Treatments (or interventions) for depression fall into one of three categories, and often several are recommended to be taken up at once. These main groupings are: medical interventions; psychological interventions and; lifestyle interventions

Beyondblue, the Australian organisation set up to tackle depression in Australia, has an excellent resource, A guide to what works for depression (Jorm et al, 2009), which outlines the various interventions and rates them according to how effective they are.

Each type of intervention is rated as “thumbs down” (let’s say, zero, or “don’t use”), “one thumb up” (equivalent to a score of one, in cases where there are at least two good studies showing that the treatment works), two thumbs up (given where there are a number of studies showing that the treatment works, but the evidence is not as strong as for the best treatments), or, for the best interventions, three thumbs up (a score of three, given when many studies confirm that the treatment works).

In this article we summarise the top several interventions within the psychological interventions category (those receiving “two thumbs up” or more).

Further reference: This article is based on Beyondblue’s guide’s general framework for reporting on the various interventions (Jorm et al, 2009). Click here to download the guide.

Cognitive behavioural therapy (CBT)

What is it? A person undergoing CBT works with a counsellor or other therapist to identify limiting or unhelpful patterns of thinking and behaviour which are making them depressed, or keeping them from getting better once they become depressed. Over the course of treatment (varying between four and 24 sessions), a client identifies the negative patterns and replaces them with thoughts (“cognitions”) and behaviours which are more positive, realistic, and helpful.

This way of improving mood and coping skills can be conducted in one-on-one therapy or in group sessions. It works by helping the person make changes in the thinking and behaviour – such as self-focused, self-critical thinking and low-energy or avoidant behaviour – which is linked with the depression. Clients begin thinking in a more life-enhancing way, and resuming activities which they may have enjoyed before, or which give them a sense of achievement.

How effective is it? CBT has shown to be effective in reducing the effects of depression for most if not all client groups, including children, adolescents, adults, and older people. Its effectiveness has been shown in more high-quality studies than any other psychological intervention for depression. Some studies show that it is even better when combined with an antidepressant, but it works quite well on its own. It is also good as a tool for preventing relapse after recovery.

What are the risks? There are no known risks.

Advice in a line: CBT is one of the most effective treatments available for depression.

Interpersonal Psychotherapy (IPT)

What is it? Proponents of IPT believe that interpersonal problems are a major cause of depression, and that by focusing on problems in personal relationships and building skills to deal with the problems, clients can come to feel better. Many of the other psychological therapies have the client’s mind as a focus (his or her thoughts and feelings). IPT, conversely, is focused on what is going on between the client and others in the client’s personal relationships.

The treatments vary, but often are conducted over four to 24 weekly sessions. By focusing together on the client’s specific interpersonal problems, client and therapist can identify the patterns in the client’s relationships with others which make the person more vulnerable to depression. Examples of problems could be grief or resentment over lost relationships, client role conflicts or the need to give up some roles and take on new ones, or angst at being over-controlled by others. As clients gain skills in dealing with different interpersonal situations, their mood improves.

How effective is it? Numerous well-designed studies have found IPT to be effective with many groups, including adults, older people, women with post-partum depression, people with HIV infections, and adolescents (this last group has been particularly well studied).

What are the risks? There are no known risks.

Advice in a line: IPT is effective in the treatment of depression.

Behaviour Therapy

What is it? Also called behavioural activation, Behaviour Therapy is part of CBT (above), but only attempts to change people’s behaviour, not their thoughts or attitudes. It aims to increase the level of activity and pleasure people are experiencing in their life. Carried out with individuals or groups, Behaviour Therapy generally lasts between 8 and 16 weeks.

People learn to become more active, and the therapy work often involves doing activities that are rewarding, either because they are enjoyable or because they engender a sense of achievement or satisfaction. By engaging life activities, clients learn to replace patterns of avoidance, inactivity, and withdrawal, which make depression worse, with rewarding experiences that reduce depression.

How effective is it? Many studies have shown CBT, which Behaviour Therapy is part of, to be effective; far fewer have looked at Behaviour Therapy alone. Those studies (often well-designed) which have investigated the effects of Behaviour Therapy have found it to work as well as CBT, and some have even suggested that it may be better than CBT for severe depression.

What are the risks? There are no known risks.

Advice in a line: Behaviour Therapy is an effective intervention for depression, and might be especially good for severe depression.

Marital Therapy

What is it? A depressed person who is also having problems with their long-term relational partner or spouse may be prescribed marital therapy, in which both the depressed person and the partner attend counselling sessions over a period of eight to 24 weeks. A two-pronged approach, marital therapy aims both to reduce the number of unhelpful interactions – such as those involving criticisms, abuse, or arguments – and increase the helpful interactions, such as forgiveness, praise, compassion, and mutual problem-solving.

The focus in marital therapy is on changing behaviour, with the idea that, as the couple’s behaviour in the relationship improves, so too does their satisfaction with the relationship, along with the depressed partner’s mood.

How effective is it? Marital therapy has been shown by research to be far better than no treatment, and roughly as effective as well-established treatments. Obviously, it is most effective when the depressed person is having relational problems; many, but not all, clients are in this situation.

What are the risks? There are no known risks.

Advice in a line: Use marital therapy when there are primary relational problems going on for a depressed person.

Problem-solving Therapy

What is it? In Problem-solving therapy, a client learns from a therapist to go through the whole problem-solving cycle, including: identifying problems, generating solutions, choosing the best solutions, developing and carrying out a plan, and then evaluating to see if the plan worked. It is an effective counter to the depressed person’s perception that problems are too large, difficult, or all-encompassing to solve.

By using standard problem-solving techniques, the person learns to not avoid problems or to attempt to solve them through unhelpful means. Depression lifts as the person discovers new effective ways of dealing with their problems.

How effective is it? The pooled results of numerous well-designed studies show that problem-solving therapy does seem to work, but research is needed to understand the differences in results.

What are the risks? There are no known risks.

Advice in a line: Problem-solving therapy seems to be effective for depression, partly because it includes some aspects of CBT, a well-established treatment.

Psychodynamic Psychotherapy

What is it? By focusing on the unconscious patterns of thoughts and feelings in clients’ minds, plus the unconscious patterns in their relationships, the psychodynamic psychotherapies (such as Freudian, Psychoanalysis, Object Relations, and Psychosynthesis) delve into issues that may be creating depression.

Often these originate in clients’ early childhood years. In these psychotherapies, the therapist uses the thoughts, images, and feelings that pass through the client’s mind, as well as the client’s relationship with the therapist, to uncover the patterns that give cues to internal conflicts in the client: conflicts often occurring out-of-awareness.

By becoming aware of them, clients can resolve the issues and lift the depression. Short-term psychotherapy may take between 20 and 30 weeks. Longer-term psychodynamic psychotherapy can take more than a year, sometimes many years.

How effective is it? There are not many studies looking at psychodynamic psychotherapy specifically for depression, but recent studies pooling the results of studies looking at the effectiveness of these methods for a range of mental health problems have found them to be better than no treatment, and just as effective as standard treatments (such as CBT) for mental health problems in general, including depression.

What are the risks? None to the clients, but the long term of treatment can be time-consuming and thus damaging to their wallets.

Advice in a line: Both short-term and longer-term psychodynamic psychotherapy appear to work for depression. More large studies are needed to confirm what has already been shown.

This article is an extract of the Mental Health Social Support Specialty “Supporting Those with Depression or Anxiety”. For more information on MHSS, visit www.mhss.net.au.    

References:

• Jorm, A.F., Allen, N.B., Morgan, A.J., Purcell, R. (2009). A guide to what works for depression. Beyond Blue, Ltd: Melbourne.