Depression
The thing standing between you and treatment is usually not willpower. It is a booking system nobody explains.
Depression is one of the most treatable illnesses there is, and Germany has a legal route to an appointment that most people never hear about: one number, a deadline the health system has to meet, and a first slot you can book without a referral, without a diagnosis and without knowing what you want.
This page is the route, in order — what to ring, what to say, what the words on the forms mean, and what the money and work side looks like while you are ill.
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If today is the problem
Take the first line that matches. Nothing further down this page needs to happen today.
If you are thinking of ending your life
That is an emergency in its own right and it is treatable too — not a failure of this page or of you. 112 in immediate danger. TelefonSeelsorge, free and anonymous, around the clock, on 0800 111 0 111, 0800 111 0 222 or 116 123, with chat and mail as well. Everything else: kantholz93.com/suicide.
You need a doctor and it is Sunday
116 117 is the out-of-hours medical service — free, around the clock, no referral. If it is worse than that, a hospital with a psychiatric department takes people at any hour, and you may go there yourself without an ambulance and without an appointment.
You need a therapy appointment and have none
Ring 116 117 and ask the Terminservicestelle for a psychotherapeutische Sprechstunde. They must arrange one within a week and the appointment must fall within four weeks. No referral is needed. This is the single most useful sentence on this page.
You cannot work
Your GP can sign you off. You do not need a psychiatrist, a diagnosis on paper or anyone's permission, and your employer never learns the reason — sick notes carry no diagnosis.
You want information, not a crisis line
The Info-Telefon Depression answers on 0800 33 44 533 — Mon, Tue and Thu 13:00–17:00, Wed and Fri 08:30–12:30 — free and anonymous, on the illness, the treatments and where to find care. It is information, not therapy, and that is exactly what makes it easy to ring.
If phoning is the thing you cannot do
This is a symptom, not a personal failing, and it is why so many people stay untreated for years. TelefonSeelsorge has a chat and a mail service. Ask someone else to make the 116 117 call for you — you may hand the phone over, and it is a perfectly ordinary thing to do.
How you actually get therapy in Germany
The order matters, and almost nobody is told it. Doing it in this sequence turns a hopeless search into a queue with deadlines attached.
1
The Sprechstunde comes first, always
Since 2017 every course of psychotherapy starts with a psychotherapeutische Sprechstunde — up to six sessions of 25 minutes. It is compulsory before any further treatment, so there is no way round it and no point looking for one. You need no referral and no diagnosis to book it. Ring 116 117 and ask for one, or ring practices directly.
2
You leave with a form called PTV 11
At the end of the Sprechstunde the therapist writes what they recommend and gives you a sheet with a code on it. That code is what unlocks the deadlines: with it, 116 117 must arrange Akutbehandlung within a week, for an appointment inside two weeks. Keep the form. Photograph it.
3
Akutbehandlung is the bridge
Up to 24 units of 25 minutes, meant to stabilise you quickly rather than to be a full course of therapy — and it needs no application to the insurer, only notification. Sessions used here are counted against a later short- or long-term therapy, so nothing is wasted.
4
Probatorik: two to four trial sessions
Before a real course starts, you and the therapist take two to four sessions of 50 minutes to see whether you can work together. You are allowed to end it there and try someone else. Fit predicts outcome more than method does, and this stage exists precisely so you can walk away.
5
Then the therapy itself, applied for on your behalf
The therapist submits the application; you sign. Kurzzeittherapie runs in two steps of 12 sessions, up to 24 in total, normally without an external assessor. Langzeittherapie is up to 60 sessions for behavioural therapy and for depth-psychological therapy (extendable to 80 and 100), up to 160 for analytical therapy (extendable to 300), and up to 36 for systemic therapy (extendable to 48). One session is 50 minutes.
When there is genuinely no place
If the Terminservicestelle cannot deliver and practices are full, there is a second route: Kostenerstattung under § 13 Abs. 3 SGB V. Where the insurer cannot provide a service in time or has wrongly refused it, it must reimburse what you necessarily spent on getting it privately. In practice this means documenting your refusals — keep a list of every practice, the date you rang and what they said, aim for a couple of dozen entries — and applying to the Krankenkasse before starting treatment. It is laborious, it is regularly refused first time, and it regularly succeeds on objection. Ask a therapist who works this way, or a Patientenberatung, to help with the letter.
What the treatment guideline actually says
Germany's national guideline for unipolar depression takes a stepped approach, and knowing it changes what you can reasonably ask for.
A first, mild episode: low-threshold help first — counselling conversations or evidence-based online programmes. Medication is not the automatic opening move.
Moderate, or recurring mild episodes: psychotherapy or medication. Both are legitimate first choices, and preferring one is a decision you are entitled to make.
Severe depression: the two should be combined. If you are severely ill and being offered only tablets with no route to therapy, or only a therapy waiting list with nothing in the meantime, that is a gap worth naming out loud to the doctor.
About the tablets, plainly
They take weeks, not days. Expect a fortnight before anything shifts and longer for the full effect. Side effects often arrive first and then fade — which is exactly why people stop in week two and conclude it does not work.
They are not sedatives and not taken as needed. They work on a daily schedule, not on bad days.
Do not stop abruptly. Coming off is a taper, planned with the prescriber. Stopping suddenly can produce a rough few weeks that is easily mistaken for the illness returning.
The first one is a starting point, not a verdict. Finding what suits often takes more than one attempt, and switching is ordinary rather than a sign of a hopeless case.
A GP may prescribe and monitor this. You do not have to wait for a psychiatrist — though for severe or unclear cases, or if nothing is working, a psychiatric opinion is worth the wait.
Work, money and being ill for a while
Sick pay runs a long time. After the employer's six weeks of continued pay, the Krankenkasse pays Krankengeld for the same illness for up to 78 weeks within three years. Depression is not a diagnosis anyone has to disclose to an employer at any point.
Coming back can be gradual. The stufenweise Wiedereingliederung under § 74 SGB V lets you return over weeks at rising hours while still counted as sick and still paid sick pay. The doctor sets out what work is possible; after six weeks of incapacity this is supposed to be considered as a matter of course. Ask for it by name — it is the difference between returning and relapsing in a fortnight.
Rehabilitation exists for this. A psychosomatic Reha — typically several weeks, inpatient or day-patient — is applied for through the Deutsche Rentenversicherung, and refusals are frequently overturned on objection.
Day clinics are the middle option nobody mentions. A Tagesklinik gives you the structure and intensity of a ward while you sleep at home. Waiting times are usually far shorter than for outpatient therapy.
Recognition as severely disabled is possible where the illness is lasting. A Grad der Behinderung of 50 brings extra leave, stronger dismissal protection and tax relief. It is applied for at the Versorgungsamt and it is not a statement about your worth — it is a set of protections.
While you are waiting
The wait between deciding to get help and having it is where people give up. These are the things that hold ground in the meantime — none of them a substitute for treatment.
Self-help groups and forums. Local groups run through the Bündnisse gegen Depression and the Deutsche DepressionsLiga; the Stiftung Deutsche Depressionshilfe runs a moderated discussion forum. Other people with the same illness are the only ones who need no explanation.
Keep one appointment a week with anyone at all. A GP check-in, a group, a walk with the same person. The mechanism is not mysterious — depression removes structure first, and a fixed point in the week is the cheapest structure there is.
Guided online programmes (digitale Gesundheitsanwendungen) can be prescribed by a doctor and paid for by the Krankenkasse. They are genuinely useful for mild to moderate depression and useless as a replacement for treatment of severe depression — which is roughly what the guideline says too.
Do the boring bodily things anyway. Sleep at consistent times, eat at intervals rather than at appetite, get outside in daylight. This is not a cure and anyone offering it as one has not been ill; it is maintenance that stops a bad week compounding.
Tell one person the actual truth. Not everyone. One. Concealment costs energy you do not have, and the loneliness of pretending is its own separate illness on top of the first.
Outside Germany
United Kingdom
NHS Talking Therapies — refer yourself
In England you can refer yourself without seeing a GP for depression, anxiety, phobias, OCD, PTSD and body dysmorphic disorder. Free; you need to be registered with a GP and aged 18 or over, or 16 in some areas. Other conditions need a GP referral. Find your local service through the NHS website.
Samaritans
116 123
Free from any phone including one without credit, 24 hours a day, and it does not appear on the bill. UK and Republic of Ireland; Welsh language line 0808 164 0123; Relay UK on 18001 44 116 123.
Shout — if you cannot speak
Text SHOUT to 85258, free on all major UK networks, 24/7, and it does not show on the bill. A trained volunteer answers by text.
Mind
0300 102 1234
Mon–Fri 09:00–18:00, except bank holidays — a support line for talking about your mental health and finding specialist help. Mind also runs an information line and a welfare benefits line. mind.org.uk
Ireland
Aware
1800 80 48 48
Seven days a week, 10:00–22:00, free. Support and information on depression, bipolar disorder and other mood conditions, plus support and self-care groups and an email service. Under 18s: Childline on 1800 66 66 66. aware.ie
Samaritans Ireland
116 123
Free, 24 hours, across the Republic of Ireland and Northern Ireland.
Elsewhere
Two things are near-universal and worth using as search terms: a national depression association that publishes what treatment should look like where you are, and a publicly funded route to a first appointment that is usually badly advertised. Ask the association how people actually get seen — they know the local shortcut, and it is rarely the one on the health ministry's website.
The part nobody writes down
Depression's cruellest feature is that it attacks the exact faculties you need to get treated. It makes phone calls impossible, forms unreadable and the future implausible, and then it tells you, in your own voice and with great authority, that this proves you are not ill but simply useless. That voice is a symptom. It is as much a part of the illness as a fever is part of an infection, and it will lift — although, infuriatingly, it lifts after you act, not before.
Which is why the practical advice on this page is deliberately small. Not a plan. One phone call to 116 117, or one person asked to make it for you. The bar is that low on purpose, because on a bad week that is genuinely the whole of what is available — and it is enough to start the deadlines running.
Two things worth holding onto while you wait. Most depressive episodes end, including the ones that arrive with total certainty that this one will not. And treatment resistance is usually a queue problem, not a you problem — most people described as untreatable have had one antidepressant for six weeks and no therapy at all, which is not a failed treatment but an unfinished one.
If it has gone as far as planning to end your life, please treat that as separate and immediate: kantholz93.com/suicide. TelefonSeelsorge, 0800 111 0 111, free and anonymous, around the clock.