What treatments might I be offered?

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options, please talk to a member of your healthcare team.

Treatments for common mental health problems include psychological treatments (sometimes called 'talking treatments') and drug treatments. The decision about what type of treatment to have will depend on your preference and a number of other factors, including:

  • whether you have had treatment for mental health problems before and how helpful it was

  • how often you have symptoms and how long they usually last

  • whether your mental health problem is mild, moderate or severe (see Common mental health problems) and how it affects your everyday life

  • whether you have a long-term physical health problem or another mental health problem.

You should be given information about the treatment itself, including whether it will affect any other treatment you may be having. You should usually be offered brief treatments, or treatments that do not require meeting with a healthcare professional on a regular basis, first. Examples of these might include self-help books or computer programmes. If these are not helpful or appropriate, you should then be offered either longer treatments or more contact with a healthcare professional.

Mild mental health problems can sometimes improve without treatment or by following advice from your GP (or other healthcare professional) on coping with problems. If you do need treatment, those for particular mental health problems are described briefly below.

In addition, if you need help with work, education or social activities, your healthcare professional should tell you about local and national self-help groups, support groups and helplines for people with mental health problems where you can talk to people with similar experiences. If your mental health problem is moderate or severe and has lasted a long time, you may be offered a befriending or rehabilitation programme for extra support.

Depression

If you have mild to moderate depression you should be offered a self-help programme, a treatment called 'computerised cognitive behavioural therapy', a physical activity (exercise) programme or, if you also have a long-term physical health problem, a peer support group. If you are pregnant or have recently given birth you should be offered counselling and support at home.

If self-help, computerised cognitive behavioural therapy, physical activity or peer support have not helped you, you should be offered either a psychological treatment, such as cognitive behavioural therapy (often called CBT) or treatments called 'interpersonal therapy', 'behavioural activation' or 'behavioural couples therapy', or an antidepressant.

You should not usually be offered drug treatment (antidepressants) for mild depression. However, if you have mild depression that has lasted a long time or has not improved after other treatments, if you have had moderate or severe depression in the past, or if your depression is affecting the treatment of a physical health problem, you may be offered an assessment for an antidepressant.

If you have moderate or severe depression you may be offered a psychological treatment (either CBT or interpersonal therapy) together with an antidepressant.

If you decide not to have an antidepressant or the psychological treatments mentioned above, you may be offered counselling or a type of treatment called 'short-term psychodynamic psychotherapy'. However, your healthcare professional should explain that it is uncertain whether counselling or short-term psychodynamic psychotherapy are helpful for people with depression.

If you have moderate or severe depression and a long-term physical health problem, and psychological treatments and antidepressants have not helped, you may be referred for long-term treatment and support from a dedicated team of professionals – this is called 'collaborative care'.

Psychological treatments can help you to understand how to stay well if there is a risk your depression may come back. CBT can help if you become unwell again or if your depression has improved but you still have some symptoms. 'Mindfulness-based cognitive therapy' can help if you are currently well but have had three or more episodes of depression in the past.

For further information on depression see www.nice.org.uk/guidance/CG90/PublicInfo

Generalised anxiety disorder

You should be offered self-help treatment or a group treatment with other people with generalised anxiety disorder (in which you will be offered advice and education about the disorder and coping with symptoms) as initial treatments for generalised anxiety disorder.

If your symptoms are seriously affecting you, or the initial treatments have not helped you, you should be offered a psychological treatment (CBT or a treatment called 'applied relaxation') or drug treatment.

For further information on generalised anxiety disorder see www.nice.org.uk/guidance/CG113/PublicInfo

Panic disorder

For mild to moderate panic disorder you should be offered self-help treatment. If you have moderate to severe panic disorder (with or without agoraphobia) you may be offered a referral for CBT or an antidepressant if you have had the disorder for a long time, psychological treatment has not helped you, or you decide not to have psychological treatment.

For further information on panic disorder see www.nice.org.uk/guidance/CG113/PublicInfo

Obsessive-compulsive disorder

If you have mild to moderate OCD you should be offered CBT that is adapted for people with OCD and includes a technique called 'exposure and response prevention' (called ERP for short); you may be able to do this treatment on your own with a self-help book, by telephone or in a group with other people with OCD.

If you have moderate OCD you should be offered CBT (including ERP) or an antidepressant; if you have severe OCD you should be offered CBT (including ERP) together with an antidepressant. You should be offered treatment at home if you are not able to attend a clinic or have problems related to your OCD that make this necessary.

If you have symptoms that have lasted a long time or are severely affecting your life, you may be offered an appointment with a specialist mental health service.

For further information on OCD see www.nice.org.uk/guidance/CG31/PublicInfo

Post-traumatic stress disorder

If you have PTSD you should be offered psychological treatment (called 'trauma-focused CBT' or 'eye movement desensitisation and reprocessing' or EMDR for short).

You may be offered drug treatment if you prefer it or decide not to have psychological treatment.

For further information on PTSD see www.nice.org.uk/guidance/CG26/PublicInfo

Social anxiety disorder

Advice about social anxiety disorder is being developed by NICE (due to be published in 2013).

Common mental health disorders during and following pregnancy

If you are pregnant or have recently given birth and are offered psychological treatment, you should receive it within 3 months (ideally within 1 month). It is important to treat mental health problems during pregnancy and after giving birth as quickly as possible because of the possible effect of the mental health problem on you and your baby. If you have had depression or anxiety before, you should be offered psychological treatments (CBT or interpersonal therapy).

For further information on common mental health problems during or after pregnancy see www.nice.org.uk/guidance/CG45/PublicInfo

If you have more than one mental health problem

If you have both depression and anxiety, the condition that causes you the most problems may be treated first. Because treatments for anxiety and depression are similar, treatment for one condition can often help the other.

If you have a common mental health problem and are dependent on alcohol, you should be offered treatment for alcohol dependence first as this may lead to improvements in symptoms of depression and anxiety.

For further information on alcohol dependence see www.nice.org.uk/guidance/CG115/PublicInfo

Drug treatment for common mental health problems

If you are offered drug treatment for a common mental health problem, you should be given full information about the treatment, and your healthcare professional should discuss with you any possible side effects and whether it can affect you if you are taking other medication. Once you have started taking the drug your healthcare professional should see you regularly to see how you are getting on.

If you are pregnant or are considering becoming pregnant and you have a common mental health problem, your healthcare professional should take this into account when offering you drug treatment for a mental health problem.

There is more information about drug treatment for particular mental health problems in the links provided in the previous sections.

Questions about treatment

  • Why have you decided to offer me this particular type of treatment?

  • What are the possible risks and benefits of this treatment?

  • What will the treatment involve?

  • How will the treatment help me? What effect will it have on my symptoms and everyday life? What sort of improvements might I expect?

  • When should I start to feel better? What should I do if I don't start to feel better by then?

  • What support should I be offered while I have this treatment?

  • What other treatment options are there?

  • Can you give me a leaflet explaining the treatment?

  • Would it help to make changes to my current treatment?

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