The way to supplement depression medication

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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 smile 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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5 Replies

  • Posted

    I totally agree with your theory.

    Having spent 5 years taking 40mg of citalopram for 5 years and basically living a uunmotivated existence for 5 years too be told by my Gp that this was a typical symptoms of depression, Only too recently discover that it was in fact the citalopram that was the cause.I decided myself too stop them all together a drastic decision I know, But three weeks on I've felt motivated too get back into running wanting too spend time with friends and basically too start living a life again.

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  • Posted

    I totally and absoluely agree with you, David. The current system is pathetic and anaemic. Everything is done on the cheap. That's one of the reasons why CBT is pushed so much. It's effectiveness is no more than other forms of therapy, but anything done in groups is cheaper. I am a 61 year old psychotherapist (no longer practicing) and my years of involvment in the Mental Health field has been a very depressing experience.  It needs a fresh approach. Too much cow-towing to the pharmaceutical industry and so-called 'experts'. Would it not be better to find out from clients themselves what has actually worked for them in relieving their depression? We should be open-minded, but not gullible, to any different means of relief. There may be people out there who have successfully treated themselves for this condition. We don't know.
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  • Posted

    In agreement too. It is too easy for a doctor to hand out a prescription and get rid of you. In and out in 2 mins. It seems to treat the symptoms not the cause. I think more research needs to be done. Yes we may have hormone imbalance etc but we are not depressed from birth. There are triggers that cause bouts of depression and this should be looked into and then ways to cope when these triggers arise would be helpful.
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  • Posted

    There is a lot of sense in what you say, but is important to be aware that there is not one simple condition 'depression'. There are conditions that are well-documented such as post natal depression and depression associated with bipolar disorder, and then there is a continuum of difficulties from feeling a bit blue for a week or two to a state of complete mental collapse. That's one of the reasons that GPs can be out of their depth. I'm not saying that your suggestions are not really sensible, but implementing them is difficult, particularly in the setting of an NHS that is being dismantled.
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    • Posted

      Hi Jo and everyone else who replied. I put that post on to see what reactions I got. I really appreciate all your comments.

      Panda, athol and catherine are on my wavelength. Panda - that was brave coming off everything - not everyone could do this. By ensuring your life is balanced, particularly remmoving the causes of stress is vital. If you feel better then elemnts of CBT will help to avoid negative thinking from returning. 

      Catherine - I agree. I'm not a scientist or a doctor - but I've done enough research to know that our brains are not hotwired for the modern world. A very common phrase in the literature is that you are depressed because of an imbalance of chemicals in the brain. Some people adapt to the modern world (progress!!) but others suffer stress that leads to depression - hence the need to identify those on a one to one basis.

      Athol - you made an interesting point that some people decide to treat themselves. Some may be successful other may choose drugs that ruin their lives. The current system encourages people taking things into their own hands. For example, a quick search of the web will reveal a drug called modafinil. It's not a true stimulent like Ritalin. It was originally created for sleep disorders. But it improves focus and cognative ability and also depression. It's very dangerous self prescribing - but if someone found this worked a lot better than something that can possibly damage the liver - who is wrong? The person depressed or the system. Only a more focused approach to patients will eliminate self prescribing.

      Jo - you are right to point out the differnt kinds of depression. My wife is a health visitor so I've heard a bit about PND. My comments were intended to classic depression that has maybe went deep. There should always be a doctor who has the ability to assess other more chronic mental conditions. To me a programme that focuses on those who have suffered severe MDD is what I would like to see developed. 

      There are a lot of variables including the ability to implement a plan given the changes in the NHS.

      As stated I am not qualified to cover all these factors. However, as someone who has suffered from MDD I know a few changes would make a lot of difference.


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