Depression (clinical) - Treating clinical depression
- Introduction
- Symptoms of clinical depression
- Causes
- Diagnosing clinical depression
- Treating clinical depression
- Living with clinical depression
- Psychotic depression
- 'It took me a long time, but I did get back on my feet'
- 'If I feel I'm getting stressed now, I know what to do'
- 'I've learnt to live with my depression'
- Complications
- drinkinganddepression
- side-effects
- prevention
- questions-to-ask-page
Talking treatments
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) helps you understand your thoughts and behaviour and how they affect you.
CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present.
It teaches you how to overcome negative thoughts, for example being able to challenge hopeless feelings.
CBT is available on the NHS for people with depression or any other mental health problem that it has been shown to help.
You normally have a short course of sessions, usually six to eight sessions, over 10 to 12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT.
Online CBT
Computerised CBT is a form of CBT that works through a computer screen, rather than face-to-face with a therapist.
It's delivered in a series of weekly sessions and should be supported by a healthcare professional. For instance, it's usually prescribed by your GP and you may have to use the surgery computer to access the programme.
Ask your GP for more information or read more about online CBT and the courses available here.
Interpersonal therapy (IPT)
IPT focuses on your relationships with other people and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.
There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.
Psychodynamic psychotherapy
In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind.
This will help you to become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems. Read more about psychotherapy.
Counselling
Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.
Counselling on the NHS usually consists of six to 12 hour-long sessions. You talk in confidence to a counsellor, who supports you and offers practical advice.
Counselling is ideal for people who are basically healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness.
Getting help
Your first port of call should be your GP, who can refer you for NHS talking treatments for depression available locally.
In some parts of the country, you also have the option of self-referral. This means that if you prefer not to talk to your GP, you can go directly to a professional therapist.
To find out what's available in your area, see our counselling and psychological therapies directory.
Antidepressants
Antidepressants are medicines that treat the symptoms of depression. There are almost 30 different kinds available.
Most people with moderate or severe depression benefit from antidepressants, but not everybody does. You may respond to one antidepressant but not to another, and you may need to try two or more treatments before you find one that works for you.
The different types of antidepressant work about as well as each other. However, side effects vary between different treatments and people.
When you start taking antidepressants, you should see your GP or specialist nurse every week or two for at least four weeks to see how well they are working. If they are working, you'll need to continue taking them at the same dose for at least four to six months after your symptoms have eased.
If you've had bouts of depression in the past, you may need to continue to take antidepressants for up to five years or longer.
Antidepressants aren't addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose (see below).
Selective serotonin reuptake inhibitors (SSRIs)
If your GP thinks you would benefit from taking an antidepressant, you'll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI). Examples of commonly used SSRI antidepressants are Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram).
They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a "good mood" chemical.
SSRIs work just as well as older antidepressants and have fewer side effects.
They can, however, cause nausea and headaches, as well as a dry mouth and problems having sex. However, all these negative effects usually improve over time.
Some SSRIs aren't suitable for children under the age of 18. Research shows that the risk of self-harm and suicidal behaviour may increase if they're taken by under-18s. Fluoxetine is the only SSRI that can be prescribed for under-18s, and even then only when a specialist has given the go-ahead.
Tricyclic antidepressants (TCAs)
This group of antidepressants is used to treat moderate to severe depression.
TCAs, which includes Imipramil (imipramine) and amitriptyline, have been around for longer than SSRIs.
They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood.
They're generally quite safe, but it's a bad idea to smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly.
Side effects of TCAs may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness, but vary from person to person.
The side effects usually ease after seven to 10 days, as your body gets used to the medication.
Other antidepressants
New antidepressants, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and Zispin Soltab (mirtazapine), work in a slightly different way from SSRIs and TCAs.
Venlafaxine and duloxetine are known as SNRIs (serotonin-noradrenaline reuptake inhibitors). Like TCAs, they change the levels of serotonin and noradrenaline in your brain.
Studies have shown that an SNRI can be more effective than an SSRI, though they're not routinely prescribed as they can lead to a rise in blood pressure.
Withdrawal symptoms
Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including:
- upset stomach
- flu-like symptoms
- anxiety
- dizziness
- vivid dreams at night
- sensations in the body that feel like electric shocks
In most cases these are quite mild and last no longer than a week or two, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).
Withdrawal symptoms occur very soon after stopping the tablets, so can easily be told apart from symptoms of depression relapse, which tend to occur after a few weeks.
Common questions about antidepressants answered:
How long does it take for antidepressants to work?
Other treatments
St John's wort
St John's wort is a herbal treatment that some people take for depression. It's available from health food shops and pharmacies.
There's some evidence that it may help mild to moderate depression, but it's not recommended by doctors. This is because the amount of active ingredients varies among individual brands and batches, so you can never be sure what sort of effect it will have on you.
Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.
You shouldn't take St John's wort if you are pregnant or breastfeeding, as we don't know for sure that it's safe.
Also, St John's wort can interact with the contraceptive pill, reducing its contraceptive effect. Read more about St John's wort.
Electric shock treatment
Sometimes electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments, including antidepressants, haven't worked.
During ECT, you'll first be given an anaesthetic and medication to relax your muscles. Then you'll receive an electrical "shock" to your brain through electrodes placed on your head.
You may be given a series of ECT sessions. It is usually given twice a week for three to six weeks.
For most people, ECT is good for relieving severe depression, but the beneficial effect tends to wear off after several months.
Some people get unpleasant side effects, including short-term headaches, memory problems, nausea and muscle aches.
Read more information about electroconvulsive therapy (ECT) on the Mind website.
Lithium
If you've tried several different antidepressants and had no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment.
There are two types of lithium: lithium carbonate and lithium citrate. Both are usually effective, but if you are taking one that works for you, it's best not to change.
If the level of lithium in your blood becomes too high, it can become toxic. You will therefore need blood tests every three months to check your lithium levels while you're on the medication.
You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet.
© Crown Copyright 2009
