What treatments are available?
At a time when you may find making decisions difficult, it can also seem like an added burden to try and choose between a range of treatment options
The following guidelines are recommended for the the treatment of depression.
- Active monitoring – this is for mild depression and means keeping an eye on you while waiting to see if your depression goes away without treatment, which mild depression often does
- Cognitive behaviour therapy (CBT), including self-help books, computerised CBT for mild depression; a series of sessions with a therapist for more severe depression
- Mindfulness-based cognitive therapy
- Behavioural activation
- Other forms of talking treatment, such as counselling or interpersonal psychotherapy.
- Medication for severe depression, but not for mild to moderate depression unless other treatments have not helped. This should be combined with CBT or psychotherapy
Cognitive behaviour therapy (CBT) helps to identify and change negative thoughts and feelings affecting your behaviour and, although often a short-term treatment, may last up to 12 months. For mild depression you may be offered computerised CBT, which uses a programme you can follow either by yourself or in addition to sessions with a therapist.
Mindfulness-based cognitive therapy is an approach to wellbeing that involves accepting life, and living and paying attention to the present moment. It includes taking time to see what is happening around you in a non-judgmental way, rather than going over your problems again and again. Mindfulness-based cognitive therapy is usually done in groups.
“Mindfulness (is) a neat little trick that really helps and I wish I’d been taught it years ago.”
Behavioural activation makes you look at the simple everyday tasks you may be avoiding and start doing them. Activity helps you to feel better, and once you have conquered some everyday tasks, you may feel ready to tackle some bigger ones. For example, you may have felt too depressed to do the washing up and let it pile up in the kitchen. The bigger the pile, the less you feel like doing it. Behavioural activation would encourage you to tackle it, even if you start by only doing some of it. As you do it, the dishes get clean, your kitchen gets tidier, and you feel a bit better about everything. Behavioural activation usually forms part of a CBT programme, but may be offered on its own.
Guided self-help delivers a 6-8 week therapy programme through selfhelp books, under the guidance of a healthcare professional.
- Interpersonal psychotherapy focuses on relationships. Therapy can continue for 6 to 12 months.
- Counselling, which can be short- or long-term. This involves talking with someone who is trained to listen with empathy and acceptance. It allows you to express your feelings and helps you to find your own solutions to your problems.
- Psychodynamic counselling and psychotherapy focus on how past experiences may be contributing to experiences and feelings in the present. Therapy can be short- or long-term. It may be more frequent and intensive than counselling, and may go deeply into childhood experience and significant relationships.
- Group therapy allows a group of people to work together on their problems, with a therapist. You may find it easier to talk with others who have similar experiences, and that the insights of others help you to understand yourself better; you may also learn about relationships with others.
“Whatever progress I have made in my battle with depression, is due entirely to group psychotherapy. It has transformed my little life in ways I thought impossible to begin with, and shown me that whenever I have suddenly felt worse, there is ALWAYS an explanation from my past.”
You can also seek therapy or counselling privately, if you are able to pay. For lists of qualified and regulated therapists, see ‘Useful contacts’. Combining a psychological treatment with medication may be the most effective course for severe depression.
Antidepressant drugs work on brain chemicals (such as serotonin and noradrenaline) to lift your mood. It often takes between two to six weeks before the drugs take effect. They don’t cure depression, but they can make you feel better so that you may feel able to take action to deal with the problems causing your depression.
If you do take antidepressants, the usual recommendation is that you stay on them for six months after you feel better in order to stop the depression coming back. Many people find them helpful, although they don’t work for everyone.
Antidepressants can cause unpleasant side effects, some of which are worse to begin with. Some can be dangerous when used with other drugs. Of the various types available, SSRIs (selective serotonin reuptake inhibitors, such as Cipramil or Prozac) are usually the preferred first choice because, they are usually better tolerated than some of the other antidepressants. But if these do not suit you for any reason, there are other types to try, which work in slightly different ways (see Making sense of antidepressants).
If you are having psychotic symptoms (see p.6), your GP may refer you to a psychiatrist who may prescribe an antipsychotic drug, such as quetiapine (Seroquel). (See Making sense of antipsychotics for more information).
Befriending, peer support and volunteering schemes
Your GP may put you in touch with a local befriending scheme, with trained volunteers who may visit you at home, or arrange to meet you somewhere for a chat, or a walk or other social occasion that you both enjoy.
You may be offered the help of a peer support worker. They have usually had similar experiences to you, and can empathise with your situation and offer hope for recovery, as well as helping you to access other services. You might also be put in touch with a volunteering scheme where you can exchange skills or offer help to others who have problems that you might be able to help them with. For example, you might not feel up to cooking for yourself, but might feel able to help someone clean their home. A neighbour might love cooking, but be unable their house. So you could house cleaning for a hot meal, and both of you benefit.
Art and music therapies may help you to express how you are feeling, especially if you are having difficulty talking. Drama therapy may help you to come to terms with traumatic events that you may have experienced in the past and which may contribute to your depression. Writing about how you are feeling can also be very helpful, and there is no need to share this with anyone if you don’t want to. Arts therapies and writing groups may be available through a local group, such as a local Mind.
Alternative and complementary therapies
Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don’t just treat their symptoms. They spend more time with you than a GP can. Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful. St John’s wort is one of the herbal remedies that many people find helpful, and may help to lift your mood. However, you should not take St John’s wort if you are taking prescription antidepressants. If you are taking any other medication you should seek advice from a pharmacist before adding St John’s wort, because it interferes with the effects of many other medicines.
What if my depression is worse, or won’t go away?
Your GP may refer you to a specialist mental health professional, such as a psychiatrist, psychologist or mental health nurse, who can review your treatment so far. They may suggest a different medication, or a combination of drugs with other treatments.
Crisis resolution services
These are teams of doctors and nurses who provide intensive support, which will enable you to stay at home if you’re in crisis, rather than going into hospital.
For more information about what help may be available to you in your area see useful contacts.
If you are severely depressed, you may need to be cared for in hospital as an in-patient. This gives a psychiatrist the opportunity to monitor the effects of different treatments, and also means that you will get regular meals. Hospital can provide a safe and supportive environment if you are
in a state of distress, and it may be comforting to have other people around you and to know that you are being cared for. However, it can be distressing to be on a ward where you may have little privacy, where you have to fit in to routines that may not suit you, and where you may be upset by the behaviour of other patients.
Electroconvulsive therapy (ECT)
This is a controversial treatment, and is usually suggested only if you are severely depressed and haven’t responded to talking treatments or different types of medication. ECT involves passing an electric current through the brain, while you are under general anaesthetic, in order to induce a convulsion, or fit, which is believed to lift the depression. Some people find it very helpful, but it can also have severe side effects, including memory loss. You cannot be given ECT without your consent unless you are assessed as being incapable of giving consent. (See Mind’s booklet Making sense of electroconvulsive therapy and Mind rights guide: consent to treatment.)
Other physical treatments
For very severe depression that has not improved with any of the normal treatments, including ECT, there are other treatments including neurosurgery, and deep brain stimulation. These treatments are used extremely rarely. For more information, see Mind’s online booklet, Making sense of neurosurgery for mental disorder.