Treatment of depression
Most people with depression can be successfully treated by their doctors. A minority – maybe 5% – may need to see a psychiatrist, and most of these people will be treated as outpatients.
Treatment of depression involves medication, ‘talking treatment’ (psychological therapies, e.g. counselling and psychotherapy), or a combination of both.
Depression may pass unrecognised by sufferers, who put up with the loss of energy, anxiety, poor sleep, low moods, and sexual difficulties. It makes a sufferer think that it is just part of life. Untreated depression leads to much misery and ill health – sadly, even loss of life. It is so important that depression is fully and adequately treated. Nobody wants to take medication unless necessary, but medication plays a key part in most people’s treatment.
A wide variety of antidepressant drugs is available. We describe the range of drugs and their side-effects. Antidepressants are not addictive. Treatment with these drugs needs to continue for a number of months – usually at least 6 months from when you start to feel better. It can take up to 3 weeks for these drugs to work, although many people notice improved sleep and more stable mood within the first week.
Depression also lowers your self-esteem, and time spent with a sympathetic counsellor or therapist can help you start to repair this damage. Counsellors and psychotherapists are available in many – but not all – doctor’s surgeries, as well as in day hospitals, Community Mental Health Teams, and in the private sector. We discuss the different types of ‘talking treatments’ available, including one-to-one therapy, self-help group therapy, and therapies such as Cognitive Behavioural Therapy, for which there is good evidence of effectiveness. Choosing your doctor
How can I choose a doctor who will really understand depression?
Doctors for example in Unted kingdom all undergo vocational training, which includes assessing ability to deal with psychological aspects of illness, so all doctors will have plenty of experience in dealing with depression – it’s part of everyday work. Most doctors work in groups nowadays (there is a minority of single-handed doctors too, who give a personal one-to-one service), so you should be able to decide whether you prefer to see a male or female doctor, or an older or younger one.
Start by asking among friends for personal recommendations. Most doctors aren’t really in a position to offer detailed, in-depth counselling owing to time pressures, nor is that really appropriate when you’re feeling very low.
Of course, we all have different chemistry, and nobody can guarantee that any two people will get on. See whether the practice has an attached counsellor, or can recommend good local ones. When you meet your doctor, see if you are comfortable and whether you are going to be able to work with the doctor.
You can always move to another practice if you really don’t get on, but this should be a last resort. If you cannot find a doctor, the local health authority will allocate you one.
Few doctors actually have official further qualifications in psychiatric illness, so looking for letters after the name in the Medical Register or the Practice Profile (every practice has one), or on a practice website, is not so helpful.
Membership of the Royal College of GPs (MRCGP) does confirm that a doctor has passed a thorough vetting in all aspects of family medicine, with special emphasis on psychological issues.
The most important part of a doctor’s job in dealing with someone who is depressed is assessment and starting medication when appropriate. So don’t be too picky, and don’t worry about shopping around for someone special. What’s more important is entering into a working relationship with your doctor, being able to trust that relationship, and making it work for you.
I don’t get on with my doctor. I need to talk about how depressed I feel, but she’s not very sympathetic. What can I do?
It can be quite a skill to get the best out of your doctor. Try thinking of them as a scarce resource that you need to work with well to get the best results. Some ways of doing this are to make early appointments rather than coming in with a complicated agenda at the end of a hectic surgery (this is likely to mean that you will be kept waiting less, too). Writing a list or letter can help you focus on what you actually want your doctor to deal with. Be prepared to come again on a second occasion rather than go through a lengthy list when there are other people waiting.
Many (or all) NHS doctors are pretty hard pressed for time, but that shouldn’t mean that they will not be interested in addressing emotional problems as well as sore throats and Pill prescriptions.
All doctors are trained in looking in depth at psychological and social aspects of the problems. Every doctors training includes video sessions to help improve their consultation skills.
My doctor never seems to have much time. How can I talk about depression to him?
The average doctor appointment is about 10 minutes nowadays, and has become longer as we have more health promotion to insert into it. (That’s advice on smoking, drinking, diet, exercise, BP checks, and contraceptive advice.) Sometimes it seems as if there isn’t time to tackle all this – 10 minutes does not sound much, but if you add it up it over a year it comes to 46 minutes on average per patient.
With a bit of leeway, most doctors normally make enough time to assess and treat depression in a busy surgery setting, but might use a series of short meetings to do this rather than one big one.
Some people just need a prescription, so most of us find we can fit the occasional longer consultation into the working day, sufficient to assess and treat depression. Some doctors are rather ‘counselling-orientated’ and are able to engage in brief counselling them. Others will work with a counsellor, within the practice or known to them. People who are very depressed are not usually ready to do a lot of talking. It is best not to tackle painful issues until you are fit enough to deal with them – then talking can be very productive.
What constitutes good practice in medicine?
Of course there is still a wide range of choice of treatments for all conditions, and depression is no exception. Where problems arise with a treatment, if the doctor concerned has practised in line with ‘a recognised body of medical opinion’, the doctor will be unlikely to be considered negligent. If national guidelines have been published by NICE (National Institute for ClinicalExcellence) or any other body, such as the Royal College of Psychiatrists or the
All the drugs used in psychiatry today have been very extensively researched. Side-effects and interactions are well recognised. What is harder to do research into is the ‘talking treatments’, such as counselling and psychotherapy. These are costly resources and health authorities won’t just take it for granted that they are beneficial. Those who want to provide counsellors in General Practices have had to argue the case very hard. Counselling is very popular with people, but its efficacy is debated.
