Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a type of talking therapy that's increasingly being used in the treatment of depression. Most experts recommend that people with moderate to severe depression are treated with a combination of CBT and antidepressants.
However, if you're unable or unwilling to take antidepressants, you have the option of receiving CBT on its own.
CBT helps you understand your thoughts and behaviour, and how they affect you. It helps you recognise 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 also teaches you how to overcome negative thoughts.
CBT is usually available on the NHS, although the waiting lists are usually long. You normally have a short course of sessions, usually 6 to 8 sessions, over 10 to 12 weeks, on a 1-to-1 basis, with a therapist trained in CBT. In some cases, you may be offered group CBT.
Computerised CBT is a form of CBT that works through a computer screen, rather than face-to-face with a therapist.
These therapies can be prescribed by your GP or a mental health specialist and are carried out with their advice and support.
Ask your GP for more information or read more about self-help therapies.
Interpersonal therapy (IPT)
Interpersonal therapy (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.
A course of IPT is usually structured in the same way as a course of CBT.
There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.
Counselling is a form of therapy that helps you think about the problems you're 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 6 to 12 sessions lasting an hour each. You talk in confidence to a counsellor, who supports you and offers practical advice.
Counselling is ideal for people who are healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness.
Research suggests that regular exercise may be a more effective treatment for mild depression than antidepressants.
Exercise helps boost levels of chemicals called serotonin and dopamine in the brain, which can lift your mood.
Exercising on a regular basis can boost self-esteem and confidence, which can help to relieve symptoms of depression.
Your GP may refer you to a qualified fitness trainer for an exercise scheme, or you can read about starting exercise.
Read more about exercise for depression.
Talking through your feelings can be helpful. You can either talk to a friend or relative, or you can ask your GP to suggest a local self-help group. There are also chat rooms on the internet that offer support.
Read more about depression support groups.
If you've tried several different antidepressants and seen no improvement, your doctor may offer you a medicine called lithium, in addition to your current treatment.
If the level of lithium in your blood becomes too high, it can become toxic. So, you'll need blood tests every few months to check your lithium levels while you're taking it.
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.
Side effects of lithium include:
- dry mouth
- a metallic taste in your mouth
- some mild shaking of your hands
These side effects usually pass with time once your body gets used to the medicine.
Electric shock treatment
Sometimes a treatment called electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments have not worked, as it can be highly effective.
During ECT, you'll first be given an anaesthetic and medicine to relax your muscles. Then you'll receive an electric current to your brain through electrodes placed on your head.
You may be given a series of ECT sessions. It's usually given twice a week for 3 to 6 weeks.
It's not exactly clear how ECT works, but recent studies suggest it may help reduce connections in an area of the brain linked to depression.
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.
But these risks need to be balanced against the risks of other treatments and the effects of not treating depression.