Nigel 
October 31st, 2009This follows up yesterday’s post which can be found either just below this one (if you’re on the home page) or here.
How can you treat depression?
This depends on the person, the type of depression, its severity, and its cause. Do not try to treat yourself. See someone who is medically trained and experienced. If you have clinical depression and they do not specialise in psychiatry they should refer you for treatment to someone who does.
The world is grey and it's always raining, but there's hope.
Treatment with medication
Severe depression needs medication first before the patient is likely to be able to cope with or respond to any kind of talking therapy. Some cases which feel like the end of the world but are less severe (such as atypical depression and the early stages of reactive depression) may well respond to the right talking therapy.
There is plenty of advice on the net about what medication to use. Be very, very wary of this. If it helps you understand the problems and how anti-depressants work that’s great. But you need someone medically qualified to diagnose the problem and identify the most likely medication to work. Even then you have to wait weeks, maybe a couple of months, to experience any effect. The dose may need to be adjusted. It may turn out the obvious treatment doesn’t actually work for you and something else needs to be tried. And then of course there are usually side effects. Almost all side effects are worth living with! Do not buy medicine over the net.
Since I was first diagnosed with depression in 1970 I’ve been prescribed a range of different medicines. Some had little or no effect and needed to be changed. One mood stabiliser made food taste like cardboard. Since throughout most of the five years I took it I was stabilised at a fairly depressed state I finally persuaded a psychiatrist I should come off it.
Warning: once you are taking any medicine for depression only reduce or stop taking it under competent medical supervision. Stopping too fast or at the wrong time can have devastating effects.
A previous article on medication for mental illness is here.
Treatment with talking
I’ve had a range of talking therapies (counselling, psychotherapy). Cognitive Behavioural Therapy (CBT) and Mindfulness Therapy have been very helpful. I also use some related stuff from Neuro-Linguistic Programming (NLP). At one stage eighteen months of psycho-dynamic therapy was highly effective. Don’t expect the therapist to do all the work, and don’t expect quick results. And by the way (note especially to Jeremy Laurance of The Independent) the old Freudian style psychoanalyst might ask you to lie down on a couch, but I doubt any other counsellor would. Also psychoanalysis seems to be unhelpful with depression.
Once clinically depressed talking therapies are unlikely to be of any help until the depression has been eased at least a bit with the right medication. If your therapist tells you medication is never needed for depression you need to find another therapist. They may be very good at what they do and mean well, but in this one statement they are dangerously wrong. Mild forms of depression can often be helped a lot by the right therapist using the right talking therapy well, but not so severe biological depression.
Two previous articles on counselling/psychotherapy for mental illness are here and here.
Treatment by other methods
I find it helpful to use light therapy. We noticed my depressive cycle is often related to time of year so bought a light box (the psychiatrist was cynical), and it works for me as part of an overall treatment plan. It should be used only in the mornings to avoid it causing sleep disturbances. I start using it on dull days well before autumn (fall) kicks in. My own light box uses fluorescent tubes. These need to be of the right type because ordinary fluorescenrt light does not contain the part of visible light I most need. Also after a year or two of use the specialist tubes wear out; they still provide plenty of light, but have lost the bit I need and I have to replace them. I haven’t tried the newer type of ‘blue’ light available. Light therapy is intended to help boost serotonin levels in people who from Seasonal Afferctive Disorder (SAD). A good introductory Wikipedia article is here. Skip the irrelevent bits.
In extreme cases of depression which do not appear to respond to medication a course of ECT may work. This involves the painless electrical stimulation of parts of the brain. I had it many years ago, and found it a perfectly acceptable form of treatment. I recovered from that depression fast as a result but later relapsed. For me a longer term treatment involving both medication and counselling was needed.
There are many ‘alternative therapies’ on offer. These include acupuncture, homeopathy, feng shui and aromatherapy. My own feeling is that these include a mixture of total junk with some stuff of value. I haven’t read up thoroughly on most of them. If you want to know more a Wikipedia article to start with is here.
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