MEDICATIONS: FREQUENTLY ASKED QUESTIONS: DEPRESSION

Q:

How will I know if my treatment for depression is working?

A:

As people recover from depression, the first symptoms that usually improve are problems with sleeping and loss of appetite (or excessive appetite). After that, energy and interest in activities improve, as do the ability to think clearly and to function more productively. The last symptom to improve is the feeling of being depressed and discouraged, which can happen many weeks after treatment has begun. Although this same sequence of improvements may not be what everyone goes through, it is common.

You may be the last to recognize when the treatment is helping. Although others may see you getting better and while you may notice that you are able to function better, you may continue to feel depressed. This lingering feeling of depression may interfere with your ability to believe you are getting better, so it is important to stick with your treatment even when you have doubts about its effectiveness.

Is there a difference in the way medications and psychotherapy work in the treatment of depression?

A:

Psychotherapy is a series of private talks with a psychiatrist where you discuss the feelings, thoughts and behavior that cause difficulty. The goal of psychotherapy is to help you understand and master your problems so you can function better. Psychotherapy can help with the symptoms of depression, such as feelings of guilt and worthlessness, sadness, anger, doubt and indecision. Depression often is related to experiences or problems you have in your relationships with important people such as family, lovers and friends. Through psychotherapy, you can examine and improve these relationships, or grieve and move beyond those that have been lost.

Antidepressant medications also help treat the psychological symptoms of depression, such as guilt, hopelessness and anxiety. They are particularly effective in treating the neurovegetative symptoms of depression. Neurovegetative is a medical term referring to the physical symptoms commonly seen in depression, such as the loss of appetite (or excessive appetite), difficulty concentrating, feeling very nervous or being unable to sit still.

Q:

What do I do if I think the treatment I am receiving is not helping?

A:

First, compare your perception of how the treatment is working with others who see you regularly and whom you trust. As mentioned in a previous answer, you may not feel better even though you are getting better. If others agree that progress is not occurring, however, don't keep quiet about it. Talk to your psychiatrist, your family or primary care physician or your therapist.

Open, direct communication is essential for treatment, and it needs to flow in both directions – from patient to doctor and vice versa. A good psychiatrist will want to hear from you and will value your concerns. Anyone who dismisses what you say may not be worth working with.

Ask your psychiatrist why progress is not occurring. Ask how else you might be helped. For example, are there other treatments that could be considered?

You should also feel free to ask your psychiatrist for a second opinion about your treatment. This means you or your psychiatrist ask another medical professional to review your care and make suggestions to improve it. Getting a second opinion is common in medical practice. It can offer a fresh perspective and the opportunity to change or enhance your treatment. In general, a psychiatrist welcomes a second opinion, and if he or she doesn't, you may not be working with the right psychiatrist.

Last and not least, don't give up. Depression is a very treatable illness. Although some people respond to treatment in a month or two, others take longer. The statistics are encouraging: As many as 85 percent of people respond to appropriate treatment.

Q:

Why do I need to keep taking antidepressant medications after I feel better?

A:

You've heard medical doctors say you need to continue taking an antibiotic for as many days as prescribed – even if you feel better sooner. The same is true for antidepressants, although you have to take them longer.

Antidepressant medications treat your symptoms, making you feel better, but the illness continues. The medication is needed to control the illness until full recovery is achieved. If this is your first episode of depression, don't be surprised if your psychiatrist says you need to take the medicine for six to nine months after you start feeling better. This is how long it takes the medicine to protect you against the depressive illness, which continues to cause imbalances in your brain chemistry and nerve cells. For someone who has suffered from more than one episode of depression, medication and psychotherapy may be necessary for longer periods of time.

Studies have shown the combination of psychotherapy and medication often is more effective than either treatment alone.

Once you begin feeling better, your psychiatrist will focus treatment on helping you avoid a relapse, which is why he or she asks you to continue taking the medication. However, if you and your psychiatrist decide to stop the medication, studies have shown the importance of stopping gradually. Abrupt discontinuation of antidepressant medications can increase the risk of a relapse.