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Depression treatments

Depression is increasingly common in our society, but unlike other common illnesses, many people do not seek help to deal with it.

Depression is often wrongly seen as a form of weakness or something to be ashamed of. But there are many ways of treating depression, and a very good chance that you will find a treatment that suits you. Depression can make the lives of people who suffer from it very miserable. In extreme cases, it can put people at risk of harming themselves. This leaflet looks at the different types of treatment for depression. For more information about the symptoms and possible causes, see the separate fact sheet Depression.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Visiting your GP (General Practitioner) is the first step someone with depression can take to recovery. It can be an enormous relief to simply share how you are feeling.

By asking specific questions about your mood, sleep patterns, appetite and energy levels, most GPs can diagnose depression. They might ask more about what is happening in your life that would help to explain the feelings you are experiencing. No matter how deeply personal or even trivial a predicament may seem, it can help to discuss it.

Doctors are trained to ask direct questions about pessimistic thoughts about the future and thoughts of self-harm that are common in depressed people. Again, it can be very helpful for people to talk openly about these issues.

 

Some family doctor practices have counsellors to help patients with depression or other emotional difficulties. Counsellors may have a background in mental health nursing or psychology.

Practice counsellors can conveniently see patients in a clinic, usually for a fixed number of sessions, which varies depending on the type of treatment offered.

Regular exercise can also be helpful in treating depression. People with marked anxiety sometimes find that relaxation, massage or yoga can help ease their symptoms.

 

There is a wide range of antidepressant medication available, for which there is strong evidence that they are effective and are not addictive.

SSRIs

SSRIS (selective serotonin re-uptake inhibitors) are the most commonly prescribed type of antidepressant. The drugs fluoxetine (Prozac), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral) are all SSRIs.

SSRIs work by raising the levels of the chemical serotonin in the brain, which in turn tends to lift your mood. When you first start taking them, you may have some sickness and headaches as side-effects, but these tend to wear off over time. They are best taken in the morning, as they can interfere with sleep.

Around 10% of people who take SSRIs also suffer from sexual difficulties, such as impotence or loss of sex drive (libido), though these can also be a symptom of depression. If sexual difficulties are side effects of the drug, they should stop when you stop taking the drug, and are a sign that your doctor may need to change your medication.

Tricyclics

Tricyclics can be as effective as SSRIs, but they can have different side-effects, which may be more troublesome for some people than others. Amitriptyline (Lentizol), dothiepin (Prothiaden) and clomipramine (Anafranil) are all tricyclics. These work by raising the levels of the chemicals serotonin and noradrenaline in the brain, which both tend to elevate your mood.

Possible side-effects include a dry mouth, constipation and putting on weight. Most people tolerate these as they gradually become familiar with their medication. They can be more sedative than SSRIs and tend to be best taken at night. Although safe in normal doses, an overdose of a tricyclic antidepressant can dangerously affect the heart rhythm.

Other types of medication

There are several new antidepressants which work in a different way from SSRIs and tricyclics. These include venlafaxine (Efexor), nefazadone (Dutonin) and mirtazepine (Zispin). They can be useful for people who experience side-effects with other medications.

Antidepressants usually need to be taken for at least six months. For many people treated, depression comes back after stopping treatment. Taking medication even after the symptoms have cleared up can help prevent this. Talk to your doctor about how long you should continue with medication.

 

GPs refer around 10% of the people with depression they see to psychiatrists. Psychiatrists are qualified doctors who specialise in mental health problems.

An initial appointment with a psychiatrist may take 30 to 45 minutes. During this assessment, your symptoms and situation are carefully explored. Psychiatrists are experienced in prescribing different types of antidepressant medication, and in spotting their side-effects. If you do see a psychiatrist for treatment for depression, you may have occasional follow-up appointments with them for several years. In other, cases, your GPs will refer you again if your symptoms recur.

Psychiatrists can also offer or refer people for psychological treatments. For example, cognitive behaviour therapy (CBT) is a form of psychological treatment that is very effective for depression. CBT involves 12 or so one-to-one sessions with a therapist. Sessions focus on the thoughts (cognitions), beliefs and behaviour patterns associated with depression and how they relate to feelings.

 

A small number of people suffer from depression so severe that they may need to be admitted to hospital. With severe depression, people can become completely withdrawn and stop eating and drinking. They may experience intense suicidal thoughts, or even try to end their life. People with severe depression may develop a psychosis, in which they lose track of reality. People with psychotic depression may hear voices when there is no one there (hallucinations). These voices may say distressing or unpleasant things about them. They may also develop false beliefs (delusions) about themselves or their health and be unable to recognise that they have an illness. Psychiatrists describe this as a lack of insight.

When somebody is this severely unwell and they are judged as a danger to themselves or to others, a psychiatrist may use the Mental Health Act to force them to be admitted them to hospital. Under strict legal guidelines, the Mental Health Act allows treatment of severe psychiatric illness to be given without the patients consent.

Electro-convulsive therapy

The quickest way of treating severe depression with the minimum of side-effects may be with ECT (Electro-convulsive therapy). During ECT, the patient receives a light general anaesthetic and muscle relaxant. An electrical current is then applied across the patients temples. This induces a seizure or fit.

It is thought that the changes in the brain that occur with the seizure help to elevate mood. Despite its effectiveness, ECT tends to receive a bad press. It is not suitable for every patient, but it can help save the lives of severely depressed people.

Alternative medicine

Many people prefer a natural approach to tackling depression. St. Johns Wort is a popular complementary medicine, available in health food stores and pharmacies.

Research studies show some promising results about its effectiveness with some types of depression. Its important to tell your doctor or pharmacist if you are taking St Johns Wort (or thinking of taking it) as it can interact with other medicines you might be taking.

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