How best to treat depression?

23 June 2014



People seem to want treatment for depression, but most are afraid of the side effects of the medications. What are your thoughts on this?


Hannah - Thank you and next question now, Michael Malone has been in touch saying, "People seem to want treatment for depression, but most are afraid of the side effects of the medications. What are your thoughts on this?" And he says thank you.

Roger - Depression is a huge issue. It's important that when we have the feelings or the symptoms that we do get help because there are various treatments, both medical and psychological that can be really helpful. So, it's great to actually go and get help in the first place. As a psychologist, I'm not qualified to talk about the medications per se, but what I would say is, if there are any kind of doubts there at all, the first thing to do is to go to someone's GP, speak to a pharmacist rightfully off or a psychiatrist if available, and get really good information right from the start because it's very common that all different individual people are so genetically, different medications affect people in different ways and there can be interactions and stuff between the medications. It's really important to get good quality advice really right from the start and that can really be helpful. That's the medication side of it. Also, as a psychologist, I have to say that we know very many psychological methods. There's a very good evidence base that help for depression with many psyches or psychological therapy whether it's CBT, cognitive behavioural therapy, psychodynamic ways of working. It's probably more likely than not that we're going to get some symptom reduction if we engage well in those therapies. So, there's an awful lot that can be done is the message.

Liz - I think one of the most difficult things is just drawing that line between how much can you cope with, can you manage without medication and using alternative therapies. I think many people find it very difficult to know at what point can I not manage this anymore on my own. At what point should I go and get some sort of chemical treatment at the end of the day? Of course, the most difficult thing with a lot of the drugs that will then be given to you is that many of their side effects are very similar to the original problem that you were having. So, some treatments for anti-depression can actually cause anxiety. They can cause paranoia. They can cause more feelings of depression. So, the last thing you want to do is to take something which makes that even worse. If you look at the history of medicine or the history of diagnosis and treatment, it tends to go through quite long waves, but it does go through waves and perhaps we've just come through 50 years of chemical intervention or treatment which we've been learning as we go along - what works, what doesn't. We don't tend to electrocute people anymore and do that kind of thing and now, it's this. Maybe we will now perhaps come to a time where we're all going, okay, if the prescriptions of anti-depressants have gone up that much, have we now reach the point where are going to say this is ridiculous actually. As more people are learning about mindfulness and learning about yoga and learning about all these stuff which was seen as very hippy, trippy, and weird, and is now becoming so mainstream. If we really can show that that can cause a real benefit to you without having to take some chemical treatment then maybe we're going to come into a new time and a new way of treatment. But if you need the medication, I mean, really need the medication, I think people have to be very, very careful to understand when you do, you do because some things we can't just deal with on our own.

Hannah - Martin, Katie, there has been kind of this big wave that neuroscience and psychiatry can be cured by chemistry and but there's all these receptors all over the brain and actually, all over the body. So, if you're going to be treating a particular condition with a chemical like an anti-depressant for example then it will have side effects in other areas of the brain. Do you think that we're learning more now about discreet circuits in the brain so that we can start targeting particular conditions in a much more focused way without these side effects that people would really do worry about or is the answer, yoga or mediation. We're going to learn about the neuroscience of yoga and meditation in the future.

Martin - I think a lot of the early pharmaceutical treatments for mental health disorders were almost sort of magic bullet treatments maybe that we don't really know what Prozac and fluoxetine were really doing when internationally has been used widely. But we've got much better understanding of how these drugs are acting now and new drugs are constantly being developed to target more specific receptor subtypes dopamine as neurotransmitter in the brain which is involved in depression and anxiety, about serotonin and nor-adrenalin. But this don't just act upon one receptor type. They multiple receptor subtypes they act upon. We're getting more information and the key thing, what receptor subtypes may be more effective to target to treat more specifically anxiety, if they're having a side effect on sleeping for example, insomnia. These treatments are getting more focused with an increasing knowledge of basic neuroscience.

Liz - Can I just do a little personal sort of anecdote in here? I remember about 14 years ago after my second child was born, I went into a very big postnatal depression after that. I put up with it for a while and I saw a lot symptoms coming back that I recognised from 10 years previously and I thought I just don't want to go there again. So, for the first time in my life, I took anti-depressants and I have a diary of the time. I felt absolutely wonderful. I felt wonderful for about 6 months while I was taking it and I remember thinking, do other people live like this because this is fantastic. I can do everything. I can go shopping and I can deal with this and I'm pretty happy. I'm lovely to be around. It felt like I've been a car that had something wrong with the engine which is something wrong and it's kind of dragging around the road and someone had fixed it. It was just rolling really beautifully. I stayed on it for a year because they said a minimum of a year and that was 15, 14 years ago and have never done it since, but I think that if people really feel that they are really trying hard and it's not working, not to feel bad for seeking some kind of medical or chemical intervention because just to have that relief, it's like going on holiday for a while. It makes everything so much easier and then you can start to deal with the problems that caused it while being in a much stronger place.

Hannah - But then what happened after that year of taking this medication?

Liz - Well, I came off it rather more quickly than I perhaps should have because I wanted to have the child. Okay, I'm going to cleanse the system. You are supposed to come off very slowly. What happened? Well, I suppose what happened was that I haven't really needed it since then. One of the nice things I think is that I know that it's there. I know it's there and for me, it worked. I would always rather not take it. I don't like to take anything. If I had a headache, I will never take paracetamol. I just don't like taking stuff generally. So, that was quite a big step for me to take something. I think it's important to know when you need that. Take it if it works for you. Well, why not? If I have a sore knee, I will bandage it up to make walking easier. If I cut myself, I will put some antiseptic on a plaster on it. But I think we should see these things a little bit in that context.

Roger - And just to support you in that is when we first accept where we are releases us to move forward. It's when we are caught up in ourselves and we're kind of feeling bad and that's most difficult to get anywhere. Conversely, if we accept actually what's going on, we can begin to take the steps out.

Martin - Yeah, but also, we're understanding more about how things like oxygen and glucose do affect neurons in the brain. There are alternative treatments and I think things like doing breathing exercises can be very efficient, as it relates to a point earlier on about having chocolate and getting glucose into the brain. This is also why exercise is recommended as a good way to try and deal with depression and anxiety because actually, you're boosting delivery of a natural fuel to the brain - oxygen.


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