Dealing with depression - Treatments

Medication, talking therapies and self-help strategies

If you are feeling depressed, the first step may be to visit your GP and ask for help. GPs manage most cases of depression without further specialist help, by talking through the issues with you and giving you guidance or through medication. The more severe your depression is, or becomes, the more likely the GP is to advise medication or request specialist help such as from a counsellor, psychologist, psychotherapist or psychiatrist.

Medication

Moderate to severe depression can be managed by medication, most commonly SSRIs (selective serotonin reuptake inhibitors) such as Fluoxetine, Citalopram and Sertraline. These medications increase the amount of serotonin (a feel-good compound known as the ‘happy hormone’). It can take several weeks for the body to respond to these antidepressants, due to their slow onset, so it is important to keep taking them long enough for you to experience their effects. However, most side effects manifest in the first few weeks so many people stop taking them before the side effects wear off and they start to feel a benefit. Your GP may prescribe a low-dose SSRI antidepressant to start with to see how your body reacts to it. The dose can then be adjusted as necesssary.

Alternatively, your GP may prescribe SNRIs (serotonin norepinephrine reuptake inhibitors) such as Venlafaxine and Duloxetine. These balance the levels of serotonin and norepinephrine (also known as noradrenaline, it affects levels of alertness and energy). Side effects may be similar to those experienced when taking SSRIs, as both medications act upon serotonin levels, but users also report side effects related to increased adrenaline.

Older antidepressants like tricyclics and MAOIs (monoamine oxidase inhibitors) may be prescribed but have more side-effects. Your GP will advise which is best for you.

Talking therapies

Psychotherapy or counselling are known as talking therapies as they involveone-to-one meetings (usually lasting 45 minutes to an hour) with another person during which you can talk about your difficulties. Talking therapies provide you with a supportive environment to discuss your issues. Your therapist will help you explore these issues, maybe helping you understand more clearly what is happening in your life and helping you come to decisions about what you might need to do.

At the first session, your therapist will generally discuss your main issues with you and ask you what you want to use any sessions for. You are likely to also discuss how often you will meet and how long for. Some therapies are open-ended and some have a fixed duration. The session should be a two-way process: feel free to ask any questions about the therapy and your therapist. If you are not comfortable with them and do not feel you can work with them, say so.

Your therapist will be impartial and not part of your social network. They will have no view one way or another on what you should do. This impartiality can help you talk openly about your feelings and any struggles you might have. The process can help validate your feelings, thought and behaviours. Therapy is not passive; it is about engaging in a process of reflection and change. It can be unsettling and disturbing at times but, ultimately, it can be rewarding.

For more about professional help for depression please click here.

For more about the types of therapy click here.

Self-help strategies

Talking

Often when we are depressed, we bottle things up, not wanting to ‘burden’ other people with our difficulties. We might put on a front to other people that everything is okay. We will be able to keep this front up for so long but eventually, if the problems continue, this is likely to put more strain on us and add to our problems. By talking to others, you might be able to see a way through your difficulties or get some help and support. If you cannot talk to your friends or family for any reason then it still might be useful to talk to someone who is not involved in your everyday life, such as a counsellor.

Groups

You may find that there are local self-help groups in your area. These groups provide a useful means of discussing your problems with other people. Sometimes knowing that you are not alone and feeling understood by others can help you feel better about yourself. Groups may contain people who have been feeling as bad as you but are now beginning to feel better. This can help you recognise that there is light at the end of the tunnel. These groups often have speakers and can provide further information to help you with your depression.

Look after yourself

When we are depressed, we tend to criticise ourselves. We tell ourselves off for being down and say that we should ‘pull ourselves together’. One of the ways we can help ourselves when we are down is to show some care and concern for ourselves. Accept that we are where we are and that we are having a tough time.

Exercise

Exercise, meditation and relaxation can ease depressive symptoms. A particular type of meditation called mindfulness can be effective for helping people with depression. Mindfulness encourages focus on the thoughts and sensations of the present moment, rather than reliving past experiences or worrying about the future. The emphasis on openness and reflection, coupled with slow and deep breathing, can be useful for those who are depressed.

There is good evidence that exercise can help– some studies have shown that it is at least as effective as psychotherapy or medication at treating the symptoms of depression. Exercise immediately increases serotonin and endorphin levels, which make you feel happier. Ideally, you should aim for 50 minutes of exercise 3-5 times a week.

St John’s Wort

St John’s Wort is used extensively in Europe to treat mild to moderate depression. A US study, however, suggests that it is no more effective than a placebo in treating major depression. It may be effective for mild to moderate depression, but it may react with other medication, such as SNRI antidepressants. We advise you to seek advice from your GP before using this remedy.