Cognitive behavioral therapy

In depression, negative thought patterns such as self-doubt and feelings of guilt often make the problem worse. Cognitive behavioral therapy aims to break these patterns bit by bit, so that people feel better about themselves.

Cognitive behavioral therapy combines two treatment approaches:

• Cognitive therapy: Cognitive therapy is based on the idea that problems are often caused less by things and situations themselves, but rather by the importance that people attach to them. So changing the way people see things can be an important step.
• Behavioral therapy: Behavioral therapy is based on the assumption that behavior is learned and can also be unlearned. The goal of behavioral therapy is to identify destructive patterns of behavior, then work at them and change them.

The goal of cognitive behavioral therapy is to become more aware of your own thoughts, attitudes and expectations. This makes it possible to identify false and distressing beliefs, and then change them.

Psychoanalytic approaches

Psychoanalytic approaches include analytical psychotherapy and methods based on depth psychology. They are based on the belief that unresolved, unconscious conflicts can cause depression. The aim is to identify and work through previously unknown issues by talking to a therapist. People who have psychoanalytic therapy have to be prepared to face potentially painful past experiences. Psychoanalysis usually takes longer than approaches based on depth psychology.

Systemic therapy

Systemic therapy approaches place a lot of importance on the relationships between people – for instance, within your family, your group of friends or at work. These relationships can play a role in the development of depression. The therapy might involve trying to improve communication within the family, for instance. The aim is to reduce the symptoms of depression.

Antidepressants

Various medications and groups of drugs are classified as antidepressants. They can have a mood-lifting effect and increase motivation. Antidepressants are often used in combination with psychological treatment. But it usually takes several days or weeks for antidepressants to start working. In acute depression they have to be taken every day for several weeks or months before they start having a noticeable effect. This is often followed by continuation treatment, which lasts four to nine months. How long people take medication for will depend on factors like their symptoms and their risk of having another depressive episode. Some people take antidepressants for years to prevent further depressive episodes.

The possible side effects of antidepressants include a dry mouth, headaches and feeling faint, restlessness and a decreased sex drive. These usually arise within the first few weeks of taking antidepressants. Whether or not someone has side effects, which side effects they have, and how frequent the side effects are will depend on the specific drug and dose that is used.

Different people react a bit differently to medication too. That’s why it’s important to see a doctor regularly while on medication, so they can see how things are going and adjust the treatment if necessary. Towards the end of the treatment, the dose of antidepressants is gradually reduced over the course of several weeks. If someone stops taking antidepressants suddenly, they might (temporarily) have problems sleeping, feel nauseous or restless. Stopping taking the medication as soon as you start to feel better without consulting your doctor can increase the risk of depression returning.

Herbal products

The most common and best-known herbal medicines for the treatment of depression are made from St. John’s wort. These products are often used to treat mild depression. Some are used to treat moderate depression too.

Some St. John’s wort products for moderate depression have to be prescribed by a doctor. When considering taking prescription-free St. John’s wort products (or most other herbal medicines, for that matter), it is important to be aware that there are a wide variety of products on the market, with very different doses and ingredients. Many St. John’s wort products only have a small amount of the extract in them. Herbal products can have side effects and interact with other medications too, so it’s important to consult a doctor before taking St. John’s wort.

Relaxation techniques and yoga

There is some evidence that relaxation techniques can help relieve mild to moderate depression. These include approaches such as progressive muscle relaxation, autogenic training, music therapy and yoga. But they aren't as effective as other treatments, such as cognitive behavioral therapy. Psychotherapists sometimes teach relaxation techniques as part of the therapy, though.

Sports and exercise

Sports and exercise – such as Nordic walking, jogging, cycling, swimming or hiking – are often recommended for the relief or prevention of depression. Many people find that physical activity improves their mood and gives them more energy, and it has been found to help relieve depression in some people too. But research has also shown that physical activity doesn’t generally have a very big impact in people with depression. And there is little research on whether the benefits of exercise last in the longer term. Sports and exercise can be a useful addition to other treatments, though.

It is also not clear how much people might benefit from different types of sports and exercise. Physical activity might not necessarily be suitable for all types of depression either. For instance, people who have severe depression are often not capable of being physically active. Being advised to do more exercise might make them feel even worse.

Light therapy

Light therapy, also known as phototherapy, is used in the treatment of seasonal affective disorder (SAD). This form of depression affects some people during the darker months of the year. Treatment with artificial light is an option here if the lack of natural bright daylight is thought to be affecting their mood. Light therapy involves sitting in front of a special bright light (a light therapy device) for about half an hour every morning.

Sleep deprivation therapy

This treatment involves temporarily depriving the patient of sleep. They stay awake for a whole night and only go to sleep the following night. It is thought that sleep deprivation changes the metabolism in the brain, and that this might lead to an improvement in mood. Sleep deprivation therapy only aims to improve the symptoms temporarily. It can be used in addition to other treatments.

Electroconvulsive therapy

Electroconvulsive therapy is usually carried out in a hospital, under general anesthetic. Electrodes are placed on the patient’s head and a short burst of electric current is passed through the brain, inducing a seizure. The patient can’t feel anything because the procedure is carried out under general anesthesia. Electroconvulsive therapy is usually only considered as a treatment option for people with severe depression if other treatments haven't helped.