Depression and drug treatment.

Not everybody who is fed up needs antidepressants.Not everybody will respond to the same drug..My advice to patients about drug treatment of depression is simple

1.If you are thought to need tablets in the first place(and this decision should not be made lightly) then you should have treatment for at least 6 months. Often up to a year is required. It often takes this long for people to sort out some of the problems which have contributed to the depression in the first place.

2.Expect side effects when you start treatment.Try to put up with them if you can.They usually settle within a week or so.

3.Dont expect to start feeling better for two weeks or so

4.Antidepressants might help you but time does have a role.Drugs will however help you to live in the world whilst you are getting better.Whether we are depressed or not we still need to eat drink go to the bathroom shop cook and keep house.Tablets will help you to cope with doing these things.

5.People who are depressed often find it difficult to keep a sense of proportion-small problems can seem as overwhelming as big ones.Try to keep things in proportion-have alook at Problem solving for some tools to help you do this.keep a diary and write in each day one thing which you are going to do.This gives some structure to your day It is very easy for people who are depressed to stare at the walls all day.:this doesnt help.If you dont do what you have set yourself dont beat yourself up over it .Some days you will some you wont.as you get better you should find you are getting more good days and fewer bad days.Keep a note of the number of good days and bad days-this can help if you feel you are not making progress.Sometimes it is difficult to remember how low you were once your mood starts to lift.You then become impatient for rapid change.Sometimes you are better going to work even if depressed unless work is part of the reason for it.

6.Dont drink alcohol.People often turn to alcohol when they are not coping.It helps them feel that they are in the same way as drunks will pick fights because they think they can win when patently they wont.Also alcohol interferes with medication.Essentially antidepressants don't work if you are drinking so its pointless taking them.Alcohol is also a depressant and although it lifts one's mood if taken in small amounts regular moderate or excessive consumption can actually lead to depression.

7.When you come off treatment do so slowly.Seroxat (paroxetine)is a particularly difficult antidepressant to come off.Ask your GP if you can have the syrup or liquid formulation especially if you are having problems reducing your dose.Remember if you go from 20mg to 15 this is a reduction of a quarter if you take 15 and reduce by 5 this is a reduction of a third and if you take 10 and reduce by 5 this is a halving of the dose.The lower you go the slower you go :this is difficult with tablets.

8.You can't pull yourself together when you are clinically depressed.It is a black cloud (Winston Churchill called it 'my black dog') which will shift eventually.When you are depressed you cannot see how the sun can ever shine again.Remember though that many others have been through the same experience and have gone on to live tolerably happy lives.Your life may not be a bed of roses but try to think positively.Think of the bus driver who when asked for a ticket to Picadilly Circus replied 'I really wouldn't start from here'.All of us start from where we are,which might not be where we wished or hoped.The proper response to the negative bus driver is well I am here and that is where I intend to go.

9.Don’t make any major life decisions when you are depressed. Sometimes people walk out of homes & jobs later to regret it.The right time to make such major decisions is when you have a clear head and can look at the problems in a cool,rational way.The decision may ultimatley be the same but it will be less likely to be the wrong decision.

9.Counselling psychotherapy and psychological interventions all have a role to play.If you have to wait for Counselling this is not necessarily a bad thing as it may give time for antidepressants to work .Sometimes counselling itself can be traumatic and require reserves of emotional strength which for some people simply are not there.Unfortunately there are some memories or experiences which are so awful no amount of counselling can help.Sometimes we need to dig deep into our own reserves of strength to find ways of coping. 'Forgetting' is a useful coping mechanism-what the eye does not see the heart does not grieve over.

Problem solving may give you some hints and tips at how to look at your problems in a constructive way.

Anxiety is a common accompaniment to depression.Click here for some information on the Anxiety network

Click here for more comprehensive information on depression kindly supplied by Dr S Cembrowickz

Useful Contacts:

• Mental Health Foundation website at www.mentalhealth.org.uk
• Foundation for People with Learning Disabilities website at www.learningdisabilities.org.uk
• Connects: the Mental Health and Learning Disabilities portal at www.connects.org.uk