Question:
I've been diagnosed with clinical depression. 3 weeks ago I was
put on sertaline and there was improvment until today when I
feel as black as the ace of spades. Can anybody tell me much
about clinical depression - medication generally and how I can
help myself out of this dark hole ?
Answer:
To break the depression cycle is difficult, but good pointers are to get
some meds and to get some therapy.Get therapy, even if you have to pay for it. The drugs are effective - after
a delay of at least a month - but they do not cure depression on their own.
They will, however, lift it off you for a while and this will save your
life - not necessarily in the sense of averting suicide, but in the sense of
giving you some life back. Be warned that the initial lifting of depression is accompanied by a
re-emergence of character and a strengthening of resolve that allows some
depressed people to finally make the decision and carry through their
suicide. At the very least, the depression will lift unevenly and
sporadically, and you'll *never* have felt so vulnerable.
All of the problems associated with early-stage SSRI treatment, as you will
have seen and heard about in the media, arise in a failure to engage in the
*treatment* of depression by careful assessment, diagnosis, counselling and
monitoring. Standard clinical practice in the UK is "Take the pills and
bugger off" and the usual outcome is a lifting and stabilisation of mood
that lasts for about a year, in which some patients get their lives back
together and the rest will slip back into deep depression after wasting a
window of opportunity in which therapy might have done some good.
Which is another way of saying: Get therapy, even if you have to pay for
it.
Oh, and part of the character that re-emerges will the bit of you that's a
right . We all have it - some more than others - but that bit of you
will have been depressed too, and as you get better it'll come back.
Possibly more than you wanted! Be positive: people will stop treating you as
a doormat, and if that adjustment is painful for them, so much the better.
You'll get side-effects: everybody does. You won't like them, and maybe
you'll have to tell your doctor that you can't live with it, and maybe he'll
prescribe something else. Me, I was lucky and got nothing all that different
to the physical symptoms of acute depression and anxiety... which I was
getting already. Nausea, vomiting, sleep disturbances, the shakes, mood
swings - nothing I could honestly say that I wasn't already enjoying, and
arguably nothing even close to being worse than untreated depression. Which
is the argument you'll use when you weigh up the disadvantages of the
medication.
As for the advantages... six to eight weeks is the time it'll take for the
medication to settle down, and for any clear benefit to emerge. Sometimes,
no clear benefit emerges. Sometimes an increase in dosage is required - note
that GP's will rarely prescribe 100mg/day or more of Sertraline, and I
didn't get the full benefit until a consultant raised the dosage to 150mg.
Sometimes no benefit emerges at all and a different drug is required, and
you're off on another six weeks' of side effects and delayed or nonexistent
improvement.
It's reassuring, in a way, that no two people react the same way to the
meds: I like to think that everyone's mind is different. Bear that in mind
when you wish for a clean and simple pill that'd clear out the depression
the way antibiotics used to work on bacteria.- because you *will* find
yourself wishing for that. We all do.
i've got a question about sertraline - you seem to have been on it for a
while. i'm taking 100mg at the moment and its more or less helping. The down
periods are still very much present, but within manageable boundaries.
However, I've been getting anxiety /and panic attacks - not because of
Sertraline I don't think, but its just not dealing with them. Every time my
dose goes up, I feel great for a month or so but then the patterns are back.
I went up to 150 for a couple of months but it killed my libido, and now
I've dropped back down. Did you get that sort of effect? i am just trying to
understand whats common and what isn't; and whether I should press my doc
into giving me mood stabilisers as well.
Would you have any insights?
Is this a recent diagnosis or have you been depressed for some time?
I don't recall ever being prescribed Sertraline (is that also called
Lustral?) although the memory is a little hazy, but certainly not in recent
years anyway, so can't offer any specific experiences regarding that AD. The
thing with the majority of AD's is that they can take up to 6 weeks to
actually start producing any positive benefits, so 3 weeks is still probably
a little too early to make any judgements as to whether this is the right
medication for you.
Usually if you're not feeling any better after this period the doctor will
review your dose and increase it to the next level. I went back on meds a
few months ago and have had my dose increased 3 times to actually find a
therapeutic level and it may even be increased again at my next pdoc visit.
Quite often if you still get no benefit from maximum recommended doses it
may be necessary to switch to a different drug. There are so many to choose
from and it often takes a few attempts (and several months) to actually find
something that works for you, and everyone has different experiences with
different types of AD.
I'm assuming from your post that you've only seen your GP at this stage?
Have you been referred to the mental health services for assessment yet?
Most people find that it is helpful to have some sort of 'talking' therapy
alongside the medication, but not knowing your history or cause of
depression it's hard to say whether this would be helpful in your case.
Maybe if you could expand a little on your problems it would give us some
clue as to where you might benefit from further help. If you don't feel able
to discuss it in here I understand but feel free to drop me a mail if
there's anything you need to talk about.
And on a final note, are you mad wanting to move to Cambridge? ;-)
There's quite a few of us around this area so you certainly won't be alone
if you want any company!
