Antidepressants: 4 things you should know first

1.    Consider a second opinion

Should you accept a prescription from your GP, or is it safer to ask for a referral? It depends. "If you've known your GP for years and he or she is knowledgeable about mental health issues, you may feel more comfortable," says Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG). "But it's advisable to see a psychiatrist and to have the necessary tests to rule out other causes for your symptoms."

Description: Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG)

Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG)

2.    Don't go mixing

Check with your doctor and pharmacist if any of your current medication clashes (is "contraindicated") with the antidepressant. Be sure to include non-prescription and natural remedies on your list. Wilson offers a common example: "Never use St John's Wort with an antidepressant - it can be dangerous."

3.    Stay the course

"Generally, it's advisable to be on antidepressants for at least six months — preferably a year," says Wilson. "This gives your body a chance to adapt to the meds properly." If the side effects bother you, speak to your doctor. Keep going back until you're satisfied your prescription is a good fit.

4.    No cold turkey

"Never stop taking medication without talking to your prescribing doctor," stresses Wilson. "You should be weaned off the medication gradually. It's important that your doctor and therapist monitor your progress continually — treatment and length of treatment is very individual."

‘Women juggle many roles – leaving them little or no time for themselves’ – ZANE WILSON, FOUNDER OF SADAG

The talking cure

Description: The talking cure

While studies show that therapy (alone) can be as effective as antidepressants (alone) in treating depression, Mahony agrees with Wilson that the best strategy is usually a combination of the two. Grob­belaar goes a step further: "Find a skilled psychologist and psychiatrist who collaborate to provide a continuum of care."

So which type of therapy is best for depression? "Cognitive Behavior Therapy (CBT) has the greatest measured success rate," says Mahony. It's a short-term approach that targets the thought pat-terns and core beliefs that contribute to depression. It's sometimes criticized, however, for neglecting the underlying issues — as if we can cure depression simply by changing our thoughts.

Dynamic psychotherapy is a more in-depth, longer-term approach that looks for the meaning behind behavioral patterns. "Many therapists may have a dynamic approach but incorporate CBT techniques where indicated, whereas oth­ers are strictly CBT," explains Grobbelaar. "If you're not comfortable with the approach of your therapist, say so. If it's simply not a good fit, change therapists!"

This rings true for Nomonde*, 40, a musician from Joburg who started seeing a psychologist during a serious bout of postnatal depression. "It wasn't a quick fix,' she admits. "But just speaking to someone who never made me feel guilty or told me to 'pull myself together' was enough to make a difference"

"There's increasing evidence that it's not the form of therapy that determines the success rate, but rather the relationship

Cape Town homeopath Dr Craig Wright agrees that many people are, indeed, overmedicated and undereducated.

Beyond Freud and PROZAC

Description: L-Tryptophan

Antidepressants and psychotherapy are the best-known treatments for depres­sion, but they're by no means the only options. When her symptoms recurred for the third time in five years, Ashleigh*, 35, a full-time mom from Cape Town, didn't want to go back on antidepressants.

A friend suggested she try L-Tryptophan (available in health stores without a pre­scription). It's an essential amino acid that occurs naturally in certain foods but is not manufactured by the body, explains Cape Town naturopath Dr Sandi Nye.

"L-Tryptophan is the precursor to 5- Hydroxytryptophan [5-HTP], which is, in turn, the precursor to serotonin.

"However, the body needs other nutrients to metabolize it, so if you have a nutritional deficiency, it's not likely to provide optimal benefits. Selective serotonin re-uptake inhibitors [SSRls] are very popular prescription drugs for increasing serotonin levels in the brain.

"But naturopathically, it makes more sense to provide the body with the tools it needs to make more serotonin. In other words, to make it rather than mimic it"

"The results," reports Ashleigh, "are as good — if not better — than any anti-depressants I've used."

1.    St John’s Wort

One alternative treatment that's had considerable press is St John's Wort, an herbal remedy made from a humble yellow wildflower. Back in 1998, the SA-born psychiatrist Norman Rosenthal enthusiastically endorsed the plant in his book St John's Wort: The Herbal Way to Feeling Good (HarperCollins).

As with any medicine that affects mood, dosage and use must be properly managed. (See Antidepressants: 4 things you should know first.)

2.    A new era of treatment

The late French neuroscientist Dr David Servan-Schreiber was schooled in psychiatry before he chose to pay serious scientific attention to alternative treatments. (See Explore the Options).

His work ushered in a new era, in which non-prescription treatments and lifestyle factors could now be seriously examined.

Dr Servan-Schreiber proposed a multi-pronged approach. This includes heart rate coherence; light therapy (more applicable, perhaps, to colder climes than ours); the Chinese system of directing Qi or energy; omega-3 fatty acids; regular exercise; and emotional communication training. It's a broad-spectrum arsenal – and it needn't end there.

Grobbelaar points, for example, to mindfulness training (see Explore the Options) and yoga, both of which have strong records in the management of depression.

The problem, says Mahony, is that such changes require energy and motivation — the very things that depression drains from us in the first place. "Do only what seems possible and sustainable, so that you're not setting yourself up for further self-degradation," she advises.

When you're feeling stronger, steadily build up habits and skills that consolidate healing and play an immunizing role against relapse.

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