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Ewan McGregor plays Sam Foster, a psychiatrist trying to help a troubled patient.

Ryan Gosling portrays Henry Letham, a young man who is contemplating suicide and challenges Sam's beliefs.

Naomi Watts depicts Lila Culpepper, Henry's girlfriend who becomes involved in his struggles.

Kate Burton plays Mrs. Letham, the concerned mother of Henry.

Elizabeth Reaser takes on the role of Athena, a friend of Henry who may provide insight into his situation.

Bob Hoskins portrays Dr. Leon Patterson, a colleague of Sam who offers a different perspective on Henry's case.

Janeane Garofalo plays Dr. Beth Levy, a psychologist who interacts with the main characters.

BD Wong takes on the role of Dr. Bradley Ren, another psychiatrist who works alongside Sam.

John Tormey plays the Custodian / Piano Mover #1, a minor character in the film.

José Ramón Rosario appears as Cabbie / Piano Mover #2, contributing to the film's atmosphere.

Becky Ann Baker plays Paramedic #1 / Butch Cook, involved in an emergency situation in the movie.

Lisa Kron portrays Paramedic #2, assisting in the emergency response.