Guest Author - Sally Davies

A visit to the doctor is a good start, but too many get nothing more than a prescription. Overcoming depression calls for change in your life, not just your biochemistry.

People are often concerned about using medication, because of side effects which can be unpleasant, and fears of becoming dependent. It is true that in cases of mild depression, the side effects of medication could be worse than the problem, which is best treated with counselling. It is also true that in many cases depression is a self limiting condition that comes right eventually. But if it is hurting your life, and the lives of others, why spend months and years in misery? At some point, financial cost and side effects are outweighed by the damage that's being done.

Addiction in the true sense does NOT occur with antidepressants, but if you need them, be prepared to stay on them for at least six months or longer. These are not “feel good” pills but work gradually to adjust your body's own biochemical balance until it is right. When you are ready to stop, medication should be withdrawn gradually under medical supervision – but this is to establish that you are now really well, and not because you can't cope without drugs.

It’s important to know that the usual medication can take two to three weeks before making any impact on symptoms. During this time, you may feel worse. Since people are often feeling very bad already, the first few weeks of treatment may be a difficult and even a dangerous time, when support is needed the most. Some patients are admitted to hospital, for rest or safety. This need not be a negative experience, as a well timed break may spare you much misery, also giving relief to frantic families. The stay is not likely to be long in most cases.

Natural remedies are popular, and may help, but use with caution. Never take herbal medicines alongside prescribed medication, and buy reputable brands. Herbal products are always more risky as the dosage of active ingredient is not easily controlled. This can be a problem for elderly people who are vulnerable to toxicity. Techniques such as aromatherapy, reflexology, massage and even chiropraxy are complementary therapies which are likely to do a depressed person some good.

ECT (Electro-Convulsive Therapy) can be very successful, though patients must be carefully evaluated to determine if it would be likely to help them. Because ECT does not affect the whole body, it may be preferable for some patients, but effects on the memory can be severe and at times traumatic (the procedure itself is carried out under light anaesthetic). Patients and families need preparation and counselling before undergoing ECT, and to understand that many repeats may be necessary to achieve relief of symptoms. It is no magical cure as some have suggested.

The main task of psychotherapy is in helping to understand how depression took hold; to explore (and resist) its effects; to constructively relate the past to the present and the present to the future; and to assist choices around holding on or letting go. Therapy is for encouragement, support, and creative solutions. Therapy work clears the path to recovery, and provides a growth experience to build resilience. This is important, since depression tends to recur.

The answer is both/and, not either/or. The best outcomes are likely to be achieved by a combination of pharmacy and counselling. Medication gets you there much more quickly than nature alone, but it doesn’t do your thinking and learning for you! By the same token, any step in the right direction is a small victory and a cause for celebration.