Depression: who to see and what helps

Depression · Kitchener, Waterloo & Cambridge

Depression is a mood disorder: feeling sad, empty or irritable, or losing interest in things, on most days for more than two weeks, to the point that work, school or relationships suffer. Canada’s depression guideline recommends three talking therapies as first-line treatments, cognitive behavioural therapy (CBT) among them, with medication added as depression gets more severe. At CARESPACE you start with a counsellor: a Registered Psychotherapist or Registered Social Worker. If you are thinking about suicide, go to the urgent section now.

What depression is

Low mood often gets better after a few days or weeks. When it has lasted two weeks or more it could be depression, which clinicians call major depressive disorder. About 12 in 100 Canadians aged 12 and older report having had an episode at some time in their lives. It often begins in the late teens or early adulthood.

Some forms and neighbours of depression have their own pages:

• Seasonal affective disorder. Depression linked to the time of year. In Waterloo Region that usually means the short days of late fall and winter.
• Burnout. The result of chronic stress at work that has not been managed. The World Health Organization classes it as an occupational phenomenon, not a medical condition.
• Stress. One of the things that can contribute to depression, not the same thing.
• Grief and loss. A natural response to losing someone or something, which for most people eases with time.
• Insomnia. Changes in sleep are a symptom of depression. If sleep is the main problem, start there.

Symptoms of depression

These occur most days, last most of the day, and go on for more than two weeks:

• Sadness, or feeling empty
• Loss of interest in things you used to enjoy
• Feeling worthless, or excessively guilty
• Trouble concentrating or making decisions
• Irritability
• Fatigue
• Aches and pains
• Changes in sleep and appetite
• Restlessness, or feeling slowed down
• Thoughts of death or suicide

What causes depression

Depression comes from genetic, biological, environmental and psychological factors acting together. A personal or family history is the greatest risk factor for an episode, and a history of trauma is a major one. Major life changes, stress, certain physical illnesses and some medications also raise the risk, though having risk factors does not mean you will become depressed.

How depression is diagnosed

A diagnosis of depression can come from a physician, a nurse practitioner or a psychologist; CARESPACE’s counsellors, as Registered Psychotherapists and Registered Social Workers, do not diagnose or prescribe. The Canadian guideline recommends a two-question screen followed, if it is positive, by a nine-question scale (the PHQ-9) and then a full diagnostic assessment. Severity, from mild to severe, decides which treatments come first.

Ontario’s quality standard sets the pace: initial treatment within four weeks of first contact for suspected mild to moderate depression, and within seven days when it looks severe.

When it is urgent

Thoughts of death or suicide are a symptom of depression, and thoughts of suicide are a mental health emergency. Ontario’s standard says people with depression who are at considerable risk to themselves or others, including those with psychotic symptoms, should get help immediately, at the point of contact, not at a later appointment.

The month after starting an antidepressant, and the month after stopping one, are periods of higher risk of suicide. If suicidal thoughts begin or grow then, use the numbers below and tell the prescriber.

If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating depression

• The sources. Canada’s 2023 depression guideline (CANMAT), the UK’s 2022 guideline (NICE, amended 2025) and Ontario Health’s 2025 quality standard. “First-line” means try this first, and “consider” is weaker than “offer” or “recommend”. These labels show how sure a panel was as well as what the trials found.
• Severity sets the first step. For mild depression, a first-line talking therapy is preferred where it is readily accessible. For moderate depression, the first choice is between structured therapy and an antidepressant. For severe depression, both together are recommended. The UK guideline says not to routinely offer antidepressants as first-line treatment for less severe depression, and to offer them only if that is the person’s informed preference.
• Three therapies are first-line. CBT, interpersonal therapy and behavioural activation. For most people the optimal course is 12 to 16 sessions, held at least weekly.
• Both together beats either alone. Combining therapy with medication is more effective than either one for treating an episode, and is associated with a lower risk of recurrence.
• Exercise is a treatment, with a dose. Supervised exercise is a first-line treatment on its own for mild depression and a second-line addition for moderate depression: low to moderate intensity, 30 to 40 minutes, three or four times a week, for at least nine weeks.
• Antidepressants take time and are continued. The first effects are watched for over two weeks, a change is offered if there is no response after eight weeks, and treatment continues for at least six months after a first episode clears, or two years after a recurrent one. Stopping is done by reducing the dose in stages.
• Diet, sleep and light. A Mediterranean-type diet has a modest effect, enough for a third-line recommendation, and there is insufficient evidence to recommend probiotics. Advice on sleep habits is likely beneficial. Bright light therapy is a second-line treatment for mild depression that is not seasonal.

What a doctor may offer

Antidepressants are prescribed and monitored by a physician, nurse practitioner or psychiatrist, with a follow-up at least every two weeks for the first six weeks. For severe depression, or depression that has not responded to other treatment, there are also electroconvulsive therapy and repetitive transcranial magnetic stimulation. CARESPACE does not provide these, but it helps to know where they fit.

How each CARESPACE service helps with depression

Counselling & Psychotherapy

CARESPACE counsellors offer cognitive behavioural therapy (CBT). Interpersonal therapy and behavioural activation are separate methods, so if you want one of those, ask when you book for a counsellor trained in it. In Ontario, structured therapy is also available by referral to the Ontario Structured Psychotherapy Program; ask a physician or nurse practitioner about that route.

See our counselling team →

More about cognitive behavioural therapy (CBT) →

Nurse Practitioner

A Nurse Practitioner is authorized in Ontario to diagnose, to order and interpret tests, and to prescribe. For depression that means the assessment described above, and prescribing an antidepressant with the close follow-up the first weeks call for.

See our nurse practitioner team →

Personal Training and Kinesiology

The exercise the guideline recommends is supervised, and that is the role here: a personal trainer or kinesiologist can set up the program and run the sessions. For mild depression it can stand as a treatment on its own; for moderate depression it is an addition to therapy or medication.

See our personal training team →

See our kinesiology team →

Nutrition

A healthy, balanced diet and correcting any nutritional deficiencies are among the strategies Ontario’s standard says people with depression should be advised about. A Registered Dietitian can help you plan regular meals and move toward a Mediterranean-type pattern. The effect on depression is modest, so this goes alongside treatment.

See our nutrition team →

Naturopathic Medicine

A Naturopathic Doctor can assess and help with sleep problems. On supplements the two guidelines disagree. Canada’s recommends St John’s wort as a first-line treatment for mild depression and second-line for moderate, with two cautions: an uncertain risk of serotonin syndrome if it is combined with an SSRI or SNRI antidepressant, and a risk of drug interactions. The UK one says clinicians should not prescribe it or advise its use, because of uncertainty about doses, variation between preparations and potentially serious interactions with other drugs, hormonal contraceptives among them. Supplements on their own are for consideration only in mild depression, and they are unregulated products. Talk to a pharmacist, physician or nurse practitioner before taking any of them.

See our naturopathic medicine team →

Other services people ask about

Acupuncture. The Canadian guideline recommends acupuncture as a second-line treatment for mild depression and a second-line addition for moderate depression. The UK guideline makes no recommendation on it and lists it as a subject for further research.

Where most people start

A counsellor is the usual first step. See a physician or nurse practitioner as well, and soon, if your symptoms are severe, if you want to discuss medication, or if nobody has assessed you.

How your team works together

Mild depression may need only a counsellor, or a supervised exercise program. Moderate and severe depression usually involve a counsellor and a prescriber, because therapy and medication together do better than either alone. Tell your prescriber about any supplement you take, St John’s wort above all.

Browse by service: counselling, nurse practitioner, personal training, kinesiology, nutrition and naturopathic medicine.

What to expect at your first visit

A counsellor is your first visit. They work to understand what you are dealing with and come up with a plan. Questions may cover:

1. Your mood. How long it has been low, and whether it has happened before.
2. Daily life. Sleep, appetite, energy, concentration, and what you have stopped doing.
3. What has changed. A loss, a job, a relationship, your health, the season.
4. Treatment so far. Medicines, supplements, and any therapy you have had.

You leave the first visit with a plan.

What you can do at home

The NHS in the UK suggests these for low mood:

• Talk about your feelings to a friend, a family member or a health professional.
• Get regular exercise, which may improve your mood and help you sleep.
• Keep to regular meals, which helps keep your energy levels stable.
• Do not use alcohol, cigarettes, gambling or drugs to relieve a low mood.

Outlook

Depression can be treated so that people recover and get back to daily life. It can return, and the risk is higher for people who have had repeated episodes, which is why treatment is continued after you feel well. If a first treatment does not work, others can be tried and may be effective.

Depression treatment in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener, Personal Trainer in Kitchener, Kinesiology in Kitchener, Nutritionist & Dietitian in Kitchener and Naturopath in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo, Nurse Practitioner in Waterloo, Personal Trainer in Waterloo, Kinesiology in Waterloo, Nutritionist & Dietitian in Waterloo and Naturopath in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge, Nutritionist & Dietitian in Cambridge and Naturopath in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is low mood the same as depression?

Not always. A low mood often gets better after a few days or weeks. If it lasts two weeks or more, it could be depression and is worth having assessed.

Should I start with therapy or with medication?

It depends on severity. For mild depression therapy comes first. For moderate depression either can come first, and for severe depression both together are recommended.

How long do antidepressants take to work?

If an antidepressant is going to work, you usually see an effect within four weeks, by the UK guideline’s estimate. A change of treatment is offered if there has been no response after eight weeks. Do not stop one abruptly, because that can cause withdrawal symptoms.

Does St John’s wort work for depression?

The guidelines disagree. Canada’s recommends it for mild depression, with cautions. The UK’s tells clinicians not to prescribe or advise it. Check with a pharmacist, physician or nurse practitioner first.

Where can I get help for depression in Cambridge?

CARESPACE offers counselling, nutrition and naturopathic medicine in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults. Canadian Journal of Psychiatry, 2024.
• National Institute for Health and Care Excellence (UK). Depression in adults: treatment and management (NG222), 2022, amended 2025.
• Ontario Health. Major Depression: Care for Adults and Adolescents (quality standard, 2025 update).
• Centre for Addiction and Mental Health (CAMH). Depression.
• NHS (UK). Low mood, sadness and depression, reviewed July 2026.
• NHS (UK). Grief after bereavement or loss, reviewed July 2026.
• World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases, 2019.
• College of Nurses of Ontario. NP Practice Resources (what Nurse Practitioners are authorized to do), viewed November 2026.
• College of Psychologists and Behaviour Analysts of Ontario. The Controlled Act of Communicating a Diagnosis (registration guidelines, section H), viewed November 2026.
• 9-8-8: Suicide Crisis Helpline. 988.ca.
• Here 24/7 (addictions, mental health and crisis services, Waterloo Wellington). here247.ca.

Related conditions

• Seasonal Affective Disorder
• Burnout
• Grief & Loss
• Anxiety
• Insomnia & Sleep Problems

Ready to book?

Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking