sassypants, have you had 4 different therapists because none of them have been helpful? Have they all used the same therapeutic approach with you? It sounds like your current therapist is CBT. This helps a lot of people with depression but not all. Do you think it is the approach that is not helpful? If so, have any of your other therapists taken different approaches? I did have major depression at one point, and the therapist I began seeing was CBT. (I didn't know that was what it was called at the time or that there were very different approaches to psychotherapy.) This therapist was not very effective and later I realized, when I knew more about therapy, that the CBT approach is not the best fit for me. My second therapist is not CBT at all--he is from the humanistic psychology tradition, although he borrows from several approaches. His general approach has worked very well for me.

One thing my CBT therapist really helped me with a lot was getting me to improve my sleep habits. Somehow being chronically sleep deprived is associated with being depressed for me. I'm not sure if the depression causes the sleep problems, or the sleep problems cause the depression, but they go hand in hand in my body and seem to feed off of each other. By working really hard to improve my sleep, I did find that this helped some with depression too (and also cognitive functioning).

I think with CBT, the idea is that all of these things you do will help a little bit and if you add them all up, they can be a significant help in reducing depression. So improve sleep, diet, exercise, socializing, take meds, etc., and each one will add to the other until you can notice an improvement. Anyhow, hang in there. Maybe ask your T if she has any other suggestions up her sleeve. A big toolbox can be so helpful with a diverse clientele.