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Treating depression: The choicesTreating depression: The choices
Depression affects about 1 in 5 Australians at some stage in their lives. Many different treatments can be used for it, and each has its own advantages and disadvantages. Choosing the most appropriate treatment requires careful thought, and may involve some trial and error before you find the treatment or combination of treatments that works best for you.
This article refers to clinical depression in adults. It does not refer to depression in children and adolescents, for which specific advice should be sought from a doctor. It also does not refer to episodes of sadness associated with grief and other unpleasant events. These usually get better with time and support from family and friends. However, if the sadness persists for longer than eight weeks or keeps recurring, treatment may be needed.
Main treatment options
The two main types of treatment for depression are medication and counselling. Antidepressant medicines help people overcome depression by increasing the levels of the chemicals in the brain that control mood. The levels of these chemicals seem to be decreased in people with depression.
Counselling helps people deal with episodes of depression by helping them change the negative thoughts, feelings and behaviours that contribute to their depression. It can also help people reduce their chances of having a relapse by helping them learn better ways of dealing with the stresses in their lives. Counselling may take many forms, including psychotherapy, cognitive-behavioural therapy, interpersonal therapy and general counselling.
Some people use either medication or some form of counselling, but the best results are often achieved when both are used. The most appropriate treatment for you will depend on many things, including:
- the severity of your depression, i.e. whether it’s mild, moderate or severe
- your preferences, i.e. whether you prefer one type of treatment over another
- the cost and availability of the options, e.g. whether affordable counselling is available in your area.
Counselling alone is often as effective as antidepressants for people with mild to moderate depression. People with severe depression usually need a course of medication. However, they often get the best long-term results if they undertake counselling as well as medication.
Coping skills
Many people augment their treatment by strengthening their coping skills through gentle exercise, relaxation therapy, reading self-help books, developing better sleeping habits, stress management and yoga. These skills can help people better manage the things that contribute to their depression, so what works for you will depend on your situation. Some people develop these skills under the guidance of a health professional, while others prefer to develop them on their own.
Some people use either medication or counselling, but the best results are
often achieved when both are used.
Antidepressant medicines
Many different types of antidepressant medicines are available. The different types are outlined in the table below, along with examples of each.
Choosing
Prescription antidepressants alleviate depression in about 70% of people, but it’s impossible to know in advance whether a particular medicine will alleviate your depression. Therefore, you may need to try more than one medicine before finding one that works for you. Your doctor will consider many things when choosing a medicine for you, including:
- whether you have used antidepressant medicines previously, and, if so, how well they worked and what side effects you experienced
- the type of depression you have, and the symptoms associated with it, e.g. whether you also have anxiety or fatigue
- any other illnesses you may have
- any other medicines you may be taking.
Antidepressant medicines sometimes interact with other medicines. When your doctor is choosing an antidepressant for you, it’s important that you tell them about all the other medicines you are taking, including any herbal and alternative medicines such as St John’s Wort. In addition, if another doctor is prescribing a medicine for you, make sure they are aware of your antidepressant medication.
Side effects
Unfortunately, side effects are common, and they usually appear soon after starting treatment. However, most are only temporary and disappear after a couple of weeks. The table below lists the common side effects. The lists are long, but don’t forget that everybody reacts differently to medicines, so you will not experience all of them.
Before starting a course of antidepressants, ask your doctor about the side effects you are likely to experience, so you know what to expect. If you are concerned about developing a particular side effect, tell the doctor. They may be able to give you a different medicine that does not cause that side effect. Also, ask your doctor or pharmacist for the medicine’s Consumer Medicine Information (CMI) leaflet, which will give you detailed information about the medicine and its side effects.
During
It can take up to 6–8 weeks for the medicine to relieve your depression. However, you will usually notice some improvement after 1–3 weeks. Visit your doctor regularly while taking the medicine, so they can keep track of your progress, particularly if you are taking it for the first time. Tell them how you are feeling, whether you think the medicine is working, the side effects you are experiencing, and any concerns you have. This information will help the doctor fine-tune your treatment if necessary. Fine-tuning may include changing your medicine if it’s not working or causing too many side effects. If you are feeling really bad or having major problems between doctor visits, ring them and talk with them or get help elsewhere. Don’t be tempted to increase the dose of your medicine.
Changing
Some people don’t respond to the first medicine they try. If you don’t feel better after 6–8 weeks, you may benefit from trying another medicine. You may also need to change your medicine if you find the side effects too unpleasant. If you switch medicines, you will usually need to withdraw gradually from the first medicine, and have a drug-free break before starting the new one.
Stopping
To avoid possible problems, talk with your doctor before stopping your antidepressant medicine. It is recommended that you take your medicines for 6–12 months after the depression has lifted, because stopping treatment too soon will increase your likelihood of having a relapse. People who have had multiple episodes of depression may benefit from continuing treatment for longer, sometimes indefinitely. Stopping antidepressants suddenly often causes unpleasant withdrawal symptoms. When coming off your medicine, you will probably need to slowly decrease your dose over 1–2 weeks or more.
Types of antidepressant medicines available in Australia and their key features and side effects
| Type & examples (Generic name first; brand names in brackets.) | Key features | Common side effects (Remember, you will not experience all the side effects listed.) |
|---|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | ||
| Citalopram (Celapram, Cipramil, Talam, Talohexal) | Most commonly prescribed type of antidepressants | Nausea, agitation, difficulty sleeping, drowsiness, tremor, dry mouth, diarrhoea, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, impotence, loss of libido, runny or blocked nose, muscle aches, rash |
| Escitalopram (Lexapro) | First choice for most types of depression | |
| Fluoxetine (Auscap, Fluohexal, Lovan, Prozac, Zactin) | Often suggested that side effects more tolerable than those of TCAs | |
| Fluvoxamine (Faverin, Luvox, Movox) | ||
| Paroxetine (Aropax, Oxetine, Paxtine) | Been used for more than 10 years | |
| Sertraline (Zoloft) | ||
| Tricyclic antidepressants (TCAs) | ||
| Amitriptyline (Endep, Tryptanol) | Often suggested that side effects less tolerable than those of newer antidepressants | Sedation, blurred vision, drowsiness, dry mouth, constipation, weight gain, dizziness on standing, difficulty passing urine, confusion, impotence, loss of libido, other sexual side effects, tremor, dizziness, sweating, agitation, difficulty sleeping |
| Clomipramine (Anafranil) | ||
| Dothiepin (Dothep, Prothiaden) | Been used for more than 40 years | |
| Doxepin (Deptran, Sinequan) | ||
| Imipramine (Melipramine, Tofranil) | ||
| Nortriptyline (Allegron) | ||
| Monoamine oxidase inhibitors (MAOIs) | ||
| Phenelzine (Nardil) | Used in small percentage of people with specific needs | Dizziness on standing, sleep disturbances (including difficulty sleeping and excessive sleeping), headache, drowsiness, fatigue, weakness, agitation, tremor, twitching, muscle spasms, unusually increased reflexes, constipation, dry mouth, weight gain, impotence, loss of libido |
| Tranylcypromine (Parnate) | Interacts with tyramine, so must avoid foods containing tyramine, ssuch as matured cheese, salami, Vegemite and red wine Often associated with weight gain Been used for more than 40 years | |
| Others | ||
| Mianserin (Lumin, Tolvon) | Similar to TCAs | Sedation, dry mouth, dizziness, vertigo (feeling that the world is spinning around you) |
| Mirtazapine (Avanza, Axit 30, Mirtazon, Remeron) | May have fewer sexual side effects than SSRIs | Increased appetite, weight gain, sedation, weakness, swelling of ankles and calves |
| Moclobemide (Arima, Aurorix, Clobemix, Maosig, Mohexal) | Less likely to cause sexual dysfunction side effects than SSRIs | Nausea, dry mouth, constipation, diarrhoea, anxiety, restlessness, difficulty sleeping, dizziness, headache |
| Reboxetine (Edronax) | Relatively new antidepressant | Difficulty passing urine, dry mouth, sweating, tingling, numbness, pins and needles, constipation, raised blood pressure, raised heart rate, impotence, difficulty sleeping, headache |
| Venlafaxine (Efexor) | Often suggested that has more tolerable side effects than TCAs | Nausea, vomiting, anorexia, headache, sweating, rash, anxiety, dizziness, fatigue, fainting, raised blood pressure, dizziness on standing, tremor |
| Herbal medicines | ||
| St John’s Wort (Hypericum perforatum) | Appears to be an effective treatment for mild to moderate depression Interacts with prescription antidepressants, so should not be used at same time Also interacts with some other prescription medicines, so check with doctor if taking other medicines | Dry mouth, dizziness, diarrhoea, nausea, increased sensitivity to sunlight, fatigue |
Getting help Websites Websites with information in other languages Books Online cognitive behavioural therapy |
MedicinesTalk is a free quarterly newsletter for consumers written by consumers about using medicines wisely. Subscribe to the hard copy version using our online ordering system, or write to MedicinesTalk, National Prescribing Service Limited, PO Box 1147, Strawberry Hills, NSW 2012.
Date published: 2004-12-01 00:00:00
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