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Treatment of Depression

 

Treatment for depression usually involves a combination of drug and psychological therapies.

 Mild depression:

If you are diagnosed with mild depression, but your GP thinks you’ll improve, or you don’t want treatment at the moment, then you should have another assessment in two weeks time to monitor your progress. This is known as ‘watchful waiting’.
If you have mild depression, antidepressants aren’t usually recommended as a first treatment.
Exercise seems to help some people with depression. Your GP may refer you to an exercise scheme with a qualified fitness trainer, while ‘watchful waiting’.
Talking through your feelings may also be helpful for mild depression. You may wish to talk to a friend or relative, or your GP may suggest a local self-help group. Your GP may also recommend self-help reading materials and computerised cognitive behaviour therapy (CBT). (See below)
If your depression is mild but you have a past history of depression your GP may however suggest that you also start on a course of antidepressants (see section on medicines).
Chronic mild depression (present for 2 years plus) is called dysthymia. This is more likely in people over 55 years and can be difficult to treat. If you are diagnosed with dysthymia your GP may again suggest that you also start on a course of antidepressants.

 Moderate depression: If your mild depression isn’t improving or you have moderate depression, your GP may recommend a talking treatment or prescribe an antidepressant (see section on medicines).
Talking treatments Cognitive behavioural therapy (CBT), problem- solving therapy, and counselling are examples of talking treatments. You normally have a fixed number of sessions - usually 6-8 sessions over 10-12 weeks. Some GP practices have counsellors specifically to help patients with depression.

  •  Cognitive behavioural therapy (CBT) is based on the principle that the way we feel is partly dependent on the way we think about things. It teaches you to behave in ways that challenge negative thoughts - for example being active to challenge feelings of hopelessness.
  • Interpersonal therapy (IPT) focuses on your relationships with other people and on problems such as difficulties in communication, or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT but more research is needed.
  • Counselling is a form of therapy that helps you to think about the problems you’re experiencing in your life, in order to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but don’t tell you what to do.

Research has shown that antidepressants and talking therapies are equally effective in treating mild or moderate depression but having the two types of treatment together does not seem to offer any extra benefits.
 Your GP may therefore alternatively suggest that you start a course of antidepressants. Your preference and the availability of talking therapies will be taken into account when deciding which treatment is most appropriate for you.

Severe depression:

If you have severe depression, your GP may recommend that you take an antidepressant together with talking therapy.
A combination of an antidepressant and CBT usually works better than having just one of these treatments in severe depression.
A combination of an antidepressant and CBT usually works better than having just one of these treatments in severe depression.
You may be referred to a mental health team if your depression is severe, or doesn’t respond to treatment from your GP. These teams are usually made up of psychologists, psychiatrists, specialist nurses, and occupational therapists. They often provide intensive specialist ‘talking treatments’ such as cognitive therapy or psychotherapy.

Sometimes other treatments such as specialist medicines (see section on medicines) or Electro convulsive therapy (ECT) may be advised if you have severe depression. Electro convulsive therapy (ECT) works for severe depression, but is only used when antidepressants and other treatments haven’t worked. If you are given ECT you are first given an anaesthetic and drugs to relax your muscles. You will then receive an electrical 'shock' to the brain, through electrodes placed on your head. You may be given a series of ECT sessions. For most people the treatment works well in relieving severe depression, but the effect may not be permanent. Some people experience unpleasant side effects, including memory problems.