Depression assessment and treatment (Assessment and treatment of depression in adults)
How depression in adults is assessed and treated, including talking therapies, medication where it is needed, and how to get help — with urgent support if you are in crisis.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- If there is immediate risk to life, or you are having thoughts of suicide or self-harm: call 999 or go to A&E anywhere in the UK. For urgent mental health support, call Samaritans free on 116 123 (24/7), or text SHOUT to 85258. In England, Scotland or Wales you can also call 111 and choose the mental health option; in Northern Ireland call Lifeline free on 0808 808 8000, or your GP out-of-hours service.
- Depression is common and treatable; assessment matches treatment to how severe it is and to your preferences, and recovery is the goal.
- Medication is not always first — for milder depression, talking therapy or guided self-help is often offered first; for moderate to severe depression, therapy and medication together can help most.
- Treatment usually takes a few weeks to work, antidepressants are not addictive but should be stopped gradually with advice, and it is fine to change approach if the first one does not suit you.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Most people with depression improve with the right treatment
Self-help or low-intensity treatment alone is not appropriate when depression is severe, there is significant risk to safety, or the person cannot...
You start treatment and arrange follow-up. If you have begun an antidepressant, early side effects may appear before benefits do. Tell your clinician if...
Clear crisis information: 999/A&E for immediate risk, Samaritans 116 123, SHOUT to 85258, and the local urgent mental health route — 111 mental health...
You start treatment and arrange follow-up. If you have begun an antidepressant, early side effects may appear...
Your treatment is reviewed. Early signs of improvement may appear. If there is no benefit at all by 3–4 weeks on...
Talking therapy and/or medication usually show clearer benefit. The plan is reviewed and adjusted, and progress is...
Antidepressants are usually continued for several months after you feel well to reduce relapse, then reduced...
What is depression assessment and treatment?
Depression is more than feeling low for a short time. It is a common and treatable condition where low mood, loss of interest or pleasure, and other symptoms — such as poor sleep, low energy, difficulty concentrating, changes in appetite, and feelings of hopelessness or worthlessness — last for weeks and affect daily life. It is not a sign of weakness, and with the right support most people improve.
An assessment is a careful, confidential conversation to understand how you are feeling, how long it has lasted, how it affects you, and whether anything else is contributing — such as physical health, life events, alcohol or other conditions. It also includes a sensitive check of your safety and any thoughts of harming yourself.
Treatment is then matched to how severe the depression is and to your own preferences. Options include talking therapies (such as cognitive behavioural therapy), self-help and lifestyle support, and antidepressant medication. Medication is not always the first step, especially for milder depression, where talking therapy or guided self-help is often offered first. For moderate to severe depression, talking therapy and medication together can work better than either alone.
The aim is recovery: to help you feel better, function again, and reduce the chance of depression coming back. Treatment is a shared decision, and you can change course if the first approach does not suit you.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Assessment
A confidential conversation about your mood, symptoms, history, physical health and circumstances, including a sensitive check of your safety and any thoughts of self-harm...
Self-help and lifestyle support
Guided self-help, structured exercise, sleep and routine support, and reducing alcohol. Often a first step for milder depression and a useful part of any treatment.
Talking therapies
Such as cognitive behavioural therapy (CBT), behavioural activation, interpersonal therapy or counselling. Available on the NHS through your local psychological therapies...
Antidepressant medication
Usually an SSRI as a first-choice medicine where medication is appropriate. Used especially for moderate to severe depression, and offered for milder depression only if that...
Preparing for your treatment
- Note how long you have felt this way, your main symptoms, and how they affect your daily life, work and relationships.
- Think about anything that may be contributing, such as life events, stress, physical illness, alcohol or other substances, or other medicines.
- Be honest about any thoughts of harming yourself or that life is not worth living — this helps you get the right support, and you will not be judged.
- Bring a list of any medicines and past treatments for your mental health, including what has and has not helped before.
- Think about what you want from treatment and any preferences (for example talking therapy, medication, or both).
- Consider bringing someone you trust for support, and write down questions you want to ask.
- Note any physical symptoms, as some physical conditions can cause or worsen low mood.
What happens
The assessment is a confidential conversation with a clinician — often a GP, therapist or psychiatrist. They will ask how you have been feeling, how long it has lasted, how it affects you, and about your sleep, energy, appetite, concentration and enjoyment of things. They may use a simple questionnaire to help measure how you are doing.
They will ask about your history, physical health, alcohol and any other substances, and other medicines, because these can contribute to low mood. They will also ask, sensitively, about any thoughts of harming yourself or that life is not worth living. This is a routine and caring part of the assessment, designed to make sure you get the right level of support.
Together you then agree a plan based on how severe the depression is and what you prefer. This might be self-help and lifestyle support, a talking therapy, an antidepressant, or a combination, with arrangements for follow-up. You can ask questions, take time to decide, and change the plan later if it is not working for you.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Self-help or low-intensity treatment alone is not appropriate when depression is severe, there is significant risk to safety, or the person cannot function — these need prompt, more intensive care.
- Antidepressants are not recommended as a routine first-line treatment for milder depression unless that is the person's informed preference.
- A routine outpatient pathway is not the right response to an immediate risk to life — that needs emergency help (999 or A&E).
- Treating low mood as 'just depression' may be wrong if symptoms point to another condition (such as bipolar disorder, a physical illness, or harmful alcohol use) that needs a different approach.
Delay or rearrange if…
- If you are in crisis or at immediate risk, do not wait for a routine appointment — use the urgent options in this guide.
- Starting or changing antidepressants needs care if you are pregnant, breastfeeding, or have certain physical conditions or other medicines.
- A clear pattern of unusually high mood or energy should be assessed before standard antidepressant treatment, as it may indicate bipolar disorder.
- Heavy alcohol or drug use may need addressing alongside, as it can worsen depression and complicate treatment.
Alternatives to discuss
- Guided self-help, structured exercise and lifestyle support, particularly for milder depression
- Different talking therapies (CBT, behavioural activation, interpersonal therapy, counselling)
- Different antidepressants or an alternative class if the first is not tolerated or effective
- Combined therapy and medication for moderate to severe depression
- Specialist psychiatric care for severe, recurrent or treatment-resistant depression
- Watchful waiting with support for very mild, short-lived low mood
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Most people with depression improve with the right treatment
- Talking therapies can help you understand and manage your thoughts, feelings and behaviour
- Medication can lift mood and restore energy, sleep and concentration where it is needed
- Treatment can reduce the chance of depression returning
- Assessment can uncover treatable contributors, such as a physical health problem or alcohol use
- Getting help early can shorten how long you feel unwell and protect your safety
Risks & complications
- Treatment usually takes a few weeks to work, which can feel slow and discouraging
- Antidepressant side effects in the first weeks, such as nausea, headache, sleep changes or feeling more anxious initially
- Talking therapy can bring up difficult feelings before things improve
- Not every treatment suits every person, so some trial and adjustment is normal
- Needing to switch medication or therapy if the first does not help
- Withdrawal (discontinuation) symptoms if antidepressants are stopped suddenly rather than reduced gradually
- Sexual side effects or weight changes with some antidepressants
- Depression that is harder to treat and needs specialist input
- A small possible increase in suicidal thoughts in the early weeks of antidepressant treatment, particularly in younger adults — which is why early follow-up matters
- Serious medication reactions or interactions, which is why your medicines are reviewed
- Rarely, a switch to high or elevated mood, which may suggest bipolar disorder and changes treatment
The most important issue is safety. If your thoughts of harming yourself become stronger or you feel unable to keep yourself safe, get urgent help straight away using the crisis options in this guide. Because antidepressants take a few weeks to work and can occasionally increase distressing thoughts early on (especially in younger adults), early follow-up is important. Antidepressants are not addictive, but stopping them suddenly can cause withdrawal symptoms, so any change should be planned with your clinician. Always mention any periods of unusually high mood or energy, as these can change the diagnosis and treatment.
Published figures to discuss
Numbers in depression treatment vary widely between people and studies, so exact figures can mislead. Response to any single treatment is far from guaranteed, many people need to try more than one approach, and benefits usually take weeks to appear. There is evidence of a small early increase in suicidal thoughts with antidepressants, mainly in younger adults, which is why early follow-up is standard. Rather than quote precise percentages, we describe these effects qualitatively and emphasise monitoring and shared decision-making.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Suicide or self-harm risk | Must be assessed, especially when depression is moderate to severe | Risk assessment should cover intent, plans, means, protective factors, substance use and support. | NHS — Treatment for depression in adultsnhs.ukSource-linked context |
| Antidepressant response | Variable; benefit is usually judged after several weeks at a therapeutic dose | Early side effects can precede benefit; a plan for review and switching/augmentation matters. | Guide sourcesClinical context |
| Bipolar disorder missed | Recognised | Past hypomania/mania, family history and antidepressant-induced activation should be screened before treatment. | Guide sourcesClinical context |
| Relapse | Common after recurrent depression | Relapse prevention may include continuing treatment, therapy, sleep/activity routines and early warning signs. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery from depression is usually gradual rather than sudden. 'Afterwards' means starting treatment, attending follow-up, noticing changes over weeks, and adjusting the plan with your clinician until you feel better and can stay well.
- Improvement coming gradually over weeks rather than all at once
- Some days being better than others, with a general upward trend over time
- Early antidepressant side effects that often settle after the first couple of weeks
- Feeling emotionally tired after talking therapy sessions
- Needing to adjust the dose, medicine or therapy before finding what works for you
Aftercare
- Attend follow-up appointments, especially in the early weeks of treatment.
- Take medication as prescribed and do not stop suddenly; talk to your clinician before making any change.
- Keep up talking therapy and any agreed activities such as exercise, routine and sleep habits.
- Limit alcohol and recreational drugs, which can worsen mood and interfere with treatment.
- Tell someone you trust how you are doing, and lean on support around you.
- Have a clear plan for what to do, and who to contact, if you feel worse or unsafe.
- Use the crisis options in this guide without hesitation if you are in distress or thinking of harming yourself.
- Crisis numbers saved: 999, Samaritans 116 123, SHOUT to 85258, and your local urgent mental health line — 111 (mental health option) in England, Scotland or Wales, or Lifeline 0808 808 8000 in Northern Ireland
- A follow-up appointment booked
- A clear note of your medication and how to take it
- Talking therapy or self-help arranged or in progress
- A trusted person who knows how you are doing
- A simple safety plan for difficult moments
- A list of questions for your next appointment
⚠ Get urgent help if…
- If there is immediate risk to life, or you have seriously harmed yourself or feel you may be about to: call 999 or go to A&E now
- If you are having thoughts of suicide or self-harm: call Samaritans free on 116 123 (24/7), or text SHOUT to 85258. In England, Scotland or Wales you can also call 111 and choose the mental health option; in Northern Ireland call Lifeline free on 0808 808 8000, or your GP out-of-hours service
- Your mood becomes much worse, you feel hopeless, or you feel unable to keep yourself safe
- You start an antidepressant and feel more agitated, restless or develop stronger thoughts of self-harm — seek advice urgently
- You stop being able to look after yourself, eat, drink or get out of bed
- You experience a sudden switch to unusually high mood, racing thoughts or risky behaviour
- You develop unusual experiences such as hearing voices or strong beliefs others do not share
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A 'good' outcome is feeling significantly better, being able to function in daily life again, and reducing the risk of depression returning. For many people this means symptoms easing over weeks with talking therapy, medication, or both, and being able to enjoy and manage life again.
Treatment does not guarantee that depression will never return, and finding the right approach can take some adjustment. The most reliable result is a clear plan, regular review, and a safety net you can use if things get worse. Recovery is realistic and is the goal of treatment.
How long benefits last varies. Some people have a single episode and stay well after treatment; others have recurrent depression and benefit from longer treatment or relapse-prevention work. Antidepressants are usually continued for at least several months after you feel well, then reduced gradually if appropriate. Keeping up the habits and supports that helped, and seeking help early if symptoms return, both protect against relapse.
Related tests, treatments or support
Treatment for depression is often combined: for example talking therapy alongside medication, or both alongside lifestyle support such as exercise and better sleep. Where depression occurs with anxiety, alcohol use, or a physical health problem, these are treated together. Your clinician will also review other medicines to avoid interactions.
Follow-up & long-term care
Follow-up is an essential part of treatment, particularly in the first few weeks. Your clinician will review how you are doing, check for side effects and safety, and adjust the plan. Reviews continue as you recover, and there should always be a clear route to urgent help between appointments if you need it.
- Continue treatment for as long as advised, even after you start feeling better, to reduce relapse
- Keep up helpful habits: regular activity, sleep routine, social contact and limiting alcohol
- Learn your personal early warning signs of relapse and act on them quickly
- Keep crisis numbers to hand and maintain a simple safety plan
- Attend reviews and discuss any changes to medication before making them
Repeat, follow-on and what comes next
- Adjusting the dose, switching medication, or changing therapy is common and expected if the first approach does not work well enough.
- Treatment is reviewed regularly, especially early on, and the plan evolves with your response.
- Recurrent depression may need longer treatment or relapse-prevention work; this is normal, not a failure.
- A diagnosis may be revised if new features emerge, such as periods of high mood.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear crisis information: 999/A&E for immediate risk, Samaritans 116 123, SHOUT to 85258, and the local urgent mental health route — 111 mental health option in England, Scotland or Wales, or Lifeline 0808 808 8000 in Northern Ireland
- Early and regular follow-up, especially in the first weeks of treatment
- A written, agreed plan including medication, therapy and self-help, and how to change it
- A personal safety plan and a named route to urgent help between appointments
- Relapse-prevention advice and a clear plan for when and how to seek help if symptoms return
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The length and type of assessment, and whether a GP, therapist or psychiatrist provides it
- The number of talking therapy sessions and the type of therapy
- Whether medication is prescribed and needs ongoing review
- How often follow-up appointments are needed
- Whether reports or letters (for example for work) are required
- Whether specialist or more intensive care is needed for severe or complex depression
- The fee for the initial assessment
- The cost per talking therapy session and the likely number of sessions
- Whether medication review and follow-up appointments are included
- What is included if treatment needs to change or be extended
- Whether letters or reports cost extra
- How urgent help is provided between appointments, and the route if your condition worsens
On the NHS? Assessment and treatment for depression are available on the NHS. In England you can often refer yourself to NHS Talking Therapies, while in Scotland, Wales and Northern Ireland the service names and referral routes differ, so ask your GP how to access psychological therapies locally. Private care is used by some people for speed, choice or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being offered medication without a discussion of talking therapy, self-help and the option to decline
- Not being warned that antidepressants take weeks to work and can cause early side effects or, rarely, increased distress
- Not being told that antidepressants should be reduced gradually rather than stopped suddenly
- No clear safety plan or route to urgent help if things get worse
- Not discussing how the condition or treatment might affect work, driving or other medicines, and who sees any report
Marketing red flags
- Promises of a 'quick fix' or guaranteed cure for depression
- Pushing medication, or a fixed number of paid therapy sessions, without proper assessment or choice
- Expensive unproven 'treatments' presented as superior to evidence-based care
- Discouraging use of free NHS services, including NHS Talking Therapies and urgent mental health help
- No clear crisis plan or safety-netting as part of the service
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Based on how I'm feeling, what treatment options would you suggest, and why?
- Would talking therapy, medication, or both suit me best — and what are the trade-offs?
- If I start medication, what side effects should I expect and when should it start helping?
- How and when will my treatment be reviewed, and how do I get urgent help between appointments?
- What can I do myself to help my recovery and reduce the chance of it coming back?
- Are there any physical health checks or other factors that could be affecting my mood?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
What should I do if I'm having thoughts of suicide or self-harm right now?
Will I have to take antidepressants?
Are antidepressants addictive?
How long do treatments take to work?
Can I get help on the NHS?
Will depression come back?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Treatment for depression in adults NICE NG222 — Depression in adults: treatment and management Royal College of Psychiatrists — Depression Mind — Depression NHS — Where to get urgent help for mental health Samaritans — Contact us (call 116 123) nidirect — Urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI) NHS England — 111 mental health crisis support NHS inform (Scotland) — Urgent mental health help NHS 111 Wales — Mental health and wellbeing nidirect — Mental health emergency / Lifeline (NI) NHS — Find NHS Talking Therapies (England) NHS inform (Scotland) — Psychological therapies NHS 111 Wales — Counselling nidirect — Mental health care professionals (NI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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