Coping with severe depression – what works?
i) Drug Treatment
Anti-depressants
Anti-depressant drugs act by increasing the activity of those brain chemicals which affect the way we feel. Anti-depressants help between 60 and 70 per cent of people with depression.
A number of different kinds of drugs may be prescribed, for example:
Tricyclic anti-depressants are prescribed for moderate to severe depression. Some examples are dothiepin, imipramine, and amitryptyline. Tricyclic anti-depressants may take several weeks to start working so don’t expect results straightaway. They sometimes cause drowsiness, so talk to your doctor if this is a problem. Other possible side-effects include blurred vision, a dry mouth, constipation, sexual problems, and weight gain. These side-effects can usually be reduced by changing to a different brand or by starting at a lower dose and gradually increasing it. Tricyclic anti-depressants are not addictive.
Newer anti-depressant drugs – selective serotonin reuptake inhibitors and selective noradrenaline reuptake inhibitors (SSRIs and SNRIs) target specific chemical ‘messengers’ in the brain.
The most well known SSRI is fluoxetine (Prozac) but there are several other brands. The most significant side-effects from these newer drugs are headaches, stomach upsets, and reduced sex drive. However some people become more anxious and restless when taking them and there have been reports of some people becoming aggressive. As with all drugs, if you have any unusual reactions you should discuss them with a doctor straightaway. For example, venlafaxine (Efexor) can cause a skin rash which should be reported to a doctor immediately.
Mood stabilisers
Lithium carbonate may be prescribed to people with bipolar disorder as a way of stabilising their mood swings. It is also sometimes used as an additional treatment for people with severe depression alongside anti-depressants. High levels of lithium in the blood can be dangerous, so if you are taking lithium you must have regular blood tests. Other mood stabilisers include carbamazepine.
How long do I have to take the drugs?
If you are prescribed drugs for depression you will probably be advised to take them for at least six months, or longer if you have a previous history of depression. Older people may have to carry on taking drugs for longer than younger people. You are more likely to ‘relapse’ (have another episode of depression) in the three months after you have started to recover – which is why doctors usually recommend taking the medication for a further six months.
It is important to feel confident that you can discuss your medication with your GP or pharmacist. Family and friends can help by encouraging you to report any unpleasant side – effects, especially when a new or different drug is prescribed. There are also special helplines which will give you general advice on medication.
What about coming off medication?
If you stop taking anti-depressant drugs suddenly you can experience unpleasant effects, such as headache, nausea, dizziness and even hallucinations. Always consult your doctor before stopping taking anti-depressants and never stop suddenly as the effects may be severe. Remember that it can take at least six weeks for you to begin to recover, but by six months four out of five people will be better.
Children and young people
Tricyclic drugs have been used with children but they seem to be less effective than with adults. The newer SSRIs have not yet been adequately tested with children.
Older people
As people grow older they are increasingly likely to be prescribed drugs for medical conditions. If drugs for depression are added there can be unexpected side-effects, such as dizziness and confusion. Sometimes just taking too many different drugs can produce symptoms of depression. People with memory problems may forget to take their drugs, particularly if they have lots of different drugs to take. You may like to ask the pharmacist to supply the pills in a ‘dosette’ – a special container, which has separate compartments for each day of the week, or each time of day.
People diagnosed with dementia (such as Alzheimer’s disease) often experience depression, but anti-depressant drugs seem to be less effective for them than for other people of the same age. They may also experience more side-effects from medication, such as loss of appetite or increased confusion.
Anti-depressant drugs should only be prescribed to people in nursing homes if they are actually depressed, not to deal with behaviour problems related to dementia.