Off To A New Hospital
The hospital where I work doesnt offer esketamine treatment, so the patient seeks it at another hospital. This clinic is farther away a burden on his already stretched schedule but he is desperate for relief. I dont hear from him again, and I wonder how he has fared. In clinical studies, 70 percent of patients substantially improve within a month with a combination of nasal esketamine therapy and an antidepressant. But nearly 40 percent relapse in subsequent months despite staying on treatment.
Antidepressants For Children And Teens
In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and behavior in children, teens, and young adults. The Food and Drug Administration now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesnt mean that people in this age group shouldnt take antidepressants. It means they should be carefully monitored by their doctor and loved ones while taking the antidepressant.
Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If youre worried your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.
Refusing Medication Because They Believe They Dont Need It
Unfortunately, this can be the hardest situation. Once a person is well, they see the medication as a hindrance, forgetting that it is the medication that made them well. This is a trick of the mind. No one wants to be on medication and this is a trick the mind plays to provide an excuse for refusing medication.
A loved one can approach this situation with logic such as, remember before the medication, you did such-and-such, whereas on the medication, youre able to such-and-such . . .
However, the truth is that the patient may simply have to fall before they realize that it was the medication that was holding them up. For a loved one this is painful to watch but try to remember to be there if something like this happens and help out with returning to treatment.
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When To Call The Doctor
Depression or anxiety might not come back right away when you stop taking the medicine, but it may come back in the future. If you start to feel depressed or anxious again, call your provider. You should also call your provider if you have the withdrawal symptoms listed above. It is very important to get help if you have any thoughts of harming yourself or others.
When The Going Gets Tough In Therapy
As with remodeling a house, when you take apart things that haven’t worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, don’t give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.
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Learn To Recognize Negative Thinking
Sometimes these thoughts can be obvious, such as times when you berate or criticize yourself. Other times, they can be more subtle. You might find yourself engaging in things like catastrophizing or all-or-nothing thinking.
Catastrophizing involves always anticipating negative outcomes. All-or-nothing thinking means that you think of things as either successes or failures with no in-between. Once you get better at recognizing these cognitive patterns, you can start working on some healthier replacements.
Helping Them Explore Other Options
Educate yourself about other treatment options. Most mental illnesses can be treated by some combination of lifestyle changes and therapy. There are things your loved one can do on their own, without needing to rely on a professional. Help them come up with ideas. Follow up to see if theyve tried any of them, and ask about how well they worked. Be patient, and respect their decisions.
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What Does Depression Look Like
Well raise your question with a few Qs of our own: Are you female? Are you a teen? Depression can also affect different ages and genders in unique ways:
are more likely to ruminate . This can look like negative self-talk, sudden crying spells, feelings of guilt, or blaming oneself. Women are also more likely to have depression at the same time as an anxiety disorder, such as panic disorder, eating disorder, or obsessive-compulsive behavior.
with depression are more likely to show signs of irritability, anger, apathy, escapist behavior , or reckless behavior .
Younger people can struggle with depression and MDD . and may sometimes exhibit oversensitivity, social withdrawal, poor school performance, frequent physical complaints , or feelings of incompetence and despair .
are often misdiagnosed or undertreated for depression because their symptoms can be mistaken for other disorders , or they may assume their feelings are just an inevitable part of aging. For many, sadness isnt the biggest indicator of depression instead, physical complaints are often the predominant symptom. Sleep trouble, low motivation, neglect of personal care or hygiene, and fixation on death are other signs of depression in older adults.
Side Effects Of Quitting Medication
Quitting cold turkey may cause withdrawal symptoms. Suddenly stopping your medicine may also worsen your depression. Here are some of the possible effects of quitting too quickly:
You get sick. Antidepressant discontinuation syndrome, also called antidepressant withdrawal, occurs when a person abruptly stops taking antidepressant medication. Many people who experience antidepressant withdrawal feel like they have the flu or a stomach bug. They may also experience disturbing thoughts or images.
You set back your treatment. Stopping medication can set back your treatment plan. It can increase the time it takes to feel better or it can actually cause your symptoms to worsen.
You contemplate suicide. Not being properly treated may increase your risk of suicidal thoughts. It also increases the risk that youll act on those thoughts. The most common health problem linked to suicide is depression, says the American Foundation for Suicide Prevention.
Other symptoms get worse. Stopping an antidepressant might worsen other symptoms associated with your depression such as headaches, pain, or insomnia. Additionally, untreated depression can make it harder for you to manage other health problems.
Other symptoms of antidepressant withdrawal include:
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Helping A Person Who Refuses Medication
No matter what camp the person falls into, its very hard, but try to look at the situation from their perspective they likely have a real reason why they are treatment noncompliant. Try to speak to that reason with compassion and concrete reasons why they should work with their doctor to rectify that problem rather than try to handle it on their own.Remember, the best medication is the medication a patient will take.
And as Ive said above, remind them that real honesty with their doctor is the most important thing and that they are in control of their own treatment. And, if you can, try to support their wishes and act as their back-stop in psychiatric appointments. People dealing with psychiatrists often feel more comfortable being honest with this back-up which means they are more likely to get treatment that works for them.
There is actually much more to say about handling this problem, but, alas, Ive gone long already. Hopefully a part two will make its way here at some point.
Different Types Of Depression
There are different types of depression, and there are some conditions where depression is a symptom. These conditions include:
- Bipolar disorder people with bipolar disorder, which is also known as “manic depression”, experience times of depression, where the symptoms are similar to clinical depression. They also go through phases when they have excessively high moods . Bouts of mania can include harmful behaviour like unsafe sex, spending sprees and gambling.
- Seasonal affective disorder is also called “winter depression”. It’s depression that is related to weather, usually winter, so it happens seasonally.
- Postnatal depression happens to some women after they’ve had a baby. It’s treated similarly to other types of depression, with antidepressant medication and talking therapy.
Learn more about how depression is diagnosed here.
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What To Do If You Suspect An Overdose
Anyone who may have taken too many antidepressants, or fears that someone else has, should call the emergency services.
If a person has taken too many antidepressants, they may become unwell, even if severe symptoms do not occur straight away.
Symptoms of an antidepressant overdose may develop over time. People should contact the emergency services immediately, even if symptoms are only mild.
The safe dosage for each type of antidepressant varies from person to person. To stay safe and well, it is important that a person taking antidepressants sticks to the dosage their doctor has prescribed. A person needs to discuss any increase with their doctor first.
If a person is still experiencing symptoms of depression or another mood disorder despite taking antidepressants, they should also discuss this with their doctor. Taking a higher dosage of antidepressants without consulting a doctor is not safe and may harm the persons well-being.
The quantities of antidepressant harmful for each person will depend on other factors, such as their weight, age, and metabolism. Whether they overdose will also depend on the presence of other medications, drugs, or alcohol in their system.
Anyone who thinks that they or someone else may have taken an unsafe dosage can contact the National Capital Poison Center at 1-800-222-1222 in the United States for advice.
When To See A Doctor
If your depression symptoms return for more than a few days, it’s time to see your doctor. But even if you feel like your antidepressant isn’t working, it’s important to keep taking it until your doctor advises otherwise. You may need a dosage increase or a slow tapering off process. With many antidepressant medications, stopping their use too quickly can cause withdrawal effects such as:
- Greater anxiety
- Suicidal thoughts
Early warning signs of breakthrough depression are the symptoms you typically experience when an episode of depression is coming on, says Nestadt. Depression symptoms vary from person to person, but signs include:
- Changes in sleep or appetite
- Loss of interest in previously enjoyable activities
If your symptoms return, don’t worry adjusting the dose or switching to another antidepressant often solves the problem.
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Vitamins And Supplements For Depression
The jury is still out on how well herbal remedies, vitamins, or supplements work in treating depression. While many supplements are widely available over the counter, in many cases their efficacy has not been scientifically proven. If your depression symptoms are in part due to nutritional deficiency, you may benefit from vitamin supplements, but this should be on the advice of your healthcare professional.
If you decide to try natural and herbal supplements, remember that they can have side effects and drug or food interactions. For example, St. John’s Worta promising herb used for treatment of mild to moderate depressioncan interfere with prescription drugs such as blood thinners, birth control pills, and prescription antidepressants. Make sure your doctor or therapist knows what you are taking.
Mild To Moderate Depression
If you have mild to moderate depression that is not improving, or moderate depression, you may find a talking therapy helpful.
There are different types of talking therapies for depression, including cognitive behavioural therapy and counselling.
A GP can refer you for talking treatment, or you can refer yourself directly to an NHS psychological therapies service without a referral from a GP.
If you have moderate to severe depression, the following treatments may be recommended.
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Looking After Someone With Depression
It’s not just the person with depression who’s affected by their illness. The people close to them are also affected.
If you’re caring for someone with depression, your relationship with them and family life in general can become strained. You may feel at a loss as to what to do. Finding a support group and talking to others in a similar situation might help.
If you’re having relationship or marriage difficulties, it might help to contact a relationship counsellor who can talk things through with you and your partner.
Men are less likely to ask for help than women and are also more likely to turn to alcohol or drugs when depressed.
What Should You Consider When Deciding Whether Or Not To Take Antidepressants
Whether antidepressants are an option will depend on things like the severity of the symptoms. Other aspects can also play a role in the decision:
- Are you going to psychotherapy or are you planning to?
- Have you taken antidepressants before and did they help?
- How bad do you think the potential side effects are compared to the possible benefits?
The question of side effects can also be key when choosing which drug to take: Some people might be more keen to avoid digestion problems. Others might prefer to avoid dizziness, decreased sex drive or erection problems.
It only makes sense to use antidepressants if the is correct. Specialists believe that some people are prescribed antidepressants unnecessarily. The fact that a lot more people take antidepressants nowadays suggests that this is true. They are sometimes already prescribed for milder symptoms, even though it’s not clear whether they help in mild .
But it’s still important to make sure that severe is diagnosed and treated properly. Antidepressants can be helpful here, and for some people may be the only way that they can get back into a daily routine or start going to psychotherapy.
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Why Am I On Antidepressants But Still Depressed
When diagnosed with major depressive disorder , the usual treatment protocol is to prescribe a combination of talk therapy and antidepressants. This cookie cutter approach to treating depression does not acknowledge the many variants involved in depression, making MDD a difficult mental health disorder to effectively treat. The heavy prescribing of of antidepressants has become a knee jerk response to an MDD diagnosis, even though evidence, such as a recent study out of Rome, shows that between 30%-50% of patients do not improve on the drugs.
The jury is still out as to why antidepressants dont work for such a wide swath of patients, but the fact is they dont make a dent in the depression symptoms suffered by so many. For those on antidepressants but still depressed, many will also experience highly unpleasant side effects from the medications. Side effects can include weight gain, fatigue, sexual dysfunction, changes in personality, nausea, insomnia, and constipation. Because the side effects can prove to be intolerable, many patients do not complete the trial.
Things Only Someone On Antidepressants Understands
There’s a spin class I like here in New York City, and the instructor happens to have diabetes. Periodically in the middle of classsometimes barely even slowing her pedaling feetshe’ll check her blood sugar with a quick prick of her fingertip. Occasionally she’ll explain herself before or after class. Other times, no explanation necessary. I’m sure others like me who have worked out with her more than a few times hardly notice anymore.
Therapists and doctors and writers like to draw an analogy between the constant vigilance required of people with diabetes and that of people with depression. A person might need to be on insulin for the rest of her life, and there’s no shame in that. Depression, too, the thinking goes, can require lifelong treatmentwhy should our perception of that medication be any different?
Still, I can’t imagine this spin instructor popping off the cap of a bottle of Zoloft in front of 30 sweaty strangers.
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It’s not a perfect analogy: We now know that depression is perhaps infinitely more complicated than the comparatively well understood fix for type 1 diabetes of replacing missing insulin. But it still makes the point so clear it nearly punches you in the stomach: We wouldn’t judge someone for treating a physical illness with medication, so why do we judge someone for doing the same for a mental illness? Diagnosing depression can be just as challenging as treating it.
You don’t have to be on them forever .
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Diagnosing And Treating Depression
There’s no physical test for depression.
If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if:
- you have symptoms of depression that aren’t getting any better
- you have thoughts of self-harm or suicide
- your work, relationships with friends and family, or interests are affected by your mood
It can be hard for people with depression to imagine that anything can help them but the sooner you seek help, the sooner the symptoms start to get better.
Your GP may examine you and perform blood or urine tests to make sure there isn’t another condition causing your depression symptoms, like an underactive thyroid.
When you see your GP, they’ll try to find out if you have depression by asking you questions. These are likely to be about your health, how you’re feeling, and how that is affecting you mentally and physically.
Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. It’s important to be as open as possible.
Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower.