Talking therapies offer two advantages over medications: no side effects from drugs, and tools you can use for the long term. There are three main psychotherapies used in Australia:
Cognitive behavioural therapy (CBT) is the most accessible. Many psychologists and some psychiatrists perform it in individual or group sessions, usually weekly for about 12 weeks. The focus is on learning to spot negative thoughts as they occur, and changing to a more realistic way of thinking. The therapist may also help the person unearth and challenge any deepseated negative assumptions they may have about themselves and the world. There is homework with each session and, by the end of treatment, the person should have learned some valuable skills to apply later in life, ideally to prevent further depressive episodes.
Interpersonal psychotherapy (IPT) also requires about 12 sessions. There are fewer trained practitioners in Australia than for CBT, but it is equally effective. It works on the premise that interpersonal problems may either be causing the depression or preventing it from getting better. The therapist helps the person identify one or two problems that are making their life difficult and learn techniques such as improving communication skills or actively expanding one’s social life to address them.
Longer-term analytic psychotherapy was famously used by Sigmund Freud in the 1930s. It is still popular today and involves one or more sessions per week, often for years, delving into the past – especially childhood – to find reasons for problems in the present. It’s very challenging work for both the patient and the therapist, and less useful for simple depression in an otherwise well-adjusted person. It is more helpful when significant childhood problems have resulted in chronic unhappiness and instability.
Both CBT and IPT have been proven to be as effective as antidepressants for mild to moderate depression. For the more severe melancholic form of the illness, they remain useful after the person has recovered enough, with the help of a powerful antidepressant, to be able to think clearly.
Exercise, relaxation techniques, yoga and meditation can all help alleviate depression, but motivation can be a big stumbling block as it’s hard for many people to make themselves exercise regularly, even when well. For a depressed person – who’s feeling lethargic and unmotivated, with black thoughts that sap the will – it’s even harder. However, because exercise boosts serotonin levels and neurotrophins and improves self-esteem, vigorous physical exercise about five times a week can greatly improve mild or moderate depression.