Note: In 2011, AOTA identified depression as an emerging niche in occupational therapy. It has since become more mainstream, so newer content appears elsewhere on this site. This page has been retained for historical information. Learn more about the 2011 Emerging Niche series here.

Depression Why emerging? Whereas one in four U.S. adults have a diagnosable mental health problem in any given year—from depression to bipolar disorder—fewer than half get any treatment for it.1,2As spending on direct-to-consumer advertising for antidepressant drugs increased from $32 million to $122 million between 1996 and 2005, the number of Americans taking antidepressants doubled, leading many to think the only and best way to treat depression is with a pill.3 Medication can be an important component to treating depression, but occupational therapy can also assist people to restructure their daily lives. Occupational therapy received even more recognition in the area of depression when AOTA nominated Katherine Burson, MS, OTR/L, CPRP, to participate in an American Medical Association (AMA) workgroup on adult depressive disorders, and the AMA invited her to participate.

Get Involved! Lisa Mahaffey, MS, OTR/L, was working in an inpatient mental health unit in the early 1980s and met people struggling with depression for many reasons—chemical depression, survivor's trauma, or multiple or catastrophic loss. Mahaffey developed a Depression and Bipolar Support Alliance support group and worked with several other programs that specifically addressed older adults with depression. "People with depression really benefit from the support and problem solving that occupational therapy brings to their care," she says. "We change their lives by helping them do those day-to-day things that they value."

Mahaffey suggests that practitioners interested in working with people with depression develop a strong knowledge of the theories related to the causes of depression and pay attention to the differences between depression in older adults and the early signs of dementia, which can look very similar. Practitioners can review resources from AOTA and the Mental Health Special Interest Section and compile evidence to support engagement in occupation as a basis for recovery. Because occupational therapy practitioners are competing for positions in a field where funding is limited, they must be prepared to educate administrators on their unique contribution, says Mahaffey. "We have to set our services apart from others and come with the attitude that what we do enhances the services provided and solves some of the problems."

Mahaffey notes that advertisements for anti-depressant medicines have actually helped normalize depression and decrease the stigma. As more information is available, she hopes that the stigma that keeps people from seeking help will be decreased, if not eliminated. "Medication helps significantly," she says. "But it cannot produce the effect gained from being successful at something you value." All practitioners need to be familiar with the factors that contribute to depression because people with untreated depression have a greater chance of having cardiac diseases and dementia and can die close to 25 years earlier, Mahaffey says. "There is no better argument for treating all of our clients holistically, with a focus on engagement in occupation."



  1. National Institute of Mental Health. (2011). Any disorder among adults. Retrieved April 28, 2011, from

  2. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States. Archives of General Psychiatry, 62, 629–640.

  3. Szabo, L. (2009, August 4). Number of Americans taking antidepressants doubles. Retrieved May 12, 2011, from