Disclaimer: This blog post was not written by a doctor and is therefore not advising on which treatment options are the most effective or providing any recommendations for the reader. If you would like to seek a diagnosis, please consult your GP first. If you would like to discuss any of these treatment options or make any changes to your current treatment plan, please consult your GP or psychiatrist. Although we offer some of these services or treatment options, we are not mentioning them based on this.
For those who have been diagnosed with depression, you may be wondering what treatment options are available to you. You may have already discussed some of these options with your GP or psychiatrist, but it may be a lot to take in. The point of this blog post is to summarise the information available about the different options that are offered for someone who has been diagnosed with depression in the UK.
The NHS (2019) recommend a combination of self-help, talking therapies and medication. They also state that the treatment program recommended to you by your GP (or psychiatrist) will be based on the type of depression you have. The NHS use 3 different terms or ‘types’, including mild depression, mild to moderate depression, moderate to severe depression. Bear in mind that some consultants may not word it exactly this way, but you can clarify it with them.
If you have been diagnosed with mild depression, your GP or psychiatrist may advise you to come back for a follow-up appointment to see if your symptoms persist before offering you any treatment. They sometimes call this ‘watchful waiting’. The time between appointments will depend on different factors, but usually it is around 2 weeks. If this is not the case, or possibly in this time between appointments, they may recommend some lifestyle changes, services or applications:
- Beginning or increasing the amount you exercise. There is a ton of research available on how exercise can help treat symptoms of depression (in fact it is good for a number of health problems). It can improve mood and reduce anxiety as during exercise ‘feel-good’ endorphins are released, which are capable of enhancing your sense of well-being whilst simultaneously distracting you from your worries. Your GP or psychiatrist will suggest what sort of exercise options and durations could be good for you. In order to receive the most out of this option, it is important that you enjoy the workout you are doing, to upkeep motivation levels, and to be safe, including not overexerting yourself, injuring yourself and keeping within governmental guidelines. Obviously, there are some people that may be unable to utilise this option, for example those who may not be physically well enough, but your GP or psychiatrist will be able to advise further. If you want read more information about exercise and the benefits, please see this NHS webpage: https://www.nhs.uk/conditions/stress-anxiety-depression/exercise-for-depression/
- They may recommend that you self-referto services that are available. Improving Access to Psychological Therapies (IAPT) is a psychological therapy service provided by the NHS and does not always require a referral from your GP. Usually, it is your responsibility to make initial contact with this service in order to get a consultation, whereby the relevant professional may (or may not) recommend some therapy to you. Options they offer include Cognitive Behavioural Therapy (CBT), Interpersonal therapy (IPT), guided self-help or counselling (for an in-depth booklet about the services offered: https://www.bacp.co.uk/media/1977/bacp-choice-of-therapies-in-iapt.pdf). Due to COVID-19, many of their services have moved online so it is likely that therapy will be over the phone or through some other remote means. The waiting time for the first session can vary and only the service in your area can tell you how long this may be. You can seek private treatment in the meantime, or if you require urgent help, please call the Samaritans on 116 123 (free) or email jo@samaritans.org. If you would like to see where your nearest IAPT service is located and their contact details, please click on this link: https://www.nhs.uk/conditions/stress-anxiety-depression/exercise-for-depression/.
- They may encourage self-help. This may include speaking with your family and friend or a support group. Mind offer some very good services and support, you can contact your closest Mind service here: https://www.mind.org.uk/information-support/local-minds/. Another self-help option that may be suggested is reading a self-help book. It is possible that your GP or psychiatrist has a preference or will recommend some based on your symptoms, alternatively they may provide you with a list of titles that you should investigate into and choose.
- They may recommend that you trial out some mental health applicationsthat you can download to your phone or tablet. Similar to above, they may have a preference or provide you with some recommendations. If you would like to see a list of applications approved by the NHS, please see this link: https://www.nhs.uk/apps-library/category/mental-health/. Not all applications are free or available on all operating systems so you must keep this in mind. It is also good to read user reviews before downloading each or any application.
If you have mild to moderate depression, your GP or psychiatrist may suggest the options above and put particular emphasis on trying the talking therapies mentioned above (IAPT).
- If you are eager to give this a try and your local IAPT services waiting time is too long, you can seek private services in your area. It is probable that many private clinics have moved over to remote consultations, and may also be offering this nationwide, meaning you may have a larger selection to choose from. If this is overwhelming for you, you can ask your GP if they have any recommendations and refer you. Although this may not be a plausible option for everyone, if you are working, you could consult with your employer to see if they would provide any financial support or enquire with your medical insurance company, if you have it, and see if your policy includes psychological or psychiatric treatment. To see the range of private services that are available, see our website: https://phoenix-mhs.com/services/.
If you have moderate to severe depression, your GP or psychiatrist may recommend additional options to the ones above.
- They may prescribe antidepressants. There are different types, suggested doses and durations and can only be prescribed by your GP or psychiatrist. Although the literature is not entirely certain on how antidepressants work, the general consensus is that they increase the levels of neurotransmitters, which are chemicals, in the brain. Different antidepressants can target different neurotransmitters, more specifically the ones that are linked to mood and emotion (and pain). In terms of effectiveness, the Royal College of Psychiatrists have estimated that 50-65% of people treated with an antidepressant for depression will see some improvement, compared to 25-30% with a placebo. Your GP or psychiatrist will have an in-depth conversation with you about this option prior to initiation.
- They may recommend a combination approach. This refers to a treatment option that combines a course of antidepressants and talking therapy – research has shown that these two options together usually work better than either option alone.
- If your depression is regarded as severe by your GP or psychiatrist, they may refer you to a mental health team, usually including a psychiatrist, psychologist, specialist nurse and occupational therapist all responsible for your different aspects of your care. This sort of treatment option is very targeted, personalised to the individual and more intense. This can occur in an outpatient setting or, if it is deemed necessary, an inpatient setting.
There are some other treatments shown to be effective for treating symptoms of depression that your GP or psychiatrist may not initially suggest, which you can discuss with them. Not all options are available (or easily available) on the NHS.
- Repetitive Transcranial Magnetic Stimulation (rTMS): This is a form of brain stimulation often recommended for those who experience persistent and severe symptoms or for those whose depression is resistant to antidepressants. This treatment is approved by the National Institute for Health and Care Excellence (NICE) and offered in some NHS hospitals, but very few. In rTMS, repetitive pulses of electromagnetic energy are delivered at various frequencies to specific areas of the brain to improve symptoms of depression. See NICE guidelines here: https://www.nice.org.uk/guidance/ipg542. This is something we offer, you can contact us for more information.
- Electroconvulsive Therapy (ECT)is another form of brain stimulation that has been available for a very long time and is also NICE approved. However, a very recent published meta-analysis found that it is not any more effective then placebo. You may still want to discuss this in more detail with your GP or psychiatrist as it is currently available.
- Transcranial Direct Current Stimulation (tDCS)is also another form of brain stimulation. This involves a small battery-operated stimulator that delivers constant low-strength current through 2 electrodes placed on your head. This electric current is thought to improve symptoms of depression. It is a lot less intense compared to the 2 previous methods and in some cases it can be self-administered, NICE also have some guidance on this, view here: https://www.nice.org.uk/guidance/ipg530/ifp/chapter/What-has-NICE-said
- Mindfulness: This involves paying close attention to the present moment, focusing on your thoughts, bodily sensations, feelings and the world around you to improve your mental wellbeing. The aim of mindfulness is to teach to how to understand your mind, interpret your bodily sensations and learn more appreciation for these things, all of which can reduce anxiety. This treatment option is recommended by NICE, see their guidelines here: https://www.nice.org.uk/guidance/cg90
- St John Wort: This is an herbal treatment that some people take for their depression and can be bought over the counter at pharmacies or from health food shops. There is some evidence that is may help with mild to moderate depression, but it is not recommended by doctors due to the inconsistences in active ingredients across different brands and batches. If you intend to take this, you should still consult your GP as there are some contra-indications you need to be aware of.
- Lithium: Your GP or psychiatrist may prescribe this if there have been no improvements with antidepressants. It can be used in combination with your current treatment. They will have an in-depth discussion with you about this before initiation.
Phoenix Mental Health Services offers nationwide remote consultations for most of our psychiatric and psychological services and some face-to-face appointments. Please email enquiries@phoenix-mhs.com or call 0870 162 0673 for more information.