Talking treatments Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) aims to help you understand your thoughts and behaviour and how they affect you. CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present. It teaches you how to overcomenegative thoughts for example, being able to challenge hopeless feelings. CBTis available on the NHS for people with depression or any other mental health problem that it's been shown to help. You normally have ashort courseof sessions, usually six to eight sessions, over 10 to 12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT. OnlineCBT OnlineCBT is a type of CBT that's delivered through a computer, rather than face-to-face with a therapist. You'll have a series of weekly sessions and you should receive support from a healthcare professional. For example, online CBT is usually prescribed by your GP and you may have to use the surgery computer to access the programme. Ask your GP for more information or read more about online CBT and the courses available . Interpersonal therapy (IPT) Interpersonal therapy (IPT) focuses on your relationships with others and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement. There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed. Psychodynamic psychotherapy In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind. This will help you become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems. Counsellors support you in finding solutions to problems, but don't tell you what to do. Counselling on the NHS usuallyconsists of sixto 12 hour-long sessions.You talk in confidence to a counsellor, whosupports you and offers practical advice. Counselling isideal for people who are basically healthy but need help coping with a current crisis, such as anger , relationship issues, bereavement, redundancy, Infertility or a serious illness. Getting help See your GP for more information about accessing NHS talking treatments. They can refer you for local talking treatments for depression. In some parts of the country, you alsohavethe option of self-referral. Thismeans that if youprefer not to talk toyour GP, youcango directly to a professional therapist. Find counselling and psychological therapies in your area . Antidepressants Antidepressants are medicines that treat the symptoms of depression . There are almost 30 different types available. 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 selective serotonin reuptake inhibitor (SSRI) . Examples of commonly used SSRI antidepressants are paroxetine (Seroxat), fluoxetine (Prozac) and citalopram (Cipramil). They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a "good mood" chemical. SSRIsworkjust as wellas older antidepressants and have fewer side effects, although they can cause nausea, 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 self-harm and suicidal behaviour may increase if they're taken by under-18s. Fluoxetine is the only SSRI that canbe prescribed for under-18s, and even then only when a specialist has given the go-ahead. Vortioxetine (Brintellix or Lundbeck) is an SSRI that's recommended by the 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, anticoagulants , antidepressants and the contraceptive pill , can also cause serious problems. You shouldn'ttake St John's wort if you're pregnant or breastfeeding, as we don't know for sure that it's safe. Also, St John's wort can interact with the contraceptive pill, reducing its contraceptive effect. 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. The electrodes are attached to a small, portable battery-operated stimulator, which delivers a constant, low-strength current to the brain. The electric current stimulates brain activity to help improve the symptoms of depression . 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. NICE has more information about transcranial direct currentstimulation for depression . Repetitive transcranial magnetic stimulation (rTMS) Repetitive transcranial magnetic stimulation (rTMS) involves holdingan electromagnetic coil against your head, whichdelivers repetitive pulses of electromagnetic energy are at various frequencies or intensities. This stimulates a part of the brain called the cerebral cortex. Treatment with rTMS usually involves a two to six week course of daily sessions that last about 30 minutes. Evidence suggests that rTMS for depression is safe, although the effectiveness of treatment can vary between individuals. NICE has more information about repetitive transcranial magnetic stimulation for depression . Lithium If you've tried several different antidepressants and there's been no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment. There are two types of lithium lithium carbonate and lithium citrate . Both are usually effective, but if you're taking one that works for you, it's best not to change. If the level of lithium in your blood becomes too high,it can become toxic. You'll therefore need blood tests every three months to check your lithium levels while you're on the medication. You'll also need to avoideating a low-salt diet because it can also cause the lithium to become toxic.Ask your GP for advice about your diet.
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