St John's Wort appears to be as effective as TCAs and causes fewer side effects, but it is not a licensed drug and little is known about any long term adverse effects. Where possible antidepressants should be withdrawn over a 4 week period, unless there are urgent medical reasons to stop the drug more rapidly. See Appendix 4 for a table with more information about drug treatments. Psychological treatments Problem-solving has been shown to work in small RCTs in depressed patients in general practice. Although it a relatively simple technique, it is likely that extra time beyond normal care is required.
Cognitive therapy is a specific form of psychological therapy.
Counselling is probably no more effective than treatment as usual from the GP for depression although patients like it. It may be valuable as a support to the GP especially in complex social circumstances. There is some evidence that exercise may also be effective - alone or in adjunct to other treatments. The Cochrane Library, Issue 4, 1999. Eccles M, Freemantle N, Mason J, North of England Anti-depressant Guideline Development Group.