Patient's Education for Depression

What treatments work for depression?

There are many treatments that work well for depression. The most difficult thing can be admitting you have a problem and asking for help. But once you get help, you may soon start to feel better.

Key points about treating depression

• Some talking treatments work well for depression. But you might not be able to get them on the NHS straight away. If you are able to pay for therapy your doctor may be able to put you in touch with a suitable therapist.
• Drug treatments also work well. But they have side effects.
• Once you feel better, carrying on taking antidepressants can stop you getting depressed again (if you get depression for a second time it’s called a relapse).
• If you are severely depressed, taking antidepressant drugs and having a talking treatment works better than having just one of these treatments.
• A herbal treatment,can help people with mild or moderate depression.
• Electroconvulsive therapy (ECT) works for severe depression. But it is used only for people who need to be treated in hospital and only when all other treatments haven’t helped.
• There are national guidelines on how doctors should treat depression. The treatment you get will depend on whether your depression is mild, moderate or severe.

Treatments for depression

There are many different treatments for depression. But which treatments work best? We've carefully weighed up the research and divided the treatments into following categories:

This talking treatment aims to change people's negative views about themselves and the world. It is often used on its own for mild and moderate depression. 

If you have mild or moderate depression, cognitive therapy can help you. It may even work better than antidepressants, but the research isn't good enough to be certain.Having cognitive therapy on its own might not help you if you have severe depression. Cognitive therapy is a kind of talking treatment (psychotherapy). During cognitive therapy you talk to a therapist about your problems. Most people with mild or moderate depression see a therapist six to eight times over about 10 weeks. Cognitive therapy is based on the idea that if you automatically think the worst of yourself, you will get depressed. You may automatically think the worst about yourself and the world without realising it. The aim of cognitive therapy is to help you think more positively.

If you have mild or moderate depression, cognitive therapy can: 

• Improve your symptoms. This could mean that you start to feel happier, more relaxed or less tired. You may have more energy and a better appetite than before
• Increase your chances of getting completely better. About half the people who try cognitive therapy recover completely during treatment. Doctors call this remission.

Cognitive therapy is likely to help your depression even if you’re older.

But depression often comes back again sooner or later after you stop having treatment. This can happen whether you have drugs or a talking treatment. It's called a relapse. Cognitive therapy may be better than antidepressants at preventing relapses. But we need more research to be certain.

In studies, 3 in 10 people got depressed again after they stopped cognitive therapy. But 6 in 10 people got depressed again after they stopped taking antidepressants.

Carrying on with cognitive therapy can help you stay well for longer. In one study, two years of cognitive therapy was better at preventing relapses than two years of treatment with antidepressants.  

Why should it work?

 Cognitive therapy changes the way you think. So if the way you think is making you depressed, cognitive therapy should help. If, say, you assume that you're no good at anything, or your family doesn't need you any more, cognitive therapy will help you stop thinking that way. You learn to look more positively at yourself and your life, so your mood gets better. 

Can it be harmful?

None of the research we found reported any harmful effects from cognitive therapy. We know that people are better at sticking with talking treatments than with drugs such as antidepressants. About 2 in 10 people drop out of psychotherapy, compared with 5 in 10 who drop out of other treatments.

If you are a younger adult with mild or moderate depression, interpersonal therapy can help. If you're an older adult (over 55), it's not clear that interpersonal therapy works any better than just having someone helpful to talk to. There isn't enough research to know if this treatment can help people with severe depression. We don't know how this treatment measures up against other good treatments such as antidepressants or cognitive therapy.

Interpersonal therapy is a kind of psychotherapy designed for people with depression. It aims to improve your relationships with other people and help the social side of your life.

It's based on the idea that depression is often linked to things like a fight with your partner or a problem with a workmate. These types of events can trigger depression. But the depression may also come first, and your mood might make fights or work problems more likely. Either way, during interpersonal therapy, your therapist encourages you to learn new and better ways of relating to people. Most people meet their therapist once a week for three months or four months.

How can it help?

If you have mild or moderate depression, you're more likely to get better if you have interpersonal therapy than if you don't.

Why should it work?

Interpersonal therapy teaches you how to relate better to the people in your life, including family, friends and workmates. So the therapy should help if your depression was triggered by interactions with other people or is causing problems with other people. The therapy can help you make up after arguments or assert yourself at work. It can also help you build stronger friendships or family ties so you have better social support. The idea is that you're less likely to get depressed and more likely to recover from depression if you have stronger, more supportive relationships.

Can it be harmful?

None of the research we found reported any harmful effects from interpersonal therapy. The main problem is that it's not always available.

There's good research showing that these antidepressant drugs work for people with depression. But selective serotonin reuptake inhibitors (SSRIs) can cause unpleasant side effects. We don't know for certain how antidepressants compare with another good treatment called cognitive therapy. But if you have mild or moderate depression, cognitive therapy may work slightly better.

What are they?

Selective serotonin reuptake inhibitors (SSRIs) are a newer type of antidepressant. Your doctor will probably prescribe an SSRI if you need drugs to treat your depression. Examples of SSRIs (and their brand names) include:

• fluoxetine (Prozac)
• fluvoxamine (Faverin)
• paroxetine (Seroxat)
• sertraline (Lustral)
• citalopram (Cipramil).

Your doctor will probably talk to you about what treatment you would like, if any. You'll probably need to take antidepressants for more than six weeks before you start to feel better. So it's important not to stop taking them early.

How can they help?

SSRIs can help you with the symptoms of depression. Between half and two-thirds of depressed people feel much better after treatment with SSRIs. Taking an antidepressant can mean:

• You feel less sad, hopeless, worried or guilty
• Your appetite improves
• Your sex drive comes back
• You can concentrate better
• You no longer think about suicide.

SSRIs seem to work as well as older kinds of antidepressants (known as tricyclic antidepressants), a newer antidepressant called reboxetine and an antidepressant called mirtazapine. But a newer antidepressant called venlafaxine (brand name is Efexor) might work slightly better than SSRIs in people with mild or moderate depression. Antidepressants may not work as well as cognitive therapy at treating depression and preventing it coming back.

Why should they work?

Antidepressants affect chemicals called neurotransmitters which help carry messages from brain cell to brain cell. As their name suggests, selective serotonin reuptake inhibitors boost the amount of a neurotransmitter called serotonin in the brain. This gradually causes changes in how your brain cells behave. It can take several weeks before you can tell if the drugs are affecting your mood. The problem is that the drugs also affect other brain cells, disrupting nerve signals and causing side effects.

Can they be harmful?

No one knows how likely you are to get side effects. Different studies say different things. Talk to your doctor if you're pregnant, or if you're planning to get pregnant, and are taking an antidepressant.

There's good research showing that these drugs work for people with depression. But they may cause more unpleasant side effects than some newer kinds of antidepressants. We don't know for certain how antidepressants compare with another good treatment called cognitive therapy. If you have mild or moderate depression, cognitive therapy may work slightly better.

Tricyclic antidepressants (TCAs) are an older type of antidepressant.Your doctor will probably prescribe a newer type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI) if you need drugs to treat your depression. You may get a TCA if the newer type of antidepressant doesn’t help you, especially if you’re a man and have been depressed for more than two years.Men don't seem to get as many side effects as women from these drugs. Examples of TCAs (and their brand names) include:

• amitriptyline (Elavil)
• dosulepin (Prothiaden)
• doxepin (Sinequan)
• imipramine
• nortriptyline (Allegron)
• trimipramine (Surmontil).

Your doctor will probably talk to you about what treatment you would like, if any. You'll probably need to take antidepressants for more than six weeks before you start to feel better. So it's important not to stop taking them early.

Why should they work?

Antidepressants affect chemicals called neurotransmitters which help carry messages from brain cell to brain cell. In particular, tricyclic antidepressants boost the amounts of the chemicals serotonin and noradrenaline. This gradually causes changes in how your brain cells behave. It can take several weeks before you can tell if the drugs are affecting your mood. The problem is that the drugs also affect other brain cells, disrupting nerve signals and causing side effects.

Can I take antidepressants if I'm pregnant?

There isn't much research on taking antidepressants if you're pregnant. Doctors are advised to avoid prescribing them to pregnant women, or to use them with care if the benefits are likely to outweigh the risks.This is because of concerns that drugs taken during pregnancy might harm the baby.

• If you take antidepressants late in your pregnancy, your baby might get withdrawal symptoms soon after birth.
• In one study, some mothers who took fluoxetine (Prozac) late in their pregnancy had smaller babies. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI).
• Another study looked at more than 3,500 women who took antidepressants during the first three months of pregnancy. It found that women who took the SSRI paroxetine (Seroxat) were more likely to have a baby with birth defects than women who took other antidepressants. The babies affected mainly had heart defects.Earlier studies didn't show a higher risk of birth defects from paroxetine or other SSRIs.

Talk to your doctor if you're pregnant, or if you're planning to get pregnant, and are taking an antidepressant.

There's good research showing that these drugs work for people with depression. But monoamine oxidase inhibitors (MAOIs) aren’t used very often because of dangers when they're taken with other drugs and some kinds of food. MAOIs may not work as well as some other antidepressants if you have severe depression. But they may be the best treatment if you have an unusual type of depression (for example, you eat or sleep more than normal).

We don't know for certain how antidepressants in general compare with another good treatment called cognitive therapy. But if you have mild or moderate depression, cognitive therapy might work slightly better.

Monoamine oxidase inhibitors (MAOIs) are a kind of antidepressant. Examples of MAOIs include:

• phenelzine (brand name Nardil)
• isocarboxazid
• tranylcypromine.

MAOIs aren't used very much any more. But your doctor might suggest you try one of these drugs if other antidepressants haven’t worked1 or if you have an unusual type of depression (for example, you eat or sleep more than normal, or you are very moody or sensitive). 

How can (MAOIs) help?

Monoamine oxidase inhibitors (MAOIs) can help you with the symptoms of depression. More than half of depressed people feel much better after treatment.3 Taking an antidepressant can mean:

• You feel less sad, hopeless, worried or guilty
• Your appetite improves
• Your sex drive comes back
• You can concentrate better
• You no longer think about suicide. 

MAOIs probably work as well as most other types of antidepressants. Some studies show tricyclic antidepressants (TCAs) might work a bit better than MAOIs if you have severe depression. TCAs are an older kind of antidepressant. 

MAOIs aren't used very often, but they may work better than other antidepressants in people whose depression has unusual symptoms. Doctors call this atypical depression. For example, some people eat or sleep more than usual, or are very sensitive or moody.

How long should I stay on antidepressants?

We don't know for certain how long you should stay on antidepressants. But specialists recommend that you take antidepressants for at least four months to six months after you start to feel better.6 That's because: 

• Depression often comes back sooner or later after you stop treatment. This is called a relapse 
• About 6 in 10 people who stop taking their antidepressants after a few months get depressed again within a year
• Staying on antidepressants for at least six months after you start to feel better can reduce your chances of a relapse.

Long-term treatment with antidepressants works. But any side effects you get will most likely continue for as long as you take the treatment.

Why should they work? 

Antidepressants affect chemicals called neurotransmitters which help carry messages from brain cell to brain cell. Monoamine oxidase inhibitors (MAOIs) block a chemical called monoamine oxidase.1 This causes amine neurotransmitters to collect, which gradually makes changes in how your brain cells behave. It can take several weeks before you can tell if the drugs are affecting your mood. The problem is that the drugs also affect other brain cells, disrupting nerve signals and causing side effects. 

Can they be harmful?

The biggest problem with monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and tranylcypromine, is that they react with lots of other medicines, foods and alcoholic drinks. 

If you take an MAOI, eating foods containing the natural chemical tyramine (such as mature cheese and Marmite) can dangerously raise your blood pressure. The first sign of very high blood pressure is usually a throbbing headache. If this happens, see your doctor straight away. People taking these drugs have to be careful about what they eat. 

If you take an MAOI, you should avoid: 

• Meat or yeast extracts such as Bovril, OXO or Marmite
• Soy sauce
• Broad beans, especially the pods
• Pickled herring
• Any game, such as pheasant or hare
• Any meat, poultry, fish or offal that you think might be a bit old or stale
• Cough, cold and flu remedies containing a decongestant
• Alcoholic drinks (even low-alcohol drinks such as alcohol-free lager).

Common side effects of MAOIs

In studies, the most common side effects reported by people taking MAOIs were:

• Low blood pressure, causing faintness
• Dizziness
• Blurred vision
• Goose bumps
• Difficulty sleeping
• Trembling
• Problems with sex, including being unable to have an orgasm.

All antidepressants can cause side effects. It's important to find the drug that suits you best. Older people may be more likely to get side effects than younger people, whatever antidepressant they take. This is because of changes in the body that happen as people get older. Older people are also often taking other medicines, so there's more chance of side effects from taking more than one drug.

Talk to your doctor if you're pregnant, or if you're planning to get pregnant, and are taking an antidepressant.

There's good research showing that venlafaxine works as well as other antidepressants for people with depression. Venlafaxine may work slightly better than selective serotonin reuptake inhibitors (SSRIs) in people with mild or moderate depression. But venlafaxine can cause unpleasant side effects. We don't know for certain how antidepressants compare with another good treatment called cognitive therapy. But if you have mild or moderate depression, cognitive therapy may work slightly better.

Venlafaxine (brand name Efexor) is a fairly new antidepressant. It is a serotonin and noradrenaline reuptake inhibitor (or SNRI). This drug is similar to selective serotonin reuptake inhibitors (SSRIs). Venlafaxine is usually used after other antidepressants haven't worked. You'll probably need to take antidepressants for more than six weeks before you start to feel better. So it's important not to stop taking them early.

How can it help?

Venlafaxine can help you with the symptoms of depression. One study found that up to 8 out of 10 people felt much better after treatment with venlafaxine. Taking an antidepressant can mean:

• You feel less sad, hopeless, worried or guilty
• Your appetite improves
• Your sex drive comes back
• You can concentrate better
• You no longer think about suicide.

Venlafaxine seems to work as well as other kinds of antidepressants.But it may work slightly better than selective serotonin reuptake inhibitors (SSRIs) for people with mild or moderate depression.

Why should it work?

Antidepressants affect chemicals called neurotransmitters which help carry messages from brain cell to brain cell. In particular, venlafaxine boosts the amounts of the chemicals serotonin and noradrenaline. This gradually causes changes in how your brain cells behave. It can take several weeks before you can tell if the drugs are affecting your mood. The problem is that the drugs also affect other brain cells, disrupting nerve signals and causing side effects.

Can it be harmful?

Venlafaxine causes heart problems in some people. You need to have your heart and blood pressure checked before taking it. You shouldn't take venlafaxine if you have heart disease or high blood pressure. In the UK, treatment with this drug should be started only by a doctor with special training in treating depression, or by a hospital specialist.

Studies show that up to 7 out of 10 people treated with venlafaxine have side effects.This is similar for people taking an SSRI drug. But you’ll probably get more side effects if you’re treated with a tricyclic antidepressant. Venlafaxine can cause sexual problems, such as problems with erections or difficulty having an orgasm.You might also feel sick, tired or dizzy, or lose your appetite if you take this drug.

Here’s what happened to people with depression who took venlafaxine in studies:

• 4 out of 10 people had stomach problems
• More than a quarter had a dry mouth
• More than a third sweated more than normal
• Two-fifths lost weight.

All antidepressants can cause side effects. It's important to find the drug that suits you best. Older people may be more likely to get side effects than younger people, whatever antidepressant they take. This is because of changes in the body that happen as people get older. Older people may also be on other medicines, so there's more chance of side effects from taking more than one drug.

Talk to your doctor if you're pregnant, or if you're planning to get pregnant, and are taking an antidepressant.

Electroconvulsive therapy (ECT) is a quick way to help some people with severe depression. It may work better than antidepressants for some people.

Electroconvulsive therapy is a series of electric shocks given to your brain through electrodes placed on your scalp. The shocks cause a brief fit, or seizure. You won't be awake during the treatment (you'll be given a general anaesthetic).

ECT is controversial. In the past it was probably used too much and on some people who didn't need it. It also has side effects. It's normally used only after treatment with drugs hasn't worked, or when a patient is so ill (suicidal perhaps, or refusing to eat or drink) that quick treatment is needed. ECT is given only in hospital. You can have ECT to one side of your brain, or both sides. And doctors can increase or decrease the power of the electric shocks depending on how ill you are.

How can it help?

In studies, people with severe depression who were given ECT got much better than people who were given a dummy treatment for comparison (a placebo).ECT's effects do not last forever, though. As with other treatments for depression, many people eventually become ill again.

Why should it work?

Experts don't know exactly why ECT works. Most think that the electric shocks increase the amount of chemicals in the brain called neurotransmitters. These chemicals help carry signals between nerves.

Can it be harmful?

The main side effect is that your memory becomes hazy. You may have trouble remembering things or recognising words. This effect can last for a few weeks or sometimes for as long as two months. But depression can affect memory too, so it's difficult to know just how much of the memory loss is because of the treatment. Having ECT on both sides of your brain seems to affect memory more than having it on just one side. And the more powerful the ECT, the more likely you are to get a hazy memory.