In a recent report, Mind (National Association of Mental Health) revealed that 93 per cent of GPs in the UK have at times prescribed antidepressants due to a lack of alternative treatment options. What were they thinking?

There are many alternatives for depression that work well in addition to or in place of anti-depressants. For me it takes a combination of treatments to stay well; medication plus a healthy lifestyle ( good food, exercise, less coffee, more sunlight, avoiding stress).

Before I continue, let me make a clarifying point. A small proportion of people with depression have what is termed melancholic or biological depression. This includes people with bipolar disorder. For such people medicine is almost always needed to reach or remain in good health, while non-medical treatments are considered to be supplementary. For the more usual non-melancholic depression, treatments that use strategies other than medication are common.

Anyway, back to the merits of different treatments. If you want to look up one of the following terms the Medicine Net medical dictionary should have a definition.

The Centre for Mental Health Research (link below) did a survey of the scientific literature available, and ranked treatments according to the depth and quality of evidence supporting them.

Medical treatments

Antidepressants and electro-convulsive therapy are both ranked highly with strong scientific evidence for their effectiveness.

Psychological treatments

Cognitive behavioral therapy ranks highest with strong evidence for being very effective. Interpersonal psychotherapy, psychodynamic psychotherapy and bibliotherapy are all on the next tier. They are supported by scientific evidence as being effective, but the evidence is not as strong.

Lifestyle & Alternative Therapies

Exercise, light therapy and St John’s Wort are ranked on the second tier as useful treatments, with good evidence but not as strong as for, say, antidepressants. On the third tier there is a large group of other promising treatments with less evidence in support. It includes acupuncture, alcohol avoidance, massage therapy, relaxation therapy, vitamins and yoga.

The Black Dog Institute took a different approach, surveying what patients rated as the most helpful treatments. The leader of the study Professor Gordon Parker said that patients “do not necessarily share the views of professionals about effective therapies for depression”. Yes, we can be fairly incisive about what is or isn’t working!

2,692 individuals took part in the survey. Leaving aside medicines and “talk” therapies, people with depression rated exercise as being the most helpful. They considered yoga, meditation, relaxation and massage to be the next most beneficial. Acupuncture and homeopathy followed with moderate ranking scores, while the various herbal and Omega 3 preparations returned the lowest rankings.

So there you have it. My experience is that it takes more than drugs to get well. The more aggressively you pursue all of the the things that work for you, the more likely you are to maintain good health. Putting it into practice is the hard part!

Centre for Mental Health Research
Black Dog Institute (see the news release dated 18/2/07)
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