Treatment

Treatment for depression usually involves a combination of self-help, talking therapies and medicines.

The treatment that will be recommended will be based on the type of depression you have.

Mild depression

If you have mild depression, the following treatments may be recommended.

Wait and see: if you're diagnosed with mild depression, it may improve by itself. In this case, you'll be seen again by your GP after two weeks to monitor your progress. This is known as "watchful waiting".

Exercise: there's evidence that exercise can help depression, and it's one of the main treatments for mild depression. You may be referred to a qualified fitness trainer for an exercise scheme. You can also find out more about starting exercise and exercise for depression.

Self-help groups: talking through your feelings can be helpful. You could talk to a friend or relative, or you can ask your GP to suggest a local self-help group. Find out more about depression support groups. Your GP may also recommend self-help books and online cognitive behavioural therapy (CBT).

Mild to moderate depression

If you have mild to moderate depression that isn't improving, or moderate depression, your GP may recommend a talking treatment (a type of psychotherapy).

There are different types of talking therapy for depression, including cognitive behavioural therapy (CBT) and counselling. Your GP can refer you for talking treatment or, in some parts of the country, you might be able to refer yourself.

Moderate to severe depression

If you have moderate to severe depression, the following treatments may be recommended.

Antidepressants: antidepressants are tablets that treat the symptoms of depression. There are almost 30 different types of antidepressant. They have to be prescribed by a doctor, usually for depression that's moderate or severe.

Combination therapy: your GP may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments.

Mental health teams: if you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication. 

Read more detailed information about a range of treatments below.

Talking treatments

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help 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's been shown to help.

You normally have a short course of sessions, usually 6 to 8 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

Online CBT is a type of CBT that's delivered through a computer, rather than face to face with a therapist.

You'll have a series of weekly sessions and should receive support from a healthcare professional. For example, online CBT is 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.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) focuses on your relationships with others 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 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're experiencing in your life so you can find new ways of dealing with them. Counsellors support you in finding solutions to problems, but don't tell you what to do.

Counselling on the NHS usually consists of 6 to 12 one-hour-long sessions. You talk in confidence to a counsellor, who supports you and offers practical advice.

Counselling is ideal for people who are generally healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or a serious illness.

Getting help

See your GP for more information about accessing NHS talking treatments. They can refer you for local talking treatments for depression.

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.

Find counselling and psychological therapies in your area.

Media last reviewed: 26/05/2015
Next review due: 26/02/2018

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are almost 30 different types 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 assess how well they're working. If they're 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 episodes of depression in the past, you may need to continue to take antidepressants for up to five years or more.

Antidepressants aren't addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose.

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 paroxetine (Seroxat), fluoxetine (Prozac) and citalopram (Cipramil).

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, although they can cause nausea, headaches, a dry mouth and problems having sex. However, these side effects usually improve over time.

Some SSRIs aren't suitable for children and young people under 18 years of age. 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.

Vortioxetine (Brintellix or Lundbeck) is an SSRI that's recommended by the National Institute for Health and Care Excellence (NICE) for treating severe depression in adults.

Common side effects associated with vortioxetine include abnormal dreams, constipation, diarrhoea, dizziness, itching, nausea and vomiting.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are a group of antidepressants used to treat moderate to severe depression.

TCAs, including imipramine (Imipramil) 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're taking TCAs because it can cause your heart to beat rapidly.

Side effects of TCAs vary from person to person but may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, feeling lightheaded and excessive drowsiness.

The side effects usually ease within 10 days as your body gets used to the medication.

Other antidepressants

New antidepressants, such as venlafaxine (Efexor), duloxetine (Cymbalta or Yentreve) and mirtazapine (Zispin Soltab), work in a slightly different way from SSRIs and TCAs.

Venlafaxine and duloxetine are known as serotonin-noradrenaline reuptake inhibitors (SNRIs). 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, but they're not routinely prescribed because they can lead to a rise in blood pressure.

Withdrawal symptoms

Antidepressants aren't addictive in the same way that illegal drugs and cigarettes are but, when you stop taking them, you may have some withdrawal symptoms, including:

  • an 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 are easy to distinguish from symptoms of depression relapse, which tend to occur after a few weeks.

Further information

Other treatments

Mindfulness

Mindfulness involves paying closer attention to the present moment, and focusing on your thoughts, feelings, bodily sensations and the world around you to improve your mental wellbeing.

The aim is to develop a better understanding of your mind and body, and to learn how to live with more appreciation and less anxiety.

Mindfulness is recommended by NICE as a way of preventing depression in people who have had three or more bouts of depression in the past.

Read more about mindfulness.

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're 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.

Brain stimulation

Brain stimulation is sometimes used to treat severe depression that hasn't responded to other treatments. Electromagnetic currents can be used to stimulate certain areas of the brain to try to improve the symptoms of depression.

There are a number of different types of brain stimulation that can be used to treat depression, including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT).

Transcranial direct current stimulation (tDCS)

Transcranial direct current stimulation (tDCS) uses a small battery-operated stimulator to deliver a constant low-strength current through two electrodes placed on the head. The electric current stimulates brain activity to help improve the symptoms of depression.

You'll be awake during tDCS, which is usually given by a trained technician (although it's possible to be trained to do it yourself). You'll have daily treatment sessions, lasting 20 to 30 minutes, for several weeks. It can be used on its own or with other treatments for depression.

NICE has more information about transcranial direct current stimulation for depression, including the benefits and risks.

Repetitive transcranial magnetic stimulation (rTMS)

Repetitive transcranial magnetic stimulation (rTMS) involves placing an electromagnetic coil against your head. The coil sends repetitive pulses of magnetic energy at a fixed frequency, which is delivered in pulses to specific areas of the brain. The stimulation can improve the symptoms of depression and anxiety.

If you decide to have rTMS, you'll be asked to give your permission (consent) to have the treatment. You should also be reminded that you can withdraw your consent at any time.

The procedure is carried out in hospital by a trained technician or clinician. No anaesthetic or sedative is needed, and you can leave hospital the same day. You can drive after having an rTMS session and continue with other activities as normal. You'll have daily sessions that last about 30 minutes, for 2 to 6 weeks.

NICE has more information about repetitive transcranial magnetic stimulation for depression, including the benefits and risks.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a more invasive type of brain stimulation that's sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life-threatening.

During ECT, a carefully calculated electric current is passed to the brain through electrodes placed on the head. The current stimulates the brain and triggers a seizure (fit), which helps relieve the symptoms of depression.

ECT is always carried out in hospital by a specialist doctor under a general anaesthetic. You'll also be given a muscle relaxant to prevent body spasms. ECT is usually given twice a week for 3 to 6 weeks (6 to 12 sessions in total).

Your specialist should clearly explain how ECT works – along with the benefits, risks and possible side effects – so you can make an informed decision.

If you decide to have ECT, you'll be asked to give your permission (consent) to have the treatment. You should also be reminded that you can withdraw your consent at any time.

Your health will be closely monitored during and after each session of ECT. Treatment will usually be stopped as soon as you start to feel better, or if the side effects outweigh the benefits.

In some cases, what's known as "maintenance" or "continuation" therapy may be recommended. This is where treatment is given less frequently (once every 2 to 3 weeks) to ensure your symptoms don't come back.

You can read more about the NICE recommendations for the use of electroconvulsive therapy.

Lithium

If you've tried several different antidepressants and there's been no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment.

There are two types: lithium carbonate and lithium citrate. Both are usually effective, but if you're 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'll 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 it can also cause the lithium to become toxic. Ask your GP for advice about your diet.

Page last reviewed: 05/10/2016
Next review due: 05/10/2019