Treatment for mixed anxiety and depression

The NHS uses a stepped care approach. You are offered the simplest treatment that is likely to help, and moved on to more intensive treatment if you need it.

Guided self-help

You work through a CBT-based course in a book, online or in an app, with regular short sessions with a trained practitioner. This works well for many people with milder symptoms.

Talking therapies

• Cognitive behavioural therapy (CBT) helps you understand how your thoughts, feelings and actions affect each other, and change unhelpful patterns.
• Behavioural activation helps you gradually get back into activities that give you a sense of enjoyment or achievement.
• Counselling gives you space to talk about what is going on.
• Interpersonal therapy (IPT) focuses on relationships and life changes.

In England you can refer yourself to NHS Talking Therapies. Sessions may be one to one, in groups, by phone, by video or in person.

Medicines

If your symptoms are more severe, have lasted a long time, or talking therapy alone has not helped, you may be offered an antidepressant, usually an SSRI such as sertraline. These can help with both low mood and anxiety.

• it usually takes 2 to 4 weeks to feel the benefit
• some people have side effects at first, such as feeling sick or more anxious, which often settle
• do not stop suddenly. Your GP will help you reduce the dose slowly when it is time to stop

NICE says doctors should treat the depression first when anxiety and depression happen together, because this often helps the anxiety too.

Other things that can help

• physical activity, including group exercise programmes
• mindfulness courses
• social prescribing, where a link worker connects you with local groups and activities

Next, read about living well with anxiety and depression.