The Role of Therapy, Medication and Lifestyle Changes in Managing Depression

Depression is a common mental health condition that affects around one in six adults in the UK. According to the World Health Organisation (WHO), there are approximately 280 million people in the world living with depression. 

As many people who experience problems with their mental health do not reach out for help, the prevalence of depression is likely to be even greater than currently available data suggests.

Having depression can affect all aspects of a person’s life and it can cause physical, psychological and emotional changes. Symptoms of depression include a persistent low mood, extreme sadness, a sense of hopelessness, appetite changes, problems sleeping or sleeping too much, headaches and stomach problems. People with depression may become isolated, withdrawn and lacking in motivation. Depression can also exist alongside other mental health issues such as anxiety or stress.  

Managing depression often requires a multifaceted approach that includes a range of interventions and strategies designed to help individuals manage their depression and improve their quality of life. In this article we will look at three of the most popular and effective treatment options for depression which are therapy, medication and lifestyle changes.

Therapy: A Cornerstone of Managing Depression 

Talking therapy and counselling are forms of treatment where individuals work with trained professionals to discuss and work through their emotions, thoughts, problems, fears and behaviours. 

Therapy can help people to gain insight into the underlying causes of their depression and equip them with coping strategies. Therapy aimed at dealing with mental health has both long- and short-term benefits. You can access talking therapies on the NHS, although waiting lists may be long, or you can pay to have private treatment.  

The type of therapy that will be most beneficial to you may depend on whether your depression is mild, moderate or severe, whether there was an inciting incident that caused your depression and whether you have other specific issues you would like to work on in your personal life, such as relationship problems. 

Some of the different types of therapy that are used to treat depression include:

• Cognitive behavioural therapy (CBT)
• Mindfulness-based cognitive therapy (MBCT)
• Interpersonal therapy (IPT)
• Psychodynamic therapy 
• Group therapy 
• Counselling for depression  
• Behavioural activation 

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a structured type of talking therapy that helps people to recognise negative and unhelpful thoughts and replace them with more positive, supportive thoughts, ultimately managing depression symptoms. 

CBT has been shown to help people who suffer from depression as well as other mental health conditions.

• CBT teaches long-term techniques that can help to free people from negative thoughts and destructive behaviour patterns
• It is highly goal oriented and requires a commitment from both the therapist and the participant
• The fundamental principles of CBT suggest that our thoughts, feelings and behaviours are all interlinked and CBT seeks to change negative emotions by challenging and changing our thoughts and behaviours 

Mindfulness-based cognitive therapy (MBCT)

MBCT combines mindfulness techniques such as meditation and deep breathing with traditional CBT techniques. It can be used to help prevent depression from recurring, as well as to treat anxiety and stress. 

Interpersonal therapy (IPT)

IPT is a treatment that aims to help people with depression to identify and address problems in their relationships. It may include examining issues within family dynamics, problems with romantic partners or even tension between friends:

• Relationship problems can make us feel low and depressed
• In turn, depression can interfere with our relationships and how we interact with others
• The above can lead to a vicious cycle where we fail to address the root cause of our problems and continue to feel down and depressed 

The main goals of IPT are to reduce depressive symptoms, understand how to improve relationship dynamics by making necessary adjustments and provide the necessary tools to address stressful situations in a more positive way. 

IPT is usually offered for 16 to 20 sessions. 

Psychodynamic therapy 

Psychodynamic therapy delves into our past and childhood and helps us to uncover our unconscious mind (the thoughts we are not consciously aware of). It aims to help us understand how our current feelings and behaviours are shaped by past experiences and unconscious thoughts. This type of therapy is usually delivered one to one, over multiple sessions. 

Group therapy 

Support groups for people with depression can help to alleviate loneliness and isolation and connect people with peers who can relate to their struggles. 

Group therapy and peer support are a form of self-help, where people are able to support others as well as receive support themselves. 

Going to a group support session can be a daunting task, especially if you struggle with social anxiety in addition to depression. Although you may find group support is more welcoming and less scary than you think, you may prefer to try an online forum initially where you can read about other people’s experiences and share your own. 

Counselling for depression  

Counselling is talked about interchangeably with therapy but counselling is actually a type of treatment on its own.

Counselling for depression involves spending time with a trained therapist who will listen to you and support you without judgement or criticism. To get the best out of a counselling session you need to be willing to open up and be honest.

Counselling is less structured than other therapies such as CBT. Counsellors may ask you questions about your experiences and feelings, with the goal of helping you to overcome obstacles and find solutions. 

Attending therapy for depression has multiple benefits for participants, including:

• Helps individuals to gain self-awareness and insight 
• Teaches powerful coping mechanisms that can be used to challenge disruptive and intrusive thoughts 
• Provides positive coping skills and tools for managing depressive symptoms 
• Offers a safe space to disclose private experiences and try to process difficult emotions 
• Improves emotional and psychological wellbeing, leading to positive changes in both the mind and body
• Helps people to articulate and communicate complex feelings or identify unconscious thoughts 
• May reduce stress, provide a sense of control and a deeper understanding of oneself 
• Provides structure to a person’s week with regular appointments (when depression may make them want to hide away at home) and gives them goals to work towards 

Behavioural activation 

This type of therapy can be effective in dealing with mild to moderate depression and low mood. It is a structured, step-by-step process aimed at helping people make gradual, necessary changes to their routine to make them feel better. It requires thinking about regular activities and breaking them down into three categories:

• Necessary 
• Pleasurable
• Routine

Depression can leave people stuck in a vicious cycle of low mood and lack of energy that leads to withdrawal from society and reduction in physical activity, which in turn leads to even lower mood and less energy. Behavioural activation seeks to break this cycle by encouraging participants to engage in activities, bit by bit, allowing them to regain a sense of control over their life. 

This type of therapy can be done one on one with a therapist (in person, online or via a phone call) or in a group setting. As with CBT, it requires you to plan, set goals and track progress but there is more of an emphasis on physical activities and motivation rather than thoughts and feelings, although behavioural activation can also help strengthen problem-solving abilities and resilience. 

Innovations in technology now allow people to access professional services via teletherapy from the comfort of their own home via video or audio connections. 

Teletherapy can help to reduce the cost burden of travelling to appointments and is especially helpful to people who struggle with social anxiety in addition to depression. Teletherapy is an accessible and cost-effective method of delivering therapy. A 2020 study found that online CBT was just as effective as in-person CBT in reducing depressive symptoms.

Medication: A Critical Tool for Balancing Brain Chemistry and Managing Depression 

If you have moderate to severe depression your doctor may prescribe you antidepressants.

Antidepressants are a type of medication (usually a tablet) that you take on a regular basis to control symptoms of depression, as well as some other mental health conditions including OCD and anxiety.

The medication is thought to work by addressing chemical imbalances in the brain which can lead to depression. They do this by increasing the activity of certain neurotransmitters in the brain, such as serotonin and noradrenaline. These chemical messengers can influence mood and emotional regulation. 

Selective serotonin reuptake inhibitors (SSRIs) 

Selective serotonin reuptake inhibitors (SSRIs) are a widely used type of antidepressant. After carrying a chemical message in the brain, serotonin (the ‘feel good’ hormone) usually goes through a process called ‘reuptake’ where it is reabsorbed. SSRIs prevent the reuptake and extend the availability of serotonin in the brain. 

Like all medicine, antidepressants can have side effects, including:

• Feeling agitated, shaky or nervous 
• Nausea and diarrhoea
• Dizziness 
• Blurred vision
• Low sex drive or problems with sexual dysfunction 

There are currently eight SSRIs prescribed in the UK:

• Citalopram (Cipramil)
• Dapoxetine (Priligy)
• Escitalopram (Cipralex)
• Fluoxetine (Prozac or Oxactin)
• Fluvoxamine (Faverin)
• Paroxetine (Seroxat)
• Sertraline (Lustral/ Zoloft)
• Vortioxetine (Brintellix)

Noradrenaline and specific serotonergic antidepressants (NASSAs)

NASSAs can be taken by people who cannot take SSRIs. They have been known to have similar side effects to SSRIs, although they may not interfere with sexual function to the same degree. 

The main NASSA prescribed in the UK is mirtazapine (Zispin).

Tricyclic antidepressants (TCAs)

TCAs were first introduced in the late 1950s as a way to treat major depressive disorder. Although they are an effective treatment for depression they are not recommended as a first line of defence as they pose a greater risk of overdose than more modern antidepressants and can cause worse side effects.

Examples of TCAs include: 

• Amitriptyline
• Clomipramine
• Dosulepin
• Imipramine 
• Lofepramine 
• Nortriptyline

This medication may still be prescribed to people with depression who have not responded well to other treatment. TCAs may also be used to treat other mental health conditions, for example OCD and bipolar disorder.

It can take some time for your body to get used to antidepressants and you may have to be patient whilst finding the correct antidepressant and dosage for you. During this time, you may experience a range of physical side effects and you may feel less alert or able to concentrate. 

They also come with a small risk of serotonin syndrome which is a rare but dangerous medical problem. You are at greater risk of serotonin syndrome if you take antidepressants (especially SSRIs) as well as certain prescribed medications, for example lithium or opiate painkillers, or some illegal drugs.

Some people find taking antidepressants is beneficial for them and helps them to manage the symptoms of their depression, especially when used in conjunction with therapy or as a short-term solution whilst waiting for NHS therapy.

Lifestyle Changes: Empowering Long-Term Wellbeing 

In addition to medication and therapy, there are a number of lifestyle changes you can make, as well as strategies you can use, to help you live well with depression and lift your mood.

Key lifestyle changes to empower long-term wellbeing include:

• Regular physical activity and exercise
• Healthy eating
• Getting enough sleep
• Mindfulness, meditation and stress reducing techniques
• Social connections and support networks

Regular physical activity and exercise 

Exercise can make you feel better, both mentally and physically. Physical activity and exercise boosts endorphins (feel good hormones), as well as improving circulation and increasing oxygen levels.

Depression often makes us want to hide away; however, making an effort to incorporate physical activity into your routine can improve your mood, help you to get out socialising with people and increase levels of self-esteem.

The type of exercise you do may depend on your fitness levels, any mobility issues you have and what sports you enjoy. You can start small and increase your activity over time if needed.

Activities to consider include:

• Yoga
• Swimming
• Walking
• Running
• Boxing
• Stretching
• Tai chi

Healthy eating 

A healthy diet supports our mental and physical health, as well as our immune system.

Tips for a healthy diet include:

• Eat at least five portions of fruit and veg per day
• Stay hydrated
• Avoid high fat and high sugar foods
• Include healthy fats such as omega-3 in your diet
• Avoid ultra-processed food
• Limit alcohol and caffeine intake

Depression has been linked to a lack of certain vitamins and minerals, including B vitamins. You can take dietary supplements if you are lacking in certain nutrients.

Getting enough sleep 

Sleep has a significant impact on our mood and ability to function properly. Having depression can affect sleeping patterns and poor sleep can also impact our mental health.

Tips for getting a good night’s rest include:

• Establish a routine (go to bed at the same time each night and get up at a similar time each day)
• Ensure your sleeping area is quiet, comfortable and at an adequate temperature
• Avoid screen time just before bed
• Alcohol and caffeine can interfere with our circadian rhythm, opt for evening drinks such as a relaxing camomile tea
• If you struggle to get to sleep, try some relaxation techniques just before bed such as a few minutes of quiet meditation

Mindfulness, meditation and stress reducing techniques 

Relaxation techniques such as mindfulness, meditation or deep breathing can help to lower our stress levels and help us to focus on the present moment and quieten negative chatter inside our minds.

Some research has suggested that taking time out for regular relaxation practices can change how the brain responds to stress and anxiety.

Practising mindfulness, meditation and deep breathing helps us to focus our attention calmy inwards, whilst putting some distance between ourselves and our problems. This can help us gain a sense of control over ourselves as we begin to recognise that our minds and bodies are separate from our problems and our problems do not have to control us.

Social connections and support networks 

Staying connected to others is essential when we have depression, even if it may be tempting to close yourself off.

Tips to stay connected include:

• Use technology to contact others even if you cannot face going outside
• Talk to your friends and family about how you are feeling rather than shutting them out
• Try to do at least one activity each week that you enjoy (cinema, exercise class, going out for a coffee etc.)
• Getting out in nature has been shown to boost our mood – try to incorporate being out in nature with socialising such as having a picnic in the park with a friend or visiting the beach
• If you have to turn down an invitation due to your mental health, be honest and let people know that you want them to keep inviting you

Some people with depression find that using certain complementary therapies can help them to relax, feel better and boost their mood. This includes therapies such as:

• Aromatherapy
• Massage
• Guided imagery
• Reflexology
• Herbal remedies (such as St John’s Wort)

Although complementary and alternative therapies will not cure depression, they may help to alleviate symptoms and provide people with relaxing, positive and enjoyable experiences. If you are on antidepressants, you should check with your GP before trying any alternative treatments in case they may interact negatively with your medication.

Conclusion

Depression is a mental health condition that affects millions of people of all ages across the globe. Treatments for depression include medication, therapy and lifestyle changes. A holistic approach to treatment that focuses on the whole person is essential to improve outcomes and reduce the way depressive symptoms affect our lives.