Treatment For Depression
There’s no one proven way that people recover from depression, and it’s different for everyone. However, there are a range of effective treatments and health professionals who can help you on the road to recovery.
There are also plenty of things you can do for yourself to recover and stay well. The important thing is finding the right treatment and the right health professional for your needs.
Psychological treatments (also known as talking therapies) can help you change your thinking patterns and improve your coping skills so you’re better equipped to deal with life’s stresses and conflicts. As well as supporting your recovery, psychological therapies can also help you stay well by identifying and changing unhelpful thoughts and behaviour.
There are several types of effective psychological treatments for depression, as well as different delivery options. Some people prefer to work one on one with a professional, while others get more out of a group environment. A growing number of online programs, or e-therapies, are also available.
Cognitive behaviour therapy (CBT)
CBT is a structured psychological treatment which recognises that the way we think (cognition) and act (behaviour) affects the way we feel. CBT is one of the most effective treatments for depression, and has been found to be useful for a wide range of ages, including children, adolescents, adults and older people.
CBT involves working with a professional (therapist) to identify thought and behaviour patterns that are either making you more likely to become depressed, or stopping you from getting better when you’re experiencing depression.
It works to change your thoughts and behaviour by teaching you to think rationally about common difficulties, helping you to shift negative or unhelpful thought patterns and reactions to a more realistic, positive and problem-solving approach.
Interpersonal therapy (IPT)
IPT is a structured psychological therapy that focuses on problems in personal relationships and the skills needed to deal with these. IPT is based on the idea that relationship problems can have a significant effect on someone experiencing depression, and can even contribute to the cause.
IPT helps you recognise patterns in your relationships that make you more vulnerable to depression. Identifying these patterns means you can focus on improving relationships, coping with grief and finding new ways to get along with others.
While behaviour therapy is a major component of cognitive behaviour therapy (CBT), unlike CBT it doesn’t attempt to change beliefs and attitudes. Instead it focuses on encouraging activities that are rewarding, pleasant or satisfying, aiming to reverse the patterns of avoidance, withdrawal and inactivity that make depression worse.
Mindfulness-based cognitive therapy (MBCT)
MBCT is generally delivered in groups and involves a type of meditation called ‘mindfulness meditation’. This teaches you to focus on the present moment – just noticing whatever you’re experiencing, whether it’s pleasant or unpleasant – without trying to change it. At first, this approach is used to focus on physical sensations (like breathing), but then moves on to feelings and thoughts.
MBCT can help to stop your mind wandering off into thoughts about the future or the past, and avoid unpleasant thoughts and feelings. This is thought to be helpful in preventing depression from returning because it encourages you to notice feelings of sadness and negative thinking patterns early on, before they become fixed. As a result, you’re able to deal with warning signs earlier and more effectively.
The main medical treatment for depression is antidepressant medication. There’s a lot of misinformation about antidepressant medication and while there is no simple explanation as to how it works, it can be very useful in the treatment of moderate to severe depression and some anxiety disorders.
If you’re experiencing moderate to severe depression your doctor may prescribe antidepressant medication, along with psychological treatments. Antidepressants are sometimes prescribed when other treatments have not been successful or when psychological treatments aren’t possible due to the severity of the condition or a lack of access to the treatment.
People with more severe forms of depression (bipolar disorder and psychosis) generally need to be treated with medication. This may include one or a combination of mood stabilisers, anti-psychotic drugs and antidepressants.
Making a decision about which antidepressant is best for each individual can be complex. The decision is made in consultation with your doctor, after careful assessment and consideration. You can help your doctor’s assessment by providing as much information as possible about yourself and your medical history. Important factors include your age, symptoms, other medications and, if female, whether you are pregnant or breastfeeding.
There are many different types of antidepressant medication which have been shown to work, but their effectiveness differs from person to person. Antidepressants take at least two weeks before they start to help, and it may also take some time for the doctor to find the most suitable medication and dosage.
Antidepressants can make you feel better, but they won’t change your personality or make you feel happy all the time. Like taking any other medication, some people will experience some side effects, and individuals should discuss the risks and benefits with their doctor. People should also ask for information about the medications so that they can make an informed decision.
Depending on which medication is taken, common side effects can include nausea, headaches, anxiety, sweating, dizziness, agitation, weight gain, dry mouth and sexual difficulties (e.g. difficulty becoming/staying aroused).
Some of these symptoms can be short-lived, but people who experience any of these symptoms should tell their doctor, as there are ways of minimising them. The likelihood of a particular side effect happening varies between individuals and medications.
It is not uncommon for people with depression to have suicidal thoughts. Treating the depression effectively will reduce the likelihood of a person hurting him or herself. In the period of time between the person starting antidepressant medication and responding to treatment – which can be more than two weeks – the person should still be monitored closely by the doctor and his or her progress reviewed, as the risk of suicidal behaviour may even be slightly increased, especially in young people.
There is a wide range of antidepressant medication available. Below is a description of the different classes of antidepressants used in Uganda.
Selective Serotonin Reuptake Inhibitors (SSRIs)
This class includes sertraline; citalopram; escitalopram; paroxetine; fluoxetine; fluvoxamine. SSRIs are:
- the most commonly prescribed antidepressants in Uganda.
- often a doctor’s first choice for most types of depression
- generally well tolerated by most people
- generally non-sedating.
Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)
This class includes venlafaxine; desvenlafaxine; duloxetine. SNRIs:
- have fewer side effects compared to the older antidepressants
- are often prescribed for severe depression
- are safer if a person overdoses.
Reversible Inhibitors of MonoAmine oxidase (RIMAs)
The class includes moclobemide. RIMAs:
- have fewer side effects
- are non-sedating
- may be less effective in treating more severe forms of depression than other antidepressants
- are helpful for people who are experiencing anxiety or sleeping difficulties.
TriCyclic Antidepressants (TCAs)
The class includes nortriptyline; clomipramine; dothiepin; imipramine; amitriptyline. TCAs are:
- effective, but have more harmful side effects than newer drugs (i.e. SSRIs)
- more likely to cause low blood pressure – so this should be monitored by a doctor.
Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)
This class includes mirtazapine. NaSSAs are:
- relatively new antidepressants
- helpful when there are problems with anxiety or sleeping
- generally low in sexual side effects, but may cause weight gain.
Noradrenalin Reuptake Inhibitors (NARIs)
This class includes reboxetine. NARIs are:
- designed to act selectively on one type of brain chemical – noradrenalin
- less likely to cause sleepiness or drowsiness than some other antidepressants
- more likely to:
- make it difficult for people to sleep
- cause increased sweating after the initial doses
- cause sexual difficulties after the initial doses
- cause difficulty urinating after the initial doses
- cause increased heart rate after the initial doses.
Monoamine Oxidase Inhibitors (MAOIs)
This class includes tranylcypromine. MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects.
- All of these drugs have been shown to be effective as antidepressants.
- When symptoms are directly due to depression, the person is likely to begin to improve after 4-6 weeks of effective therapy. For example, although SSRIs commonly make sleep difficulties or insomnia worse initially, they are associated with improved sleep 4–6 weeks later.
- SSRIs or clomipramie (TCA) would be the first choice if obsessive compulsive disorder symptoms were prominent.
Like any medication, the length of time someone needs to take antidepressants depends on the severity of their condition and how they respond to treatment. Some people only need to take medication for a short time (usually 6–12 months), while others may need it over the long term, just like someone with diabetes might use insulin or someone with asthma would use ventolin. Stopping antidepressant medication should only be done gradually, on a doctor’s recommendation and under supervision.
The important thing is finding the treatment that’s right for you. Just because a treatment has been shown to work scientifically, that doesn’t mean it will work equally well for every individual. Some people will have complications, side effects or find that the treatment doesn’t fit in with their lifestyle. It can take time, strength and patience to find a treatment that works.
After seeking appropriate advice, the best approach is to try a treatment you’re comfortable with and one that works for most people. If you don’t see an improvement or experience problems with the treatment, discuss this with your health professional and consider trying another.
OTHER SOURCES OF SUPPORT
If left untreated, depression and anxiety can go on for months, even years. The good news is that a range of effective treatments are available, as well as things you can do yourself to recover and stay well.
Different treatments work for different people, and it’s best to speak to your GP or mental health professional about your options and preferences. If you’ve taken the first step and talked through some treatment options with a health professional, you might like to try a few of the following ideas for lifestyle changes and social support. Most people find that a combination of things work best.
It’s important to remember that recovery can take time, and just as no two people are the same, neither are their recoveries. Be patient and go easy on yourself.
Staying well is about finding a balance that works for you, but there are some general principles that most people find useful.
These include maintaining a healthy lifestyle – eating a healthy, balanced diet; doing some form of regular physical activity; and having a good night’s sleep. It can also be useful to cut back on alcohol and drugs.
Reducing and managing your stress levels by making sure that you make time to do something distracting, relaxing, satisfying or enjoyable each day – even if you initially feel you can’t be bothered – can also help. You may find it helps to get the help of a friend or family member to help you stay active. It’s also important to deal with any setbacks and keep trying.
As with any health condition, the more you learn and know about depression and anxiety conditions, the better able you will be to work out what’s right for you. It’s important to learn the facts using reliably sources of information such as the Beyond Blue website, pamphlets and booklets.
A number of other organisations provide useful information too. It may be worth talking to your doctor or mental health professional about what you’ve read if you want to make sure it is accurate and reliable.
Support groups for people with depression and anxiety can provide an opportunity to connect with others, share experiences and find new ways to deal with challenges from others who have experienced the same issues as you. Contact your local community health centre or the mental health association/foundation in your state or territory to find your nearest group, or try searching online.
Some people prefer to seek and offer support or share their stories via online forums. You can join speakoutu’s online community
The people close to you can play an important role in your recovery by providing support, understanding and help, or just being there to listen. It can be hard to socialise if you’re experiencing anxiety or depression, and many people tend to withdraw or avoid social contact. But spending time alone can make you feel lonelier and cut off from the world, which in turn makes it harder to recover.
It is important to try to get out and spend time with your family and friends, and keep saying ‘yes’ to social invitations – even if it’s the last thing you feel like doing.
It can help to talk about how you are feeling with someone who is caring and supportive. Even if you are not looking for support, it can still be helpful to let family and friends know what you are going through, so they are aware. This can help them to support you better.
If you don’t feel like talking and interacting, try an activity where you don’t have to make conversation, like watching a movie or playing sport.
Staying connected improves your wellbeing and confidence, and doing some physical activity has the added bonus of helping you keep fit and bust stress.