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Diagnosed With Depression

Discussion in 'Health Issues' started by ShabnamF, Sep 26, 2016.

  1. Rihana

    Rihana Moderator Staff Member IL Hall of Fame

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    Why do you care?
     
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  2. Shreema86

    Shreema86 Platinum IL'ite

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    Taking anti depressants for depression is like aspirin for head ache . It treats the symptoms not the cause. So it's a temperorary fix. Not a cure. You can take a very low dosage along with other therapies if you really need immediate relief. Long term , you need to combine meditation , homeopathy, yoga, a healthy diet , positive affirmations, spirituality to cure yourself . Definitely taking western medicines is a short cut, but with lots of side effects.
     
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  3. madras2018

    madras2018 Platinum IL'ite

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    @Rihana - If I have to be frank, some parts of your response were somewhat incorrect and those with actual experience may disagree. I care because depression and its treatment is serious enough that advice that basically tells someone to not take medicine for 4-6 months and try self-help methods instead, despite being diagnosed by a medical professional, is actually irresponsible.

    And hence I was wondering if this comes from first-hand experience or theoretically speaking.
    I disagree on your POV that almost second-guesses the doctor. While I agree that no harm can come out of a 2nd opinion, the fact remains that we have to trust a mental health professional's expert judgment when it comes to such things. This is because there is no blood test, ultrasound, scan or biopsy that will accurately give a patient data to self-diagnose or confirm a depression diagnosis. She has to trust her doctor. And her relationship with her doctor is going to be a huge part in her recovery.

    In my experience, I consulted 1 doctor and I trusted her approach fully to take her suggestion of medicine. Psychiatrists often do 1-2 or even 3-4 rounds of patient consultations to understand the patient and quiz on her/his signs and symptoms before recommending medicines.
    This part is actually dangerous advice to someone who has already been diagnosed by a psychiatrist as being clinically depressed. If we were to assume that this is a life threatening illness, as you put it, I doubt anybody would wait 6 months to seek medical treatment in spite of being formally diagnosed. 4-6 months of self-help may work if someone has a mild case of the blues. Not clinical depression.
    This part is bordering on 'diagnosis', partly or wholly based on your understanding of OP via her IL posts. Besides OP has already made clear that this is not about the engagement issue. It's beyond the general 'feeling low' state of mind. And to advise someone that they could skip treatment based on the little we know of them online, and that they could set aside a psychiatrist's evaluation for now - is a tad reckless.

    I appreciate the place of concern that your advice comes from - which is to be cautious about taking drugs that relate to one's state of mind. But really, it's nothing to be overly worried about in this day and age. I understand this because I reacted much the same way at the very beginning. Wrongly thinking I'd be giving up full control of my mind and such. My doctor told me and infact studies clearly document that the half-life of an anti-depressant is 6 - 30 hours. That's it. It's in and out of your body in 2-3 days. So nobody's going to be having mind-altering withdrawal symptoms or losing their 'self-hood' in the process.

    Back to my own experience, I waited about 4-6 months similar to what you suggested the OP. It was actually a mistake and mine was mild/moderate, not even acute depression. Symptoms became worse - I was unable to concentrate at work. I became irritable and this impacted my relationships. I had trouble sleeping and this impacted daytime alertness. Life became more difficult as a result of untreated depression (and it wasn't obvious to me). Often the patient cannot be an accurate gauge of his/her own mental health. Many are in denial. In other words, setting aside a medical diagnosis of clinical depression for X months, is actually a bad idea.

    The OP can get a 2nd or 3rd opinion over the next few days/weeks, and if they all concur, she would be best served to start treatment immediately. And I cannot stress enough - that foremost @ShabnamF needs to trust her doctor or find a doctor she can trust. Treatment's not going to work otherwise.
     
    Last edited: Sep 27, 2016
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  4. skalluri

    skalluri Gold IL'ite

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    Dear OP,

    Yes, anti-depressants will have side effects, everyone is different, it depends on how your body and mind reacts to it. Before taking the medicines, you should know some points.

    (YOU SHOULD FOLLOW DOCTOR DIRECTIONS AND TAKE MEDICINE IF YOU ARE SUICIDAL OR GETTING FEELILNGS OF HARM YOURSELF OR OTHERS.)

    1.Once you start taking the medicines, the symptoms will increase initially for 1 or 2 weeks and then gradually make you calm.

    2.second, once you start taking medicines, you should not step abruptly just because you don't feel comfortable with side effects or whatever reason, you should continue taking otherwise the depression symptoms increases.

    3. Anti-depressants will help you only to suppress the symptoms (adding some side effects) , may make life easier by making you sleep better etc but it will not cure unless you address the underlying cause, so you have to manage the symptoms with lifestyle changes like yoga, meditation, diet, reading good blogs on positive attitude etc. along with taking medicines.

    4. It may put you on guilt that you became mental patient, your self-esteem may reduce, on the other hand you will gain confidence in day to day life as you will be sleeping better, so you are confusing the mind and you are under control of medicine but may not recognize your own abilities.

    5. Doctors may prescribe medicines by listening to your symptoms, but you are the best doctor to yourself, ask yourself if the symptoms are manageable with lifestyle changes, do you have will power to manage without taking medicines.

    In any case, you should take the medicines as per doctors prescription if your symptoms are severe and making you sleepless in the nights and tiresome and fatigue in day times and make you crying all the time and feeling stuck, feeling low, feeling helpless and hopeless , and feeling suicidal, if all these symptoms are severe, then you should follow the Doctor. You should also follow the lifestyle changes for permanent solution.

    Don't stress yourself by analyzing all this, relax, discuss with your close friends, family, everything will be alright. God is great.

    SK
     
  5. Rihana

    Rihana Moderator Staff Member IL Hall of Fame

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    Good response. Lots of material for OP to read and think.

    I am not currently up for more discussion about this. We had a thread on it a while ago: Depression - myth, reality, or a little of both?

    Feel free to bump up the thread. You are very knowledgeable and any inputs you have will benefit many - current readers and those who read it later too.
     
  6. Gauri03

    Gauri03 Moderator Staff Member IL Hall of Fame

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    OP, for mild to moderate cases of depression, most doctors prescribe medication because patients are not willing to keep up with the rigors of alternate treatments like exercise, meditation and therapy. In the last year alone I have read a few highly regarded studies that have questioned the efficacy of medication as a first line of treatment for depression.

    1. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis by Jay, C., et al. published in The Journal of the American Medical Association (source). They conclude --

    "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial."

    2. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis (article) by Cipriani, A. et al. published in The Lancet Volume 388, No. 10047, p881–890, 27 August 2016. Their findings indicate that out of 14 antidepressant drugs, only fluoxetine was more effective at relieving the symptoms of depression than placebo, whilst some drugs were linked with an increased risk of engaging in suicidal thoughts and attempts compared with placebo.

    3. Here is an article describing another Lancet study which concluded that mindfulness meditation is almost as effective as prescription drugs in treating recurrent depression. They showed that 8-weeks of mindfulness based cognitive therapy produced the same results as a 2-years course of antidepressants.

    There are other studies that I can list if you are interested. Fact is, the drugs we currently have to treat depression just aren't that effective. They can help certain individuals more than others, but across the mean, their efficacy is marginal. This combined with the side-effects, which can be severe, make me question their use in cases of mild or moderate depression. I have dealt with this for over two decades, and I am not an advocate of medication unless every other line of treatment has been exhausted. I definitely do not recommend medication without accompanying talk/behavioral therapy.

    Despite the misgivings, antidepressants are prescribed because, at least in the short term, they prove to be effective. However in most patients the symptoms return once the medication is stopped, not to mention that withdrawal from these drugs is an ordeal in itself. Personally, I have found that psychotherapy, Cognitive Behavior Therapy in particular, helps in identifying and correcting the perceptions and behavior-patterns that underlie mood-disorders, and are very effective in mitigating symptoms with or without drugs. Behavioral therapy combined with exercise and meditation is, in my opinion, the most effective approach to treating mild or moderate depression. It does take a fair bit of consistency and patience for the results to become apparent.

    In my experience doctors in India tend to be prescription-happy. Patients want immediate results and drugs are the favored form of treatment. In the United States there is growing awareness that mood-altering drugs are not a cure-all, and may be doing more harm than good. If your doctor has prescribed medication without recommending alternate treatments, then I would be very cautious in following his/her advice. Unless you have a long history of recurrent depression, drugs should not be your first resort. A second opinion is highly recommended.
     
    Last edited: Sep 27, 2016
  7. madras2018

    madras2018 Platinum IL'ite

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    @Gauri03 - In the scientific community, it is well known that there are a whole slew of published papers that also prove the opposite - i.e the efficacy of medication in relieving depressive symptoms to give the patient the impetus to help themselves. I am not disputing the basis of the papers you cited but there are legions of men and women who have vastly benefited from medication across all spectrums of depressive disorders.
    The same article has this to say about mindfullness therapy - The results of Kuyken’s trial may disappoint some mindfulness advocates. Mindfulness didn’t prove superior to antidepressants. The relapse rate for both groups over 24 months was more or less identical: 44% for the MBCT cohort and 47% for those taking antidepressant medication.
    I do believe this comment is a generalization and I speak from experience from having consulted doctors both in the U.S and India. Just as my experience may not be indicative of every single doctor/treatment plan out there, likewise the statement above doesn't accurately reflect the ground realities in India or the U.S. "Growing awareness" in the west cannot be equated to mean that American doctors have replaced the first line of treatment with CBT. CBT is still not offered by many psychiatrists although it has been proven to be highly effective. By default psychiatrists are western medicine practitoners and they usually straight away dismiss ayurvedic / homeopathy treatments because among other reasons they are not licensed to be endorsing such things. If one were to ask their psychiatrist if they can use yoga/ exercise / meditation as the first line of treatment, the most likely response would be a non-committal statement such as 'you may try, I cannot comment on the efficacy of such treatments'. They will not deny that such lifestyle practices work in tandem with medication, but would not outright endorse the exclusive use of such approaches.

    One important point to be noted in applying alternative therapies (yoga/exercise/mindfullness) is that there is no global standardized treatment plan for depression. What technique was used on the patients in those trials - who knows ? Second problem is access to such new-age treatments - how many centers are there in India (or for that matter USA) that teach mindfullness as a therapeutic tool ?

    If one were to be cynical of western medicine and psychiatrists who recommend them, then there are very few reliable, standardized options available to the average aam-junta.

    Even if all such tools are available, the weakest link still remains the patient himself. Depression leads to a lack of motivation and will. A sense of hopelessness pervades. They are not ideal candidates who can be reliably expected to practise techniques they learnt in a disciplined manner.

    Hence the most reliable treatment option available still remains medicine. And a patient is still safest in the care of a medical practitioner rather than heading into the woods by themselves, seeking out non-standardized new-age(Or ancient) treatments. CBT is an exception - and this the OP may try upon the approval of her psychiatrist/therapist (if quality CBT is even available in her city in the first place).

    I think that we are doing a dis-service to people such as OP (whose depression severity we know little to none)by stating generalizations such as "drugs we currently have to treat depression just aren't that effective" or that medication is as good as placebo etc. It flies in the face of much evidence and first-hand experiences.

    Rather what I will agree with is this
    1. Most medicines have side effects - one needs to understand side effects to determine suitability of use. It's all about weighing benefits against side-effects
    2. Medicines have been proven to work in a vast number of people
    3. People benefit most when medicine is used to stabilize them to a satisfactory baseline, sufficient to get them back on their feet to solve their problems
    4. Medication ought not to be a long-term solution (unless there is a serious condition)
     
    Last edited: Sep 27, 2016
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  8. Gauri03

    Gauri03 Moderator Staff Member IL Hall of Fame

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    Can you cite some journal articles published in the last one year that support your assertion? I would like to read them.

    Data show 100% success rate of antidepressants? Is that why they are favored?

    I cited a highly referenced study published in a very reputed journal. A study that was corroborated by similar independent studies. I wasn't stating an opinion. You claim that there is much evidence to show the benefits of anti-depressants over other forms of treatment. Source please! Cite data that shows antidepressants have the long-term benefits you claim. Not blogs or newspapers, but peer-reviewed scientific studies.

    Aren't you being presumptuous here? : ) What makes you think I haven't consulted said doctors? I can count a few doctors in India and the US who owe me their fancy cars! ;) I avoid discussing this subject online but I will say this -- I have been on more than my share of anti-depressants, anti-anxiolytics and anti-psychotic drugs. When I said, 'In my experience', I meant, in my personal experience. Over two decades of it.

    Personally, I place my trust in the scientific state of the art, not 'first-hand' experiences. Your anecdotal evidence is only as good as mine, isn't it? : ) Both are isolated data points; neither is representative of the entire spectrum of experiences with psychiatric drugs. We have provided our individual perspectives, gleaned from our experiences. I, for one, did not intend mine to be the final word on the subject, though I have a vested interest in staying abreast of advances in mental health treatments. I keenly follow the research for my personal reasons. I stand by my advice to OP.

    If you want to continue this discussion, we can do so on Rihana's thread. I would prefer not to divert OP's thread any further.

    PS: You seem to have edited your post heavily since I first read it. I will respond to some of the added points later, on the depression thread.
     
    Last edited: Sep 27, 2016
  9. madras2018

    madras2018 Platinum IL'ite

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    @Gauri03 I am saying that the efficacy of using medicine in managing depression to a satisfactory level has been proven across drug classes. I did not compare it against alternate treatment methods. We dont have to limit ourselves to the last year to understand this. There have been papers published on this topic for several decades. This is in response to your comment that
    It's about as "factual" as the "fact" that different classes of drugs have been proven to work on vast number of patients with considerable diversity in issues.
    They are favored because each drug has been proven to work in at least a % of cases with documented side effects and very importantly, standardized means of administering them. And there are a variety of drug classes that a person can choose from. So even if one doesnt work, there are others. Yes at times none work. But meds still are the dominant line of treatment (incumbent). Hence any alternate treatment plans which need equal endorsement need to match similar results across varieties of cases with a standardized protocol of administering them to patients.

    And it is unlikely that psychiatrists who are purveyors of the drug industry are going to recommend alternate treatments as the first step. That said, as things stand, drugs have a decent enough track record of cure. Second, finding quality, reliable treatment via alternative methods is still niche. I already tried looking in my hometown and was disappointed. CBT/mind-fullness/yoga as therapy for depression etc are good under expert guidance - but such expertise is not widely available. Outcomes are highly subjective to the discipline and rigor of the patient.

    This leaves the average Joe or aaam junta precious little options. Such patients are safer in the care of a medical professional until such time alternate approaches are more ubiquitous and standardized with known outcomes with a high degree of consistency across a wide spectrum of issues.
    Looks like i was editing my post just as you were also drafting your response (i often refine/edit all my posts up to the 1 hr limit). I think the points i made in my final update addresses your comments.

    I wont be responding further on this topic anytime soon as i already spent too much time on it. I rest my case. I think Op will be benefited most by responses from people with real life experiences.

    I think she would do well to work with a good psychiatrist whose opinion and treatment plan she has full faith in.
     
    Last edited: Sep 27, 2016
  10. somsar2014

    somsar2014 Silver IL'ite

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    Good morning Lady

    When the doctor gave you some medicines, you are none to decide whether to take or not. When you, on your own, have gone to him, you should obey his instructions also. But as man cannot be so mechanical, he might have some curiosity or questions, as to how the medicine will work, let me try to answer to in my own way. But please know, I am not a doctor nor a health worker .

    You have been diagnosed, having depression. Now tell me which person does not have depression ? Md. Azharuddin played 99 tests but was not allowed 100th test for some reasons. Was it not a matter of depression for him?

    Chetan Chauhan played so many memorable innings with Gavaskar but could not hit a century. In the Scholar's world, there are so many more erudite scientists writers , or experts who did not get any award like Nobel etc, but are they any less ? Will they suffer from depression and stop doing their normal instinctive work? Do all good candidates win elections?

    In my opinion, the pent up energy and feelings in a depressed mind are the source of great creativity . Those who are swimming in the ocean of pleasure do not depth compared to the apparently less successful people.

    The doctors actually prescribe some sleeping pills. and nerve cooling pills so that the patients can have sound sleep . A sound sleep is a key to all kinds of right pragmatic thinking. So, without any worries take the medicines , if he is a recognized qualified doctor.

    Best wishes.
     
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