Depression Treatment: Therapy, Medicines and Self-Help Explained

Depression can feel overwhelming, but it is a condition with recognised treatments. The right approach depends on how severe the depression is and on the person, so a doctor or mental health professional should guide the choice. This article describes what the NHS, WHO and MedlinePlus say in general terms.

Mild depression

For mild depression, the NHS says a doctor may first suggest "watchful waiting", which means a review after 2 to 4 weeks. Other options include:

• Guided self-help: usually 6 to 8 sessions working through a workbook or online course with support from a therapist, based on cognitive behavioural therapy (CBT) ideas.
• Exercise: the NHS describes it as one of the main treatments for mild depression, and group exercise classes may be offered.
• Group mindfulness: recommended as an option for less severe depression.

The NHS also says that St John's wort is not recommended by doctors. Products vary in what they contain, and it can interact with other medicines. Please speak to a doctor before using any herbal product.

Talking therapies

Talking therapies help people understand and change patterns in thoughts, feelings and behaviour. The NHS lists several, usually delivered over about 8 to 16 sessions:

• CBT, which looks at present thoughts and behaviour
• interpersonal therapy, which focuses on relationships
• behavioural activation, which links activities to mood
• counselling, which helps with coping
• psychodynamic psychotherapy, which explores patterns in feelings and relationships

The WHO also names behavioural activation, CBT, interpersonal psychotherapy and problem-solving therapy as effective psychological treatments, and says that psychological treatment is a first-line option.

Medicines

Antidepressants are prescribed by a doctor, usually for moderate or severe depression. According to the NHS, most people with moderate or severe depression benefit, but not everyone does, and more than one medicine may need to be tried. The WHO says antidepressants are not needed for mild depression. For moderate and severe depression, psychological treatment can be combined with medicines, and the NHS says the combination usually works better than either alone.

Medicines come in different classes with different side effects, and a doctor chooses based on the person. The NHS and WHO both say extra caution is needed with children and teenagers.

Some points to remember:

• The NHS says symptoms should start to improve within about 4 weeks of starting an antidepressant, and doctors review progress regularly in the early weeks.
• Contact a doctor straight away if hopelessness or thoughts of suicide start or get worse after starting a medicine.
• Do not stop a medicine suddenly. The NHS says doses should be reduced gradually to avoid withdrawal symptoms.

Other treatments for severe depression

MedlinePlus says that when depression is severe or other treatments have not worked, specialists may consider brain stimulation methods. These are only arranged by a specialist team after assessment.

Everyday habits

MedlinePlus says most depression cannot be prevented, but regular exercise, a consistent sleep schedule and managing stress support long-term mental health.

When to see a doctor

Please see a doctor if you think you may be depressed, if you have felt low most of the day, every day for two weeks or more, or if you are already in treatment and it does not seem to be helping. If you have thoughts of harming yourself, contact a doctor, counsellor or crisis help line in your area immediately. Help lines exist in India and the United States and a local health service can tell you which are available.

Do not stop or change prescribed treatment without talking to your doctor.

In an emergency, call your local emergency number (112 in India, 911 in the United States).