How is depression treated?

The first step to getting treatment is often through your GP. If your GP thinks you have depression they will talk to you about suitable treatments.

You will decide together which treatment option works best for you. Such as:

• Talking therapies
• Couples’ behavioural therapy for depression
• Guided self-help & digital therapy
• Physical exercise
• Antidepressant medication
• Light therapy
• Electroconvulsive therapy
• Brain stimulation
• Nerve stimulation

What are talking therapies?

Talking therapy is a general term to describe any psychological therapy that involves talking. You may also hear the terms counselling or psychotherapy used to describe talking therapy.

Therapy should offer you a safe, confidential place to talk through areas in your life which are difficult for you. Talking with someone who is trained to listen and ask questions can help you to improve how you are feeling and move forwards.

Talking therapy can take place face to face, over the phone, by video call or online. Tell your therapist if you prefer how your therapy is delivered.

There are different types of talking therapy that you might be offered.

The type of therapy you are offered may depend on your symptoms, treatment availability and your preference.

See further down this page for more information about different talking therapies available for depression.

How can I access talking therapies?
You can:

• Contact your local NHS talking therapies service directly to access talking therapy for mild to moderate symptoms
• Ask for a referral through your GP
• Search for a private counsellor
• Search for a charity providing free or low cost therapy
• Contact your Employee Assistance Programme, if your employer pays for this service
• Contact student services, if you are a student

See our webpage on Talking therapies for more information.

What is couples’ behavioural therapy for depression?

Couples’ behavioural therapy is a talking therapy. It should be considered for you if:

• your relationship could be contributing to your depression, or
• it would be helpful for you to have your partner involved in your treatment.

You should be given 15 – 20 sessions over 5 to 6 months.

What is guided self-help & digital therapy?

Guided self-help helps you to think about how your thoughts, beliefs, feelings, and behaviour all affect each other. It gives coping skills for how to manage areas of your life.

You will work through digital or printed resources alone. But you will have regular support from a practitioner. Support can be delivered in person, by telephone or online.

Your treatment will be made up of:

• cognitive behavioural therapy,
• structured behavioural activation,
• problem solving, or
• psychoeducation.

This type of treatment may suit you if you:

• need more flexibility due to other commitments,
• have access to a computer,
• prefer digital therapy,
• have self-motivation, and
• are willing to work alone for some of your treatment.

What is an antidepressant?

Antidepressants are a type of medication. Your doctor might offer you an antidepressant to help reduce your symptoms.

You may need to try different types of medication before you find one that works for you.

Antidepressants can have side effects. They can also affect other conditions you have or other medicines you are taking.

Your doctor should discuss side effects with you. They should also discuss any concerns you have about taking or stopping the medication.

Talk to your doctor before you stop taking medication. Stopping suddenly can cause problems.

If you do not want to take antidepressants, tell your doctor, you can discuss other options.

See our webpage on Antidepressants for more information.

How can physical exercise help?

Regular exercise, especially if it is outdoors, can help improve your mood. Talk to your GP if you are interested in trying exercise.

GP surgeries can put you in touch with a trained practitioner who will deliver group sessions.

There will usually be 8 people in the session alongside you. The programme should run for 10 weeks. You should have at least 1 session per week.

This programme is sometimes called ‘exercise on prescription’.

It can also be a way to meet new people and offer peer support.

You can read more about exercise and self-care in the final sections at the bottom of this page.

What is light therapy?

If your depression gets worse in the winter, you may want to try light therapy instead of talking therapies or medication.

But it’s unclear how effective light therapy is for depression.

What is electroconvulsive therapy (ECT)?

Electroconvulsive therapy (ECT) is a treatment sometimes used to treat severe depression.

During the procedure an electrical current is briefly passed through your brain while you are under general anaesthetic. You will not be awake during the procedure.

You may be offered ECT if it is your preferred treatment option or no other treatments have worked.

You may be given ECT if your depression is life-threatening, and treatment is needed as soon as possible.

See our webpage on Electroconvulsive therapy (ECT) for more information.

What is brain stimulation for depression?

Brain stimulation treatments may be offered to you if you have not responded to other treatment options or medication is not suitable for you.

Repetitive transcranial magnetic stimulation & Transcranial direct current stimulation.
These non-invasive treatments use:

• electromagnetic coils to stimulate specific areas of your brain, or
• weak electrical currents to stimulate your brain

You are awake during the 20-30-minute procedures, with daily sessions for 2-6 weeks.

There is not a lot of evidence for how these treatments work for depression, the benefits vary for people. But there are no major safety concerns.

Vagus nerve stimulator
The aim of this treatment is to improve mood by sending signals to your brain through the vagus nerve. You will have a small procedure to have the nerve stimulator implanted.

It is unclear how effective this treatment is. There are concerns about complications.

How can complementary or alternative therapies help?

Complementary treatments may help improve your wellbeing and may help with side effects. They can include aromatherapy, acupuncture, massage, and yoga.

Complementary treatments are not part of mainstream healthcare.

See our webpage on Complementary and alternative treatments for mental health for more information.

What treatment should I be offered through the NHS?

Your doctor should consider depression guidance from National Institute of Health and Care Excellence (NICE) when discussing your treatment options with you.

NICE recommend that depression is treated differently depending on your symptoms and other mental or physical health conditions:

Treatment for a new episode of less severe depression

Treatment options recommended by NICE guidelines are:

• Guided self-help & digital therapy
• Group physical exercise
• Couples behavioural therapy for depression
• Antidepressant medication
• Group or individual cognitive behavioural therapy (CBT)
• Group or individual behavioural activation (BA)
• Group mindfulness and meditation
• Interpersonal psychotherapy (IPT)
• Counselling
• Short-term psychodynamic psychotherapy (STPP)

Your doctor should not offer you antidepressants as the main treatment for less severe depression, unless this is your preferred treatment.

See our webpage on Talking therapies for more information.

Treatment for a new episode of more severe depression

Treatment options recommended by NICE guidelines are:

• A combination of individual cognitive behavioural therapy (CBT) and antidepressant medication
• Individual CBT
• Individual behavioural activation (BA)
• Antidepressant medication
• Individual problem-solving therapy sessions
• Counselling
• Short-term psychodynamic psychotherapy (STPP)
• Interpersonal psychotherapy (IPT)
• Guided self-help support
• Group physical exercise
• Electroconvulsive therapy (ECT)
• Couples behavioural therapy for depression

See our webpage on Talking therapies for more information.

Treatment for depression with personality disorder

You should be offered treatment for depression if you also have a diagnosis of personality disorder. Treatment should not be withheld.

Your doctor should consider offering you antidepressant medication and a form of talking therapy.

The treatment should be given in a multidisciplinary setting. This means that professionals with different expertise will work together to meet support needs you may have. Treatment can be given for up to 1 year.

Your doctor should consider referring you to a specialist personality disorder treatment programme if they have not done so already.

See our webpage on Personality disorders for more information.

Treatment for psychotic depression

Psychotic depression means that you have depression with psychotic symptoms.

Your doctor should offer to refer you to specialist mental health services for treatment and support.

Once referred you should:

• be offered joined up support from different health professionals with different areas of expertise to support your needs, and
• be offered talking therapies once your psychotic symptoms improve.

You may be offered antipsychotic medication with antidepressant medication.

If you don’t want to take both medications, you should be offered the antidepressant medication on its own.

See our webpage on Psychosis for more information.

Treatment for low mood due to perimenopause or menopause

Symptoms of perimenopause or menopause are similar to symptoms of depression. But they are different and should be treated differently.

If you don’t have an existing diagnosis of depression, there is no evidence that antidepressant medication helps reduce low mood for peri and menopausal people.

Your doctor should consider offering the following to help with symptoms such as low mood and anxiety: ,

• Hormone replacement therapy (HRT)
• Cognitive behavioural therapy (CBT)

How do I work with my doctor to decide which treatment is best for me?

Your doctor should talk to you about the following when considering treatment options for you:

• what, if anything, you think may be causing your depression
• if you have had depression before
• if you have any treatment preferences
• if there is anything that would help you to engage with treatment
• what you would like to gain from treatment

Your doctor should discuss your treatment options with you. They should explain:

• the treatments recommended in the NICE guideline,
• how they will be delivered, and
• where they will be delivered.

They will also deal with anything that may make treatment more difficult for you to access. Such as disability, language, or other communication needs.

You can:

• decline any treatment offered to you
• change your mind once your treatment has started
• attend some or all of your treatment with a friend or family member
  express a preference for the gender of the healthcare professional delivering treatment
• ask to see a professional that you have a good relationship with
• ask to change professional if the relationship is not working

You should reach a shared decision with your doctor on your treatment plan based on your clinical needs and treatment preferences.

If there is a waiting list to start treatment, your doctor should:

• tell you how long the wait is likely to be,
• keep in regular touch with you while you wait,
• make sure you understand how to get help if your depression gets worse,
• make sure that you know who to contact for updates on the waiting time,
• think about giving you self-help support, and
• think about ways to deal with social support issues. Such as putting you in touch with social services or a social prescriber.

Your doctor should offer you a follow-up appointment between 2 - 4 weeks after starting any treatment.

What is a social prescriber?

Social prescribing uses non-medical options to help improve your wellbeing.

You can talk to your GP about being referred to a social prescriber, also known as a link worker. Link workers aren’t yet available in all areas of the country. The NHS say there will be more link workers in place by 2024.

A link worker will work with you to find out what is important to you. They can connect you with local support such as:

• activity groups,
• support groups,
• services, such as charities, and
• social services.