in Bolivia: during those hours, the safe option is to go directly to the emergency department of the nearest hospital.