Depression is increasingly
common in our society, but unlike other common illnesses, many
people do not seek help to deal with it.
Depression is often wrongly seen as a form of weakness or something
to be ashamed of. But there are many ways of treating depression,
and a very good chance that you will find a treatment that suits
you.
Depression can make the lives of people who suffer from it very
miserable. In extreme cases, it can put people at risk of harming
themselves.
This leaflet looks at the different types of treatment for depression.
For more information about the symptoms and possible causes, see
the separate fact sheet 'Depression'. |
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| What your GP (General Practitioner)
can do |
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Visiting your GP (General
Practitioner) is the first step someone with depression can take
to recovery. It can be an enormous relief to simply share how
you are feeling.
By asking specific questions about your mood, sleep patterns,
appetite and energy levels, most GPs can diagnose depression.
They might ask more about what is happening in your life that
would help to explain the feelings you are experiencing. No matter
how deeply personal or even trivial a predicament may seem, it
can help to discuss it.
Doctors are trained to ask direct questions about pessimistic
thoughts about the future and thoughts of self-harm that are common
in depressed people. Again, it can be very helpful for people
to talk openly about these issues. |
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| Psychological treatments
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Some family doctor practices
have counsellors to help patients with depression or other emotional
difficulties. Counsellors may have a background in mental health
nursing or psychology.
Practice counsellors can conveniently see patients in a clinic,
usually for a fixed number of sessions, which varies depending
on the type of treatment offered.
Regular exercise can also be helpful in treating depression. People
with marked anxiety sometimes find that relaxation, massage or
yoga can help ease their symptoms. |
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| Antidepressant medications
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There is a wide range of
antidepressant medication available, for which there is strong
evidence that they are effective and are not addictive.
SSRIs
SSRIS (selective serotonin re-uptake inhibitors) are the most
commonly prescribed type of antidepressant. The drugs fluoxetine
(Prozac), paroxetine (Seroxat), citalopram (Cipramil) and sertraline
(Lustral) are all SSRIs.
SSRIs work by raising the levels of the chemical serotonin in
the brain, which in turn tends to lift your mood. When you first
start taking them, you may have some sickness and headaches as
side-effects, but these tend to wear off over time. They are best
taken in the morning, as they can interfere with sleep.
Around 10% of people who take SSRIs also suffer from sexual difficulties,
such as impotence or loss of sex drive (libido), though these
can also be a symptom of depression. If sexual difficulties are
side effects of the drug, they should stop when you stop taking
the drug, and are a sign that your doctor may need to change your
medication.
Tricyclics
Tricyclics can be as effective as SSRIs, but they can have different
side-effects, which may be more troublesome for some people than
others. Amitriptyline (Lentizol), dothiepin (Prothiaden) and clomipramine
(Anafranil) are all tricyclics. These work by raising the levels
of the chemicals serotonin and noradrenaline in the brain, which
both tend to elevate your mood.
Possible side-effects include a dry mouth, constipation and putting
on weight. Most people tolerate these as they gradually become
familiar with their medication. They can be more sedative than
SSRIs and tend to be best taken at night. Although safe in normal
doses, an overdose of a tricyclic antidepressant can dangerously
affect the heart rhythm.
Other types of medication
There are several new antidepressants which work in a different
way from SSRIs and tricyclics. These include venlafaxine (Efexor),
nefazadone (Dutonin) and mirtazepine (Zispin). They can be useful
for people who experience side-effects with other medications.
Antidepressants usually need to be taken for at least six months.
For many people treated, depression comes back after stopping
treatment. Taking medication even after the symptoms have cleared
up can help prevent this. Talk to your doctor about how long you
should continue with medication. |
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| Psychiatric help |
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GPs refer around 10% of
the people with depression they see to psychiatrists. Psychiatrists
are qualified doctors who specialise in mental health problems.
An initial appointment with a psychiatrist may take 30 to 45 minutes.
During this assessment, your symptoms and situation are carefully
explored. Psychiatrists are experienced in prescribing different
types of antidepressant medication, and in spotting their side-effects.
If you do see a psychiatrist for treatment for depression, you
may have occasional follow-up appointments with them for several
years. In other, cases, your GPs will refer you again if your
symptoms recur.
Psychiatrists can also offer or refer people for psychological
treatments. For example, cognitive behaviour therapy (CBT) is
a form of psychological treatment that is very effective for depression.
CBT involves 12 or so one-to-one sessions with a therapist. Sessions
focus on the thoughts (cognitions), beliefs and behaviour patterns
associated with depression and how they relate to feelings. |
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| Severe depression |
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A small number of people
suffer from depression so severe that they may need to be admitted
to hospital. With severe depression, people can become completely
withdrawn and stop eating and drinking. They may experience intense
suicidal thoughts, or even try to end their life. People with
severe depression may develop a psychosis, in which they lose
track of reality. People with psychotic depression may hear voices
when there is no one there (hallucinations). These voices may
say distressing or unpleasant things about them. They may also
develop false beliefs (delusions) about themselves or their health
and be unable to recognise that they have an illness. Psychiatrists
describe this as a 'lack of insight'.
When somebody is this severely unwell and they are judged as a
danger to themselves or to others, a psychiatrist may use the
Mental Health Act to force them to be admitted them to hospital.
Under strict legal guidelines, the Mental Health Act allows treatment
of severe psychiatric illness to be given without the patient's
consent. |
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| Electro-convulsive therapy
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The quickest way of treating
severe depression with the minimum of side-effects may be with
ECT (Electro-convulsive therapy). During ECT, the patient receives
a light general anaesthetic and muscle relaxant. An electrical
current is then applied across the patient's temples. This induces
a seizure or 'fit'.
It is thought that the changes in the brain that occur with the
seizure help to elevate mood. Despite its effectiveness, ECT tends
to receive a bad press. It is not suitable for every patient,
but it can help save the lives of severely depressed people. |
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| Alternative medicine |
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Many people prefer a 'natural'
approach to tackling depression. St. John's Wort is a popular
complementary medicine, available in health food stores and pharmacies.
Research studies show some promising results about its effectiveness
with some types of depression. It's important to tell your doctor
or pharmacist if you are taking St Johns Wort (or thinking of
taking it) as it can interact with other medicines you might be
taking. |
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| Further information |
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Hong Kong Mood Disorders
Center (The Chinese University of HK)
Hotline : (852) 2833 0838 - 8
http://www.hmdc.med.cuhk.edu.hk/main.html
Mental Health Association of Hong Kong
http://www.mhahk.org.hk/
Hong Kong Christian Service (Counselling Service)
Address: 5/F, 33 Granville Road, Tsim Sha Tsui, HK
Tel. : (852) 2731 6251
Fax : (852) 2724 3655
Homepage: http://www.hkcs.org/
Email: cfle@hkcs.org
Caritas Family Service
Tel: (852) 2843 4670
http://family.caritas.org.hk/
St. John's Counselling Service
Address: 7D, On Hing Building., 1-9, On Hing Terrace, Central,
HK
Tel: (852) 2525 7207/8
Fax: (852) 2524 2777
Email: counsell@stjohnscathedral.org.hk
National Foundation for Depressive Illness
http://www.depression.org/
Dr. Ivan's Depression Central
http://www.psycom.net/depression.central.html
The Depression Alliance
http://www.depressionalliance.org/
Internet Mental Health
http://www.mentalhealth.com/
The Royal College of Psychiatrists
http://www.rcpsych.ac.uk/info/help/dep/
American Psychological Association
http://helping.apa.org/therapy/depression.html
Depression Alliance
http://www.depressionalliance.org.uk/
MIND
http://www.mind.org.uk/ |
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Healthwise (Health Information Resource
Centre)
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : info@healthwise.org.hk
Homepage : http://www.healthwise.org.hk/
This leaflet is for information only. For a detailed
opinion or personal advice, please consult with your own
doctor |
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