When should you medicate for depression?

It is known as the common cold of psychiatry, but should you just pop a pill for your depression?

15 January 2013
by Joanne Lillie

Many people in today's world will experience at least one depressive episode in their lifetime. But how do you know when it’s time to seek medical help?

Meg Meyer (40) was surprised when she was diagnosed with clinical depression. "I kept thinking 'but I don’t have anything to be depressed about'," she says. Meg is a busy mom of two who runs her own estate agency. "I didn’t know what was wrong initially, but I felt continually down and tearful for no reason. I began to eat more, especially comfort foods, and had no energy to get up in the morning. I wanted to sleep all the time, but never woke up feeling refreshed," she recalls.

"I lost interest in things that used to bring me pleasure and felt terribly guilty when I battled to interact with my children. I found I was worrying about things totally out of my control, like starving children in Ethiopia and polar bears losing their habitat to global warming. I found myself in this negative spiral and I couldn’t get out," says Meg.

Meg isn’t alone. Depression can affect all of us and it’s on the increase. "It's predicted that it will be the second leading cause of disability in developing countries by 2020," says psychiatrist in private practice, Dr Rykie Liebenberg.

"Modern living is stressful and people face situations of new stress every day, more than ever before. Nothing is certain or sure anymore, whether it’s keeping the same job, staying in an important relationship or keeping up with information and technology. People are also estranged from close and strong interpersonal relationships, and all of this could contribute to the increase in the need for treatment of this condition," says Dr Liebenberg.

A dramatic downturn in world economies has also had a role to play, notes clinical psychologist, Dr Colinda Linde. "When there is a lot of uncontrollable, chronic stress people feel more helpless and hopeless. These feelings are a recipe for depression, especially if compounded by financial woes, or for some people retrenchment or losing their home." Other factors like genetics can make some people more vulnerable to depression.

Luckily, depression is one of those conditions that responds very well to treatment and people needn’t suffer from it unnecessarily. The two main treatment options include psychotherapy and medication.

The role of therapy

"One-on-one therapy can be the lifeline people need to remind them that there is hope of change," says Dr Linde says. "It also supports them through the dark parts, before medication kicks in, and it helps them to learn new coping skills and find ways of making changes. With depression, it's very difficult to make decisions, so a safe space to think aloud and get good guidance on a realistic way forward, and plan the practical steps, makes all the difference."

Justine Bartlett, a clinical psychologist practising in Durban, highlights that cognitive behavioural therapy (CBT) in particular can have life-changing results. "CBT can change patterns of thinking indefinitely. Once we’re aware of the processes behind our thinking, that we are in control of our thoughts and can choose which patterns we want to instil in our own minds, we can begin to change them," says Bartlett.

Dr Linde says that CBT can also prevent a relapse into depression as it challenges the thoughts and beliefs that maintain depression, for instance: "It will always be bad like this", or "I will never improve". A more realistic way to think would be: "Life goes through stages, nothing stays the same forever, and even if I do nothing my mood shifts through the day, so I can’t say that things stay the same and can’t change."

When meds are best

Although therapy has an enormous role to play in treating depression, someone has to be ‘reachable’ for therapy to work, says Dr Linde. If you're severely depressed, your brain may have shut down too much to be able to absorb the benefits of therapy, and medication would be needed first. A psychiatrist would need to assess you and give you a prescription.

Depressive illness can be caused by a decrease of certain chemicals or neurotransmitters in the brain that are responsible for mood. Antidepressants stimulate chemical changes that increase the levels of these neurotransmitters. The three main neurotransmitters associated with mood are serotonin, norepinephrine and dopamine. Different antidepressant medications affect one or more of these neurotransmitters.

When taking antidepressants, it's vital to keep taking the medication for at least six months after you get well. Although the medication reduces symptoms fairly quickly, it doesn’t mean that the depression is completely healed and if you stop the medication the moment you feel better the depressive symptoms will soon return.

Most therapists agree that the ideal treatment scenario uses a combined approach, with medication as the booster to get you into a functional state, and then therapy to provide the tools to improve that functioning and to ensure you stay well. And the sooner you seek help the better.

It has been five years since Meg’s diagnosis, and she is living a full and joyful life once again. "I still use the tools I learned in therapy almost daily. Now every negative thought that comes into my mind is checked and challenged – and most are discarded as unfounded," she says. "It’s like a light has been switched on, and I only wish I had been open to treatment sooner. It has given me my power back and put an end to the darkness."

Depression treatment tips

  • Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first.
  • It takes time to find the right treatment. For example, it might take a few tries to find a therapist that you click with if you decide to go the therapy route. Likewise, you might need to try a couple of different medications before you find the right one for you.
  • Don’t rely on medication alone. Although medication can relieve the symptoms of depression, studies show that other treatments, including exercise and therapy, can be just as effective. And remember that medication works best when you pursue therapy as well.
  • Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to a family member or friend. Asking for help is not a weakness but a sign of strength.
  • Treatment takes time and commitment. Getting over depression might at times feel frustratingly slow. That is normal. Recovery has its ups and downs.
Read More: Depression Super Section