Depression

Information about depression, its symptoms and possible causes, and how you can access treatment and support. Includes tips on caring for yourself, and guidance for friends and family.

This page is also available in Welsh (Cymraeg).

Coronavirus (Covid-19) is impacting all our lives, and we know that the usual advice might not quite apply. Some ideas for looking after yourself may feel unrealistic right now. And some treatment and support options will be harder to access, or may be unavailable for a while. But we hope that you can still find information here that helps you understand what you're going through, and find a path forward.

You can also find lots of resources in our coronavirus information hub. And our page of coronavirus useful contacts can direct you to more support.

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What treatments are there for depression?

There are various treatments that have been found to help with depression. This page covers:

There is also information that you may find useful if a treatment isn't helping you to feel better.

Remember: you have a right to be involved in your treatment.

The sort of treatment you're offered for depression will depend on how much your symptoms are affecting you, and it should take into account your personal preference for what sort of treatment you find helps you.

See our pages on seeking help for a mental health problem for more information on speaking to your doctor and having your voice heard.

"I really struggled with the SSRIs, even though my GP told me that was the only course of action. They made me feel worse than I did to start with, then incredibly tired. I fought for a referral for CBT and in the end it saved me."

Self-help resources

A self-help resource might be the first treatment option your doctor offers you, especially if your depression is mild. This is because it's available quite quickly, and there's a chance it could help you to feel better without needing to try other options.

Self-help could be delivered through:

A self-help programme. For example, your GP might recommend you work through a self-help programme, often called a self-help manual. A healthcare professional should provide you with support and check your progress, either face-to-face or over the phone.
A computer-based CBT programme for depression. Your GP might refer to this as computerised cognitive behavioural therapy (CCBT). Some people find CCBT helps them understand their depression and challenge negative thoughts. Beating the Blues is an example of a CCBT programme that you might find helpful.
A physical activity programme. Your GP might recommend that you join a group exercise class. These are specifically designed for people with depression and run by qualified professionals.

Talking treatments for depression

There are many different talking treatments that can be effective in treating depression:

cognitive behavioural therapy (CBT)
group-based CBT
interpersonal therapy (IPT)
behavioural activation
psychodynamic psychotherapy
behavioural couples therapy – if you have a long-term partner, and your doctor agrees that it would be useful to involve them in your treatment.

Your doctor or mental health professional can talk through the options available in your area and help you find the right kind of talking treatment for you. Unfortunately, we know that in many places NHS waiting lists for talking treatments can be very long.

Our talking therapy and counselling page has more detail about these therapies, and information on how to access them – through the NHS, charities and privately.

In England, you may be able to refer yourself for therapy via the Improving Access to Psychological Therapies (IAPT) programme.

"Talking things through with a counsellor or therapist really helps me to see things more rationally and make connections between reality and inside my head."

Should I stop therapy if I start to feel better?

If you're currently receiving a talking treatment, you don't have to stop just because you're feeling better. You can discuss your mood with your therapist and talk about what options might be right for you.

NICE guidelines recommend CBT or mindfulness-based cognitive therapy to help you stay well if you've had episodes of depression in the past.

Opening up about depression

"The more I opened up in counselling, the less of a burden I felt on my shoulders."

Read Sam's story

Medication for depression

If self-help, computerised cognitive behavioural therapy or physical activity have not helped you, you might also be offered an antidepressant medication, either on its own or in combination with a talking treatment. There are different types of antidepressant:

Different people find different medications most helpful. You can talk to your doctor about your options – you might find you need to try out a few different types of medication before you find the one that works for you. See our pages on antidepressants for more information.

"Antidepressants have helped to put me in a place where I was more able to cope with counselling. This required a lot of hard work and I had to accept a completely different way of thinking."

Coming off medication

If you are taking medication for depression, it's important not to stop suddenly. Withdrawal symptoms from antidepressants can be difficult to cope with, and stopping suddenly can be dangerous. See our pages on coming off antidepressants and coming off psychiatric medication for more information.

If you decide to try coming off your medication, it's very important to:

get support, preferably from others who have come off successfully and from a professional who understands the process
find out the possible risks and how to minimise them
come off gradually, over a period of time.

NICE guidelines recommend that you continue to take your antidepressants for at least six months after your episode of depression ends. If you've experienced several episodes of depression before, you might want to keep taking your medication if you feel it could help you prevent another episode.

"I've had three experiences of reducing/coming off medication all together with my GP: one was a successful reduction that led to 5 years full time work whilst the other two led to what I believe was 'rebound psychosis' (rather than 'a return to my underlying illness'). I believe this happened because I came off medication too quickly ie over months rather than over a year or more."

Alternative treatments

There are also options you can try instead of, or alongside, medication and talking treatments. These include:

Your doctor may be able to refer you to some of these. You can also contact your local Mind to find out what they have available.

"Taking care of my diet and body, talking and alternative methods work far better for me."

Treatment for severe and complex depression

If your depression is severe and complex, your doctor should refer you to specialist mental health services. They can discuss with you the following options:

Trying talking treatments and medication again. Your healthcare team may suggest a different medication, or a combination of drugs with other treatments.
Medication for psychotic symptoms. If you are experiencing depression with psychotic symptoms, your healthcare team may prescribe antipsychotic medication alongside your current treatment plan. See our pages on psychosis and antipsychotics for more information.
Crisis resolution services. A crisis resolution and home treatment (CRHT) team is a team of mental health professionals who can support you at your home during a mental health crisis, rather than going into hospital. See our page on crisis services for more information.
Hospital admission. If you are severely depressed and at risk of suicide, self-harm or self-neglect, you may need to be cared for in hospital as an in-patient. A hospital can provide a safe and supportive environment if you are in a state of distress. See our page on hospital admission for more information.

"A majority of the treatments I tried were ineffective – but at crisis point, about to be admitted to a psychiatric hospital, I started Interpersonal Psychotherapy and Sertraline. I can honestly say that they saved my life."

ECT

Electroconvulsive therapy (ECT) should only be considered a treatment option for depression in extreme circumstances.

According to NICE guidelines, this could be if you're experiencing a long and severe period of depression, and either:

other treatments have not worked, or
the situation is life-threatening.

If you feel like you're in this situation, your doctor should discuss this option with you in a clear and accessible way before you make any decisions.

See our pages on ECT for more information about this treatment and when it can be performed. Also see our legal pages on consent to treatment and the Mental Capacity Act 2005 for information about your legal rights regarding treatment.

Repetitive transcranial magnetic stimulation

According to NICE guidelines, you might be offered repetitive transcranial magnetic stimulation for severe depression that has not responded to other treatments.

Treatment involves daily sessions of about 30 minutes, lasting for a number of weeks.

The NICE guidelines say that it's safe enough and works well enough to be offered on the NHS. Currently this treatment is available at a limited number of NHS trusts and some private clinics.

Is neurosurgery ever used to treat depression?

Neurosurgery for mental disorder (NMD) is only performed very rarely, in extreme circumstances. NMD is only offered if all other treatments have failed and cannot ever be performed without your consent. See our pages on NMD for more information.

What if I don't feel better?

Different things work for different people, so if a particular medication or talking treatment doesn't work for you, your doctor should offer an alternative.

It's important to remember that recovery is a journey, and it won't always be straightforward. You might find it more helpful to focus on learning more about yourself and developing ways to cope, rather than trying to get rid of every symptom of your depression.