A guide to depression
and its treatment
Depression is common
Depression is common. It affects more than 264 million people worldwide.1
Depression is much more than simply feeling “fed up“
Depression affects different people in different ways
Depression affects different people in different ways, and the symptoms can include sadness, feeling empty and hopeless, diminished interest or pleasure, problems eating, problems sleeping, restlessness or being slowed down, lack of energy, low self-esteem, guilt, difficulty concentrating and making decisions, or even thoughts about death.4
Depression can evolve over time
In some people, depression can be progressive with symptoms changing and evolving over time.4,5 For these people, longer and more frequent episodes of depression might increase vulnerability to further episodes, triggering a progressive course.5 It is therefore important to seek help early because if left untreated, depression can have a significant negative impact.6 Mental health specialists encourage early and appropriate treatment to avoid symptom progression.6
Reversing the vicious cycle of depression
Depression can have a huge impact on your life, daily routines, and behavior which can actually make your depression worse and stop you from getting better. When this happens, you have become locked in a “vicious cycle“ of depression.3 But, it is possible to reverse this cycle by seeking appropriate help and support.3
What are the different
There are different ways to reach recovery
Depression is not a sign of weakness or something you can just “snap out of”. But, with the right treatment and support, people with depression can progress towards recovery.2 The main goal of treatment will be the complete relief of your symptoms (this is called remission) and when this happens in the longer term, this is called recovery7,8 To achieve this, treatment can involve medications, and/or psychological therapies which are sometimes called talking therapies.2,7,9,10,11 Support programs and the sharing of personal experiences can also play a very important role in recovery.2,7,10 What type of treatment you receive will be based on several aspects including symptom severity and your preference.2,7 Your doctor will explain the different treatment options to you and, taking into account your preferences, will decide which is the best and most appropriate for you.9
Types of treatment
These are prescribed medicines and there are several different types of antidepressants.7,9 The choice of the antidepressant prescribed will depend upon the severity of your depression and how long you have been depressed, your age, any other medical conditions you might have, whether you have previously been treated with antidepressants, and your preference.9,11
These types of therapies include cognitive behavioral therapy (CBT), electronically-delivered cognitive behavioral therapy (eCBT), and interpersonal therapy (IPT). In some people, outcomes are improved when psychological therapies are combined with antidepressants.7,10,11
- Other treatments that aim to stimulate the brain, such as electroconvulsive therapy (ECT), deep brain stimulation (DBS), or transcranial magnetic stimulation (TMS) can be useful and prescribed by your doctor.12
- Physical activity is increasingly proposed as treatment for depression as well.11
- While not strictly classified as a treatment, support programs can play a very important role in recovery for many people.2,7,10 Support programs are sometimes referred to as peer support and allow people with depression to share their experiences. Peer support can be helpful either alone or combined with antidepressants and/or psychological therapies.10 Sharing experiences with others in a similar situation can help you to gain a better understanding of your depression.
- Mindfulness can also be proposed and relaxation techniques may reduce depressive symptoms.7,13
Depression can be treated by different means including antidepressants and/or psychological therapies7,9,10,11
What type of treatment you receive will be based on several aspects including symptom severity and your preference7,9,10,11
Support programs allow people with depression to share experiences7,12
WHO. Depression. Available from: https://www.who.int/mental_health/management/depression/en/. Accessed on: February 5, 2020.
NHS. Clinical depression. Available from: https://www.nhs.uk/conditions/clinical-depression/. Accessed on: December 9, 2019.
Government of Western Australia. Department of Health. Depression: Reversing the vicious cycle. Available from: https://healthywa.wa.gov.au/Articles/A_E/Depression-reversing-the-vicious-cycle. Accessed on: December 9, 2019.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5 ed. Washington, DC: American Psychiatric Press 2013.
Moylan S, Maes M, Wray NR, et al. The neuroprogressive nature of major depressive disorder: Pathways to disease evolution and resistance, and therapeutic implications. Mol Psychiatry. 2013;18(5):595-606.
Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13(4 Suppl):S92-7.
National Institute for Health and Clinical Excellence. Depression in adults: Recognition and management. Clinical guideline 90. Last updated April 2018. Available from: https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742638037. Accessed on: December 9, 2019.
Furukawa TA, Fujita A, Harai H, et al. Definitions of recovery and outcomes of major depression: Results from a 10-year follow-up. Acta Psychiatr Scand. 2008;117(1):35-40.
Kennedy SH, Lam RW, McIntyre RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. Can J Psychiatry. 2016;61(9):540-560.
Parikh SV, Quilty LC, Ravitz P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 2. Psychological treatments. Can J Psychiatry. 2016;61(9):524-539.
Qaseem A, Harris RP, Forciea MA, et al. Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):350-359.
Malhi GS et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2015;49(12):1087-1206.
Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression (Review). Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007142.
If your symptoms worsen, please consult a health care professional, such as your referring doctor.