Depression Treatment & Management

Category: Treatments & Interventions Created: Wednesday, 02 September 2020 08:53

The treatment that's right for you will depend on how bad your depression is, your symptoms, what is happening in your life, your preferences, and your personality.

Mild depression is usually treated with psychological treatments (talking therapies). Medication is not normally needed.

Moderate depression can be treated with psychological treatments or medication.

Most people with more severe depression will need a combination of antidepressant medication and psychological treatment.

While symptoms are at their worst, the aim of treatment is to make the symptoms less severe.

After symptoms are under control, the aims of treatment are to get you back to living a full life, and to stop symptoms coming back again.

Learning about depression can also be part of treatment. 

What works?

People with depression do best if they:

• get psychological treatment (talking therapies)
• get on with life in the community (get help from friends and family, join support groups, have somewhere to live, keep a job)
• have a healthy lifestyle (eat well, stay physically active, get good and regular sleep, quit smoking and other drugs)
• get the right medication (for moderate and severe depression).

Psychological treatments

Psychological treatments (talking therapies) are used to treat all types of depression. For mild depression they might be the only treatment needed.

Treatment is provided by trained therapists (e.g. psychiatrists, psychologists, or GPs).

Several different psychological treatments work for depression. These include:

• cognitive behavioural therapy (CBT)
• interpersonal psychotherapy
• problem-solving therapy
• short-term psychodynamic therapy.

CBT and interpersonal therapy work just as well as medication for people with mild-to-moderate depression.

Some psychological treatments, such as CBT and mindfulness-based cognitive therapy, can also stop depression coming back after you have recovered.

If you have psychological treatment as your main treatment, it should be started as soon as possible after you get the diagnosis of depression.

If you are taking medication for depression, your doctor or psychologist might advise you to start psychological treatment a bit later. 

Medication

Antidepressant medications are used to treat moderate and severe depression.

Antidepressant medications can reduce symptoms of depression, such as feelings of sadness, thoughts of suicide, tiredness, poor appetitie and sleep problems. 

Brain stimulation treatments

Electroconvulsive therapy (ECT)

For severe depression, ECT works better than medication. It’s a safe and effective treatment.  

Doctors mainly recommend ECT when someone has not improved after trying several different medications.

It can be the best treatment for people with severe symptoms –for example someone whose depression is so bad that they can’t eat or drink, are at high risk of suicide, or are having hallucinations or delusions. 

Repetitive transcranial magnetic stimulation (rTMS)

rTMS works in a similar way to ECT, but uses magnets near the head to change brain activity.

Doctors use it when medications or psychological treatments haven't worked.

People are awake during the treatment and there are few side effects.

It is currently only available in some private hospitals and clinics. 

Will I have to go to hospital?

Most people with depression don’t need to stay in hospital. Normally your treatment will involve regular visits to your GP or psychologist.

You may need to stay in hospital if:

• you are suicidal or at risk of physical harm
• you can’t eat and drink properly
• you have a medical illness that is making your depression severe
• you have serious problems with alcohol or other drugs
• you need a special hospital-only treatment like ECT.  

Why should I get treatment?

With effective treatment, you can recover from depression and live a full, satisfying life.

The right treatment can help you:

• recover from symptoms of depression
• get on with life – study, work, finances and relationships
• stop symptoms coming back again
• stop having thoughts about suicide or self-harm. 

What if I'm not getting better?

If your symptoms don’t improve with treatment, there are several things your doctor or psychologist will check before deciding what to do.

Reasons for not getting better can include:

• not taking the medication properly (e.g. not being able to take it every day, or taking other medications that are interfering with it)
• treatment that doesn’t suit you (e.g. medication that isn’t working for you, or having psychological therapy from a therapist who's not a good match for you)
• having another mental health problem (e.g. anxiety or borderline personality disorder) as well as depression
• having depression that's caused by undiagnosed bipolar disorder – up to 1 in 10 people with depression go on to be diagnosed with bipolar disorder
• problems with alcohol or other drugs.

If you're receiving psychological treatment alone, your therapist might suggest starting medication.

If you're already taking medication, your doctor might suggest increasing the dose or changing to a different medication.

If you want, you can ask for a second opinion from another doctor.

 

<h1">Antidepressant medication

What are antidepressants?

Antidepressants are medications that can reduce symptoms of depression, such as feelings of sadness, thoughts of suicide, tiredness, poor appetite and sleep problems.

They are used to treat moderate and severe depression.

Antidepressants are also used to treat anxiety disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

What types are there?

There are several different types of medications for treating depression.

Newer antidepressant medications work by altering the amounts of natural chemicals in your brain, such as serotonin or noradrenaline.

These types of medications include:

• ‘selective serotonin reuptake inhibitors’ (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline
• other medications that alter serotonin, such as vortioxetine
• medications that alter both serotonin and noradrenaline, such as desvenlafaxine, duloxetine, mianserin, mirtazapine and venlafaxine
• medications that alter serotonin and melatonin, such as agomelatine.

Older types of medication are used when the newer medications don’t work or are not appropriate. These types of medications include:

• ‘tricyclic antidepressants’, such as amitriptyline, clomipramine, dothiepin, doxepin, imipramine and nortriptyline
• ‘monoamine oxidase inhibitors’, such as moclobemide, phenelzine and tranylcypromine.

St John’s wort (a herbal medicine) is sometimes used for mild depression, but it can cause problems with other medications. St John’s wort should not be used at the same time as a prescription antidepressant medication. If you are thinking of using any non-prescription medications to treat your depression, talk to your doctor first.

What should I know if I’ve been prescribed an antidepressant?

• Take every dose of your medication at the time recommended to you by your doctor.
• When starting a medication, give it time to start working properly.
• Don’t change your medication without talking your doctor.
• If you have symptoms that you think could be the side effects of medications, tell your doctor as soon as possible.

What are the side effects?

Antidepressant medications can sometimes cause side effects, especially when you start a new medication.

Side effects of antidepressants differ between medications and from person to person.

Ask your doctor or pharmacist to explain the possible side effects of your medication.

If you have side effects that bother you, speak to your doctor about them. They might be able to reduce the side effects by changing the dose or switching to a different medication. Some side effects will get better after a few days and some can be treated with other medications.

Possible side effects can include:

• weight gain
• sexual problems (e.g. taking longer to reach orgasm)
• sleepiness or tiredness
• sleep problems
• dizziness
• agitation
• dry mouth
• diarrhoea or constipation
• nausea
• headache
• teeth-grinding
• problems with the heart and blood pressure
• seizures. 

Sometimes young people have suicidal thoughts while they're taking antidepressant medication. Children, teenagers and young adults need to be checked during the first few weeks of treatment to make sure they are safe.

Many people only have side effects in the first few days or weeks.

How long will I need to take an antidepressant?

Antidepressants need time to start working. Most people improve within a few weeks, but you may need to take an antidepressant medication for up to 6 weeks before your symptoms of depression are under control.

After you start to get better, you usually need to keep taking the medication for at least 6 months. This helps you recover completely, and can stop the symptoms coming back.

Most people don’t need to stay on antidepressant medications for years, but it may be necessary if you've had depression before.

Taking medication every day

Many people find it hard to keep taking their medication.

If you have trouble remembering to take your medication, or you are taking several different medications, ask your pharmacist to package the tablets in containers with compartments for each day. They might use a blister pack (sometimes called a Webster-Pak or Medico Pak) or a plastic container (called a dosette box).

It is a good idea to always go to the same pharmacy so they can keep track of all your medications and give advice about them when needed.

What if the medication doesn’t work for me?

If an antidepressant medication is right for you, your symptoms will start to improve within about 2 weeks. If you are no better after 3–6 weeks, your doctor might recommend a different medication.

Pregnancy and breastfeeding

If you are pregnant, planning to become pregnant or breastfeeding it's essential to discuss this with your doctor.

It’s best to be cautious about using medications during pregnancy. Some medications could harm an unborn baby, but stopping medication during pregnancy may be risky for the mother. 

If you are already pregnant, talk to your doctor as soon as possible about keeping yourself and your baby safe during pregnancy and breastfeeding.

If you need medication for postnatal depression, talk to your doctor about whether it’s safe to breastfeed. 

Other medications

Before you start taking a new medication, tell your doctor if you are taking any other medication (including over-the-counter or complementary medicines). Some medications cannot be mixed.

 

7 Ways to Overcome Depression Without Medication

To overcome depression, it helps to know the facts.Depression is a medical condition and not “laziness” or a temporary response to normal grief and/or discouragement.

Symptoms of Depression

A major depressive episode is defined as experiencing five or more of the following symptoms every day (or most days) for two weeks or more:

• Depressed or irritable mood
• Sleep problems (i.e., sleeping too much or too little; sleeping mainly during the day)
• Change in interests (i.e., not being interested in what you used to enjoy) or low motivation
• Excessive guilt or unrealistically low self-image
• Significantly low energy and/or change in self-care (i.e., not showering anymore)
• Significantly worse concentration (i.e., sharp decline in grades or performance)
• Changes in appetite (i.e., eating too much or too little)
• Agitation or severe anxiety/panic attacks
• Suicidal thoughts, plans or behaviors — including self-harm (i.e., intentionally cutting or burning yourself)

It’s important to remember that not everyone who is depressed is suicidal. You can still seek help even if you haven’t demonstrated any specific suicidal or self-harm behaviors, or even if your symptoms aren’t as severe or persistent as the symptoms noted above.   

OK, I’m feeling depressed… so now what?

Now that you know the symptoms of depression, some positive coping skills can be useful. All of the following techniques are supported by scientific research and medication prescribers — like psychiatrists — and these skills are frequently recommended as important parts of treatment even for patients who continue to take antidepressant medications.

WARNING: Do not suddenly go off your prescribed antidepressant medications without first talking to your medical provider. Discuss any questions or concerns about the side effects of your medications with your provider.   

Practice These Coping Skills Every Day

I recommend doing many — if not all — of the following coping skills and techniques once a day when experiencing depression. It’s important to know you probably won’t be motivated to do any of them at first because depression frequently saps motivation. In other words, know that it’s normal to feel unmotivated until you’re halfway done.

The patients I work with who frequently practice these coping skills get better. The seven techniques can be memorized with the acronym MY PEERS.

1. Meaning: Find small ways to be of service to others. 

Find personal meaning by serving something larger than yourself. Remember service doesn’t have to be big to count. Consider this, “Success, like happiness, cannot be pursued; it must ensue… as the unintended side effect of one’s personal dedication to a course greater than oneself.” – Viktor E. Frankl, Man’s Search for Meaning

 

2. Your goals: Find workable goals that give you a sense of accomplishment.

Most people feel guilty when talking about goals because they set unreasonable or unworkable goals. A goal is workable if it’s:

1. Something you can control (i.e., it doesn’t depend on others)
2. Manageable (i.e., not overwhelming)
3. Realistic for you (not for someone else)
4. Measurable (i.e., you know whether or not it is done or getting done)

If something goes wrong with your goal, adopt a “what can I learn from this?” attitude (versus a judgmental, “this is why I’m horrible” attitude). Also, be careful when comparing your progress with others. We usually compare our biggest weakness with another person’s biggest strength. This is unfair (and usually not accurate anyhow).

3. Pleasant Events: Schedule pleasant activities or events.

Don’t wait for yourself to be “in the mood.” For example, give yourself permission for a 30-minute “vacation” or schedule a healthy hobby every day. Just remember to do these activities with the right attitude (see Engagement).  Also, practice gratitude — take time to notice what went well today, not just what went wrong.  Consider keeping a gratitude journal.  Know that being grateful for your blessings doesn’t mean you have to discount your problems.

4. Engagement: Stay in the present.

This practice is sometimes called mindfulness. As best you can, during activities try not to be in your head with self-judgment. You may not be able to turn off the self-judgment, but you can notice it and bring yourself gently back to the present.  Research shows that people with higher self-compassion also have higher self-worth or self-confidence. 

5. Exercise: And, eat right too.

Doing moderate exercise about five times a week (30 minutes a pop) can dramatically help your mood.  Moderate exercise is a level of activity where it is difficult to sing from your diaphragm while doing it.  Also pay attention to how the type of food or drink you’re eating influences your mood.  You don’t have to do fad diets, but anyone will be depressed if they frequently binge on carbs, junk food, and energy drinks. Remember the virtue of moderation.

6. Relationships: Focus on people who lift you up.

Interact frequently with others that bring you up (not people that bring you down). While it’s OK to have some alone time, find a balance and don’t isolate yourself or the depression will linger. 

7. Sleep Regularly: Try to keep a regular sleep schedule.

Keep a balance with not too little and not too much sleep. Staying up late one night and then sleeping in excessively the next day is a sure-fire way to feed depression.  Also, don’t try to solve problems late at night when your brain is half-asleep.

As you practice these coping skills, know that you’re on the path to overcoming depression

In contrast, depression tends to linger when patients make up a reason why they can’t do these things.  No matter what medication you’re taking, doing several of these activities every day — especially when you don’t feel like it — is vital to the treatment of depression.  These positive coping skills may take time and practice, but if we don’t take the time to be well now, the periods of “unwellness” may be forced upon us later.

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