Patient information from BMJ

Depression in adults: what treatments work?

Last published:Mar 02, 2021

Treatments for depression can work well, improving your symptoms and helping you feel more like yourself again.

The main options are medicines called antidepressants and talking treatments (psychotherapies). Having both an antidepressant and a talking treatment works best for some people, especially if they have more severe depression.

Talking treatments

If you have mild or moderate depression, a talking treatment may be all you need. However, many people have a talking treatment combined with an antidepressant. Here are the most common talking treatments for depression:

Cognitive behavioural therapy (CBT) is based on the idea that the thoughts you have and certain beliefs you have about your life cause you to think the worst of yourself.

This can make you depressed. You may automatically think the worst about yourself and the world without realising it. The aim of cognitive behavioural therapy is to change this way of thinking to help you look at things more positively.

Interpersonal therapy helps you learn new and better ways of relating to other people, including family, friends and workmates. This can help you build stronger relationships so you have better social support and cope better day to day.

Problem-solving therapy teaches you how to solve problems in a step-by-step way. You work out what the problem is, work out ideas about how to solve it, choose a solution and decide on the steps you can take to get there. These new skills are designed to help you cope better with life's problems.

Your doctor can help you decide what type of talking treatment is right for you. You may have a combination of these therapies. Many people have weekly therapy sessions for at least three or four months.

Antidepressants

Antidepressants work well for many people. There are several types of antidepressant. You can talk with your doctor about which one might suit you.

You may feel somewhat better within one to two weeks of starting an antidepressant, but it often takes six to eight weeks to feel a lot better. So it's important not to stop taking them if they don't seem to be working right away.

Once an antidepressant is working, doctors usually recommend taking it for nine to 12 months. However, if you've had depression before and it has come back, your doctor may recommend taking it for longer.

Side effects of antidepressants

Antidepressants can cause side effects in some people. Common ones include:

• a dry mouth

• dizziness

• an upset stomach, and

• problems sleeping.

Your doctor should help you find the antidepressant that works best for you, and which causes the fewest side effects.

Some antidepressants can sometimes cause more serious side effects. Your doctor should discuss these with you and tell you what to look out for.

Some antidepressants can cause withdrawal symptoms if you stop taking them suddenly or if your dose is reduced. Talk to your doctor first if you decide you want to stop taking an antidepressant.

Electroconvulsive therapy (ECT)

Most people think of ECT as a treatment from the past, and as something cruel and frightening. And to be fair, that is a fairly accurate picture of how it was used many years ago.

But modern ECT techniques are painless and helpful to many people with severe depression who have not improved with other treatments.

No one is really sure exactly how it works, but it could be linked to improved flow of blood and chemicals in parts of the brain. Either way, after a course of sessions, many people say that they feel much better.

ECT delivers weak, short electric currents into the brain. It is done under general anaesthetic, so you're asleep during the treatment. A course of treatment is about 12 sessions. People usually have two or three sessions a week.

The main side effect of ECT is short-term memory loss. If you have this treatment, your doctor should explain all the possible side effects to you in detail.

Things you can do for yourself

When you are depressed, it's hard to cope with everyday things like looking after yourself. But eating well, keeping active and staying in touch with friends can all be helpful.

There's some research to show that doing exercise may help you feel better. If you are depressed, exercise may be the last thing you feel like doing. But gentle exercise like walking or swimming may lift your mood. Some research suggests that yoga and tai chi may also be helpful.

Other treatments that may be beneficial include relaxation therapy, light therapy and acupuncture. Some people are also helped by self-help books based on cognitive behavioural therapy.

A herbal treatment called St. John's wort may help if you have mild or moderate depression. However, St. John's wort can interfere with the way other medicines work, such as the contraceptive pill, and medicines for diabetes and high blood pressure.

Before taking St. John's wort, be sure to check with your doctor or pharmacist. You also shouldn't take it along with an antidepressant.

Side effects of St. John's wort can include stomach problems (such as nausea or diarrhoea), dizziness, confusion, tiredness, and a dry mouth.