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 (if this is possible) 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 for a person who also has a long-term physical health problem include a physical activity programme (exercise), a peer support group, a self-help programme and a treatment called computerised cognitive behavioural therapy. These are described in the table below.

Initial treatments for mild to moderate depression in people with a long-term physical health problem (Where possible, treatment should be provided in your preferred language )

What treatment have I been offered?

What does it involve?

How long does it usually last?

Physical activity programme

A group exercise class. The instructor will take into account how each person's physical ability might be affected by their particular health problem. The class will also be coordinated with any rehabilitation programme for the physical health problem.

Usually 2 or 3 sessions a week (lasting 45 minutes to an hour) over 10 to 14 weeks.

Peer support group

A series of meetings in which people with the same physical health problem get together to share their experiences and feelings of having the problem. Healthcare professionals should help people to attend the meetings, know about their physical health problem and check their progress.

Usually 1 session a week for between 8 and 12 weeks.

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 in Treatments for moderate or severe 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.

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 above or

  • your depression has lasted a long time or

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

  • your depression is affecting the treatment of your physical health problem.

For more information about antidepressants, see the section on 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.

Further treatment for mild to moderate depression

If physical activity, a support group, self-help and/or computerised cognitive behavioural therapy have not helped you, you should be offered:

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