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Hello - I'm hoping for some feedback here - maybe even identify some key factors of helping people suffering from bad depression. I've already posted by disappointment in current medication. Valdoxan to me was less helpful than a Mars Bar (need to lose a stone so not a good idea). This was prescribed by a consultant and I'll give her the benefit of the doubt - it's new, gets good clinical reviews (or clever marketing - make up your own mind). I hope it's just me and it helps some people. Most GPs have a standard list - starting with Prozac and when a few have failed the trusty Effexor is used. There are people posting on this site - their first experience of going to the GP and are scared when they are given a prescription for the first time. They go onto forums like this and get no response - probably because a one line question on a particular drug is ignored considering the wealth of information on the web.
Maybe this post will be ignored too So better get to the point. The average depressed or even chronically depressed is given a drug with little information. Sometimes they feel worse than ever when they start taking it. And the encouragement to ride out the first 2 or 3 weeks is often missing. I'm very disappointed in the failure of drug companies in what they produce. I believe the next decade will see one or two drug companies finding out more about the causes of depression, stop the hit and miss approach to AD development and produce something that works fast and allows sufferers to get on with all the other necessary actions necessary to improve depression.
However, we are where are. Drugs available, despite the multitude of side effects and questionable efficacy it's often a fist critical step to recovery.
Is it just me? or are we crying out for a strategy to help badly depressed people other that prescribing the fist thing on the list. If I had just taken bad depression I would want the following
A questionaire or review that allows an analysis of symptoms, the opportunity to list side effects that may make your situation worse - e.g. if a big problem is your marriage a drug that takes away your libido and also takes away your ability to orgasm is not appropriate.
The questionaire or review would identify those ADs to try first with the caveat that a failure to respond may mean trying other drugs with some of the side effects listed as undesirable
Then the patient receives his medication. How many of you have taken out the information leaflet in the box, read it, underlined the important parts. Depressed people are unlikely to do this - as soon as they get home the first pill goes down with a glass of water (or wine if you missed the part that alcohol and most of these drugs are bad news)
I personally would want someone to take me through an A4 sheet with no more than 10 clear points (type size 14) relating to that drug - why you might have depression, how long it takes to work, what you will probably feel the first week, reassurance that most side effects will pass, how long to leave it before knowing that it doesn't work, support contacts if the mood takes a nose dive, etc.......
Maybe the biggest failing of treating mental health is what the patient should do while on the medication. Again it has to be simple - information on exercise, diet, life changes proven to reduce stress.
Quite often relatives are neglected. At the very least there should be short concise information on why the patient may have depression, what to expect when they start the medicine, how they can assist in making life changes.
CBT - often hailed 'as effective' as drugs. This may be the case is an average depressed person attends sessions several times (with someone who knows what they are doing!) a week and is guided through a plethora of techniques. This will not work with a badly depressed person without support. CBT is a powerful tool - but has to be simple, very simple at the start - maybe tackling one negative thought at a time. CBT is a skill to be learnt. There's no doubt in my mind that changing habitual ways of thinking is one of the most powerful tools in recover. However, simple, simple, simple at the start. If the patient has success then there will be a next step and so on. A patient who eventually become a master of CBT has a tool for life. A 300 page book or 6 x 2hr online sessions is not the answer, at least at the start (again, in my opinion).
I've become interested in how we treat badly depressed people. It is (in my opinion) inadequate resulting in people staying on SSRIs for the rest of their life. Wouldn't it be good if someone could introduce a 'resource friendly' programme that takes what we have available and ensures it is delivered in a way that has the best chance of working. Depression causes the loss of billions in the economy - surely a revised approach is required.
I've worked for 22 years in a particular field - reaching fairly high levels in multinationals. In the next month or two I need to find a way back in (otherwise the kids will starve!!) My approach to work has changed - effectiveness does not equal time worked. In the mean time it's good to put down thoughts like this on forums. If I had the opportunity of helping just one person it would be worth a million times more that the company work I did last year. Even better, a few keen minds developing a simple but more effective approach to MDD would achieve much more.
Sorry for the long post (you may have stopped reading!!!!) I'm throwing out the idea that there are huge gaps in current treatment that could be filled through some simple ideas and processes (any taker?)
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