What is the best treatment for depression?

by Sarah Graham
Friday 16 October 2015
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If you're struggling with depression, it can be difficult to know which treatments will be most effective or suitable for you. Some people worry about the side effects of taking medication, while others may feel nervous about telling a stranger about their problems and worries. The good news is that there are plenty of options, many of which are recommended as effective and evidence-based by medical experts - and you don't have to choose just one. Many of the following options can be used in combination with each other to help you gain greater control and mastery over your depression.

 

Talking therapies:

'Talking therapy' is the name given to any treatment that involves sitting down with a psychologist, counsellor, or other type of therapist, and talking about your problems.

If your depression is mild or moderate, talking therapies can be used as effective stand-alone methods for treating depression - meaning they can be used as an alternative to anti-depressants.

Unlike medication, talking therapies aim to tackle the cause of your difficulties, rather than just the symptoms of depression. As such, they can also help you identify early warning signs and prevent future relapses into depression.

Depending on your particular needs, and what you want to achieve through therapy, there are a number of different options that can be effective for treating depression. 

 

1. Cognitive Behavioural Therapy (CBT)

CBT is the talking therapy most commonly offered on the NHS, and is one of three therapies recommended by the National Institute for Health and Care Excellence (NICE). CBT teaches you self-help techniques to manage your thoughts and feelings, so that you can effectively become your own therapist.

CBT is based on the principle that thoughts, emotions and behaviours are linked. You will begin by developing on understanding of how your thoughts and behaviours contribute to your depression, by identifying patterns of negative thoughts and behaviours that can help to sustain depressive feelings.

Depression is commonly linked with negative thoughts about yourself and the world around you, and unhelpful behaviours like socially isolating yourself and reducing engagement with your usual, enjoyable activities. By identifying these unhelpful thoughts and behaviours, you and your therapist can work together to develop techniques for noticing and challenging those thoughts and behaviours in your everyday life.

CBT is a collaborative process between you and your therapist, and it is necessary for you to be fully engaged in the process of identifying, recognising and challenging harmful thoughts and behaviours in yourself - including by practising outside of your sessions, often using mood diaries or worksheets as a prompt. It may take time for the process to become habitual.

Read more about CBT as a treatment for depression, and find out about Andrea's experience of CBT to treat depression.

 

2. Psychodynamic Therapy

Like CBT, psychodynamic therapy is recommended as a treatment for depression by NICE. However, psychodynamic therapy differs from CBT in that its focus is on understanding how experiences from your past have affected the way you think and behave in your current situation.

A psychodynamic therapist will look for patterns and hidden meanings in what you do and say that could be contributing to your depression. They will then try to link those patterns with events and relationships from your early years, to try and understand why you feel and react the way you do now.

The focus is on identifying and uncovering unconscious aspects of your behaviour, thoughts and feelings that may be driving your depression. If, for example, you were bullied as a child, you may have unconsciously absorbed certain negative feelings and beliefs about your own self-worth, which can be a significant cause of depression.

Psychodynamic therapy is therefore particularly useful if you want to understand the root source of things you struggle with, and gain a better awareness of how and why your mental processes have developed. By uncovering unconscious beliefs you may hold about yourself as a result of past experiences, it is possible to begin challenging and changing those beliefs.

The relationship with your therapist is very important in psychodynamic therapy, as you will need to feel comfortable talking about whatever thoughts and feelings are present for you in that moment. By working through these thoughts and feelings together, you can begin to understand and acknowledge the causes of your unhelpful reactions and behaviours and, through increased self-awareness, set about developing more helpful ways of thinking and behaving.

Read more about psychodynamic therapy as a treatment for depression.

 

3. Interpersonal Therapy (IPT)

IPT is the third therapy recommended by NICE to treat depression. It focuses on interpersonal relationships and problems in how you relate to other people, and the way these relationships interact with your depression.

For example, if you have recently come through a relationship breakdown, have trouble communicating with family members, or are struggling with a bereavement, these issues will undoubtedly impact on your thoughts and feelings, contributing to and sustaining your depression. 

IPT also acknowledges that, if you are struggling with depression, this has an impact on both you and your relationships with the people around you.

This form of therapy therefore involves discussing your problems and anxieties in relation to the important people in your life, who may also attend therapy sessions with you if you're comfortable with that. As well as understanding the role that interpersonal issues play in your depression, IPT works by helping you to develop techniques for better managing your relationships and feeling more connected to the significant people in your life.

This may help you and your friends or relatives support each other more effectively, as well as helping you to understand and feel more control over the way depression affects you.

Read more about IPT as a treatment for depression.

 

4. Counselling

Counselling is not specifically recommended as an evidence-based treatment for depression, but many people do find it helpful. It involves talking to a trained counsellor, in a more general way, about your feelings about yourself and your situation.

The aim of counselling is to offer a safe and secure listening ear; somewhere you can speak openly and honestly about what's going on for you, and begin to understand your problems by talking them through with an objective figure. Often counsellors listen without offering advice, and instead gently guide you towards drawing out your own positive solutions for dealing with your depression.

Speaking to a counsellor can help you explore your feelings, needs and troubles in a space that is confidential, safe and empathic. It can be a useful space to clarify your thoughts, build self-awareness, and help you find a way through your current difficulties.

Read more about how counselling works, and find out about Helen's experience of counselling to treat depression.

 

Self-help:

If your depression is relatively mild, you may be able to treat it using self-help methods. However, all of these methods can also be used to supplement and complement other treatment types - be that talking therapy, medication, lifestyle changes, or any combination of these.

1. Online CBT

Online CBT uses similar principles and techniques to face-to-face CBT, but in a digital self-help format, which you can work through on your computer or smartphone at your own pace.

2. Self-help groups

Talking through your feelings can be helpful. You could talk either to a friend or relative, or you can ask your GP to suggest a local self-help group, where you and others can support each other without the guidance of a therapist or other health professional professional. 

3. Self-help books

Your GP may also recommend self-help books, many of which use principles similar to CBT to help you develop coping techniques and strategies. Again, these can also be a really useful guide and prompt between face-to-face CBT sessions.

 

Medication:

If you are considering medication to treat depression, discuss the best options with your GP or psychiatrist. A talking therapist will not be able to prescribe anti-depressant medication.

1. SSRIs

Selective serotonin reuptake inhibitors (SSRIs) help to increase the levels of mood-boosting chemical serotonin in your brain. They can be used to treat moderate to severe depression, and can be particularly effective in combination with talking therapy. SSRIs may take a couple of weeks to take effect, and side effects can include nausea, headaches, low sex drive or problems having sex.

2. TCAs

Tricyclic antidepressants (TCAs) increase the levels of mood-boosting chemicals serotonin and noradrenaline in your brain, in a similar way to SSRIs. Likewise, they can be used to treat moderate to severe depression, can be used in combination with talking therapy, and may take a couple of weeks to take effect. Side effects can include dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness.

3. SNRIs

Serotonin-norepinephrine reuptake inhibitors (SNRIs), like TCAs, change the levels of serotonin and noradrenaline in your brain, which boosts your mood. Like SSRIs and TCAs, they can be used to treat moderate to severe depression, and can be used in combination with talking therapy. It is believed that they can be more effective than SSRIs in certain cases. Side effects are similar to those associate with TCAs, and SNRIs may also increase your blood pressure.

4. Lithium

Lithium is typically used to treat severe depression; if you've tried a number of different types of anti-depressants without seeing an improvement, your GP or psychiatrist may suggest taking lithium in addition to your existing medication. There is a long list of side effects, and you will need regular blood tests to monitor the lithium levels in your blood, to avoid toxicity.

 

Combination therapy (talking and medication):

As the name suggests, combination therapy involves both taking anti-depressant medication and seeing a talking therapist for a course of either CBT, psychodynamic therapy, IPT, or counselling. This can be an especially effective treatment for depression, as the medication will treat the symptoms of depression, while talking therapy tackles the cause and helps you develop techniques for coping.

 

Natural remedies:

If you're not keen on the idea of taking medication, or if you want to supplement medication with more natural methods, there are a number of pharmaceutical-free options that you can incorporate into your lifestyle - including, of course, talking therapy and self-help methods.

1. St John's wort

St John's wort is a herbal treatment that may be effective for treating mild to moderate depression. However, it is not recommended by doctors, and cannot be taken alongside anti-depressant medication. It should also be avoided when pregnant or breastfeeding. St John's wort can be purchased in health food shops and pharmacies.

2. Diet

Diet is often overlooked but can have a significant impact on your mood. Sugars, saturated fats, caffeine and alcohol can destabilise your moods and emotions, while foods rich in vitamins D, B, tryptophan, and omega 3 all have mood-boosting properties that can help lift you out of depression.

Read more about how to eat yourself to a more mentally healthy state of mind.

3. Exercise

Like making changes to your diet, there is evidence that introducing more exercise into your lifestyle can help relieve depression, anxiety and stress, and improve your overall sense of wellbeing. This could be something low intensity and meditative, like yoga or pilates, which offers time and space for contemplation and self-awareness; or something more active, like running, cycling, or regular gym sessions, which release feel-good chemicals called endorphins and help to stave off anxiety causing adrenalin.

Read more about how exercise can boost your mental health and wellbeing.

 

Electroconvulsive therapy (ECT):

ECT is very rare, and only used to treat severe or life-threatening depression when all other treatments have failed to bring about improvements. In ECT your muscles are relaxed and you receive electric shocks through electrodes attached to your head. ECT can cause short-term improvements to your symptoms, but needs to be used regularly to prevent relapse, and there's a risk of severe side effects, including headaches, memory problems, nausea and muscle aches.


Finding support


You can find out more about symptoms and causes of Depression, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.

Find a Therapist working with Depression

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Updated 10 November 2015