Depression and treatments

The antidepressant and depression debate

We all go through phases where we feel miserable or sad. However what happens when it becomes increasing and gets worse? What happens when you feel apathetic, exhausted, agitated, anxious at the thought of going out/meeting people/doing certain tasks, fed up and cannot get out of bed or feel life is pointless? When this is persistent over a period of time this is clinical depression. Seeking help is not easy and takes time as often the belief it is just a phase, bad weather etc. However when eventually a GP is approached there is a limited range of options. Everyone should have access to medication if they want it however what is crucial is the choice of talking treatments to work with/without the medication.

CBT -mild to moderate depression- up to ten sessions are recommended. Severe depression may need longer. Trauma Focussed CBT should be offerred for tauma related work.THis can be short or long term.
Computerised CBT -structured computer programme over 6 to 8 sessions working with a computer and graduate mental health worker.
psychotherapy -formal psychotherapy-waiting lists are usually long as this is a long term treatment of choice for many.
counselling -counselling is usually available through a GP surgery -however not for complex problems and only 6 to 8 sessions. Waiting lists vary.
supportive psychotherapy-this is supportive work by a psychotherapist or other mental health practitioner helping to manage better.
other talking and creative treatments. -there is art therapy, music therapy, drama, and other types of talking treatments for more complex issues. (CAT, SFT, DBT,MBT etc)

Treatment should be based on complexity of need not a resource issue. ie more than six sessions of SKILLED CBT not someone trained over a few hours or days . Someone experienced. Who will assess and guide through a process over the time it needs.

Contributory Factors
Housing
Work Issues
Unemployment
Debt/Financial Stress
Bereavement
Divorce
Bullying at home/work
Child Abuse/Abusive relationship
Family dysfunctional relationships
Anxiety
Chronic Pain
Chronic Physical Illness

Medication has a clear role to play. However should always be used with close supervision and adjunctive treatment (see NICE gudelines for depression http://http://www.nice.org.uk/)

Exercise has been shown to be useful as well-however that alone for many people is not enough and needs to be part of a structued treatment programme.