Depression - treatment and management

Taking the first step to seek support can be hard for someone with depression. Many people need encouragement from family members, friends or a health professional to get started. There is no single proven path to recovery, but a range of treatments, health professionals and services is available to help. There are also many things people with depression can do to help themselves.

Depression is common. Over a lifetime, around one in six women and one in eight men experience it. The good news is that, like a physical illness, depression is treatable and effective treatments are available. The sooner a person seeks support, the sooner they can recover.

Why treatment matters#

There are different types of depression, and symptoms can range from relatively minor (but still disabling) through to very severe. The main types include major depression, dysthymic disorder, bipolar disorder (once called manic depression), cyclothymic disorder and seasonal affective disorder (SAD).

Depression is unlikely to simply go away on its own. If it is ignored and left untreated, it can continue for months, sometimes years, and have many harmful effects on a person’s life. Every person needs to find the treatment that is right for them, and it can take time and patience to find one that works.

Getting started#

Treatment for depression should start with seeing your doctor. Where possible, book a longer consultation so you have time to discuss your symptoms and treatment options. Your doctor may ask you to fill out a screening questionnaire or arrange some tests to rule out other conditions.

Depending on your needs, your doctor may refer you to a psychologist, social worker, counsellor or psychiatrist. They can also tell you about local mental health and community services, and about where to go for a mental health assessment.

In an emergency, contact your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) or go to your nearest hospital emergency department to obtain a mental health assessment.

Matching treatment to severity#

Different types of depression need different treatment. Mild symptoms may be relieved by:

• learning about the condition
• lifestyle changes, such as regular physical exercise
• psychological therapy provided by a mental health professional or through online e-therapies

For moderate to more severe depression, medical treatment is likely to be needed in combination with these other approaches.

Psychological treatments#

Psychological treatments (also called talking therapies) are an effective way to treat depression. They help you change unhelpful thinking patterns and improve your coping skills, so you are better equipped to deal with life’s stresses and conflicts. As well as supporting recovery, they can help you stay well by identifying and changing unhelpful thoughts and behaviour.

There are several types of psychological treatment, including:

• cognitive behaviour therapy (CBT)
• interpersonal therapy (IPT)
• behaviour therapy
• mindfulness-based cognitive therapy (MBCT)

CBT is one of the most commonly used. It helps people monitor and change negative patterns of thinking and improve their coping skills.

Antidepressant medication#

Antidepressant medication may be prescribed alongside psychological treatments when a person has a moderate to severe episode of depression. It is sometimes prescribed when other treatments have not worked, or when psychological treatment is not possible because of the severity of the condition or a lack of access.

People with more severe forms of depression, including bipolar disorder and psychotic depression, generally need to be treated with medication. This may include one or a combination of mood stabilisers, antipsychotic drugs and antidepressants.

There are many types of antidepressants, and choosing the best one for a person can be complex. The decision is made together with a doctor after careful assessment. Antidepressants take at least two weeks before they start to help, and it can take time for the doctor to find the most suitable medicine and dose.

Antidepressants can help people feel better, but they will not change a person’s personality or make them feel happy all the time. As with any medicine, some people have side-effects. Depending on the medicine, common side-effects include:

• nausea
• headaches
• anxiety
• sweating
• dizziness
• agitation
• weight gain
• dry mouth
• sexual difficulties (for example, difficulty becoming or staying aroused)

Some of these can be short-lived. Anyone who has side-effects should tell their doctor, as there are ways to reduce them. The likelihood of a particular side-effect varies between people and medicines.

How long a person needs to take antidepressants depends on the severity of their condition and how they respond. Antidepressants are safe, effective and not addictive. Stopping should only be done gradually, on a doctor’s recommendation and under supervision.

Finding the right treatment for you#

Just because a treatment works scientifically does not mean it will work equally well for everyone. Some people have complications, experience side-effects, or find a treatment does not fit their lifestyle. It can take time and patience to find what works.

After getting appropriate advice, the best approach is to try a treatment you are comfortable with and that works for most people. If you do not recover quickly enough, or you have problems with the treatment, discuss this with your health professional and consider trying another option.

Helping yourself recover and stay well#

Alongside psychological and medical treatment, there are many things people can do to help themselves get better and stay well.

Staying active#

When you are depressed, you may not enjoy activities you once loved, or you may expect not to enjoy something and then enjoy it more than you thought. If you stop trying activities, you reduce the things that could help you cope. To build up enjoyable activities:

• list activities you used to enjoy, including as many as possible
• plan one of these activities each day
• gradually increase the time available for activities you enjoy
• afterwards, think about or write down what you enjoyed
• talk to others about activities they like

If you keep going, it will help you get better, and you will enjoy activities more as you recover.

Sleeping patterns#

Depression can disrupt sleep, so it is important to try to restore a regular pattern. Tips include:

• Try to go to sleep and get up at about the same time each day.
• If you worry during the night, set aside some time for problem solving during the day.
• Avoid caffeine after the late afternoon, and try not to drink more than two caffeine-type drinks (such as coffee, strong tea, cola or energy drinks) a day.
• Avoid using alcohol to help you sleep. As alcohol is broken down in your body, it causes you to sleep less deeply and wake more often.
• Allow yourself time to wind down before bed. If you are working or studying, stop at least 30 minutes beforehand and do something relaxing.
• Give your mind a break from online activity such as social media for an hour before bed, and consider keeping your phone in a separate room at night.

Managing negative thoughts#

Worrying or thinking negatively is common in depression. It affects your ability to focus on getting better and makes you more vulnerable to unhealthy emotions. Tips to control worry and reduce negative thinking include:

• Write down what you are worried about, then go through each concern and consider how realistic your negative thoughts are.
• Explore alternative thoughts and explanations.
• Try not to focus on things you cannot change, and focus on the present.
• Accept your thoughts without actively engaging with them.
• Write down your problems and brainstorm solutions, noting the pros and cons of each option and choosing the one that seems best. Afterwards, review whether it worked.
• Avoid making major life decisions during this time.

Dealing with irritability#

Some people with depression feel irritable, and this can worsen with changes in sleep and lifestyle. To help manage it:

• Tell friends, family and colleagues what you are going through and that you may seem irritable.
• Talk to people who are supportive.
• If you feel yourself getting angry, stop and take some time out to settle down.
• Practise regular relaxation to reduce the effect of irritating or frustrating situations.

Anxiety and depression together#

Many people with depression also experience anxiety at the same time. In most cases the treatment for anxiety is similar to that for depression, but it is important to tell your doctor or mental health professional about any anxiety symptoms so they can tailor treatment to both conditions.

Key points#

• A range of treatments, health professionals and services is available to help with depression.
• Like a physical illness, depression is treatable and effective treatments are available.
• Symptoms can range from relatively minor (but still disabling) through to very severe.
• Treatment should start with seeing your doctor, who can assess you and arrange referrals.
• Every person needs to find the treatment that is right for them.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).