Depression

What do we mean by depression or low mood?

Everyone feels down in the dumps occasionally. It's a natural response to difficult events, and it usually passes in a few weeks. People often think that's what depression is. But when depression becomes an illness it involves more extreme feelings, such as worthlessness, loneliness and despair, and these feelings don't go away so easily.

People with depression may lose interest in things that would usually appeal to them (including food and sex). Physical symptoms are also common. Tiredness and loss of energy, a dry mouth, indigestion, loss of weight, sleep problems (particularly early morning waking) and mood swings may all be part of the picture. Severe depression is dangerous because people may start to feel like ending it all. But because these thoughts of suicide are symptoms of depression, they go away when the cause is treated properly. So it's vital to get medical advice if you suspect you are 'clinically depressed'. Depression is curable!

Things that people have found helpful

If you are depressed it won't help if people just say 'pull yourself together'. You will almost certainly need support from healthcare professionals. But there are also many things you can try yourself that may help:

• exercising helps your body produce natural anti-depressant chemicals. Start getting out for a half hour walk or a jog every day
• aim to get enough sleep but don't spend more than 8 hours in bed
• spruce yourself up! Feeling clean and fresh goes more than skin deep
• tackle some housework or potter around in the garden or the allotment
• phone someone you like, who you've lost touch with
• arrange to meet up with people to do something you used to enjoy
• think about volunteering. Being helpful can make you feel better about yourself. To find something in your area go to Volunteering or call 0845 305 6979
• eat a balanced diet and try not to eat too much or too little
• don't let the big picture overwhelm you. Break things down into small tasks and aim to achieve one or two that seem manageable. Success will boost your morale
• when daylight and sunlight are in short supply many people suffer from seasonal affective disorder (SAD). A special light can help - they are widely available. See Seasonal Affective Disorder Association for more information
• discuss potentially useful complementary therapies with your doctor or practice nurse
• don't be fooled that alcohol or recreational drugs will help. They can definitely make depression worse

What other information might be helpful:

• if you think that you might be suffering from anxiety (feeling nervous or having worrying thoughts that are making you feel very tense), you might find our leaflet on STRESS AND ANXIETY helpful
• if you have general feelings of pain in several places in your body and this is making your low mood worse, you might find our leaflet on SORE MUSCLES helpful
• if you think your low mood might be caused by lack of sleep, you might find our leaflet on SLEEP PROBLEMS helpful
• if you are feeling exhausted, you might find our leaflet on TIREDNESS AND FATIGUE helpful

Further information

• NHS Choices
• Royal College of Psychiatrists
• MIND
• BluePages is produced by the Centre for Mental Health Research at the Australian National University. This website provides information on treatments for depression based on the latest scientific evidence. It also offers screening tests for depression and anxiety, a depression search engine, and links to other helpful resources.
• Healthtalkonline is a website where people share their experiences of being unwell. They have a very helpful section where people who have been through depression talk about their experiences.

When to see your doctor

Immediately:

• if you are having thoughts of suicide
• if you have other symptoms as well as problems with low mood
• if you have a medical condition that seems to be getting worse
• if you have realised that you are not just feeling low, but that you are depressed.

• sadness throughout the day, nearly every day
• loss of interest in or enjoyment of your favourite activities
• feelings of worthlessness
• excessive or inappropriate feelings of guilt
• thoughts of death or suicide
• trouble making decisions
• fatigue or lack of energy
• sleeping too much or too little
• change in appetite or weight
• trouble concentrating
• feelings of restlessness or being slowed down

This checklist is only meant to help you discuss your concerns with your doctor and find out about different treatment options. Don't be scared if you recognise the thoughts and feelings listed. If several of them do apply to you, this could mean that you are suffering from depression. But remember, there are good treatments available to help you get through it and back to feeling well again.

If you have recently started taking new medication, it would be also be worth speaking to your doctor about whether this might be making you feel low or depressed.

Make Some Simple Changes

Eating a healthy diet read more Overview It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Improving your diet could help with your mood. The Food Standards Agency has eight tips for eating well: 1 Base your meals on starchy foods. 2 Eat lots of fruit and vegetables. 3 Eat more fish. 4 Cut down on saturated fat and sugar. 5 Try to eat less salt - no more than 6 g a day. 6 Get active and try to keep to a healthy weight. 7 Drink plenty of water. 8 Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing. Treatment Options: Books and Audio Aids read more Overview There is some research showing that using self-help books and audio aids can be helpful for people with depression. There are many books to choose from, and they seem to work even better with support from a professional. Evidence Research has shown that this sort of self-help can be useful for some people with depression. But it isn't for everyone and it takes some effort and good reading skills. Safety There are no safety issues. Cost You will need to pay for the books but the cost is one-off. Find out more The Depression Alliance has a list of recommended self-help books dealing with depression. View References (2) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. Evidence suggests that bibliotherapy is helpful for depressive disorders. However a number of caveats should be noted. The trials have not evaluated the use of bibliotherapy in the absence of any professional involvement. Also, not everyone may benefit from bibliotherapy; there are those who may lack the concentration or motivation required, have insufficient reading skills, or not be suited for personality reasons. There is no evidence on the effects of bibliotherapy in non-clinically depressed people. Link to Abstract Self-help books for depression: how can practitioners and patients make the right choice? Anderson, L., Lewis, G., Araya, R., Elgie, R., Harrison, G., Proudfoot, J., et al. British Journal of General Practice, 55, 387-392. (2005) Link to Abstract Creative Distraction read more Overview It's common sense to try and take your mind off gloomy thoughts. But researchers have found that thinking pleasant thoughts really can lift a low mood, for a while at least. When looking for a distraction, try to do something that's good for your health, rather than, for example, simply sitting in front of the TV eating ice cream and smoking. It is all too easy to end up over-eating and treating your body badly when you are feeling low and tired. But exercise can be a healthy, enjoyable distraction, as can gardening or voluntary work. It's also well known that having a pet can improve low mood, although that doesn't mean it can cure depression. Humour (watching a funny video) improves mood for a while, but it's probably not going to work if you try to beat depression with humour alone. Listening to music can help lift mood for a short time (up to an hour, according to the research that's been done). But there is no evidence to show that it helps for longer than this, or that it benefits people with clinical depression. Another study found that group singing improves people's mood. Is it the singing or the getting together with other people that helps? We don't know, and it doesn't matter, because any of these ways of feeling more alive, or all of them, could become valuable parts of your 'beating depression toolkit.' The important thing is to try an activity and see whether it works for you. Evidence There is good evidence that distraction helps lift mood in the short term, particularly if the alternative to it is thinking about being depressed or dwelling on feeling low, as people tend to do. A number of distractions have been tested in research, including things like describing pictures or playing a board game. Deliberately thinking pleasant thoughts, or imagining peaceful, beautiful scenes can help too. Safety There are no safety problems, but don't try to distract yourself when you should be concentrating on something else, for example when driving. Cost Many of the activities described above are free or cost very little. Find out more See the Exercise, Classes or Practitioner sections for other suggestions for healthy distractions. View References (1) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. Based on series of studies in depressive disorders and the non-clinically depressed. There is good evidence that distraction (in the form of thinking or visualising pleasant or neutral thoughts) is helpful for temporarily alleviating depressed mood, particularly if the alternative is ruminating on the causes and consequences of it. Studies in non-clinically depressed elderly nursing home residents suggest a positive effect of live-in pets on depression symptoms. These results may not generalise to the broader population. There is no evidence on the effects of pets on depressive disorders. Listening to music can be an effective method of lifting mood in the short term (less than an hour) in non-clinically depressed individuals, but there is no evidence that music can reduce depression over periods of days or weeks. There is no evidence on the effects of music on depressive disorders per se. Limited research suggests that group singing may improve depressed mood or depression symptoms in non-clinically depressed individuals, however these results require replication. The effects of singing have not been examined in individuals with depressive disorders. Link to Abstract Exercise read more Overview Compared to 100 ago when people didn't have cars, washing machines or TV most of us don't work hard with our bodies. Our lifestyles are relatively lazy - a trend that science tells us is bad for our health. Being more active does more than keep you fit. Importantly for low mood and depression, it triggers brain chemicals that lift your mood and can generate a real sense of wellbeing. It makes your heart and lungs work better, tones your muscles and strengthens bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems. So it's good to get outdoors: one study found that after a walk in the country people were much less depressed than those who spent the same time walking round a shopping centre! So perhaps where you get active is important as well as how much. Green spaces could be good for your mood! Evidence Getting more active, even just a half hour's walk every day, helps reduce depression symptoms in adults. Even a single session of exercise seems to lift mood. Safety If you're not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn't helping or that you're getting worse in any way, check with your doctor. Anyone with severe osteoporosis, arthritis, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist. Cost You can exercise at home for nothing, remember walking and gardening are both forms of exercise. There will probably be a small cost, if you join an organised programme. Find out more Natural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company. Check your local leisure centre for exercise classes. See also the Classes section for more information. View References (2) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF Ann Gen Psychiatry. 2008 Aug 19;7:13. MIND executive summary of a study by the University of Essex (country walks or supermarket) Link to Abstract Exercise for depression. Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub4. Systematic review, 28 trials, 23 trials (907 participants) compared exercise with no treatment or a control intervention large clinical effect, only moderate when only good quality trials were included. Link to Abstract Relaxation Techniques read more Overview Many people who feel depressed say they get tense and have problems sleeping. Relaxation skills can help with this. This technique teaches you to notice muscular tension and learn to relax your muscles to release the tension. Progressive relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper. Evidence Learning relaxation techniques can be helpful for people who feel depressed. Researchers who collected together all the experimental evidence on using relaxation techniques for depression concluded that the people who used them said they helped them feel better. But relaxation techniques don't seem to help as much as psychological treatments do. Safety These techniques are generally safe unless you have a severe or long-standing mental health problem. Cost Once you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially. Find out more Visit The British Holistic Medical Association for podcasts and leaflets. View References (1) Evidence: Cost: Safety: Relaxation for depression. Jorm AF, Morgan AJ, Hetrick SE. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007142. DOI: 10.1002/14651858.CD007142.pub2. Cochrane review of 15 trials (11 included in meta-analysis). Conclusions: Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Link to Abstract Self-help on the internet read more Overview There are several self-help programmes on the Internet that aim to lift depression by helping you learn to think in more positive ways. Evidence These approaches are fairly new, so not much research has been done on them yet. They seem to work better if they are used with supervision from a professional. Safety It is important to choose a programme that has been properly tested. One self-help programme that has been tested in research studies is MoodGYM Another is the Beating the Blues programme Cost There are no costs if you already have Internet access. View References (3) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. The evidence for computerised interventions for depressive disorders appears promising, particularly if a professional is involved (based on meta-analyses below). Link to Abstract Internet based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V Psychol Med 2007, 37:319-328. Meta-analysis of 12 RCTs, interventions for symptoms of depression had a small mean effect size and significant heterogeneity. Link to Abstract Status of computerized cognitive behavioural therapy for adults. Titov N Aust NZ J Psychiatry 2007, 41:95-114. Link to Abstract Special Diets read more Overview While there is no 'magic diet' that works for everyone whose mood is low, eating right can help you feel better. Some people say that certain foods affect their mood. And if you have problems with digestion as well as mood, keeping a food diary might help you find out whether certain foods make you feel worse. Write down what you eat and make a note of how you feel a couple of hours afterwards, bearing in mind that you might feel the effects of certain foods some time after you have eaten them. Evidence Some people have found that avoiding certain foods (such as barley, rye, sugar, wheat or dairy foods) has helped their mood, but there isn't much research to help us decide about this. Safety It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is important to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need. Cost Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice. View References (2) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF Ann Gen Psychiatry. 2008 Aug 19;7:13. Potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance. Link to Abstract BluePages Depression Information. The Centre for Mental Health Research, The Australian National University. Website: http://bluepages.anu.edu.au/ One trial, 20 patients, refined sucrose- and caffeine-free diet or a red-meat-free and artificial-sweetener-free diet (control group). Greater improvement in depression in test group. Link to Abstract

Buy Something

Before You Buy read more Overview For safe use of over-the-counter medicines, herbal remedies and supplements: Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement: - if you have a serious medical condition - if you are breast-feeding, pregnant or planning to become pregnant - if you are already taking other medicines, herbal remedies or supplements - if you suffer from allergies Always read the package insert before taking any product. Avoid taking the product if you think you may be allergic to any of the ingredients. Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist). Seek advice from your doctor or pharmacist: - If your symptoms do not get better - if your symptoms get worse - if you get new symptoms or have a side effect The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children. Herbal remedies and food supplements read more Overview Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. It's possible these 'natural medicines' work by improving the functioning of the nerves, muscles, brain and digestion. Researchers are discovering that many herbal medicines have powerful effects on the body, especially in healing and repair. Over-the-counter medicines read more Overview There are no standard medicines, you can buy without a prescription, which are likely to help with depression. Treatment Options: Light Therapy read more Overview When daylight and sunlight are in short supply many people suffer from seasonal affective disorder (SAD). Many people say their mood improves when they get more light. It has been estimated that approximately 5% of the UK population suffers from SAD. Research has shown that bright light boxes and dawn simulation lights (light alarms) can help lift depression. You have to sit close to the light for about 30 minutes a day if you use one of the very bright boxes. Evidence There is good evidence that light therapy helps people with winter depression or low mood. It also seems to be helpful for other types of depression, although the effects are less noticeable. Safety Light therapy can make some people slightly over-excited and they may have problems getting to sleep at night. You should therefore use your light in the morning. Cost A special light therapy box can help and they are available from specialist retailers. These lights are expensive but this is a one-off purchase. Find out more To find out more about the condition, visit the Seasonal Affective Disorder Association View References (4) Evidence: Cost: Safety: Light room therapy effective in mild forms of seasonal affective disorder -a randomised controlled study. Rastad C, Ulfberg J, Lindberg P. J Affect Disord. 2008 Jun;108(3):291-6. Epub 2007 Nov 28. Light room therapy was effective in reducing depressive symptoms in subjects with winter depressive mood. Results were maintained over a period of one month. Link to Abstract Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report. Virk G, Reeves G, Rosenthal NE, Sher L, Postolache TT. Int J Disabil Hum Dev. 2009 Jul;8(3):283-286. Link to Abstract Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. There is good evidence that light therapy is effective for SAD (winter depression). It also appears to be helpful for non-seasonal depressive disorder, but the evidence is not as strong and the effect is smaller. It may also be helpful for non-clinically depressed individuals who experience mild symptoms of SAD. Link to Abstract Light therapy for non-seasonal depression. Tuunainen A, Kripke DF, Endo T. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2 For patients suffering from non-seasonal depression, light therapy offers modest though promising antidepressive efficacy, especially when administered during the first week of treatment, in the morning, and as an adjunctive treatment to sleep deprivation responders. Hypomania as a potential adverse effect needs to be considered. Due to limited data and heterogeneity of studies these results need to be interpreted with caution. Link to Abstract Omega-3 read more Overview There is growing evidence to link depression and low mood with a lack of fatty acids, of which omega-3 seems to be the most important. Oily fish is a good source of omega-3, which is also found in flax seeds, pumpkin seeds and walnuts. Evidence Research suggests that omega-3 supplements do help some people with depression. But people in the studies tended to take high doses, and they sometimes had problems with nausea, diarrhoea and a fishy aftertaste. Safety Omega-3 thins the blood slightly, so get a doctor's advice if you take anti-coagulants, aspirin or other blood-thinning medicines. Cost There are many varieties of Omega-3 supplements available, differing in cost. View References (4) Evidence: Cost: Safety: A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. Lin PY, Su KP. Journal of Clinical Psychiatry. 2007, 68(7):1056-61. Link to Abstract Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials. Appleton KM, Hayward RC, Gunnell D, Peters TJ, Rogers PJ, Kessler D, Ness AR. American Journal of Clinical Nutrition. 2006, 84(6):1308-16. Link to Abstract Do essential fatty acids have a role in the treatment of depression? Williams AL, Katz D, Ali A, Girard C, Goodman J, Bell I. Journal of Affective Disorders. 2006, 93(1-3):117-23. Link to Abstract Cross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders. Simona Noaghiul S, Hibbeln JR. Am J Psychiatry 160, 2222) (2003) Link to Abstract SAMe (S-adenosylmethionine) read more Overview SAMe occurs naturally in the body. Scientists say 'Sammy' is an anti-oxidant, an anti-inflammatory and helps produce important brain chemicals including serotonin which may be low in people who have depression. If you decide to try SAMe you should let your doctor know first. A full dose of SAMe is 400 mg three to four times a day but some people get digestion problems if they start this straight away. Build the dose up to this amount if you can, starting with 200 mg twice daily. Aim to reduce to a lower dose if you start to feel better on the full dosage. EVIDENCE There is some good evidence to show that SAMe does help people with depression. But there are still some questions about the best dose to use and how safe it is as a long-term treatment. SAFETY SAMe can interact with standard anti-depressants so don’t take it without your doctor’s advice. Bipolar patients may find that SAMe swings them into elevated mood states. Do not take it with other medicines, remedies or supplements unless you have checked with a qualified person (such as a pharmacist). The best and safest doses are not yet certain. COST SAMe is regulated by the Medicines Act, and does not yet have a UK licence, so it cannot be sold over the counter in the UK. It can be purchased from Internet retailers, but there are no guarantees of quality and as this is an expensive supplement, whose long term effects are uncertain. View References (1) Evidence: Cost: Safety: Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. There is consistent evidence that SAMe may be helpful for depressive disorders in adults. Further large, longer-term RCTs are needed to clarify questions regarding optimum dosage, safety and comparison with newer antidepressants. There is no evidence on the effects of SAMe in non-clinically depressed people. Link to Abstract St John's Wort (Hypericum) read more Overview According to the available research, St John's Wort is a valuable treatment for mild to moderate depression. It can also ease the sleep problems and tension that often go with depression. It does not help everyone (though it helps perhaps two people out of three) and it takes up to six weeks to start working. If you think you are depressed, and you're considering taking St John's Wort, you should ask your doctor's advice. It is definitely not a major treatment for more serious types of depression. Overall it is safer than conventional anti-depressants. No serious harm has been reported by doctors in Europe, where St John's Wort has been used very widely and in large doses for many years. But it would be unwise to take it if you are already on prescribed anti-depressants. You should wait at least one month after you have stopped taking them. St John's Wort may also interfere with certain prescribed medicines. You should always get medical advice before taking St John's Wort while on other medicines. This is especially important if you are taking: warfarin (anti-coagulant), digoxin (for heart failure), oral contraceptive, protease inhibitors for HIV infection, chemotherapy or transplant drugs, or anti-schizophrenia drugs. Evidence There is some very good research showing that St John's Wort is as good as standard anti-depressant medicines (such as Prozac) for mild to moderate depression. But there are some concerns about safety and what the best dosage might be. Safety St John's Wort is generally safe, but should not be taken with some medicines (see above). COST View References (1) Evidence: Cost: Safety: St John's wort for major depression. Linde K, Berner MM, Kriston L. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3. The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation. Link to Abstract Vitamin supplements read more Overview It isn't likely that taking extra vitamins will make much difference to low mood or depression. It is true that many people don't get quite enough B, C and D vitamins in their food. And it's also true that the brain and nervous system need these vitamins. Because they don't get stored in the body, our daily diet has to supply them. Research has shown that people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines. So, if you are eating a very poor diet, taking extra vitamins just might help. It's also worth remembering that alcohol, refined sugars, nicotine and caffeine all take these vitamins out of the body. Yet most people who feel depressed probably won't benefit from taking vitamins alone. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds. Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood. There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression. Vitamin C levels fall after surgery or inflammatory disease. The body needs more vitamin C when coping with stress, pregnancy and breast feeding. Aspirin, tetracycline and contraceptive pills take vitamin C out of the body. Smokers also need extra vitamin C because nicotine removes it. Fresh fruit and vegetables are the best sources of vitamin C. Doctors are increasingly concerned about low vitamin D, especially in the Asian community. A lack of vitamin D can lead to depression. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. Do you get enough sunshine and eat a good diet? It is estimated that worldwide over 1 billion people get too little vitamin D. Evidence Taking supplements of vitamins B and D might help some people, whose diet is poor, but more research is needed. Safety High doses of vitamins and minerals can upset the body and cause side-effects. Get medical advice if you intend to take large doses. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds. Cost If your diet is poor and you don't get into the sun, ask your doctor about a vitamin D blood test. If it's normal, there's no point in taking vitamin D. If it's low, your GP will prescribe it for you or you can buy a vitamin D supplement. View References (6) Evidence: Cost: Safety: Folate, Vitamin B12, Homocysteine, and the MTHFR 677CT Polymorphism in Anxiety and Depression: The Hordaland Homocysteine Study. I. Bjelland et al. Arch Gen Psychiatry, vol 60, pp. 618-26 (2003). Link to Abstract Serum 25-Hydroxyvitamin D and Depressive Symptoms in Older Women and Men. Y. Milaneschi, M. Shardell, A.M. Corsi, R. Vazzana, S. Bandinelli, J.M. Guralnik, L. Ferrucci. Journal of Clinical Endocrinology & Metabolism Published online ahead of print, doi:10.1210/jc.2010-03 Link to Abstract Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. Jorde, R et al. J Intern Med 2008 Dec;264(6):599-609 Link to Abstract Vitamin D and mood disorders among women: an integrative review Murphy, P and Wagner, C. Journal of Midwifery & Women's Health. 2008, 53(5):440-6. Link to Abstract Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. The limited evidence suggests that thiamine, vitamin B6, vitamin B12 and folate supplementation are not helpful for depressed mood or symptoms in non-clinically depressed individuals. The evidence for vitamin D in non-clinically depressed individuals is inconsistent, but the larger, longer trials suggest it is not helpful. The evidence is more conclusive that multivitamins are not helpful for depressed mood in non-clinically depressed people. However, limited evidence suggests that vitamin C may be helpful in non-clinically depressed individuals, but these results require replication. Link to Abstract Folate for depressive disorders. Taylor MJ, Carney SM, Geddes J, Goodwin G. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003390. DOI: 10.1002/14651858.CD003390 This systematic review was undertaken to see if giving folate to people with depressive disorders reduced their depressive symptoms. Three randomized trials were identified, involving a total of 247 people. In all three trials, folate was well tolerated. In two of these trials, folate was added to other antidepressant drug treatment and there was limited evidence that folate helped. In the third trial, folate was compared to trazodone, an antidepressant drug. No difference was found. There is therefore limited evidence that adding folate to other antidepressant may be helpful, but larger trials are needed before patients and clinicians can be confident that it will be helpful. Link to Abstract

Attend Classes / Visit Practitioner

Visiting a Practitioner read more Overview There isn't very much evidence on the effectiveness of going to a complementary therapist for depression. A lot depends on the skill of the practitioner and how you feel about working with them. Complementary therapies are not widely available through the NHS, so a typical session could cost you from £20 to £50. Nevertheless, some people say they have found having time with a practitioner very helpful. You should always look for a practitioner who is properly trained and registered with the relevant professional body. Treatment Options: Acupuncture read more Overview Acupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief. Evidence There have been a lot of studies on the effects of acupuncture, but most of them have been in China using daily acupuncture, which is not used in the UK. There is no good research evidence about the effects of acupuncture on depression. Safety Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally). Cost A session may cost £35-£50. Frequency of treatment will depend on you and your practitioner. Find out more The following professional organisations can help you find a qualified practitioner: Acupuncture Association of Chartered Physiotherapists British Academy of Western Medical Acupuncture British Acupuncture Council British Medical Acupuncture Society View References (2) Evidence: Cost: Safety: Acupuncture for depression. Smith CA, Hay PPJ, MacPherson H. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004046. DOI: 10.1002/14651858.CD004046.pub3. SR of 30 RCTs of depression and post-stroke depression. We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria. Link to Abstract Test Reference Link to Abstract Autogenic Training (AT) read more Overview AT classes require time and discipline, but may have greater benefits than simple muscle relaxation. In AT classes you learn to create feelings of warmth and heaviness throughout your body, and this is said to bring about very deep physical relaxation, mental peace and a quietening of negative thoughts. AT uses simple phrases that you repeat to yourself as you release tension from each part of your body. Evidence There is some evidence that AT might be helpful to people with low mood or depression. The research suggests that it is more effective if you learn the method in a class. Safety AT is best learned from an experienced teacher in a small class. There are no safety issues, though anyone with a long-term mental health problem should get advice from their psychiatrist before starting AT. Cost You will have to pay for the classes but once you have learned this technique you can practise it at home. Find out more The British Autogenic Society (BAS) is the professional and educational organisation for autogenic therapists in the UK. View References (2) Evidence: Cost: Safety: Autogenic training: a meta-analysis of clinical outcome studies. Stetter F, Kupper S. Appl Psychophysiol Biofeedback. 2002 Mar;27(1):45-98 Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynaud's disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders. Link to Abstract Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug. Potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance. Link to Abstract Exercise programmes read more Overview Exercise definitely has positive effects on the brain and physical activity is one of the best anti-depressants. It takes a few weeks to make a difference, and it seems to be more effective if you do it with other people. It improves the way your brain works in all kinds of ways and it may even help prevent dementia. There are three types of exercise. Vigorous exercise classes, such as aerobics, stepping and walking, make the heart and lungs work harder. Strengthening exercises make muscles work against resistance. Stretching exercises, such as Tai Chi, Qigong and yoga, are slower. Although they won't necessarily make you fitter, they have a wonderfully relaxing effect on the body and mind, and they make your joints more flexible. If you haven't been active for some time, you should start slowly and build up. If you have heart or chest problems, get medical advice first. You don't have to use the gym to exercise. Even 30 minutes of brisk walking every day is enough to make a useful difference to your mood. There are walking groups in many areas. Evidence There is good evidence that exercise helps lift depression in adults. Even a single exercise class can lift your mood. And research has shown that 16 weeks of regular classes can be as effective as medication. More research is needed to find out what type of exercise is best, and how much exercise has the best effect. Safety Supervised exercise programmes are safe for most people. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise. Cost Many different types of exercise programmes are provided, at a small cost, by your local council. Private classes will cost more. The monthly cost will depend on how regularly you attend classes. Find out more Classes and exercise programmes are run in most areas by both local authority leisure services and private gyms. View References (2) Evidence: Cost: Safety: Exercise for depression. Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub4. Systematic review, 28 trials, 23 trials (907 participants) compared exercise with no treatment or a control intervention large clinical effect, only moderate when only good quality trials were included. Link to Abstract Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. Link to Abstract Homeopathy read more Overview The basic principle of homeopathy is that 'like cures like'. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body's self-healing processes into action. Homeopathy has been called 'unscientific' because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Evidence Though some people say they have found homeopathy helpful when they were depressed, there is very little scientific research to back this up. Safety Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms at first but this generally only lasts a short time. Cost The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £20-£50. Find out more There are a number of professional organisations covering homeopathy: The British Homeopathic Association Faculty of Homeopathy The Society of Homeopaths View References (1) Evidence: Cost: Safety: Homeopathy for depression: a systematic review of the research evidence. Pilkington, Karen and Kirkwood, Graham and Rampes, Hagen and Fisher, Peter and Richardson, Janet. Homeopathy, 94 (3). pp. 153-163. ISSN 1475-491 Link to Abstract Massage read more Overview There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils. Evidence Some research suggests that massage by trained therapists helps depression. One small study showed that using essential oils may also help but more research is needed to prove this. Safety Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage. Cost Monthly cost will depend on how regularly you receive treatments. Find out more It is important to find a qualified practitioner such as one registered with The General Council for Massage Therapies View References (4) Evidence: Cost: Safety: Massage therapy for the treatment of depression: a systematic review. Coelho HF, Boddy K, Ernst E. International Journal of Clinical Practice. 2008, 62(2):325-33. There is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD. Link to Abstract A meta analysis of massage therapy research Moyer CA, Rounds J, Hannum JW. Psychological Bulletin. 2004, 130(1):3-18. Link to Abstract A meta-analysis of massage therapy research. Moyer CA, Rounds J, Hannum JW. Psychological Bulletin. 2004, 130(1):3-18. Link to Abstract Aromatherapy and massage for depression: a systematic review. Pilkington K, Kirkwood G, Rampes H, Richardson J. Complementary and Alternative Medicine Evidence Online (CAMEOL) Database. (2006 Link to Abstract Psychological therapies read more Overview When people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS. Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. Cognitive-behavioural therapy (CBT) is the psychological treatment most widely available in today's NHS to help treat depression. This is because there is a lot of good research showing that it helps people recover from depression. Evidence There is good evidence that CBT can help ease depression. But not everyone benefits from this type of treatment and some people benefit from CBT best when used in conjunction with other types of treatment. Safety CBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist. Cost In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions. Find out more It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society View References (8) Evidence: Cost: Safety: Psychotherapy for depression. Hermann EK, Munsch S, Biedert E, Lang W. Ther Umsch. 2010 Nov;67(11):581-584. 'Based on empirical evidence, psychotherapeutic treatment of depression is recommended if the following methods are applied: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Psychoanalytic/Short-term Psychodynamic Therapy. The empirical evidence for the efficacy of CBT and IPT is established, whereas data supporting the efficacy of psychoanalytical/psychodynamic techniques is not as well documented. In addition, considering the cost-benefit aspects of treatment, CBT and IPT are highly recommendable.' Link to Abstract A review of empirically supported psychological therapies for mood disorders in adults. Hollon SD, Ponniah K. Depress Anxiety. 2010 Oct;27(10):891-932. The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD. Link to Abstract Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression. Luty SE, Carter JD, McKenzie JM, Rae AM, Frampton CM, Mulder RT, Joyce PR. Br J Psychiatry. 2007 Jun;190:496-502. Link to Abstract Mindfulness-based Cognitive Therapy to Prevent Relapse in Recurrent Depression. Kuyken, W, Taylor, RS, Barret, B et al. Journal of Consulting and Clinical Psychology. 2008, 76(6): 966-978. Link to Abstract A meta-analysis of the effects of cognitive therapy in depressed patients. Gloaguen V, Cottraux J, Cucherat M, Blackburn IM Journal of Affective Disorders 1998; 49: 59-72. Link to Abstract A systematic review of controlled trials of the effectiveness of brief psychological treatments for depression. Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, Wessely S. Health Technology Assessment 2001; 5: No. 35. Link to Abstract BluePages Depression Information. The Centre for Mental Health Research, The Australian National University Blue Pages Depression Information website Link to Abstract Depression: The treatment and management of depression in adults. NICE clinical guideline 90: The National Collaborating Centre for Mental Health Issue date: October 2009 Link to Abstract Yoga read more Overview Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation. Evidence There is some research to show that yoga can help people with depression. Going to yoga classes probably helps most. Safety Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries. Cost Once you have learned the techniques you can do this at home, at no cost. Find out more Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance and the The British Wheel of Yoga. View References (2) Evidence: Cost: Safety: Yoga for depression: the research evidence. Pilkington K, Kirkwood G, Rampes H, Richardson J. Journal of Affective Disorders.2005;89(1-3):13-24. SR of 5 RCTs. There is evidence of potentially beneficial effects of yoga interventions on depressive disorders. Link to Abstract Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Morgan AJ, Jorm AF. Ann Gen Psychiatry. 2008 Aug 19;7:13. Initial evidence suggests that yoga may be beneficial for depressive disorders. The evidence is inconsistent for effects in non-clinically depressed individuals. Link to Abstract

References

1. 8 Tips for Healthy Eating
NHS Livewell Campaign
Last reviewed: 20/12/2010

Link to Abstract

2. A meta analysis of massage therapy research
Moyer CA, Rounds J, Hannum JW.
Psychological Bulletin. 2004, 130(1):3-18.

Link to Abstract

3. A meta-analysis of massage therapy research.
Moyer CA, Rounds J, Hannum JW.
Psychological Bulletin. 2004, 130(1):3-18.

Link to Abstract

4. A meta-analysis of the effects of cognitive therapy in depressed patients.
Gloaguen V, Cottraux J, Cucherat M, Blackburn IM
Journal of Affective Disorders 1998; 49: 59-72.

Link to Abstract

5. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids.
Lin PY, Su KP.
Journal of Clinical Psychiatry. 2007, 68(7):1056-61.

Link to Abstract

6. A review of empirically supported psychological therapies for mood disorders in adults.
Hollon SD, Ponniah K.
Depress Anxiety. 2010 Oct;27(10):891-932.
The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.

Link to Abstract

7. A systematic review of controlled trials of the effectiveness of brief psychological treatments for depression.
Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, Wessely S.
Health Technology Assessment 2001; 5: No. 35.

Link to Abstract

8. Acupuncture for depression.
Smith CA, Hay PPJ, MacPherson H.
Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004046. DOI: 10.1002/14651858.CD004046.pub3.
SR of 30 RCTs of depression and post-stroke depression. We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.

Link to Abstract

9. Aromatherapy and massage for depression: a systematic review.
Pilkington K, Kirkwood G, Rampes H, Richardson J.
Complementary and Alternative Medicine Evidence Online (CAMEOL) Database. (2006

Link to Abstract

10. Autogenic training: a meta-analysis of clinical outcome studies.
Stetter F, Kupper S.
Appl Psychophysiol Biofeedback. 2002 Mar;27(1):45-98
Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynaud's disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders.

Link to Abstract

11. BluePages Depression Information.
The Centre for Mental Health Research, The Australian National University.
Website: http://bluepages.anu.edu.au/
One trial, 20 patients, refined sucrose- and caffeine-free diet or a red-meat-free and artificial-sweetener-free diet (control group). Greater improvement in depression in test group.

Link to Abstract

12. BluePages Depression Information.
The Centre for Mental Health Research, The Australian National University
Blue Pages Depression Information website

Link to Abstract

13. Cross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders.
Simona Noaghiul S, Hibbeln JR.
Am J Psychiatry 160, 2222) (2003)

Link to Abstract

14. Depression: The treatment and management of depression in adults. NICE clinical guideline 90:
The National Collaborating Centre for Mental Health
Issue date: October 2009

Link to Abstract

15. Do essential fatty acids have a role in the treatment of depression?
Williams AL, Katz D, Ali A, Girard C, Goodman J, Bell I.
Journal of Affective Disorders. 2006, 93(1-3):117-23.

Link to Abstract

16. Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials.
Appleton KM, Hayward RC, Gunnell D, Peters TJ, Rogers PJ, Kessler D, Ness AR.
American Journal of Clinical Nutrition. 2006, 84(6):1308-16.

Link to Abstract

17. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.
Jorde, R et al.
J Intern Med 2008 Dec;264(6):599-609

Link to Abstract

18. Exercise for depression.
Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub4.
Systematic review, 28 trials, 23 trials (907 participants) compared exercise with no treatment or a control intervention large clinical effect, only moderate when only good quality trials were included.

Link to Abstract

19. Exercise for depression.
Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub4.
Systematic review, 28 trials, 23 trials (907 participants) compared exercise with no treatment or a control intervention large clinical effect, only moderate when only good quality trials were included.

Link to Abstract

20. Folate for depressive disorders.
Taylor MJ, Carney SM, Geddes J, Goodwin G.
Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003390. DOI: 10.1002/14651858.CD003390
This systematic review was undertaken to see if giving folate to people with depressive disorders reduced their depressive symptoms. Three randomized trials were identified, involving a total of 247 people. In all three trials, folate was well tolerated. In two of these trials, folate was added to other antidepressant drug treatment and there was limited evidence that folate helped. In the third trial, folate was compared to trazodone, an antidepressant drug. No difference was found. There is therefore limited evidence that adding folate to other antidepressant may be helpful, but larger trials are needed before patients and clinicians can be confident that it will be helpful.

Link to Abstract

21. Folate, Vitamin B12, Homocysteine, and the MTHFR 677CT Polymorphism in Anxiety and Depression: The Hordaland Homocysteine Study.
I. Bjelland et al.
Arch Gen Psychiatry, vol 60, pp. 618-26 (2003).

Link to Abstract

22. Homeopathy for depression: a systematic review of the research evidence.
Pilkington, Karen and Kirkwood, Graham and Rampes, Hagen and Fisher, Peter and Richardson, Janet.
Homeopathy, 94 (3). pp. 153-163. ISSN 1475-491

Link to Abstract

23. Internet based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis.
Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V
Psychol Med 2007, 37:319-328.
Meta-analysis of 12 RCTs, interventions for symptoms of depression had a small mean effect size and significant heterogeneity.

Link to Abstract

24. Light room therapy effective in mild forms of seasonal affective disorder -a randomised controlled study.
Rastad C, Ulfberg J, Lindberg P.
J Affect Disord. 2008 Jun;108(3):291-6. Epub 2007 Nov 28.
Light room therapy was effective in reducing depressive symptoms in subjects with winter depressive mood. Results were maintained over a period of one month.

Link to Abstract

25. Light therapy for non-seasonal depression.
Tuunainen A, Kripke DF, Endo T.
Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2
For patients suffering from non-seasonal depression, light therapy offers modest though promising antidepressive efficacy, especially when administered during the first week of treatment, in the morning, and as an adjunctive treatment to sleep deprivation responders. Hypomania as a potential adverse effect needs to be considered. Due to limited data and heterogeneity of studies these results need to be interpreted with caution.

Link to Abstract

26. Massage therapy for the treatment of depression: a systematic review.
Coelho HF, Boddy K, Ernst E.
International Journal of Clinical Practice. 2008, 62(2):325-33.
There is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD.

Link to Abstract

27. Mindfulness-based Cognitive Therapy to Prevent Relapse in Recurrent Depression.
Kuyken, W, Taylor, RS, Barret, B et al.
Journal of Consulting and Clinical Psychology. 2008, 76(6): 966-978.

Link to Abstract

28. Psychotherapy for depression.
Hermann EK, Munsch S, Biedert E, Lang W.
Ther Umsch. 2010 Nov;67(11):581-584.
'Based on empirical evidence, psychotherapeutic treatment of depression is recommended if the following methods are applied: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Psychoanalytic/Short-term Psychodynamic Therapy. The empirical evidence for the efficacy of CBT and IPT is established, whereas data supporting the efficacy of psychoanalytical/psychodynamic techniques is not as well documented. In addition, considering the cost-benefit aspects of treatment, CBT and IPT are highly recommendable.'

Link to Abstract

29. Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression.
Luty SE, Carter JD, McKenzie JM, Rae AM, Frampton CM, Mulder RT, Joyce PR.
Br J Psychiatry. 2007 Jun;190:496-502.

Link to Abstract

30. Relaxation for depression.
Jorm AF, Morgan AJ, Hetrick SE.
Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007142. DOI: 10.1002/14651858.CD007142.pub2.
Cochrane review of 15 trials (11 included in meta-analysis). Conclusions: Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive.

Link to Abstract

31. Self-help books for depression: how can practitioners and patients make the right choice?
Anderson, L., Lewis, G., Araya, R., Elgie, R., Harrison, G., Proudfoot, J., et al.
British Journal of General Practice, 55, 387-392. (2005)

Link to Abstract

32. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
Evidence suggests that bibliotherapy is helpful for depressive disorders. However a number of caveats should be noted. The trials have not evaluated the use of bibliotherapy in the absence of any professional involvement. Also, not everyone may benefit from bibliotherapy; there are those who may lack the concentration or motivation required, have insufficient reading skills, or not be suited for personality reasons. There is no evidence on the effects of bibliotherapy in non-clinically depressed people.

Link to Abstract

33. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF
Ann Gen Psychiatry. 2008 Aug 19;7:13.
Potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.

Link to Abstract

34. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF
Ann Gen Psychiatry. 2008 Aug 19;7:13.
MIND executive summary of a study by the University of Essex (country walks or supermarket)

Link to Abstract

35. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
Based on series of studies in depressive disorders and the non-clinically depressed. There is good evidence that distraction (in the form of thinking or visualising pleasant or neutral thoughts) is helpful for temporarily alleviating depressed mood, particularly if the alternative is ruminating on the causes and consequences of it. Studies in non-clinically depressed elderly nursing home residents suggest a positive effect of live-in pets on depression symptoms. These results may not generalise to the broader population. There is no evidence on the effects of pets on depressive disorders. Listening to music can be an effective method of lifting mood in the short term (less than an hour) in non-clinically depressed individuals, but there is no evidence that music can reduce depression over periods of days or weeks. There is no evidence on the effects of music on depressive disorders per se. Limited research suggests that group singing may improve depressed mood or depression symptoms in non-clinically depressed individuals, however these results require replication. The effects of singing have not been examined in individuals with depressive disorders.

Link to Abstract

36. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
The evidence for computerised interventions for depressive disorders appears promising, particularly if a professional is involved (based on meta-analyses below).

Link to Abstract

37. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
There is consistent evidence that SAMe may be helpful for depressive disorders in adults. Further large, longer-term RCTs are needed to clarify questions regarding optimum dosage, safety and comparison with newer antidepressants. There is no evidence on the effects of SAMe in non-clinically depressed people.

Link to Abstract

38. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug.
Potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.

Link to Abstract

39. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
The limited evidence suggests that thiamine, vitamin B6, vitamin B12 and folate supplementation are not helpful for depressed mood or symptoms in non-clinically depressed individuals. The evidence for vitamin D in non-clinically depressed individuals is inconsistent, but the larger, longer trials suggest it is not helpful. The evidence is more conclusive that multivitamins are not helpful for depressed mood in non-clinically depressed people. However, limited evidence suggests that vitamin C may be helpful in non-clinically depressed individuals, but these results require replication.

Link to Abstract

40. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
There is good evidence that light therapy is effective for SAD (winter depression). It also appears to be helpful for non-seasonal depressive disorder, but the evidence is not as strong and the effect is smaller. It may also be helpful for non-clinically depressed individuals who experience mild symptoms of SAD.

Link to Abstract

41. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.

Link to Abstract

42. Self-help interventions for depressive disorders and depressive symptoms: a systematic review.
Morgan AJ, Jorm AF.
Ann Gen Psychiatry. 2008 Aug 19;7:13.
Initial evidence suggests that yoga may be beneficial for depressive disorders. The evidence is inconsistent for effects in non-clinically depressed individuals.

Link to Abstract

43. Serum 25-Hydroxyvitamin D and Depressive Symptoms in Older Women and Men.
Y. Milaneschi, M. Shardell, A.M. Corsi, R. Vazzana, S. Bandinelli, J.M. Guralnik, L. Ferrucci.
Journal of Clinical Endocrinology & Metabolism Published online ahead of print, doi:10.1210/jc.2010-03

Link to Abstract

44. Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report.
Virk G, Reeves G, Rosenthal NE, Sher L, Postolache TT.
Int J Disabil Hum Dev. 2009 Jul;8(3):283-286.

Link to Abstract

45. St John's wort for major depression.
Linde K, Berner MM, Kriston L.
Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3.
The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.

Link to Abstract

46. Status of computerized cognitive behavioural therapy for adults.
Titov N
Aust NZ J Psychiatry 2007, 41:95-114.

Link to Abstract

47. Vitamin D and mood disorders among women: an integrative review
Murphy, P and Wagner, C.
Journal of Midwifery & Women's Health. 2008, 53(5):440-6.

Link to Abstract

48. Yoga for depression: the research evidence.
Pilkington K, Kirkwood G, Rampes H, Richardson J.
Journal of Affective Disorders.2005;89(1-3):13-24.
SR of 5 RCTs. There is evidence of potentially beneficial effects of yoga interventions on depressive disorders.

Link to Abstract