Treatment options for clinical depression 

Treatment
Pros
Cons

Useful links

Watchful waiting

If you're diagnosed with mild depression your GP may ask to see you again a few weeks later as the condition may improve by itself

  • May work for some cases of mild depression
  • No need for medication with associated side effects
  • Unlikely to be effective for more severe forms of depression
Exercise

Regular exercise has been shown to have mental health benefits, particularly in cases of depression

  • Many other health benefits from exercising regularly 
  • No need for medication with associated side effects
  • May not be physically possible for some people
  • May not be effective in treating more severe forms of depression
Self-help therapy

Several types of self-help therapy are available for depression, including books or computer, phone and email counselling. Your GP may be able to recommend a suitable type of self-help therapy

  • Many free or low-cost therapies available
  • Treatment can be at your own pace and at a time that suits you
  • No need for medication with associated side effects
  • Often needs to be combined with a talking therapy
  • May be difficult to motivate yourself to complete the course
  • May not be effective in treating more severe forms of depression
Self-help groups

Talking through your feelings can be helpful, particularly to others in a similar situation. You could also talk to a friend or relative, or you can ask your GP to suggest a local self-help group

  • May offer other benefits such as improved self-confidence or shared interests
  • No need for medication with associated side effects
  • Some people may not feel comfortable talking about their condition
  • May not be effective in treating more severe forms of depression

Talking therapy

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that helps you understand your thoughts and behaviour and how they affect you. Instead of talking about the past, CBT aims to help you develop skills to deal with current problems

  • Can help to treat mild to moderate depression
  • Evidence-based treatment
  • May also be available as group therapy or an online course
  • A short course of CBT lasting around 10-12 weeks may be available on the NHS
  • No need for medication with associated side effects
  • Attempts to treat the cause of the problem rather than treating the feelings of depression
  • Some people may not be comfortable talking about their condition
  • Access to CBT can be limited in some parts of England and Wales and you may have to wait for treatment
  • May need to be combined with medication in more severe cases
  • Improvement of symptoms may not be immediate
  • Must be able to commit to weekly or fortnightly sessions
  • Must be willing to co-operate with the therapist and practise techniques at home
Counselling

Counselling involves talking to a trained counsellor in confidence about how you feel about yourself and your situation. It aims to help you understand your problems and find ways of dealing with them

  • Can help to treat mild to moderate depression
  • A short course of counselling lasting around 6-12 weeks may be available on the NHS
  • Provides a safe and secure environment to talk openly and honestly about your problems
  • Aims to help you find a positive solution to your problems
  • Some people may not be comfortable talking about their condition
  • Access to counselling can be limited in some parts of England and Wales and you may have to wait for treatment
  • May need to be combined with medication in more severe cases
  • Improvement of symptoms may not be immediate
  • Not evidence-based treatment

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) boost levels of the chemical serotonin in the brain, which helps to lift your mood. A course of SSRIs usually consists of one to three tablets, capsules or liquid solutions a day for at least six months, depending on your prescription

  • Often effective at treating moderate to severe depression
  • May be used in combination with talking therapy
  • Not thought to be addictive
  • Not suitable for everyone
  • Full course of medication must be taken to avoid withdrawal symptoms
  • Side effects may include nausea, headaches, low sex drive or problems having sex
  • May take a couple of weeks to work
Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) work by raising the levels of the chemicals serotonin and noradrenaline in your brain, which both help lift your mood. A course of TCAs usually consists of one to three tablets, capsules or liquid solutions a day for at least six months, depending on your prescription

 

  • Often effective at treating moderate to severe depression
  • May be used in combination with talking therapy
  • Not thought to be addictive
  • Not suitable for everyone
  • Full course of medication must be taken to avoid withdrawal symptoms
  • Side effects may include dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness
  • May take a number of weeks to work
Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs, like TCAs, change the levels of serotonin and noradrenaline in your brain to lift your mood. A course of SNRIs usually consists of one to three tablets or capsules a day for at least six months, depending on your prescription

  • Often effective at treating moderate to severe depression
  • May be used in combination with talking therapy
  • May be more effective than SSRIs in some cases
  • Not thought to be addictive
  • Not suitable for everyone
  • May cause a rise in blood pressure
  • Full course of medication must be taken to avoid withdrawal symptoms
  • Side effects may include dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness

Other treatments

St John's wort

St John's wort is a herbal treatment that some people take for depression

  • Some evidence that it can help to treat mild to moderate depression
  • Available from health food shops and pharmacies
  • Not recommended by doctors as ingredients vary between brands so full effects aren't known
  • Can't be taken with antidepressant medication
  • Should be avoided if pregnant or breastfeeding as more research is needed
Lithium

If you've tried several different antidepressants with no improvement, your doctor may offer you a type of medication called lithium, in addition to your current treatment. A course of lithium usually consists of one to three tablets or liquid solutions a day for at least six months, depending on your prescription, and tests to monitor your lithium levels

  • Often effective at treating severe depression
  • Not suitable for everyone
  • Can't be used if breastfeeding
  • Full course of medication must be taken to avoid withdrawal symptoms
  • Can cause lithium toxicity if blood levels become too high
  • Blood tests needed every three months
  • Must avoid eating a low-salt diet
  • Long list of potential side effects
Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is where electrodes are placed on your head through which a small electric current is delivered to your brain

  • A safe and non-invasive treatment
  • No need for anaesthesia
  • May be effective at treating severe depression when other types of treatment have been ineffective
  • May provide rapid short-term improvement of symptoms
  • Not suitable for everyone
  • Only used in certain cases of severe depression
  • May have to travel to find a clinic offering ECT
  • Treatment is usually needed on a daily basis for several weeks
  • Side effects may include short-term headaches, memory problems, nausea and muscle aches
  • Uncertainties surrounding the way treatment is administered, frequency of treatment and long-term effectiveness