Decoding the ‘Green Flags’ of Depression (AKA How You Know When a Treatment Is Working)

Picture this: You’ve started treatment for depression—therapy, medication or both—and weeks in, you realize you don’t “feel better.” This scenario is extremely common for people taking the first steps toward getting help. But the good news is, just because you don’t feel better doesn’t mean it isn’t working. To decode the green flags of depression, we spoke to a clinical psychiatrist about what exactly to look for to see if you’re making progress with your mental health. 

Dr. Tamir Aldad, MD, MBA, is a board-certified clinical psychiatrist who specializes in the treatment of major depressive disorder, anxiety, ADHD, post-traumatic stress disorder (PTSD), bipolar disorder and adjustment disorders. Dr. Aldad is the founder and CEO of Mindful Care, the first-ever psychiatric urgent care in the U.S. with 15 locations across New York, New Jersey, Illinois, Florida and Connecticut. He’s also the author of the upcoming book Too Close for Comfort.

“Mood lifts last, not first,” Dr. Aldad says. Instead, the earliest reliable signals of effective treatment are usually neurovegetative and functional, he explains. And this is important to note so that people don’t dismiss real progress simply because they don’t “feel happy” yet. Dr. Aldad highlights five signs to look out for.

1. Your sleep begins to normalize. Think falling asleep faster, fewer night wakings or less hypersomnia (which means extreme daytime sleepiness and long sleep hours).
2. You initiate small daily tasks, like tossing in a load of laundry, texting someone back the same day or making your bed. 
3. Your appetite returns to baseline, and you have a small increase in energy while feeling less weighed down.
4. You’re less irritable and reactivity slightly softens.
5. You’re able to hold your concentration for a little longer than before.

It’s also recommended to explain this to family and friends, as they are also most likely watching for your mood to improve first. With others knowing the key signs to look for, it’ll help you recognize the small changes in yourself even more. 

When seeking professional help for depression, you need to remember that there are multiple types of treatment that can be done singularly or combined—and everyone responds to these differently. However, here are the green flags to look for depending on your treatment type.

• Medication only: “Early flags are largely biological and somatic, including sleep, appetite, energy and psychomotor speed, often visible in weeks two to four, and sometimes before any mood change,” Dr. Aldad says. How you respond to medication is also an indicator: Side effects that are tolerable, stabilizing or fading are positive signs of appropriate titration. 
• Therapy only (specifically cognitive behavioral therapy or CBT): Green flags for CBT often show up before mood improves (see the trend here?), but rather than symptom relief, it looks like skill use. Dr. Aldad says things like catching a distorted thought in real time, using a coping skill without being prompted, tolerating distress for slightly longer before avoidance or actually following through on a scheduled activity, even a small one, instead of just planning it. 
• Combined treatment: This is where green flags compound—medication can help create enough of a physiological floor for therapy skills to actually be practiced and retained, Dr. Aldad notes. “A useful marker of combined treatment working is when therapy homework becomes easier to complete, not just easier to discuss,” he says. 

Hard truth: Just because you’re in treatment doesn’t mean your bad days are over. “Recovery is rarely linear or symptom-free,” says Dr. Aldad. “The real signal is the trajectory and recovery speed, not symptom absence.” The following are subtle things that people either completely miss or dismiss, even though they hint at progress:

1. You recover from a bad day faster. You can still experience rough ones, but you bounce back in hours instead of days. 
2. You catch yourself spiraling—and snap out of it sooner. You notice “I’m spiraling” mid-thought instead of realizing it two days later. 
3. You reach out instead of isolating. You text a friend or provider during a low moment instead of keeping to yourself. 
4. You feel bored. You actually want to do something.
5. You start complaining. You grumble at mundane things like traffic, chores or even slow walkers. This is a sign of re-engaging with life enough to have minor friction with it, says Dr. Aldad.  

These types of examples are proof that the struggle is resolving faster than before. Say it with us: progress! 

Treatment for depression requires a lot of trial and error—and a lot of patience. This is not an overnight fix, and if you accept and understand that, then that’s already a step in the right direction. Knowing how long to wait before flagging it is a skill in itself: Too short and you miss real progress, and too long and you stay in something that isn’t working. As a general rule, Dr. Aldad says you should see signs of improvement when taking medication within two to four weeks for things like sleep and energy, six to eight weeks for a fuller assessment response and possibly up to 12 weeks at an adequate dose before concluding a trial has failed. For therapy, specifically CBT, he says meaningful change in symptoms is typically assessed around when you’ve attended six to 12 sessions. 

When talking with your provider, it helps neither them nor you if you’re vague. Simply saying “I don’t feel better” is hard to act on clinically, says Dr. Aldad, so come prepared with specifics. He recommends tracking and reporting your behaviors, such as sleep patterns, energy throughout the day, things you got done or avoided doing or any moments of relief and engagement. And rather than offering a summary, share one concrete example, like going to a family event despite dreading it, and it turning out fine. 

“If there’s been no movement at all—not even subtle physiological or behavioral shifts—by the six-week mark on an adequate medication dose, or by eight to 10 sessions in structured therapy with no change in engagement or symptoms, that’s the point to revisit the plan with the provider,” explains Dr. Aldad. Then, they’ll consider adjusting your dosage, adding an additional medication, trying a different modality or even ruling out other variables (like an undiagnosed thyroid issue, for example). 

If you do need to readjust your plan, that’s a completely normal part of the process and shouldn’t be perceived as a failure. 

“What would you expect to see by now if this is working, and what would tell you it’s not?” Dr. Aldad says to ask this question because it “gives the patient a concrete benchmark instead of vague reassurance, and turns the follow-up visit into a structured check against expected milestones rather than an open-ended ‘how are you feeling’ question.”

The bottom line? You don’t have to wait to feel amazing to know you’re headed in the right direction.