Treatment

Most people with moderate or severe depression benefit from antidepressants, but not everybody does.You mayrespond to one antidepressant but not to another,and youmay need to try two or more treatments beforeyoufind one that works for you.

The different types of antidepressant work about as well as each other. However,side effects varybetween different treatments andpeople.

When you start taking antidepressants, you should see your GP or specialist nurse every week or two for at least four weeks to assess how well they're working. Ifthey're working, you'll need tocontinue taking them at the same dose for at least four to six months after your symptoms have eased.

If you've had episodes of depression in the past, youmayneed tocontinue totake antidepressants for up to five years or longer.

Antidepressants aren't addictive, but you mayget some withdrawal symptoms if you stop taking them suddenly or you miss a dose (see below).

Selective serotonin reuptake inhibitors (SSRIs)

If your GP thinks you would benefit from taking an antidepressant, you'll usually be prescribed a modern type called a headaches , a dry mouth and problemshaving sex. However, these side effects usually improve over time.

Some SSRIsaren't suitable forchildren and young people under 18 years of age. Research shows that the risk of National Institute for Health and Care Excellence (NICE) for treating severe depression in adults.

Common side effects associated with vortioxetine include abnormal dreams, constipation , diarrhoea , dizziness, itching , nausea and vomiting.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are a group of antidepressants that areused to treat moderate to severe depression.

TCAs, including imipramine (Imipramil)and amitriptyline,have been around for longer than SSRIs.

Theywork by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood.

They're generally quite safe, but it's a bad idea to smoke cannabisif you're taking TCAs because it can cause your heart to beat rapidly.

Side effects of TCAsvary from person to person but may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness.

The side effectsusually ease afterseven to 10 days, as your body gets used to the medication.

Other antidepressants

New antidepressants, such as venlafaxine (Efexor),duloxetine (Cymbalta or Yentreve)and mirtazapine (Zispin Soltab), work in a slightly different way from SSRIs and TCAs.

Venlafaxine and duloxetineare known as serotonin-noradrenaline reuptake inhibitors (SNRIs). Like TCAs,they change the levels of serotonin and noradrenaline in your brain.

Studies have shown that an SNRI can be more effective than an SSRI, but they're not routinely prescribed because they can lead to a rise in blood pressure.

Withdrawal symptoms

Antidepressants aren't addictive in the sameway thatillegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including:

• upset stomach
• flu-like symptoms
• anxiety
• dizziness
• vivid dreams at night
• sensations in the body that feel like electric shocks

In most cases, these are quite mild and last no longer than a week or two, but occasionallythey can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) andvenlafaxine (Efexor).

Withdrawal symptoms occur very soon after stopping the tablets, so are easy to distinguish from symptoms of depression relapse, which tend to occur after a few weeks.

Further information:

How long does it take for antidepressants to work?

Can I drink alcohol if I'm taking antidepressants?

How should antidepressants be stopped?

Other treatments

Mindfulness

Mindfulness involves paying closer attention to the present moment and focusing on your thoughts, feelings,bodily sensations, andthe world around you to improve your mental wellbeing.

The aim is to develop a better understanding of your mind and body, and learn how to live with more appreciation and less anxiety.

Mindfulness is recommended by the National Institute for Health and Care Excellence (NICE) as a way of preventing depression in people who've had three or more bouts of depression in the past.

It's available from health food shops and pharmacies.

There's some evidence that it may help mildto moderate depression, butit's not recommended by doctors. This is because the amountof active ingredients varies among individual brands and batches, soyou can neverbe surewhat sort of effect itwill have on you.

Taking St John's wort with other medications, such as anticonvulsants, Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is sometimes recommended in cases of severe depression where other treatments, including antidepressants, haven't worked.

For most people,ECT is effective at relieving severe depression, although the beneficialeffect tends to wear off after several months.

Some people also experience unpleasant side effects after having ECT, including short-term headaches, memory problems, nausea and muscle aches.

There are two types of ECT recommended by NICE transcranial direct current stimulation (tDCS) andrepetitive transcranial magnetic stimulation (rTMS). These are discussed below.

Transcranial direct current stimulation (tDCS)

Transcranial direct current stimulation (tDCS) involves placingelectrodes on your head.

You'll remain awake and alert throughout the procedure, which is usually carried out by a trained clinician. However,it's sometimes possible for tDCS to be self-administered. The treatment can be usedon its ownor in addition to other treatments for depression.

Treatmentsessions are carried out daily andlast for about 20-30 minutes, with a course of treatment typically lasting several weeks.

Treatment with tDCSis safe and has been found to be effectivein some cases. There's some uncertainty about the way tDCS is delivered, the number of treatments needed, and how long its effects last, so further research in these areas is needed.