Depression is a clinically heterogeneous disorder, and as such can be treated through several approaches.¹ A range of both pharmacological and psychological therapies make up today’s clinical repertoire of antidepressant treatments, while a number of alternative medicines, activities and techniques have also been claimed to offer some relief.^2,3

According to NICE clinical guidance (CG90), it is recommended that patients with mild to moderate depressive symptoms should be offered either guided self-help, computerised cognitive behavioural therapy, a structured group physical activity programme, or a combination of these.⁴ However, for those patients who present with moderate or severe depression, a combination of both pharmacological intervention and a high-intensity psychological therapy should be prescribed.⁴

The research literature supports this recommendation. One meta-analysis of 19 randomised studies (figure 1) involving over 1800 patients with depression evaluated the difference in effect size between psychological therapy alone and a combination of both pharmacological and psychological treatment. It found a significant (P<0.001) difference in effect size between these two therapeutic approaches, with a combination strategy proving more efficacious.⁵

A number of alternative strategies have also been suggested to provide relief from depressive symptoms, including meditation, exercise, yoga, light therapy and St. John’s Wort.^6-9 However, clinical research and experience focuses on psychotherapy and pharmacological treatments, and these remain the mainstay of clinical depression therapy.