Frequently Asked Questions about Depression Treatment
Not all depression requires treatment but when a very low mood is persistent or has declined to a level in which your life has become affected, it is time to look at what treatments are available to you.
Commonly known as “happy pills”, antidepressants offer relief and respite to many people, but it isn’t uncommon for people to fear taking them because of past experience, or what they have heard about them. People who are severely depressed may worry that their depression may never go away, and pictures of electroconvulsive therapy or ECT bring thoughts of sheer horror for some sufferers.
Therapy, especially psychotherapy, can play a huge part in treating depression, either alone or alongside medication. You may not know what therapy is available to you or how to find a therapist. You may be tempted to take medication alone because it seems easier.
This article will look at common questions posed for three forms of treatment; that of medications, ECT and psychotherapy.
Medications for Depression
Which are the best antidepressants?
SSRI (selective serotonin reuptake inhibitors) antidepressants are the most common medication for depression. These act on the chemical serotonin in the brain, which is thought to be imbalanced when we are depressed. Most antidepressants are effective for a large majority of people but it is difficult to advise anyone which is the best to take. One antidepressant may work well for someone but not effectively enough for someone else.
It isn’t unusual to have to try more than one SSRI to find a suitable one that is both tolerated well and works effectively.
Everything You Need to Know about Antidepressants
A good guide book for those on antidepressants
How soon will my anti depressants work?
Most SSRI antidepressants take several weeks to “kick in”, and in that time you may experience an increase in your anxiety levels. The anxiety calms down after about a month. Many people will have only a negligible improvement in mood after two or three months and perhaps need a higher dose. The dosage may be increased several times as seen fit by your administering doctor, until the desired effect is maintained. Again, not one answer will fit everyone. One must take into account the severity of depression for instance. Some people may only need a very low dose and it starts working within a few weeks, whilst others may need the maximum dose before relief is obtained and this can take months.
How long will I need to take antidepressants for?
The general rule seems to be that once your mood is elevated, you will probably need to take your antidepressant for at least a year. Some people however, are able to stop their medication after six months with no rebound depression. People with a severe mental illness, whereby depression is part of that illness, may find themselves on repeated, lifelong and often high doses of antidepressant. For these people, a tolerance can be built up and they may have to change their antidepressant periodically.
Stopping Antidepressants Safely
What are the side effects of antidepressants?
Common side effects of SSRI antidepressants are:
- Dry mouth
- Weight gain
- Sexual problems – loss of libido, erectile dysfunction
How should I stop taking my anti depressants?
Always seek the advice of your doctor when wanting to stop taking your antidepressants. Depending on how long you have been taking your antidepressant, it usually takes a minimum of four weeks to taper off them. This may be considerably longer if you have been taking them for a long time. Don’t be tempted to just stop them as the adverse effects can be very unpleasant.
Withdrawal Problems with Paxil
Withdrawal effects of antidepressants
The effects of withdrawal will be much worse if antidepressants are stopped abruptly but if tapered off them sensibly, withdrawal side effects should be minimal for most people. Withdrawal symptoms may vary with different antidepressants, but some common symptoms are:
- Mood changes
- Unreal feelings
- Electric shock sensations
- Muscle spasms
- GI problems
Will my depression come back after stopping medication?
Rebound depression can not be ruled out, but apparently is less likely to happen if you have been taking your antidepressants for at least six months. If you are suffering from a reactionary depression due to a traumatic event in your life, it makes sense to also address the cause, even if you are taking antidepressants. Some therapists will see you at the same time as you are taking antidepressants. Sometimes, a few months of antidepressants are enough to get you through the depressive phase and back to normality.
ECT is Still Used Today
Electroconvulsive Therapy (ECT)
What is ECT or shock therapy?
ECT is usually only used as a last resort for a major depressive state that has not responded adequately to other treatments. If your depression is considered life threatening, this is a form of treatment that will be considered. An electric current is passed through the brain to induce a short seizure that is thought to reduce depression. In the UK you would usually have two sessions of ECT therapy a week. The overall number of treatments varies from person to person. It can be an effective treatment, though it remains very controversial.
Will ECT hurt?
You will know nothing about the actual seizure as you will have been given anaesthetic. A muscle relaxant is also given so that the body doesn’t convulse as you would imagine with a tonic colonic type seizure. The whole procedure is very short and relatively safe as resuscitation equipment is nearby in the unlikely event it is needed.
Personal accounts of ECT on DVD - myths and realities
What are the side effects of ECT?
The risk of death is extremely small from an ECT treatment but those with a pre existing medical conditions may be more at risk. Prolonged seizures have been noted by those people with a low seizure threshold. The first thing you will notice after a treatment is a drowsy feeling. You may feel disorientated; have some nausea, achy muscles and a powerful headache. You will feel a need to rest for at least a couple of hours. The after effects are not actually dissimilar to those who have true epileptic fits.
The one thing that is apparent is loss of memory, and this can persist for weeks or months. It has been known for memory problems to be permanent and for ECT treatment to leave you with a difficulty in retaining information. There are mixed feelings about the permanent after effects of ECT, with some people saying it is a small price to pay for a life threatening depression and others horrified by the effects.
Mind - Full explanation of consent to treatment.
- Mind rights guide 3: Consent to treatment | Mind
Mind is the leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress.
Can I be given ECT against my will?
You should be fully informed about ECT before consenting to go ahead with it. You need to know the risks and be offered a choice. The only time ECT might be given without consent is if you, the patient, is not able to make a decision due to mental incapability and a second doctor’s opinion recognizes this incapability. That said, if you have made your wishes known in a personal advance decision document, then this must be taken into consideration. There are also other ways you can refuse treatment – see the information link above.
Do You Think ECT Should be Banned?
Psychotherapy for Depression
What is the best therapy for depression?
Talking therapy such as psychotherapy can help those with depression. Looking at negative thinking and behavioural traits which help to build up to depression is useful. Coping strategies for life problems, either ongoing or past difficulties, can be learned in order to prevent depression from becoming a major crisis. Discussing your emotions and negativity with a therapist or even a general counselor can be very therapeutic. If the depression is not too severe, this may be all that is needed and can be embarked upon with or without medication.
True Life Account of Struggle With Depression
How do I find a good therapist?
Finding a good therapist isn’t always easy. If you are at the mercy of the NHS Community Therapy Services, then your choice will be limited. You need to have a good rapport with a therapist and finding the right one for you may take time. Currently in the UK, free community therapy is usually based on around six sessions which isn’t nearly enough in my opinion. If you can afford to pay for a therapist you will have more choice and will be more likely to find the therapist that is right for you. You can find a UK or US approved psychotherapist by following the links below.
Finding an approved therapist in UK
- BACP Seeking a Therapist - Finding the right therapist
Seeking a Therapist - Finding the right therapist
Finding the Right Therapist Can be Difficult
Finding an approved therapist US
- Find a Therapist, Psychologist, Counselor - Psychology Today
Psychology Today: Browse our extensive directory of the best therapists, psychologists and counselors near you.
How much will I have to pay for a therapist?
The fees for psychotherapy vary tremendously and paying more doesn’t always necessarily mean better therapy! Expect to pay at least £20 - £45 per hour. Some psychotherapists may ask for much more, but others may offer a reduced rate scheme for those on low wages or unemployed. Counsellors tend to charge a little less than psychotherapists and may be just as helpful in some instances for those with depression.
How long will therapy take to work?
How long is a piece of string? The NHS seems to think that therapy will be brought to a successful conclusion in six hours! Many people will find this is way too little session time. If you are paying of course, you have much more control over how much or little therapy you receive. Good therapy takes as long as it needs to, until a patient or client feels their problem is sufficiently resolved.
Online Therapy for Depression
There are more and more therapists and counselors offering therapy online, particularly by telephone and Skype. Beware of email therapy which is slow and can become open to misinterpretation. Also be aware that it is easy for a therapist to write up a list of good positive reviews on his/her website. Always check your therapist or counselor is registered with a legitimate body before parting with any money.