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Depression treatmentsAround one in four people in Britain experience depression at some time in their life. Unlike other common illnesses, many people do not seek help to deal with it. Depression is often wrongly seen as a form of weakness or something to be ashamed of. But there are many ways of treating depression, and a very good chance that a suitable treatment can be found. DepressionPeople with depression have a reduced quality of life. In extreme cases, it can put them at risk of harming themselves. This factsheet looks at the different types of treatments for depression. For more information about the symptoms and possible causes, see the separate Bupa fact sheet Depression. What your GP can doVisiting the GP is often the first step someone with depression can take to recovery. It can be an enormous relief to simply share how you are feeling. By asking specific questions about your mood, sleep patterns, appetite, libido (sex drive) and energy levels, most GPs can diagnose depression. They might ask more about what is happening in your life that would help to explain the feelings you are experiencing. No matter how deeply personal or even trivial a predicament may seem, it can help to discuss it. Doctors are trained to ask direct questions about pessimistic thoughts about the future and thoughts of self-harm that are common in depressed people. Again, it can be very helpful for people to talk openly about these issues. Psychological treatmentsMany GP practices have counsellors to help patients with depression or other emotional difficulties. Counsellors may have a background in mental health nursing or psychology. Practice counsellors can see patients at the doctor’s surgery or health centre, usually for a fixed number of sessions. The exact number of sessions varies depending on the type of treatment offered. Regular exercise can also be helpful in treating depression. People with anxiety, which often occurs with depression, sometimes find that relaxation techniques, massage or yoga can help ease their symptoms. Antidepressant medicationsThere is a wide range of antidepressant medications available. There is good evidence that these medicines are effective and are not addictive. SSRIsSSRIs (selective serotonin re-uptake inhibitors) are now the most commonly prescribed type of antidepressant. The drugs fluoxetine (Prozac), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral) are examples of SSRIs. SSRIs work by raising the levels of the natural chemical serotonin in the brain, which in turn tends to lift the mood. When you first start taking an SSRI medicine, you may have some nausea and/or a headache as a side-effect, but this tends to wear off over time. SSRIs are best taken in the morning, as they can interfere with sleep. Around 10% of people who take SSRIs also suffer from sexual difficulties, such as loss of sex drive (libido) or impotence, though these can also be symptoms of depression. If sexual difficulties are a side-effect of the drug, these would clear up when you stop taking the drug. Discuss any such problems with your doctor, who can consider changing your medication. SSRIs are not considered to be addictive (in the way that nicotine or tranquillisers are). Nevertheless, some people may have temporary withdrawal effects such as stomach upset or flu-like illness when treatment is first stopped. Reducing the dose progressively may reduce the risk of these symptoms. TricyclicsTricyclics are as effective as SSRIs, but they can have different side-effects, which may be slightly more troublesome for some people. Amitriptyline, dothiepin (eg Prothiaden) and clomipramine (eg Anafranil) are examples of tricyclics. These work by raising the levels of the chemicals serotonin and noradrenaline in the brain, which both tend to elevate the mood. Possible side-effects include a dry mouth, constipation and weight gain. Most people tolerate these as they gradually become familiar with their medication. They can be more sedative than SSRIs and tend to be best taken at night. Although safe in normal doses, an overdose of some tricyclic antidepressants can dangerously affect the heart rhythm. Other types of medicationThere are several new antidepressants which work in a different way from SSRIs and tricyclics. These include venlafaxine (Efexor), nefazodone (Dutonin) and mirtazapine (Zispin). They can be useful for people who experience side-effects with other medications. Antidepressants usually need to be taken for at least six months. Taking medication even after the symptoms have cleared up can help prevent a relapse of depression. Talk to your doctor about how long you should continue with medication. Psychiatric helpMost people who seek medical help for depression are treated by their GPs. Around 10% are referred to a psychiatrist, a qualified doctor who specialises in mental health problems. An initial appointment with a psychiatrist typically takes 30 to 45 minutes. During this assessment, your symptoms and situation are carefully explored. Psychiatrists are experienced in prescribing the different types of antidepressant medication, and in spotting their side-effects. If you do see a psychiatrist for treatment for depression, you may have occasional follow-up appointments with them for several years. In other cases, your GP will refer you again if your symptoms recur. Psychiatrists can also provide, or make a referral for psychological treatments. For example, cognitive behaviour therapy (CBT) is a form of psychological treatment that is very effective for depression. CBT involves 12 or so one-to-one sessions with a therapist. Sessions focus on the thoughts (cognitions), beliefs and behaviour patterns associated with depression and how they relate to feelings. Severe depressionA small number of people suffer from depression so severe that they may need to be admitted to hospital. With severe depression, people can become completely withdrawn and stop eating and drinking. They may experience intense suicidal thoughts, or even try to end their life. People with severe depression may develop "psychosis", in which they lose track of reality. People with psychotic depression may hear voices when there is no one there (hallucinations). These voices may say distressing or unpleasant things about them. They may also develop false beliefs (delusions) about themselves or their health and be unable to recognise that they have an illness. Psychiatrists describe this as a "lack of insight". When somebody is this severely unwell and they are judged as a danger to themselves or to others, a psychiatrist may use the Mental Health Act to oblige them to be admitted to hospital. Under strict legal restrictions, the Act allows treatment of severe psychiatric illness to be given without the patient’s consent. Electro-convulsive therapyThe quickest way of treating severe depression with the minimum of side-effects may be with ECT (Electro-convulsive therapy). During ECT, the patient receives a light general anaesthetic and muscle relaxant. An electrical current is then applied across the patient’s temples. This induces a seizure or "fit". It is thought that the changes in the brain that occur with the seizure help to elevate mood. Despite its effectiveness, ECT tends to seen by the public as an extreme or harsh treatment. But, although it is not suitable for every person with severe depression, it can help save the lives of some. Complementary medicineMany people prefer a "natural" approach to tackling depression. St. John’s Wort is a popular complementary medicine, available in health food stores and pharmacies. Research studies show some promising results about its effectiveness with mild to moderate depression. It’s important to tell your doctor or pharmacist if you are taking St John's wort (or thinking of taking it) as it can interact harmfully with other medicines you might be on. Further informationDepression Alliance MIND The Samaritans
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