High depression score: what to do after a self-assessment
You have answered a self-assessment questionnaire and the result indicates moderate or severe depression. Here are the concrete steps to follow, in order, without panicking.
Understanding what a high score really indicates
Standardized self-questionnaires — whether it's the PHQ-9, the Beck Depression Inventory, or the HAD scale — share the same logic. They take the medical criteria for depression and transform them into accessible questions, with a score that indicates the intensity of symptoms experienced over the past two weeks. This score is not meant to replace a clinical evaluation, but it provides a useful objective indication for the professional who will see you.
Specifically, a moderate score indicates established depression that requires medical advice. A severe score indicates a situation that requires a quick consultation, within the week if possible. A very high score, especially if accompanied by thoughts of death, justifies a consultation within 24 to 48 hours or a call to a dedicated emergency service.
| Score level | What it suggests | Recommended time frame for consultation |
|---|---|---|
| Light | Present depressive symptoms but not very disabling | Within a few weeks, monitoring |
| Moderate | Probable depressive episode, daily impact | Within 2 to 3 weeks |
| Moderately severe | Characterized depression requiring follow-up | Within 1 to 2 weeks |
| Severe | Intense depression with significant impact | Within a few days |
| Very severe or dark thoughts | Relative or absolute emergency | Immediately, 24-48h max |
🚨 If you have thoughts of death or suicide
3114 is the national suicide prevention number, free, 24/7, anonymous. You can also go to the psychiatric emergency room of your hospital, or call 15 (SAMU) for guidance. Don't wait for these thoughts to "pass on their own": they signal a suffering that requires immediate support. You don't have to justify yourself; you have the right to be well.
Step 1: don't stay alone with the result
The first useful reflex, even before making an appointment, is to share the result with a trusted person. Not for them to diagnose you, but to break the isolation that often characterizes depression. Sharing your words triggers a process, puts into words what was previously confusing, and then facilitates the medical approach.
Choose someone capable of listening without wanting to "solve the problem": a partner, a parent, a close friend, sometimes a trusted colleague. Avoid people who tend to minimize ("it will pass", "everyone has down days"). If no one seems available in your circle, listening lines exist — SOS Friendship at 09 72 39 40 50, available 24/7.
Step 2: make an appointment with your primary care physician
Why start with the primary care physician
For the vast majority of situations, the primary care physician is the right entry point. They know you, can rule out physical causes that may mimic depression (hypothyroidism, anemia, vitamin D or B12 deficiency, medication side effects), and refer you to a psychiatrist or psychologist as needed. They can also initiate first-line treatment and a work stoppage if necessary.
How to present your request
Do not minimize when making the appointment. Instead of saying "I would like a consultation to talk a bit," say "I would like a consultation for depressive symptoms." This allows the secretary to schedule a longer slot and prepares the doctor. Bring the result of your self-questionnaire; it is a concrete support to start the exchange.
What happens during the consultation
The doctor will ask questions about the duration of symptoms, their impact on your daily life, your personal and family history, your alcohol or substance use, and your thoughts about death. They may prescribe a blood test to rule out a physical cause. At the end, several options may be proposed depending on the severity.
Step 3: understand the proposed care options
Psychotherapy as first-line treatment
For mild to moderate depressions, official recommendations place psychotherapy as the first-line treatment. Cognitive-behavioral therapies (CBT) have the best-documented effectiveness, with structured protocols over 10 to 20 sessions. Other approaches — interpersonal therapy, acceptance and commitment therapy, EMDR if associated traumas — also have validated results.
Since 2022, the Mon soutien psy program allows for 12 sessions per year with a contracted psychologist, reimbursed by Health Insurance with a medical prescription. Psychiatrists are reimbursed without upfront costs for patients in care pathways. Consultations with non-contracted psychologists are not reimbursed by Health Insurance but may be partially covered by some mutual insurance companies.
Medication treatment
For moderate to severe forms, or when psychotherapy alone is not sufficient, an antidepressant may be prescribed. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used first-line treatment due to their good efficacy/tolerance ratio. The effect is not immediate: it takes two to four weeks before the first benefits, and six to eight weeks to assess the full response.
Treatment is not a "crutch for life" as is sometimes heard. The recommended duration is generally six to twelve months after complete remission for a first episode, longer in case of history. Stopping should always be done gradually, under medical supervision, to avoid withdrawal syndrome.
Work stoppage
Many people hesitate to request a work stoppage for fear of professional consequences. However, in a characterized depression, continuing to work can worsen exhaustion and delay recovery. Stopping is not an escape; it is a framework that allows treatment to take effect. Work stoppages for depressive episodes last on average 110 days according to Health Insurance data, but this varies greatly depending on severity and context.
🎯 What happens after the first appointment
If the consultation with the primary care physician leads to a referral to a psychiatrist or psychologist, expect 1 to 4 weeks depending on the areas. In case of emergency, explicitly ask your doctor for an urgent consultation — most CMPs (Medical-Psychological Centers) see patients within a few days on medical referral. CMPs are free and public, available throughout France.
Step 4: implement non-medical levers
Alongside medical follow-up, several levers have demonstrated effectiveness and can be activated right now.
Regular physical activity
Thirty minutes of moderate-intensity activity, three times a week, have an effectiveness comparable to a mild antidepressant for moderate forms of depression. Fast walking, cycling, swimming, dancing — it doesn't matter the modality, it's the regularity that counts. Start small if motivation is lacking: ten minutes are better than zero, and the effect on mood is noticeable from the first week.
Sleep, rhythm, and light
Maintaining regular bedtimes and wake-up times, even on difficult days, stabilizes the thymic system. Exposure to daylight, especially in the morning, plays a key role in serotonin and circadian rhythm. For those sensitive to the decrease in winter light, light therapy (30 minutes in the morning in front of a 10,000 lux lamp) has proven effective.
Nutrition and social connections
A varied diet rich in omega-3 (fatty fish, nuts, seeds), green vegetables, and fermented foods supports mental health via the gut-brain axis, which is now well documented. Maintaining a minimum of social connections — even brief ones, even those that require effort — protects against depressive withdrawal. Just one daily interaction is enough to break the cycle of isolation.
Gentle cognitive stimulation
Depression alters concentration, working memory, and decision-making, and these cognitive disorders often persist for several weeks after thymic stabilization. Maintaining stimulating but pressure-free brain activity helps rebuild the sense of personal effectiveness. The JOE app for adults offers short, playful exercises with adjustable intensity, particularly suited for this phase. If you initially completed a self-questionnaire and wish to recheck your state after a few weeks of care, you can take an online self-questionnaire that allows tracking the objective evolution of symptoms.
💡 The trap of "well-intentioned" isolation
When we are not feeling well, we tend to withdraw to "not bother others." This is precisely the opposite of what should be done. Depression feeds isolation, and isolation worsens depression. Accept invitations even if brief, even if you don't feel like it at the moment. Mood often follows action rather than precedes it.
Step 5: structure follow-up over time
A well-managed depression cannot be treated in two consultations. The journey spans several months, with distinct phases.
The acute phase, from the first weeks to about two months, aims to initiate improvement: starting treatment, implementing psychotherapy, possibly adjusting the living or working environment. This is the most difficult period, where one does not yet feel that things are changing.
The consolidation phase, from months 2 to 6, aims to stabilize improvement and avoid early relapse. Medication is maintained, psychotherapy continues, and activities begin to be gradually resumed.
The maintenance phase, from 6 to 12 months, aims to prevent long-term recurrences. Treatment may be continued or gradually reduced depending on the case. Psychotherapy may sometimes shift to spaced sessions, and protective routines are established that will remain.
Recognizing signs of improvement
The first encouraging signs are not always where one expects them. Before mood really improves, one often observes better sleep, returning concentration, less irritability, and a resumption of appetite. Note them: in depression, the brain tends to filter out the negative and forget progress. Keeping a small journal of developments helps to stay grounded.
For professionals who support
Caregivers, home helpers, nurses, family caregivers who support depressed individuals play an essential role in daily support and in identifying aggravations. Understanding the dynamics of depression, knowing what to observe, when to alert, how to maintain a caring support relationship without being overwhelmed oneself: these are skills that can be learned. The DYNSEO online training, certified Qualiopi, addresses these issues in several courses dedicated to mental health and mood disorder support.
What to remember
A high score on a self-questionnaire is a starting point, not a condemnation. Depression can be treated in the vast majority of cases, provided the right steps are taken: not staying alone, consulting the primary care physician, accepting a care pathway that may combine psychotherapy, treatment, and non-medical levers, and embedding it all over time. The path is not linear — there are good and bad days — but the slope reverses with structured care.
Frequently asked questions
How long before feeling better after starting treatment?
For antidepressants, expect 2 to 4 weeks for the first effects, 6 to 8 weeks for full response. Psychotherapy produces more gradual but lasting effects, noticeable from the first 4 to 6 sessions. Some levers (physical activity, sleep, light) yield results from the first week.
What if the first treatment doesn't work?
This is common: about one-third of patients do not respond sufficiently to the first antidepressant. The doctor then adjusts the dose, changes the molecule, or adds a second medication. A resistant depression (failure of two well-conducted treatments) benefits from specific approaches in specialized consultation.
Does the sick leave appear on the pay slip or in the HR file?
The medical reason never appears on the documents sent to the employer. Only "sick leave" is listed on the bulletin sent by Social Security. The diagnosis is covered by medical confidentiality and is known only to your doctor and the consulting physician of the CPAM.
Can one undergo psychotherapy without antidepressants?
Yes, this is even the official recommendation for mild to moderate depression. The combination of both is advised for more severe forms, or in cases of resistance to psychotherapy alone. The decision is made with the doctor based on severity, history, and your preferences.
What to do if one cannot call or make an appointment oneself?
Asking a loved one to make the appointment for you is perfectly possible. The initial consultation can also be done via teleconsultation, which facilitates the first step. In case of prolonged blockage, the primary care physician can make a home visit to initiate follow-up.
How do CMPs work in practice?
Medical-Psychological Centers are public, free structures accessible in the territory according to your address. They offer psychiatric, psychological, and nursing consultations. The access time varies from a few days in emergencies to several weeks outside of emergencies. Sectorization is done by postal code.
How to explain the situation to children?
In simple words, adapted to their age. "Mom/Dad is going through a difficult time, it's like a flu of the head, it can be treated and it's not your fault." Children pick up on mood changes even without being told — explaining it prevents them from feeling responsible or rejected.
Is it useful to redo the self-questionnaire to track progress?
Yes, retaking the questionnaire every two to four weeks provides an objective measure of progress, which complements the sometimes biased subjective perception due to depression itself. Bring the results to your consultations, your doctor will appreciate this quantified follow-up.
Move forward step by step
Depression is one of the most studied and best-treated mental disorders. A high score on a self-assessment is not bad news; it is, on the contrary, an early signal that opens the door to care. The next steps are a few concrete actions: talk to someone, make an appointment with the primary care physician, accept the proposed pathway, activate daily levers, and maintain it over time. You are not alone in going through this, and the vast majority of people who embark on this path come out of it.
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