There are a lot of things that can be done to help people who suffer from depression.
- talk to someone who can help
- keep as active and occupied as possible, but don’t overstress yourself
- you are not alone - depression is a common problem and can be overcome.
When specialist help is needed
If the depression is dragging on and causing serious difficulties, it’s important to seek treatment. Your general practitioner will be able to advise you about what help is available and to arrange a referral to the mental health service.
Talking treatments for depression
It can be a great relief to ‘off-load’ to a sympathetic, understanding, uncritical listener. This could be a friend, a relative, a volunteer or a professional. There are more specialised psychological, or talking treatments.
Psychotherapy helps you to understand depression in terms of what has happened to you in the past.
Cognitive Behavioural Therapy
CBT is a type of talking treatment that helps someone understand their thoughts, feelings and behaviour (see Royal College of Psychiatrists leaflet on CBT). CBT tries to help you think in ways that make you feel better. These can be arranged through your GP, a community psychiatric nurse, psychologist or psychiatrist.
Your family doctor may ask a psychiatrist to see you for some expert advice.
If your depression has been triggered by a bereavement or problems in a relationship, then bereavement counselling or marriage therapy can help.
Are there problems with talking treatments?
They are very safe. However, sometimes psychotherapy can bring up unhappy memories from the past. A good therapist will know how to deal with this. If you have concerns, you should discuss them with your doctor or therapist.
If you are so depressed that you have physical symptoms, such as poor sleep, poor appetite and loss of weight, or the depression has gone on for a long time, your doctor will often suggest an antidepressant. About 50-60% of people who take these tablets will find them helpful. There are several different types of antidepressant now available, so there should be no difficulty in finding one to suit you.
How do antidepressants work?
Antidepressants boost the levels of two chemicals in the brain that get depleted in depression. These chemicals are called serotonin (also called 5HT), and noradrenaline.
Antidepressant medication is best used with a psychological therapy such as CBT. Antidepressant medication usually needs to be taken for several weeks before the person feels better. Mild depression is often not treated with antidepressants, but instead with general help and support (see Royal College of Psychiatrists’ leaflet on antidepressants).
Do antidepressants have side effects?
Modern antidepressants are very safe. Some can make you feel sick or more anxious over the first few days, but these effects usually wear off. Others may make you sleepy or give you a dry mouth. They can sometimes interfere with other medicines that you are taking, but your doctor will be aware of this. About one in three people get mild withdrawal symptoms if they stop these medicines suddenly. So it’s best to come off them slowly under the supervision of your Doctor.
Antidepressants usually take one or two weeks to start working although they may improve your sleep quite quickly. You may find that it takes 6 to 8 weeks for them to really make a difference. Many antidepressants slow down your reactions and may make you a bit drowsy. It is important not to drive if this happens to you. If you take several sorts of pills, you may find that you get muddled and forget to take some of your medicines. If so, your doctor, chemist or community nurse can help. They can give you a special box, or blister pack, with all the tablets set out for you to take at the right time of the day for a whole week.
Going into hospital
A small number of people need to have their depression treated in hospital. If you are very unwell -perhaps unable to eat or drink, or have tried to kill yourself - you might need to have ECT or electroconvulsive therapy. If recommended, you will need to discuss this thoroughly with your relatives and doctors. If you are unwilling or unable to give consent to this, an independent doctor would be asked to see you to decide if it is really necessary.
Which treatment is best?
Talking treatments and antidepressants work equally well. Your doctor is more likely to recommend antidepressants if your depression is severe or has gone on for a long time. Antidepressants also work a bit faster than talking treatments and are taken in conjunction with talking treatments. Some people prefer to try and get over the depression without medicine, whilst others prefer taking tablets. You can have both talking treatments and antidepressants. Your GP will be able to give you advice. It is also sometimes helpful to talk over the options with your family or a close friend.
What if depression is not treated?
Most people will get better, after weeks, months or even a year or two, but the shorter the depression lasts, the better. Talking with friends or family or self help may be enough to help you feel better again. If the depression is very severe, it may lead to a person taking their life or becoming very ill through not eating and drinking enough as people tend to neglect themselves when they are depressed.
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