Treatment - Depression in adults

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

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

Mild depression

If you have less severe (mild) depression, the following treatments may be recommended.

Wait and see

If a GP diagnoses you with mild depression, they may suggest waiting a short time to see if it gets better by itself. In this case, you'll be seen again by the GP after 2 to 4 weeks to monitor your progress. This is known as watchful waiting.

Guided self-help

Your GP may suggest trying guided self-help to see if it can help with your depression.

You'll usually have 6 to 8 sessions where you work through a workbook or online course, with support from a therapist. The sessions may be in person, by phone or online.

Guided self-help for depression is usually based on the principles of cognitive behavioural therapy (CBT). CBT is a type of therapy that can help you manage your problems by changing the way you think and behave.

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 group exercise class that's designed to help with depression.

Find out more about walking for health and exercise for depression.

Talking therapies

If you have mild depression that's not improving, you may find a talking therapy helpful.

There are different types of talking therapies for depression, including cognitive behavioural therapy (CBT) and counselling.

A GP can refer you for talking therapies, or you can refer yourself directly to an NHS talking therapies service without a referral from a GP.

Find an NHS talking therapies service

Moderate to severe depression

If you have more severe depression, which includes moderate or severe depression, the following treatments may be recommended.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are many different types of antidepressant.

They have to be prescribed by a doctor, usually for depression that's moderate or severe.

Combination therapy

A 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 medicine.

Talking therapies

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 it's been shown to help.

If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks. This may be a group session or an individual session.

The course of treatment usually lasts for between 8 and 16 sessions, depending on how severe your condition is.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) focuses on your relationships with others and problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.

If it's recommended you'll usually have 8 to 16 sessions with a trained practitioner, depending on how severe your condition is.

Behavioural activation

Behavioural activation therapy focuses on identifying links between your activities and your mood, rather than focusing on thoughts and feelings. It can be useful if depression has led to you withdrawing from social activities.

It helps you to make practical changes to your behaviour that may improve your mood.

If it's recommended you'll usually have 12 to 16 individual sessions with a trained practitioner, depending on how severe your condition is.

Individual problem-solving

Individual problem-solving is a type of therapy that focuses on identifying problems and developing plans to solve them. It's only recommended for more severe depression.

If it's recommended you'll usually have 6 to 12 sessions with a trained practitioner, depending on how severe your condition is.

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 difficult feelings in significant relationships and stressful situations, and how patterns in what you do or say may be contributing to your problems.

If it's recommended you'll usually have 8 to 16 sessions with a trained practitioner, depending on how severe your condition is.

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 do not tell you what to do. You can talk in confidence to a counsellor, who supports you and offers practical advice.

On the NHS, you may be offered 8 to 16 sessions of counselling, depending on how severe your condition is.

It's 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.

Behavioural couples therapy

You may be offered behavioural couples therapy if relationship problems could be contributing to your depression, or if involving your partner could help with your treatment.

If it's recommended you'll usually have 15 to 20 sessions over 5 to 6 months.

Getting help

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

You also have the option of self-referral. This means that if you prefer not to talk to a GP, you can go directly to an NHS talking therapies service.

Waiting times for talking therapies can be several weeks or months. A GP can tell you how long you might need to wait, and what to do if your condition gets worse or you need support during this time.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are many different types available.

Most people with moderate or severe depression benefit from antidepressants, but not everybody does. 

You may respond to 1 antidepressant but not to another, and you may need to try 2 or more treatments before you find one that works for you.

The different types of antidepressant work about as well as each other. But side effects vary between different treatments and people.

When you start taking antidepressants, you should see a GP or specialist nurse every week or 2 for at least 4 weeks to assess how well they're working.

Contact a GP straight away if you have any feelings of hopelessness or suicidal thoughts that start or get worse after starting antidepressants.

You should find that your symptoms start to improve within 4 weeks of starting antidepressants.

If they're working, you'll need to continue taking them at the same dose for at least 4 to 6 months after your symptoms have eased.

If you have had episodes of depression in the past, you may need to continue to take antidepressants long term. You'll be reviewed at least twice a year to see whether you need to keep taking them.

Antidepressants are not 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 a GP thinks you'd 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 sertraline (Lustral), 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, tiredness, sleeping problems and problems having sex. But these side effects usually improve over time.

SSRIs may not be prescribed for people with certain health conditions, or 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.

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. 

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.

Some of the side effects may gradually improve as your body gets used to the medicine.

Serotonin-noradrenaline reuptake inhibitors (SNRIs)

Antidepressants such as venlafaxine (Efexor) and duloxetine (Cymbalta or Yentreve) work in a slightly different way from SSRIs and TCAs.

They're 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 can lead to a rise in blood pressure.

Mirtazapine

Mirtazapine is an antidepressant that increases the amount of serotonin and noradrenaline in your brain.

It's sometimes used together with other types of antidepressant.

It can make you feel sleepy. This can be helpful if you have depression and difficulties getting to sleep.

Vortioxetine

Vortioxetine (Brintellix or Lundbeck) is recommended by the National Institute for Health and Care Excellence (NICE) for treating adults who are having a first or recurrent major depressive episode, if the current episode has not responded to 2 other antidepressants.

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

Withdrawal symptoms

Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but you may have some withdrawal symptoms when you stop taking them.

You'll be advised to reduce your dose gradually to help avoid withdrawal symptoms.

These can include:

• 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 1 or 2 weeks, but occasionally they can be quite severe.

They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).

Contact a doctor if you get withdrawal symptoms and they do not improve after 1 or 2 weeks or they get worse.

Read more about stopping or coming off antidepressants.

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 learn how to live with more appreciation and less anxiety.

Group mindfulness is recommended by NICE as an option for treating less severe depression.

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 less severe 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'll have on you.

Taking St John's wort with other medicines, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.

You should not take St John's wort if you're pregnant or breastfeeding, as we do not know for sure that it's safe.

Also, St John's wort can interact with the contraceptive pill, reducing its effectiveness.

Brain stimulation

Brain stimulation is sometimes recommended by a specialist to treat severe depression that has not 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.

These include:

• transcranial direct current stimulation (tDCS)
• repetitive transcranial magnetic stimulation (rTMS)
• electroconvulsive therapy (ECT)
• vagus nerve stimulation (VNS)

The mental health charity Rethink has more information on depression and brain stimulation treatments.

Lithium

If you have tried several different antidepressants and there's been no improvement, a specialist may offer you a medicine called lithium in addition to your current treatment.

There are 2 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 3 to 6 months to check your lithium levels and check for side effects while you're on the medicine.

You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic.