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Preparing a Review When Depression Has Not Improved With Therapy

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If you have participated in therapy and still feel depressed, it can be difficult to know what to say next.

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If you have participated in therapy and still feel depressed, it can be difficult to know what to say next. You may worry that you have done something wrong or that requesting a review will dismiss the effort you and your therapist have made. When considering psychiatrist vs therapist services, understanding their different roles may help clarify whether additional assessment or treatment options are appropriate. A review can begin with a simpler statement: “I am still struggling, and I would like us to look at the plan again.”

The National Institute of Mental Health’s (NIMH) psychotherapy guidance recommends speaking with your therapist if you feel you have participated in therapy for a reasonable amount of time without improving. It also suggests discussing other professionals or treatment approaches. This provides a reason to ask questions, not a basis for diagnosing yourself with treatment-resistant depression or deciding that medication must be the next step.

Name What Remains Difficult

Describe how depression currently interferes with your life, whether that involves getting out of bed, keeping up with responsibilities, enjoying time with others, or another concern that matters to you. Include a specific example and approximately when you noticed the current pattern. You do not need to convert your experience into a numerical score for it to deserve attention.

Distinguish between “nothing has changed” and “some things have improved, but the main problem remains.” For example, you might find it easier to identify your feelings while still missing work. Both observations are relevant to the review. NIMH’s depression information describes effects on daily activities such as sleeping, eating, and working. Your examples can help explain which activities remain most difficult.

Reconstruct What You Tried Without Grading Yourself

Prepare a brief treatment history using what you remember, including the clinician or service, approximate dates, treatment goals, therapeutic approach if known, and whether appointments were regular or interrupted. If you do not know the name of the therapy, describe what you did during sessions. “We discussed relationships and practiced managing difficult conversations” is more useful than guessing a technical term.

Note any between-session activities you were assigned and whether they were practical for you. Include previous medications or other treatment experiences when relevant, but do not independently determine whether a medication trial was medically adequate. Dates, records, and personal experiences provide useful information, while the clinician is responsible for interpreting them within the appropriate clinical context.

Include Benefits, Barriers, and Difficult Experiences

Write down what helped, even if the benefits were limited. Then identify what made treatment difficult, such as cost, transportation, privacy concerns, language barriers, scheduling challenges, an approach you did not understand, or discomfort discussing something important. These are relevant considerations for treatment planning, not evidence that you failed therapy.

If a therapeutic exercise or conversation made you feel worse, describe what happened and what support you needed. You do not need to recount every painful detail in an administrative message. Request time to discuss the experience with your treating clinician and how it should influence the treatment plan.

Ask What Needs Reassessment

Consider asking these questions: “Are we working toward the goals that matter most to me?” “How are we evaluating progress?” “Could another explanation or health condition require assessment?” and “What would you need to understand before recommending a change?” NIMH’s psychotherapy guidance explains that treatment choices depend on individual needs and medical circumstances.

Ask your clinician to explain the reasoning behind any recommendation, including areas of uncertainty. You can also ask what continuing the current approach would accomplish and how an alternative treatment might address the difficulties you have described. These questions support informed discussions rather than determining which treatment is appropriate.

Clarify Whether Additional Medical Input Would Help

You can ask whether a primary care consultation or psychiatric assessment would provide useful information. NIMH’s depression guide explains that certain medical conditions and medications can contribute to symptoms resembling depression. It also identifies psychotherapy and medication as treatment options. The appropriate choice depends on individual circumstances rather than a fixed sequence of treatment steps.

If another professional becomes involved, clarify who will coordinate care and what information may be shared with your permission. A referral does not guarantee that a new clinician will diagnose a different condition or recommend medication. Discuss questions about proposed medications with the prescribing professional rather than independently changing an existing treatment plan.

Bring a One-Page Review Summary

Use five brief statements to organize your concerns: “What remains difficult: __. What we hoped would improve: __. What I tried and any improvements: __. Barriers or difficult experiences: __. What I want help deciding today: __.” Include a current medication list when applicable. NIMH’s guidance for communicating with healthcare providers recommends preparing questions and relevant information before appointments. A perfect treatment history is not required.

Before leaving, clarify the next steps, who is responsible for each part of the plan, and when progress will be reviewed together. Confirm how to obtain assistance sooner if symptoms worsen. Do not wait for a routine appointment during a crisis. NIMH’s mental health assistance guidance recommends calling 911 or visiting the nearest emergency department for life-threatening situations. In the United States, call or text 988 for a suicidal crisis or emotional distress.

This article provides general educational information only. The review worksheet cannot diagnose depression, determine treatment resistance, or identify the most appropriate next treatment for an individual.