The alternatives to antidepressants

Everything from talking therapies to psychedelics
14 July 2023

Interview with 

Karen Adams & Clare Layton, NHS Cambridgeshire and Peterborough & Celia Morgan, University of Exeter


Woman running in the sunset


There are a range of ways to manage depression, alongside traditional antidepressants treatments. The NICE guidelines currently list 19 other means of treating depressive symptoms that don’t involve antidepressants, so what do some of them involve?

Karen - I'd like to give one example of a man. He was a man from a different country. His English wasn't his first language. And at first he was very down. I wasn't sure if he needed an interpreter, but he told me he didn't. But what I noticed was that he was very inactive. He wasn't engaging with his children, he wasn't engaging with his wife. He did have a trauma. And it took us about two or three sessions really to get to an understanding of the problem. And we started to work on helping him change his behaviour and to think about the trauma. And it took a little bit of work, but the one thing I noticed, and it always brings back very warm memories, is that with each session he got brighter and brighter. And I just remember thinking, I asked this man, did he need an interpreter? He didn't need an interpreter. It was just that as his mood improved, his English got better. And he left our therapy session, I feel, a happier, more rounded individual.

Will - Karen Adams works at NHS Cambridgeshire and Peterborough for a scheme called Talking Therapies, cognitive Behavioural Therapies that invite anyone suffering from stress, or sleep loss, or low self-esteem to come in and talk.

Karen - The first thing we want to do is to get to know the person. We want the person to feel comfortable and safe in this space. So every therapist is curious about finding out what brought you here today? Why now? What do you want to get out of therapy? And that often is a starting point for us. And we want to find out what the current stresses and problems the person has. And then our therapy session really spends time thinking about exploring the history, how did it develop, what actually keeps those problems going for you? What people are in your life that are supporting you. We want to make sure the person is safe. We want to make sure that they have a safety net, and if not, we want to explore ways of giving that to them. But the whole idea of that session and the questions really is to get more information to establish a relationship and to put a plan together. And that plan, that provisional plan really helps and guides us to decide the best interventions for that person.

Will - Communication and community go hand in hand, and more and more organisations are trying to combat the link between isolation and depression. Sometimes we just need someone to give us a hand, and that is the crux of schemes like connector services and social prescribing, trying to give people the confidence to go out and interact with their communities. I spoke to Claire Layton, also at NHS Cambridgeshire and Peterborough about the encouraging stories coming from it.

Claire - We had someone whose physical health was really affecting their mental health and they, again, felt very isolated and didn't want to leave the house. So they were kind of putting off going to appointments. One of my team members really encouraged them to get back the mobility that they need, which is then essentially going to improve their mental health as well. So she was brilliant with him and took him along. He then got that confidence to now be going on his own, and so he is still building that confidence up. So doing small steps at a time to get him where he wants to be and essentially improving his mental health.

Will - The act of getting out and about and exercising is a very effective means of treating depressive symptoms for a great number of people, it's naturally very hard to estimate the effect it can have on the individual, but a moderate amount of exercise every day has shown to reduce depressive symptoms in a lot of studies as well as being really good for you anyway. And speaking of exercise, fancy a dip? Because early researchers suggested that taking the plunge into cold water can in fact help people's mental health. Indeed, there was a case study of a woman in 2018 who after four months of cold swimming no longer required medication. It's anecdotal for sure, but might be worth a go. I mean, you can go, I'll stay here and look after the towels. And in the search for depression treatment comes the somewhat new field of psychedelic treatment. The use of substances such as psilocybin on those with depression that has not responded to traditional treatment. Celia Morgan is from the University of Exeter, and she took me through the procedure.

Celia - There's very varying procedures across different studies and protocols, but in essence, I guess the fundamental of this psychedelic treatment, people will have a number of sessions of therapy what people count as preparation, where they'll talk about their intentions for their treatment, things like what to expect through the treatment, how to manage difficult situations, some kind of guidance on the experience in the treatment with psychedelic. Then there'll be the drug experience, and typically people have the substance, but now have either one or often two therapists present in the therapy. And then following the drug treatment, they will have the next stage. They, what we people call it integration, which is where they'll talk about things that came up in the experience and be given either some guidance or some prompts to go deeper into that or how to kind of explore that psychologically.

Will - But why go through the effort of using previously banned substances instead of more traditional ones?

Celia - The real advantages of this treatment compared to standard antidepressant treatment is that in terms of the drug, you only have a couple of sessions with the drug. We don't yet know whether that needs repeating as the effects wear off. People have talked about maybe when you come back every year and have a dose and some therapy around it. But in terms of the drug, yeah, we're looking at one, two, maybe three doses, and then that's it. So it's very, very different from treatment with antidepressants. I think we do need more research and a bit of caution before we start kind of adopting this much of a widely. But yeah, I think it's the most exciting because there hasn't been anything new really in depression treatment for a long time. So it really represents an exciting opportunity there.

Will - So the future certainly looks interesting for depression treatments. Obviously the variety and complexity of each individual means there cannot be a one size fits all treatment. It's important to state that not all of these will be effective for everyone, but it goes to show that there's help out there in a wide array of forms. And if you are feeling depressed, there are loads of people who want to help you out.


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