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What treatment available for depression

Treatment for depression

What treatments are available for depression?

At a time when you may well find making decisions difficult, it can also seem like an added burden to try and choose between a range of treatment options.

What is actually available to you may depend very much on where you live. For example, talking treatments, such as counseling and psychotherapy, are more readily available in London and the South-East than they are in rural areas of northern England. You should be able to choose freely among a range of treatment options, but, in practice, most people attending GP surgeries are offered antidepressants as the first treatment choice. Don't be afraid to ask your GP about the treatments offered and what the alternatives are. Depression can be treated like other diseases.

The National Institute for Health and Clinical Excellence (NICE) published guidelines on the treatment of depression, in December 2004. These suggest that, for mild depression, antidepressants are not appropriate because the hazards outweigh the benefits. Suggested treatments include watchful waiting “ a recognition of the fact that depression often goes away without treatment“ guided self-help, short-term talking treatments such as cognitive behaviour therapy (CBT), and exercise programmes. For more severe depression antidepressants are appropriate, and selective serotonin re-uptake inhibitors (SSRI)s are suggested because their side effects are usually better tolerated than those of the alternative types of antidepressants. However, combining a psychological treatment with medication maybe the most effective course for severe depression.

Antidepressants
Antidepressant drugs are the most common medical treatment for depression. They work on chemical messengers in the brain to lift your mood. They can't cure depression, but they can alleviate the symptoms so that you may feel able to take action to deal with the depression yourself. It often takes between two to four weeks before the drugs take effect. The usual recommendation is that you stay on them for six months in order to prevent a recurrence. They don't work for everyone.

Antidepressants frequently cause unpleasant side effects, which are worse to begin with. Some can be dangerous when used with other drugs. Of the various different types available, SSRIs are usually the preferred first choice because, although they have as many listed side effects as older drugs, they are usually better tolerated. Others include tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors). Whichever type of antidepressant you take, you may experience withdrawal symptoms when you stop taking them, especially if you have been taking them for some time. Because of this you should withdraw slowly, reducing the dose in stages over a period of weeks.

Psychological treatments
Your GP may offer you one of the following psychological treatments. The choice will depend on what's available, your own preferences, how severe your depression is and other factors:

* Five or six sessions of problem-solving therapy can help people break down their problems into manageable portions and provides strategies for coping with them.
* Cognitive behaviour therapy (CBT) helps to identify and change negative thoughts and feelings affecting behaviour and may last up to 12 months. Computerized CBT (CCBT) is now available and can be used in addition to or instead of sessions with a therapist. It is not suitable for someone with severe symptoms though, and NICE recommend individuals are assessed before using one of the programmes.
* Guided self-help delivers a six to eight week therapy programme through self-help books, under the guidance of a health care professional.
* Interpersonal psychotherapy (IPT) focuses on relationships. Therapy can continue for 6 to 12 months.
* Counseling can be short- or long-term. It involves talking with someone who is trained to listen with empathy and acceptance. This allows you to express your feelings and find your own solutions to your problems.

Psychotherapy is not usually available on the NHS. It is more frequent and intensive than counseling, and goes more deeply into childhood experience and significant relationships. Most psychotherapists work in private practice.

Painful experiences are hard to talk about, but health care professionals understand this. Be as frank as possible, so that people can offer you the best help. Don't be afraid to ask questions about your condition.

Befriending schemes
Your GP may put you in touch with a local befriending scheme with trained volunteers who could visit, weekly, to give you practical advice, support and a sympathetic ear.

What if my depression is worse, or won't go away?

Your GP may refer you to a specialist mental heath professional, such as a psychiatrist, psychologist or mental health nurse, who can review your treatment so far. They may suggest a different medication, or a combination of drugs or of treatments. Medication combined with psychological treatments seems to be the most effective way of dealing with severe or long-lasting depression.

You may need support to live independently, in the community. The Care Programme Approach aims to ensure that you are assessed and that the right services are provided for you by social services and the health authorities. You should be allocated a care coordinator to be responsible for this. You should be given an advance directive, which is a written treatment plan that also specifies which treatments you would prefer not to have.

Community Mental Health Teams (CMHTs) are often the most easily accessible service for people with mental health problems. They can provide support for people living in their own homes. The CMHTs are multi-disciplinary teams, which may include a psychiatrist, community psychiatric nurses (CPNs), social workers and support workers, among others.

Hospital admission
If you are severely depressed, you may need the shelter and protection offered by the psychiatric ward of a hospital. It also gives a psychiatrist the opportunity to monitor the effects of different treatments. Hospital can provide a safe and supportive environment if you are in a state of distress, and it may be comforting to have other people around you and to know that you are being cared for.

However, it can be distressing to be on a ward where you have little privacy, where you have to fit in to routines that may not suit you, and where you may be upset by the behaviour of other patients. Generally, doctors want to keep patients out of hospital, but some patients are compulsorily detained, if it's thought to be necessary, for their own health or safety or the protection of others.

Crisis resolution services
These are teams of doctors and nurses who provide intensive support, which will enable you to stay at home if you're in crisis, rather than going into hospital. This service is not yet available countrywide.

Electroconvulsive therapy (ECT)
This is a controversial treatment, usually offered only when people who are severely depressed haven't responded to drug treatment. It involves passing an electric current through the brain, while you are under general anaesthetic. The resulting convulsion may alleviate the depression, but can also have severe side effects, including memory loss.

What can friends or relatives do to help depression problem?

The very nature of depression, which brings a sense of hopelessness, helplessness and worthlessness, can prevent someone who's depressed from seeking help. They often withdraw from friends and relatives around them, rather than asking for help or support. However, this is a time when they need your help and support most. Perhaps the most important thing that you can do is to encourage your friend or relative to seek appropriate treatment.

Try not to blame them for being depressed, or tell them to "pull themselves together". They are probably already blaming themselves, and criticism is likely to make them feel even more depressed. Praise is much more effective than criticism. You can reassure them that it is possible to do something to improve their situation, but you need to do so in a caring and sympathetic way.

People who are depressed need someone who cares for them. You can show that you care by listening, sympathetically, by being affectionate, by appreciating the person, or simply by spending time with them. You can help by encouraging them to talk about how they are feeling and getting them to work out what they can do, or what they need to change, in order to deal with their depression.

If the person you are supporting is severely depressed, you may be faced with some hard decisions about how much to do on their behalf. If, for example, they are not looking after their physical needs, should you take over and do the shopping, cooking and cleaning for them, if you are able to? Or should you try and encourage them to do it? There are no easy answers to this situation. It will help if you can find someone with whom you can discuss these and other issues.

Supporting a friend or relative who is suffering from depression is an opportunity to build a closer and more satisfying relationship. However, it can also be hard work and frustrating, at times. Unless you pay attention to your own needs, it can make you feel depressed, too. Try and share the responsibility with as many people as possible, and find people to whom you can express your frustrations. There may be a local support group of others in your situation. You could also talk to your GP or another health care professional about getting help for yourself and your family.

These are the treatment available for depression but first you must know the symptoms of depression to cure it. 

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