CBT and depression

In the NHS, CBT is the treatment of choice for depression. NICE guidelines are that CBT should be tried and failed or offered and refused before other talking therapies are used. Why? Because CBT has a huge evidence base for showing that it is effective, providing quick and cost-efficient cures, and produces more long-lasting effects than taking anti-depressants.

What is depression?

There are any number of definitions of what depression is but "negative perception of self, the world or the future" will do just fine. It is the most common illness in the UK and perhaps one person in six is depressed at any one time. Lots of depressed people are ashamed of being depressed and so hide the fact they are, and mostly, mild to moderate depression doesn't show; think of four people you know, and chances are better than even that one of them is depressed. IAPT (NHS) figures are that in June 2011, there were 6.1 million adults in the UK with depression or anxiety.

Apart from bipolar disorder (which used to be called manic depression), depression comes in two main flavours, clinically called major depressive disorder ("reactive depression") and dysthymia ("endemic depression").

Major depressive disorder is cyclical, with the depressed period lasting for typically about two years. The first time this form of depression is triggered, there was probably a cause for it, but after that it tends to become a pattern of being and can be triggered more and more easily.

Dysthymia is a fairly constant feeling of sadness, mostly present, and affecting the depressed person throughout their life.

People with dysthymia can also get major depressive disorder – double depression.

Depression and anxiety often go hand in hand, making it harder for the person to do anything about it by themselves – the depression removes the desire and motivation to do anything about it and the anxiety makes it scary to do anything about it. Depression is often experienced as low self-esteem.

We have lots of tests for finding out how depressed you are, but if you ever feel like just pulling the duvet over your head and staying in bed for ever, that's a good enough test.

Perhaps you're just unhappy and diagnosing this as depression is simply medicalizing the problem? It doesn't make much difference as CBT could call it mild depression and give you the appropriate talking therapy, or call it unhappiness and give you life-coaching; but the treatment and the resulting effect, improvement in your mood, would be more-or-less the same.

But despite all that bad news, depression is treatable with CBT and depressed people can be cured. You can beat your depression and you have taken the first step.

The term clinical depression has been used in the past to signify that depressed people are unwell and not just skiving, but any depression that requires treatment is clinical. Now, depression is more likely to be qualified by a number from a questionnaire or by the qualifiers: mild, moderate or severe.


Should you take anti-depressants? That's largely a matter of choice – some people are happy taking drugs but uncomfortable with the idea of talking therapies, others don't like the idea of taking drugs at all. If you have major depressive disorder and are one of the few people for whom anti-depressants have a beneficial effect, then taking them is a good idea as they will improve your mood until you come out of depression by yourself. If you have the long term, chronic, form of depression, dysthymia, there is less likely to be a long term benefit. If you are on anti-depressants when you come to therapy, then the goal would be to wean you off them, with your GP's knowledge and help, during therapy.