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
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.
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.
meloncauli (author) from UK on January 29, 2013:
Thank you Pamela-anne. I am glad you found it useful.
Pamela-anne from Miller Lake on January 28, 2013:
Thanks for all the informative info on depression I have a loved one that suffers from this; your hub has been most helpful take care.
meloncauli (author) from UK on October 10, 2012:
Hi greatstuff and thanks for the comments. You are right to say that finding a good therapist isn't always easy. The greater rapport you have with a therapist, the more likely you are to make great headway with your problems. It is great to have seen one of my hubs as HOTD :)..thanks again.
Mazlan A from Malaysia on October 10, 2012:
Congrats on your HOTD! So proud that many of our team members were given this recognition. This will definitely lift the spirit of any one suffering from depression. Finding a good therapist is not easy. A friend spends a lot of money for their daughter's treatment, with little success. In the end, it was going back to religion that helps her recover, slowly. Keep up the good work and hope to see you gaining more HOTD award.
meloncauli (author) from UK on October 09, 2012:
Thanks for the comment Will. Yes, antidepressants can make you feel very wooly headed (amongst other side-effects), and they can dull you so that you find thinking and remembering more difficult.
Will Apse on October 09, 2012:
I was given anti-depressants after a heart attack. I honestly don't think they did me any good. In fact, I think they did positive harm. My memory took a long time to recover.
meloncauli (author) from UK on October 07, 2012:
Many thanks for your comment DzyMsLizzy. You raise some good points. Denial isn't uncommon, I think probably more so in men.
After researching this subject recently, it would appear that many people do indeed relate their feelings of suicide, but because of the misconception that warning someone doesn't equate to intent, they are often not given the observation needed. I think ALL people who are severely depressed should be monitored closely for the risk of suicide whether they have spoken out or not.
One of my other articles talks of sudden and impulsive suicides, which may happen equally to those who speak of suicide feelings and those who don't.
Thanks again for your interesting input.
Liz Elias from Oakley, CA on October 06, 2012:
Congratulations on HOTD! This is a well-done article, and sure to be of value to many people.
I think one thing to remember is that true depression may go unrecognized by the sufferer. They may be in denial, and think they 'just don't feel good.' It may take a family member to notice that something is way 'off' about the persons' behavior or mood.
What is unfortunate is the length of time needed for medications to have any effect. The person wants to feel better, NOW, not a month and a half down the road. Sadly, the medications in that category usually fall under "illegal."
On the other hand, if you've had a spell of rotten luck or health issues, saying "Oh, man I'm so depressed," is probably a fairly common reaction, when in fact, it is not true clinical depression, but just a low mood point (understandable) in reaction to the stressful situations.
Thinking back to Psych 101 class, we were taught that the highest suicide risks are not from those who threaten to do so--that's mostly a call for help or attention. We learned that those most at risk for suicide are likely to be those coming up out of the lowest point of a depression, who realize they never want to be that low again, and they usually just act, without warning. It is the point at which they should be monitored most carefully, and under medical supervision.
I can't believe ECT is still in use in the 21st century! WOW!
Voted up, useful and interesting.
meloncauli (author) from UK on October 06, 2012:
Thanks Denise. Yes, although the memory issue in particular can be a great drawback, in treating severe depression it has saved countless lives. I know many who simply will not entertain the idea of having ECT, but it has to be said when you are so severely ill, and nothing else has worked, ECT may just be the only thing that will bring on the start of recovery!
Denise Handlon from North Carolina on October 06, 2012:
Congratulations on your HOTD Interesting that so many people are not aware that ECT is still being practiced as a form of depression for people with severe depression or catatonia. I currently work in a hospital that offers that form of treatment and have seen amazing results.
Well written. Thanks for sharing your expertise here.
meloncauli (author) from UK on October 06, 2012:
Many thanks for the comment and vote :)
meloncauli (author) from UK on October 06, 2012:
Thanks so much for your comment. Many (not all), private counselors and therapists do make allowances for those on a low income. The NHS waiting list for counselling and therapy does leave a lot to be desired.
Thanks again :)
Abhimanyu Singh Baghel from Satna, Madhya Pradesh (India) on October 06, 2012:
awesome hub! no doubt why it has been selected as the hub of the day! very useful and informative. voted up. :)
Tara Carbery from Cheshire, UK on October 06, 2012:
An excellent informative hub. I wasn't aware that some counsellors have a subsidised payment scheme for the unemployed. This is especially important when the nhs waiting list for counselling is over two years! A well deserved hub of the day!
meloncauli (author) from UK on October 06, 2012:
Many thanks for your comment Marlene. Online therapy for many of the less severe mental health problems has been growing in recent years.
Thanks again for dropping by to read.
Marlene Bertrand from USA on October 06, 2012:
This is a wonderful hub filled with lots of helpful information. Well, I learned a lot, including something new - I didn't know there was such a thing as online therapy. That's interesting and with the direction of today's society, I can see that working very well.
Congratulations on receiving Hub of the Day!
meloncauli (author) from UK on September 16, 2012:
Thanks for dropping by lindacee. I do hope so, the more we know the better! Thanks again :)
Linda Chechar from Arizona on September 15, 2012:
Wonderful Hub filled with important information. I was not aware there were withdrawal symptoms associated with antidepressants. I always learn so much from you!
meloncauli (author) from UK on September 08, 2012:
Thanks for your comment Om. I think many people still have the image of ECT being given without unaesthetic. In fact I think some might confuse it with the state prison electric chair routine!
Om Paramapoonya on September 07, 2012:
Just like Leah, I'm also surprised that ECT is still used on patients with depression. Good to know that patients are given anaesthetic before an ECT procedure, though. Still, it is scary stuff! Great hub, by the way. Very well-researched.
meloncauli (author) from UK on September 06, 2012:
Thanks Leah. Yes, it is still used. I did try to find the data on how much ECT is used today but there doesn't seem to be any up to date data. There was a decline but then figures increased a few years ago.
Leah Lefler from Western New York on September 06, 2012:
Wow, meloncauli - I didn't realize that ECT was still used. I know it used to be fairly common in the earlier part of the 20th century. This is an extremely thorough and valuable guide for those looking at treatment options for depression!