Depression

There are a number of treatments for depression. The two main treatments are talking (psychological) therapies such as counselling, and antidepressant medicines. Your treatment will depend on how severe your depression is.

Self-help

Doing some exercise in addition to your medication and/or counselling may help your symptoms. Try a few sports or activities to find something you enjoy, and that you can keep doing in the long-term. Relaxation and meditation may also help your symptoms.

If you're depressed it can be tempting to use alcohol to enhance your mood. If you drink alcohol, it's important that you don't drink to excess because it can affect your sleep and your mood, and can lead to a range of long-term health problems including liver damage. Guidelines for recommended alcohol limits differ from country to country.

Medicines

Antidepressant medicines aren't always needed in mild or moderate depression. A large number of people with depression get better within six months without medication.

There are several different types of antidepressant medicine available. All can have side-effects, so it's important to find the medicine that suits you best. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Tricyclic antidepressants (TCAs) alter your brain chemistry (delaying the absorption of the natural brain chemicals norepinephrine (noradrenaline) and serotonin, so that there is more of these chemicals in your brain for longer). This is thought to help with depression. TCAs can have troublesome side-effects, including increased appetite, weight gain, dizziness, sweating, drowsiness and shaking. Dosulepin and clomipramine are examples of TCAs.

Monoamine oxidase inhibitors (MAOIs) such as phenelzine, are used less frequently than other antidepressants because they can cause serious side-effects if you eat certain foods such as cheese. Your doctor will explain these side-effects and give you a card with a list of foods to avoid.

Selective serotonin re-uptake inhibitors (SSRIs) such as fluoxetine and paroxetine increase the level of serotonin in the brain. This in turn appears to lift your depression. SSRIs tend to cause fewer side-effects than other antidepressants so many people find them easier to take. They are often the first type of antidepressant used.

There are many other types of antidepressant, which work in a different way. These include venlafaxine and mirtazapine. They can be useful for people who experience side-effects with other medicines, or people who have specific symptoms.

Taking your medication for at least six months after you start to feel better can help prevent the depression coming back. Ask a doctor for more information on each medicine. When stopping antidepressant medication, your doctor will usually reduce your dose gradually over at least four weeks. Don't stop taking your medication suddenly because you may experience withdrawal reactions.

Talking therapies

A doctor may be able to arrange for you to have talking therapy as part of your treatment.

Counselling is usually a one-to-one session where you have a chance to express your feelings and problems, with the counsellor listening and asking questions. The counsellor will listen to what you have to say and then helps you to try and see your feelings and problems in a different way.

There are also more structured types of talking therapy. These include cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (a type of talking treatment that goes more deeply into childhood experience and significant relationships).

The type of talking therapy you have will depend on what's available, your preferences, and how severe your depression is.

Complementary therapies

St John's wort (Hypericum perforatum) is a complementary medicine that can help mild or moderate depression. You can buy this as tablets in health food stores and pharmacies (chemist or drugstore). You should always ask for advice from a doctor or pharmacist before taking St John's wort, especially if you are also taking prescription or over-the-counter medicines (including antidepressants). This is because St John's wort can interact with some other commonly used medicines, such as the contraceptive pill.

Hospital treatment

Most people who have depression can be successfully treated without being admitted to hospital. However, if you have severe depression and have suicidal thoughts, you, your family, or a psychiatrist may feel you need the shelter and protection of a hospital.

Before going into hospital, you may have a mental health assessment. This involves talking with a doctor and answering some questions about how you are feeling.

Electroconvulsive therapy (ECT)

ECT is a controversial treatment because it's not absolutely clear how it works. A side-effect of ECT is memory loss.

ECT often works very quickly, greatly lifting your depression. However, it doesn't appear to stop depression coming back in the future.

This treatment is only considered if you're severely depressed or if treatment with medicines hasn't worked for you. ECT is always given in hospital under general anaesthesia, which means you will be asleep during the procedure and feel no pain. It works by passing an electric current through the brain and causing a seizure. People tend to have ECT sessions twice a week for six to 12 sessions.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.