Depression is treatable. Close to 85% of people suffering from depression recover and go back to a level of functioning before the start of their illness. Treatment for depression is often multidimensional including antidepressants, counseling, cognitive behavior therapy, family therapy, psychotherapy and social therapy.

Antidepressants are useful in treating mild, moderate and severe depression. Psychotherapy alone may be useful only for mild depression. Combination treatments however have the best results. Treatment is divided into two distinct periods. Because of the complex way the treatment works, response to treatment only begins two to three weeks after starting it. Most patients feel significantly improved after four to six weeks. The treatment that doctors choose depends on a number of factors, such as severity, types of symptoms, lifestyle and other medication. As well as conventional therapy, a variety of complementary therapies can also help sufferers to manage depression.

ELECTROCONVULSIVE THERAPY (ECT)

On rare occasions, electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life-threatening or who cannot take antidepressant medication. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms.

ANTIDEPRESSANT MEDICATIONS

Antidepressant drugs work by affecting the levels of chemicals in the brain, such as serotonin. There are many types of antidepressants – exactly how they work is not clear but they frequently lift a person’s mood and can allow them to address the problems which caused the depression in the first place. Antidepressant drugs can take several weeks to start having a noticeable effect.

Three groups of antidepressants medications are most often used to treat depressive disorders: tricyclics, monoamine oxidase inhibitors (MAOs) and lithium. Lithium is the treatment of choice for manic-depressive illness and some forms of recurrent major depression. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes dosage must be increased to be effective. Patients often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. In cases of manic-depressive illness and chronic major depression, medication may have to become part of everyday life to avoid disabling symptoms.

Antidepressant drugs are not habit-forming, so you need not be concerned about that. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly. If you are taking MAO inhibitors, you will have to avoid certain foods, such as cheeses, wines, and pickles. Be sure you get a complete list of foods you should not eat from your doctor and always carry it with you.

Other forms of antidepressants require no food restrictions. Never mix medications of any kind prescribed, over-the-counter, or borrowed without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug that you are taking antidepressants. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Note that alcohol can reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor.

Antianxiety drugs, such as Valium, are not antidepressants. They are sometimes prescribed along with antidepressants; however, they should not be taken alone for a depressive disorder, such as amphetamines, which are also inappropriate. Be sure to call your doctor if you have a question about any drug or if you are having a problem, you believe is drug related.

THERAPY AND COUNSELLING

Psychological therapies and counselling can often assist a person with depression to recognize the problem and begin to address the root cause of their depression. The most common therapies used to treat depression are problem-focussed psychotherapies such as cognitive therapy, cognitive behavioural therapy and the Interpersonal Psychotherapy frameworks. Counselling can also successfully help people to overcome and deal with a wide range of problems and may be carried out by a trained counsellor, a psychologist or psychotherapist. The second phase of treatment includes a continuation of the same treatment for a predetermined period to prevent the depression from recurring.

Treatment is available at all psychiatric clinics throughout the country. As it is now recognized as a public health issue, treatment is also available at all primary care centers as well as in general practice. Because there is so much stigma associated with seeking help from psychiatric units, the Malaysian Psychiatric Association is committed to training and supporting all primary care and general practice in managing depression in the community. It is vital that people suffering from this disabling illness shed their fear and prejudice from seeking treatment that is effective and which is now widely available.

Depression is not a personal weakness. It can strike anyone at any time and has no preferences. Families and communities have a responsibility to help their members to seek appropriate help. The earlier the onset of treatment the higher the chances of recovery.

SIDE EFFECTS OF ANTIDEPRESSANTS

Antidepressants may cause mild and usually temporary side effects in some people. Typically, these are annoying, but not serious. However, unusual side effects or those that interfere with functioning should be reported to your doctor. The most common side effects and ways to deal with them are:

• Dry mouth
• Drink lots of water
• Chew sugarless gum
• Clean teeth daily
• Constipation
• Eat bran cereals, prunes, fruits, and vegetable
• Bladder problems, emptying your bladder may be troublesome, and your urine stream may not be as strong as usual; call your doctor if there are any pain
• Sexual problems, sexual functioning may change; if worrisome, discuss with your doctor
• Blurred vision: this will pass soon; do not get new glasses
• Dizziness, rise from bed or chair slowly
• Drowsiness, this will pass soon; do not drive or operate heavy equipment if you are feeling drowsy or sedated.