Treatments for mild to moderate depression

Treatments for mild to moderate depression

Mild depression can sometimes get better by itself without treatment or by following advice from your GP (or other healthcare professional) on coping with problems and improving sleep. They should offer you advice on going to bed and getting up at regular times, not eating large meals or smoking or drinking alcohol just before going to bed, and taking regular exercise (as this can also improve sleep).

If you do not want treatment or if your healthcare professional thinks you may recover without it, you should be offered another appointment within 2 weeks to see how you are. Your healthcare professional should contact you if you miss this appointment.

Possible first treatments for mild to moderate depression include a self-help programme, a treatment called computerised cognitive behavioural therapy and a physical activity programme (exercise). These are described in the table below, 'Initial treatments for mild to moderate depression'. If you decide not to have these treatments or they are not available, you may be offered cognitive behavioural therapy (CBT for short) in a group with other people who have similar problems (see table below, Psychological treatments for depression).

Initial treatments for mild to moderate depression[a]

What treatment have I been offered?

What does it involve?

How long does it usually last?

Self-help programme

A treatment in which a person works through a book, often called a self-help manual. A healthcare professional will provide support and check progress either face to face or by phone.

Up to 6 to 8 sessions over 9 to 12 weeks.

Computerised cognitive behavioural therapy (CCBT)

A treatment based on cognitive behavioural therapy (CBT – see table below, Psychological treatments for depression). The person works through a computer programme that helps them understand depression and develop skills to deal with problems, including challenging negative thoughts and monitoring their own behaviour. A healthcare professional should provide some support, show the person how to use the programme and review their progress.

Between 9 and 12 weeks

Physical activity programme

A group exercise class.

Three sessions a week (lasting 45 minutes to an hour) over 10 to 14 weeks.

[a] Where possible, treatment should be provided in your preferred language.

You should not usually be offered an antidepressant if you have mild depression. But sometimes it may help you – for example if:

  • you still have depression after having the treatments described in Treatments for mild to moderate depression, or

  • your depression has lasted a long time, or

  • you have had moderate or severe depression in the past.

For more information about antidepressants, see Treatments for moderate or severe depression.

Advice on St John's wort

St John's wort is a plant extract that can be bought from health-food shops, herbalists and pharmacies and is used by some people for depression. But your healthcare professional should not offer you St John's wort or advise you to take it, for the following reasons:

  • the correct dose for depression is not clear

  • different preparations vary in what they contain

  • it can cause serious problems when taken with other medicines – particularly the contraceptive pill, anticoagulants or anticonvulsants.

If you would like more advice about St John's wort, ask your GP or pharmacist.

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.

Further treatment for mild to moderate depression

If self-help, computerised cognitive behavioural therapy and/or physical activity have not helped you, your healthcare professional should discuss with you whether to try either an antidepressant (see Treatments for moderate or severe depression) or a psychological treatment.

Psychological treatments include one-to-one cognitive behavioural therapy (CBT) or interpersonal therapy. You may also be offered a treatment called behavioural activation. If you have a regular partner you may be offered behavioural couples therapy. For details of these treatments see the table below, 'Psychological treatments for depression'.

If you decide not to have an antidepressant, CBT, interpersonal therapy, behavioural couples therapy or behavioural activation, you may be offered counselling or short-term psychodynamic psychotherapy (see table below, 'Psychological treatments for depression'). However, your healthcare professional should explain that it is uncertain whether counselling or short-term psychodynamic psychotherapy are helpful for people with depression.

Psychological treatments for depression[a]

What treatment have I been offered?

What does it involve?

How long does it usually last?

Cognitive behavioural therapy (CBT)

CBT is based on the idea that the way we feel is affected by our thoughts and beliefs and by how we behave. People with depression tend to have negative thoughts (such as 'I am a failure'), which can lead to negative behaviour (such as stopping doing things that used to be pleasurable). CBT encourages people to engage in activities and to write down their thoughts and problems. It helps them to identify and counteract negative thoughts.

  • Group CBT consists of a course of sessions run by two healthcare professionals in groups of 8–10 people.

  • Individual CBT takes place in one-to-one sessions with a therapist.

  • Group CBT: 10 to 12 sessions over 12 to 16 weeks.

  • Individual CBT: 16–20 sessions over 3 to 4 months.

People with moderate or severe depression may have two sessions a week at the start of treatment. The treatment may be extended further in order to help people stay well.

Interpersonal therapy

A treatment which helps people with depression to identify and address problems in their relationships with family, partners and friends.

  • Between 16 and 20 sessions over 3 to 4 months. People with severe depression may have two sessions a week for the first 2 to 3 weeks of treatment.

Behavioural activation

A treatment in which the person with depression and the therapist work together to identify the effect of behaviour on symptoms, feelings and problems. It encourages people to develop more positive behaviour, such as planning activities and doing constructive things that they would usually avoid doing.

  • Between 16 and 20 sessions over 3 to 4 months.

People with severe depression may have two sessions a week for the first 3–4 weeks of treatment. A further four sessions may be offered in the 3–6 months after the end of treatment.

Behavioural couples therapy

A treatment that enables couples to understand any links between their behaviour with each other and the symptoms of depression. The aim is to help couples develop a more supportive relationship.

  • Between 15 and 20 sessions over 5–6 months.

Counselling

Counselling enables people to explore their symptoms and problems. Trained counsellors will not usually give advice, but will offer support and guide people to help themselves.

  • Between 6 and 10 sessions over 8 to 12 weeks.

Psychodynamic psychotherapy

A treatment that includes 'dynamic' because it focuses on the different forces (or dynamics) that are present in a person's life and that may be causing them difficulties. The aim is to examine, understand and work through the dynamics and difficulties, which may have begun in childhood.

  • Between 16 and 20 sessions over 4 to 6 months.

[a] Where possible, treatment should be provided in your preferred language.

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