Depression is not always the same. Doctors evaluate: How severe are the symptoms? How long do they last? And how do they progress over a lifetime? This classification helps in choosing the right treatment. Below you will find the most important forms.

What it is: A depressive disorder without manic phases. "Unipolar" means the mood only goes downwards, rather than fluctuating back and forth between "highs" and "lows."

Severity Levels

• Mild: The mood is low, drive is reduced, and carrying out daily life is still possible, but exhausting. Early talk therapy is helpful here.
• Moderate: Individuals feel significantly burdened as sleep, appetite, concentration, and self-esteem suffer. A combination of psychotherapy and an antidepressant is frequently recommended.
• Severe: Those affected experience severe limitations in their daily lives, often accompanied by feelings of hopelessness and guilt, and sometimes suicidal thoughts. This requires prompt, closely monitored treatment—often combining intensive psychotherapy, medication, and a crisis plan.

What Helps

Talk therapies such as Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are highly effective. Antidepressants can provide additional support, particularly for moderate and severe cases.

What it is: There are phases with distinct symptoms and phases where you feel well again. The episodes recur at intervals.

What helps: After initial improvement, prevention through so-called maintenance therapy is crucial. You continue with what successfully helped you—just at a calmer pace, with longer intervals, and following a clear plan. Maintenance therapy secures your newly found stability and helps prevent relapses.

What it is: A depressive episode that regularly occurs in autumn or winter. Typical signs include low mood, a loss of joy, and a severe lack of drive. During the brighter months, the symptoms subside significantly or disappear entirely. This pattern repeats for at least two consecutive years. Doctors refer to this as a "depressive episode with a seasonal pattern."

What helps: A clear daily routine with plenty of daylight and outdoor exercise is highly beneficial. Following a consultation with your doctor, light therapy can be a meaningful option. Cognitive Behavioral Therapy (CBT) works just as well as light therapy and reduces the risk of relapse the following winter. Medication is added if the symptoms are severe or if other measures are insufficient—this is a decision you will make together with your doctor.

What it is: This form of depression can develop during pregnancy or after giving birth. It manifests as persistent low mood, severe withdrawal, intense exhaustion, feelings of guilt, and often deep anxiety regarding the child's well-being. The symptoms go far beyond ordinary mood swings and last for weeks.

What helps: Prompt support from specialists who understand this unique phase of life is crucial. A tailored psychotherapy adapted to pregnancy and the postpartum period is the primary approach. Your doctor will carefully evaluate with you whether an additional medication is necessary. In doing so, they weigh the benefits and risks for both you and your child, and can involve your partner or close relatives if desired.

What it is: In the case of high-functioning depression, those affected appear completely normal to the outside world. They go to work, take care of their families, and keep their appointments. On the inside, however, much of it feels empty, heavy, and meaningless. Individuals force themselves through the day, ruminate constantly, and feel chronically exhausted. "High-functioning depression" is a colloquial term rather than an official medical diagnosis, but it describes this pattern accurately.

What helps: The same effective treatments used for other depressive disorders are successful here. Psychotherapy that initiates step-by-step, practical changes for daily life is particularly useful. This includes scheduling small, manageable activities, setting realistic goals, and developing specific strategies to handle distressing thoughts. If the symptoms are more pronounced, antidepressants can provide additional support.

What it is: Chronic depression is present when depressive symptoms persist uninterrupted for at least two years or return so frequently that there are virtually no symptom-free periods in between.

Chronic depression impacts daily life deeply. It often begins early, accompanies individuals for years, and shapes their self-image, leading to thoughts like: "I cannot change anything." This perception is understandable, but it is incorrect: effective solutions do exist. Here are the core characteristics of chronic depression:

• Duration and patterns: Symptoms can persist over a very long period, sometimes even for decades. This can severely exhaust a person both mentally and physically.
• Relationships: Many people with chronic depression increasingly withdraw, avoid intimacy, or anticipate rejection. This is a consequence of the depression—not a "character flaw."
• Early onset: Chronic depression frequently starts as early as adolescence. If those affected do not receive help at that stage, the illness becomes an ingrained part of life that makes everything harder.
• Accompanying symptoms and conditions: Individuals with chronic depression often experience sleep issues, anxiety, and physical pain. Thought loops such as "It is my fault" keep the illness going and drain the energy needed for solutions.
• Frequent relapses: New episodes can follow even after successful psychotherapy. This is why patience and persistence are essential.

The treatment follows a straightforward principle: start effectively, evaluate the impact, and adjust systematically. In doing so, there are overlaps with the treatment of "ordinary," non-chronic depression.

• The Same: A combination of talk therapy and antidepressants, alongside plenty of exercise, good sleep hygiene, a consistent daily routine, and social support works best for chronic courses as well.
• Different: With chronic courses, combined treatment is initiated right from the start. Monitoring its effectiveness happens early and systematically. If there is insufficient improvement, targeted adjustments are made. For example, the medication dosage is adjusted or switched to a different antidepressant. If the treatment is effective, it is consistently maintained for 6 to 12 months.

In Cognitive Behavioral Therapy (CBT), you sit down with your therapist and take a close look at your thoughts. Many depressive thoughts are very harsh or negative, such as: "I will never manage this" or "I am worthless." In therapy, you learn to identify these thoughts, question them, and find more realistic perspectives. At the same time, you practice taking small steps in daily life: doing activities again, maintaining contacts, and engaging in things that bring you joy. Sometimes you receive small homework assignments, like taking a short walk or making a phone call to a friend. The goal is to get back into motion step by step.

In Interpersonal Therapy (IPT), the focus is on your relationships and life changes that are causing you distress. Perhaps you have lost someone important, retired, or are caught in a conflict. In the sessions, you talk specifically about these situations with your therapist. Together, you look for ways to handle them better, resolve conflicts, or reach out for support. The therapy helps you strengthen your relationships so you no longer have to carry burdens entirely on your own.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a specialized form of therapy designed specifically for people who have been depressed for a very long time. Many of them had difficult experiences in childhood or adolescence, such as rejection or a lack of emotional closeness. These experiences continue to resonate into adulthood. In CBASP, you practice interacting differently with other people. The therapist shows you the impact of your reactions, and you try out new behaviors directly during the session. This creates a kind of "training ground" where you realize: I can do things differently—and get different reactions in return. Step by step, you learn to break free from old patterns.

These measures enhance the effectiveness of your treatment and provide you with daily stability.

• Exercise: A short daily walk is an excellent starting point. As you begin to feel better, you can gradually increase either the duration or the pace.
• Daily routine: Set times for waking up, going to bed, and having meals help bring stability to your everyday life. It is also beneficial to schedule at least one small task or appointment each day to help you stay active.
• Sleep hygiene: Avoid prolonged screen time in the evening, ensure your sleeping environment is quiet, and cut back on caffeinated drinks in the afternoon. These simple habits improve your chances of getting restful sleep.
• Social support: Intentionally connect with at least one person every day—even a brief conversation can make a difference. A few minutes of interaction is far better than none at all.
• Crisis plan: Write down important phone numbers, your personal warning signs, and concrete next steps. If you are experiencing acute suicidal thoughts, dial 112 immediately or reach out to your local crisis services

Digital Health Applications (DiGAs) are government-tested, CE-marked medical devices available "by prescription" that can be prescribed by doctors or psychotherapists. The statutory health insurance funds cover the costs entirely, provided the application is listed in the BfArM DiGA directory. For depression, deprexis is available—a digital therapy designed to provide supportive care for unipolar depression.

In the past—specifically during the 1990s—many treatments were discontinued far too early, often as soon as the first signs of improvement appeared, and there was no structured, step-by-step approach.

Since the year 2000, the landmark STAR*D study (Sequenced Treatment Alternatives to Relieve Depression), a highly recognized large-scale study on depression, has demonstrated that adjusting treatment plans systematically—by either switching or supplementing therapies—enables significantly more people to achieve near or complete freedom from symptoms.

Today, medical guidelines strongly recommend transitioning directly into a maintenance therapy once initial improvement is achieved. This means that the successful treatment is consistently maintained for an additional 6 to 12 months to prevent the depression from returning.

Furthermore, for long-term progressions, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is now available. This is a specialized form of talk therapy that uniquely integrates behavioral training with interpersonal relational experiences.

Many people experience significant improvement or even become entirely symptom-free if they persevere and follow a structured treatment plan. The following statistics demonstrate that long-term commitment to therapy combined with an antidepressant yields the highest chances of recovery.

• Success through multiple stages: According to the landmark STAR*D study, up to 67% of patients can achieve remission when utilizing multiple, sequential treatment steps over time.
• The power of combination therapy: A major study published in 2000 showed that combining CBASP with an antidepressant was significantly more effective than using either method alone. Specifically, 73% of participants responded positively to the combined treatment, compared to just 48% when only one method was utilized