Depression treatment options: therapies, medicines and support in the UK

The NHS describes depression as more than feeling unhappy or fed up for a few days: you feel persistently sad for weeks or months. It is a real illness with real symptoms, not a sign of weakness. Symptoms range from lasting unhappiness and hopelessness to losing interest in things you used to enjoy, tearfulness, anxiety and physical symptoms such as tiredness, poor sleep, low appetite and aches and pains.

Treatment for depression usually involves a combination of self-help, talking therapies and medicines, and is tailored to severity. It is best not to delay seeking help. The sooner you see a doctor, the sooner you can be on the way to recovery.

For less severe depression the NHS lists the following approaches.

• Watchful waiting: a GP may suggest waiting a short time to see if it improves on its own, with a review after 2 to 4 weeks.

• Guided self-help: usually 6 to 8 sessions working through a workbook or online course, with support from a therapist, often based on CBT principles.

• Exercise: described as one of the main treatments for mild depression, sometimes through a group exercise class.

• Talking therapies, such as CBT and counselling, if mild depression is not improving.

The NHS describes several talking therapies and the usual course lengths. Cognitive behavioural therapy (CBT) helps you understand how thoughts and behaviour affect you and usually runs for 8 to 16 sessions. Interpersonal therapy focuses on relationships and usually involves 8 to 16 sessions. Behavioural activation looks at links between activities and mood and usually involves 12 to 16 individual sessions. Individual problem-solving is only recommended for more severe depression and usually involves 6 to 12 sessions. Psychodynamic psychotherapy and counselling usually involve 8 to 16 sessions, and behavioural couples therapy may be offered when relationship problems contribute, typically over 5 to 6 months.

You can refer yourself to an NHS talking therapies service or be referred by a GP. The NHS notes that waiting times can be several weeks or months, and a GP can advise on what to do if your condition worsens while waiting.

Antidepressants treat the symptoms of depression and are usually prescribed for moderate or severe depression. The NHS says most people with moderate or severe depression benefit, but not everybody does, that you may respond to one and not another and that the different types work about as well as each other, although side effects vary.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, citalopram and paroxetine are usually prescribed first. They can cause nausea, headaches, dry mouth, tiredness, sleeping problems and sexual problems, which usually improve over time. Other groups include tricyclics such as amitriptyline, SNRIs such as venlafaxine and duloxetine, mirtazapine, which can make you sleepy, and vortioxetine, recommended by NICE for adults whose episode has not responded to 2 other antidepressants.

When you start, you should see a GP or specialist nurse every week or 2 for at least 4 weeks. Contact a GP straight away if hopelessness or suicidal thoughts start or get worse. Improvement should begin within 4 weeks, and if they work you continue for at least 4 to 6 months after symptoms ease, with longer treatment if you have had previous episodes. Antidepressants are not addictive, but stopping suddenly can cause withdrawal symptoms, so dose is reduced gradually. The NHS says fluoxetine is the only SSRI that can be prescribed for under-18s and only with specialist approval.

A GP may recommend an antidepressant plus talking therapy, particularly if depression is quite severe. The NHS says a combination of an antidepressant and CBT usually works better than either alone. People with severe depression may be referred to a mental health team of psychologists, psychiatrists, specialist nurses and occupational therapists, who provide intensive talking treatments and prescribed medicine.

When several antidepressants have not helped, the NHS says a specialist may offer lithium in addition, with blood tests every 3 to 6 months, or brain stimulation treatments such as rTMS, tDCS, ECT or vagus nerve stimulation for severe depression that has not responded to other treatments.

Group mindfulness is recommended by NICE as an option for less severe depression. St John's wort is a herbal remedy, but the NHS says it is not recommended by doctors because the active ingredients vary and it can interact with medicines including antidepressants, anticoagulants and the contraceptive pill. Lifestyle changes, such as more exercise, cutting down on alcohol, stopping smoking and eating healthily, and support groups or self-help books, are also described as worthwhile.

The NHS says severe depression can make you feel suicidal. Its advice on suicidal thoughts is to tell someone, and it lists a GP (ask for an emergency appointment), NHS 111 or your mental health crisis team as routes to help. If your life is in danger, for example if you have seriously harmed yourself or feel you may be about to, call 999 for an ambulance or go straight to A&E, or ask someone else to. Contact a GP straight away if feelings of hopelessness or suicidal thoughts start or get worse after starting an antidepressant.

NHS routes include GP care, self-referral to NHS talking therapies and community or specialist mental health teams. Private therapists and psychiatrists are available for faster access or particular therapies, and it is sensible to check registration with a professional body and whether the approach matches NHS-recommended therapies for depression.