Medication versus alternative in different forms of depression

nesf

Starting from this post: http://www.boards.ie/vbulletin/showpost.php?p=61891103&postcount=137

I'm bored so I started it. From my limited understanding the alternatives range from very effective (with mild to moderate depression) to not very useful (in some of the more severe or unusual cases) in general and in specific cases you'll find exceptions to this. A psychiatrist would probably be able to expand on this in a lot more detail and I'm sure amacachi has more questions. I'd probably start with emphasising that there isn't a dichotomy between the two and they can be complimentary.

Agonist

I think a GP is irresponsible to prescribe antidepressants to a patient without arranging another form of nondrug treatment.

If a patient needs any medication beyond mild tranquillisers and antidepressants I think they should be referred to a psychiatrist.

I don't know where to source the statistics but I know that the new recovery model of treatment has been shown to be effective for mild to moderate depression as well as self-helps groups like GROW. It's not difficult to beat the effectiveness of drug treatments, now that we know that they work to a limited degree and only in a minority of patients.

Not a professional opinion but an educated one.

nesf

Agonist wrote: »

now that we know that they work to a limited degree and only in a minority of patients.

Source? Rather large claim to be making.

seanybiker

Gp put me on antidepressents years ago. Eventually I just got worse. Went to phsyciatrist all he done was asked me how I felt. Told him how I felt so he upped me dosage. Roughly 10 years later and Im after going through many different tablets and am back on ones I started on. Still no better. Well I have me ups and downs but roughly the same as I was.

Agonist

nesf wrote: »

Source? Rather large claim to be making.

Here's a recent paper on the subject.

Committee for Medicinal Products for Human Use (CHMP) Assessment on Efficacy of Antidepressants

http://www.medscape.com/viewarticle/702349

...Even so, the responder rate for placebo averages 33%; that for active drug is 49%: a difference of only 16%. Nevertheless, the CHMP concluded that this was a clinically meaningful difference.

nesf

Agonist wrote: »

Here's a recent paper on the subject.

Committee for Medicinal Products for Human Use (CHMP) Assessment on Efficacy of Antidepressants

http://www.medscape.com/viewarticle/702349

I can't access that, it requires a password etc. I'm curious, were they comparing SSRIs to a placebo or a selection of different classes of antidepressant?

Agonist

nesf wrote: »

I can't access that, it requires a password etc. I'm curious, were they comparing SSRIs to a placebo or a selection of different classes of antidepressant?

This is a link to a Q&A about the original study of four SSRIs compared to placebo
http://www.rsc.org/chemistryworld/News/2008/February/26020802.asp

There was a second broader study done:
http://content.nejm.org/cgi/content/full/358/3/252?ijkey=eb6d75bdcf64c3040e8f8907ab614bd61426cc95

I hope these links work for you.

Edit: The second link is to a report on whether antidepressant trial are selectively published to show greater efficacy, not quite on topic.

Here's a quote summarising it.

"We found a bias toward the publication of positive results. Not only were positive results more likely to be published, but studies that were not positive, in our opinion, were often published in a way that conveyed a positive outcome. We analyzed these data in terms of the proportion of positive studies and in terms of the effect size associated with drug treatment. Using both approaches, we found that the efficacy of this drug class is less than would be gleaned from an examination of the published literature alone. According to the published literature, the results of nearly all of the trials of antidepressants were positive. In contrast, FDA analysis of the trial data showed that roughly half of the trials had positive results. The statistical significance of a study's results was strongly associated with whether and how they were reported, and the association was independent of sample size. The study outcome also affected the chances that the data from a participant would be published. As a result of selective reporting, the published literature conveyed an effect size nearly one third larger than the effect size derived from the FDA data."

tallaght01

Just to remind everyone that this is a science forum.

So, try and discuss the study design and the merits of the study if you're going to use it as evidence. Posting someone else's opinion of a study isn't really science, especially if you're going to make claims that are a bit controversial.

Agonist

tallaght01 wrote: »

Just to remind everyone that this is a science forum.

So, try and discuss the study design and the merits of the study if you're going to use it as evidence. Posting someone else's opinion of a study isn't really science, especially if you're going to make claims that are a bit controversial.

Point taken.

The first link I gave I don't think is controversial.

Agonist wrote: »

Committee for Medicinal Products for Human Use (CHMP) Assessment on Efficacy of Antidepressants

http://www.medscape.com/viewarticle/702349

This study was commisioned by the European Commission via the European Medicines Agency.

It says that although there were flaws in the initial studies that showed that antidepressants are less effective than has been claimed, clinicians should "bear in mind that antidepressants are not miracle drugs and their usage in clinical practice needs further optimisation. Depressed patients and their carers should be informed of the limitations of current antidepressant drugs so that they can cooperate fully in maximizing their potential."

However, "The European Regulatory Agency justifies its past licensing of the newer antidepressants and maintains its position that they are useful."

My other links were to the two studies that prompted the Commission to look into this matter.

When I wrote

Agonist wrote: »

Here's a quote summarising it.

I should have written "Here's an extract from the study"


Without a science background I don't feel competent to assess the studies for myself but I understand that the findings have been accepted by the medical community.

I must point out that I'm not antipsychiatry and I know that there's a role for antidepressants.

tallaght01

The problem is we can all throw reports at each other all day, or studies where we've just read the author's conclusion. In science, it's not generally acceptable to say "it's written here, so it must be true".

Within the community, lots of people will take a consensus issue from a particularly respected body as being good enough for them (like one of the royal colleges), but there will still often be people who won't.

It all comes down to how these people have drawn their conclusions, and whether that's a valid way of doing it, and whether it's applicable to the situation at hand.

Throwing reports and conclusions won't get people engaged, or at least the people who would be interested in scientific debate.

A good way to start is to look at something like the NICE guidelines or the SIGN guidelines, and see what you think of their recommendations, and the rationale behind them.

ZYX

tallaght01 wrote: »

The problem is we can all throw reports at each other all day, or studies where we've just read the author's conclusion. In science, it's not generally acceptable to say "it's written here, so it must be true".

Within the community, lots of people will take a consensus issue from a particularly respected body as being good enough for them (like one of the royal colleges), but there will still often be people who won't.

It all comes down to how these people have drawn their conclusions, and whether that's a valid way of doing it, and whether it's applicable to the situation at hand.

Throwing reports and conclusions won't get people engaged, or at least the people who would be interested in scientific debate.

A good way to start is to look at something like the NICE guidelines or the SIGN guidelines, and see what you think of their recommendations, and the rationale behind them.

I disagree here. Agonist has said he is not a scientist. It is fair to present someone elses view as possible correct and allow people to disagree. This is especially if posting a comment that goes against accepted thinking. So if someone has written a scientific paper that has been published in a peer reviewed journal it is fair to post that persons comments to allow debate.

You are asking Agonist to judge the NICE guidelines which is unfair as he/she has no scientific background. Lets face it guidelines change all the time. Agonist has raised a valid point. Are anti-depressants over prescribed?

tallaght01

Well, I didn't stop him doing it. But allowing people to just post links to reports is how we got into all the hassle with the alternative medicine stuff.

It is a science forum. But if people just want to post links to reports to each other, then I don't care enough to stop them. But it's not going to engage people.

PhysiologyRocks

I may be wrong, but having people post links like that may potentially allow people to plead ignorance.

Fair enough if people genuinely don't know, but it creates a grey area in which people can post bad reports under the guise of not knowing.

I also agree that it's simply not engaging.

nesf

Agonist wrote: »

Without a science background I don't feel competent to assess the studies for myself but I understand that the findings have been accepted by the medical community.

I must point out that I'm not antipsychiatry and I know that there's a role for antidepressants.

Specific issues are these:

First there are many classes of anti-depressant. Testing one antidepressant against a placebo doesn't answer any questions about how useful antidepressants are in general! This is particularly relevant when SSRIs are the antidepressant used in the test since it's rapidly becoming clear that their effacity over older antidepressants was vasty overstated by drug companies.


Secondly, with any study on mental illness study design is an enormous issue. Non-compliance with medication, people dropping out of the study and so on are all much greater problems when studying people with mental illness. If the group taking the drug has a lot of people who aren't complying to how the drug needs to be taken (i.e. skipping days or whatever) then you'd get a result that underestimates the effectiveness of the drug.


Thirdly, and most importantly, even with a respected group of researchers who are all honestly trying to find the correct answer, you can have biased studies. It's human nature to see what you expect/want to see in the results.


Others who study in the area can give you more, the above are what I see as someone who trained in a very different area of science.

nesf

PhysiologyRocks wrote: »

I may be wrong, but having people post links like that may potentially allow people to plead ignorance.

Fair enough if people genuinely don't know, but it creates a grey area in which people can post bad reports under the guise of not knowing.

I also agree that it's simply not engaging.

It's only an issue if they continually do it and don't take on board legitimate criticisms of the studies they are reporting.

Someone putting up a study, finding out that it is flawed and then accepting those flaws is surely a good thing on this forum no?

PhysiologyRocks

nesf wrote: »

It's only an issue if they continually do it and don't take on board legitimate criticisms of the studies they are reporting.

Someone putting up a study, finding out that it is flawed and then accepting those flaws is surely a good thing on this forum no?

Absolutely!

My only issue would be with people pretending they didn't know, and using that as an excuse to post bad links. Not sure why they would, but it takes all sorts...:)

If people genuinely don't know, then I'm all for it.

PhysiologyRocks

So what might realistic, effective alternatives to antidepressants be?

nesf

PhysiologyRocks wrote: »

So what might realistic, effective alternatives to antidepressants be?

Light therapy, pscyhological treatments like counselling, CBT etc. St. John's Wort isn't one since it effectively does the exact same thing as antidepressants. Electro-shock therapy is one, though I doubt alternative proponents have it in mind when suggesting what should be used.

PhysiologyRocks

How does CBT for depression work/ how is it conducted?

I understand it in terms of OCD, but beyond that I know nothing.

Agonist

I wouldn't be brave enough to post in this forum about something I know nothing about!

nesf wrote: »

Specific issues are these:

First there are many classes of anti-depressant. Testing one antidepressant against a placebo doesn't answer any questions about how useful antidepressants are in general! This is particularly relevant when SSRIs are the antidepressant used in the test since it's rapidly becoming clear that their effacity over older antidepressants was vasty overstated by drug companies.

This was point I was making, that the wonder drugs of the 90s aren't all they were cracked up to be. I think the SSRIs are still the ones that are prescribed first by GPs. The aren't as dangerous in overdose as TCAs and have a better side effect profile than SNRIs. I don't think the newer ADs are being prescribed much yet.

This leaves the alternative treatments in a better position to hold up against comparisons with current drug treatments as the bar isn't as high as we thought it was.

I think doctors need to see themselves as having a range of treatments to choose from, not that they can treat the chemical side of things and the patient must discover the other treatments on his own. Every GP should have the information about additional treatments at hand, contact details for relevant organisations and groups, recommended reading lists and referrals to appropriate third parties, including MABS and the Rape Crisis Centre, for example.

nesf wrote: »

Light therapy, pscyhological treatments like counselling, CBT etc. St. John's Wort isn't one since it effectively does the exact same thing as antidepressants. Electro-shock therapy is one, though I doubt alternative proponents have it in mind when suggesting what should be used.

Mindfulness techniques are particularly good for helping during a crisis.

Omega 3 fatty acids have a role to play in maintaining good mental health.


Other effective alternative therapies include groups like GROW. Training the patient to help themselves, accept personal responsibility and feel empowered has a huge impact on the course of their illness reducing hospitalisations and improving quality of life. GROW is based on the 12 step program. There's also the Wellness Recovery Action Plan. One has been funded by the HSE and the other by the VHI so there must be some proof of their benefits.

JuliusCaesar

PhysiologyRocks wrote: »

How does CBT for depression work/ how is it conducted?

I'm afraid that as I wrote an answer to this, went to dig up a ref, and came back to fiind I'd been logged out, grrr. Here's the short answer:

Royal College psychiatrists on CBT

And a seminal paper on depression and cbt which is available full text I think: Jacobson, NS et al, 1996 A component analysis of cognitive behavioural treatment for depression, Journal of consulting and clinical psychology, 64, 295-304

nesf

Agonist wrote: »

This was point I was making, that the wonder drugs of the 90s aren't all they were cracked up to be.

That isn't the point you made! You claimed that all antidepressants were of limited effectiveness which is a dramatically broader claim than criticising SSRIs (the latter is something you'll find much agreement on in this forum).

Agonist wrote: »

Omega 3 fatty acids have a role to play in maintaining good mental health.

There isn't really sufficient evidence to support this. Meta-studies of late have been finding (if I recall correctly) little to support the above. Like many things of the 90s these may turn out to be an initially promising dead-end unfortunately. It would be fantastic if they actually were as effective as was hoped.


Edit: As an additional point, SSRIs weren't the only class of new antidepressants coming out in the 90s. SNRIs like venlafexine (Effexor) and (I've no idea which class it belongs to) mirtazapine (Zispin) are two that I've taken which are very different in mechanism of action compared to SSRIs and both are 90s drugs if I remember correctly.

AmcD

Agonist wrote: »

I think doctors need to see themselves as having a range of treatments to choose from, not that they can treat the chemical side of things and the patient must discover the other treatments on his own. Every GP should have the information about additional treatments at hand, contact details for relevant organisations and groups, recommended reading lists and referrals to appropriate third parties, including MABS and the Rape Crisis Centre, for example.

Thanks for the top tips!
Believe it or not, GPs don't just write out scripts for antidepressants the moment somebody bursts into tears. But occasionally there isn't much else to offer. There are some organisations which can help, but suprisingly (in my experience) most of my patients haven't been interested in them. GROW looks excellent, but I have yet to convince anybody to engage with them.
The same old point needs to be trotted out again: access to CBT or any other psychology services can be extremely limited. It would be great if we had this option for all our patients.

Just on another tangent, I am getting a bit sick and tired of the anti-medical tirade in the media at the moment. Treatment of depression is an emotive issue. But it seems to be taken as gospel that doctors have some kind of evil agenda to do harm by deliberately prescribing antidepressants because pharmaceutical companies have brought every single doctor on lavish 5 star trips.

nesf

AmcD wrote: »

Believe it or not, GPs don't just write out scripts for antidepressants the moment somebody bursts into tears. But occasionally there isn't much else to offer. There are some organisations which can help, but suprisingly (in my experience) most of my patients haven't been interested in them. GROW looks excellent, but I have yet to convince anybody to engage with them.
The same old point needs to be trotted out again: access to CBT or any other psychology services can be extremely limited. It would be great if we had this option for all our patients.

This is a crucial point, antidepressants are most certainly over-prescribed but much of this is down to GPs (especially in rural areas) not having other options to choose from.

On the organisation point, tried AWARE myself and it really didn't suit me. Great organisation and I donate to them regularly but not for me unfortunately.

tallaght01

nesf wrote: »

It's only an issue if they continually do it and don't take on board legitimate criticisms of the studies they are reporting.

Someone putting up a study, finding out that it is flawed and then accepting those flaws is surely a good thing on this forum no?

The problem is we have an imbalance. You have poster x doing a google search for "anti-depressants overpresrcibed" or whatever. So, you'll definitely find a match, and it will link you to a conclusion.

Then you copy and paste the conclusion. So, you've done 3 minutes work. Then the onus is on everyone else to read through and find the methodological flaws, or to agree the findings are genuine. That's what happens continually on this forum, and that's why I pointed it out.

That's why the people who would be interested in talking about the actual evidence don't generally post on threads like this, in my opinion.

GradMed

Perhaps stickying the thread by physiology rocks on how to read up on medical research might be useful
http://www.boards.ie/vbulletin/showthread.php?t=2055628849&highlight=trisha

Agonist

ZYX wrote: »

Agonist has raised a valid point. Are anti-depressants over prescribed?

Thanks for the support. However, I didn't say that antidepressants are overprescribed. I'm saying I'd like to see them being used in conjunction with other forms of therapy.

nesf wrote: »

That isn't the point you made! You claimed that all antidepressants were of limited effectiveness which is a dramatically broader claim than criticising SSRIs (the latter is something you'll find much agreement on in this forum).


Edit: As an additional point, SSRIs weren't the only class of new antidepressants coming out in the 90s. SNRIs like venlafexine (Effexor) and (I've no idea which class it belongs to) mirtazapine (Zispin) are two that I've taken which are very different in mechanism of action compared to SSRIs and both are 90s drugs if I remember correctly.

Yes, I should have been more specific. I didn't appreciate the level of accuracy that is required in this forum.

I was on Effexor in the late 90s. Again, I was not being 100% accurate. I was thinking of the 'Prozac Generation' and the huge leap forward that psychiatry made back then.

AmcD wrote: »

Thanks for the top tips!
Believe it or not, GPs don't just write out scripts for antidepressants the moment somebody bursts into tears. But occasionally there isn't much else to offer. There are some organisations which can help, but suprisingly (in my experience) most of my patients haven't been interested in them. GROW looks excellent, but I have yet to convince anybody to engage with them.
The same old point needs to be trotted out again: access to CBT or any other psychology services can be extremely limited. It would be great if we had this option for all our patients.

No need to be dismissive! I would much prefer someone to be prescribed antidepressants than not, if they present with symptoms of depression.

I'd like to see GPs being more active in getting the patient other forms of treatment. If a patient is handed the date and time of a meeting and advised to go the patient will take it a lot more seriously than if they just see the poster on the wall of the GPs waiting room. I think GPs have power to encourage patients down non-drug routes that they do not always use. For example (acknowledging that this treatment isn't fully proven to help), Omega 3 can be prescribed. Depression itself makes it difficult for patients to discover complementary therapies.

A Primary Care Counselling programme has been launched in some places now so I think there's progress being made in adding to a GP's armoury.

AmcD wrote: »

Just on another tangent, I am getting a bit sick and tired of the anti-medical tirade in the media at the moment. Treatment of depression is an emotive issue. But it seems to be taken as gospel that doctors have some kind of evil agenda to do harm by deliberately prescribing antidepressants because pharmaceutical companies have brought every single doctor on lavish 5 star trips.

That may not be directed at me but I seem to have generated a lot of discussion about linking to dodgy research and antipsychiatry motives being veiled by claims of ignorance. If my presence here derails the thread further I'll opt out. It's a very important subject.

sam34

Agonist wrote: »

I think a GP is irresponsible to prescribe antidepressants to a patient without arranging another form of nondrug treatment.QUOTE]

this old chestnut again!

there are a number of reasons why a GP might not arrange some non-pharmacological treatment for someone.

the patient may not want it, for starters, not everyone wants counselling.

not everyone would be suitable for it, either.

most commonly, it is simply not available.

i think it is ridiculous that GPs are castigated for prescribing anti-depressants to someone who is depressed. it is unbeliebvable that they are essentially being criticised for doing their job, ie treating the patient in front of them.

lets look at an analogy here. if someone presented to a gp and had hypertension, what would teh gp do? we all know that teh optimum management of hypertension is lifestyle modification along with anti-hypertensives.

now, lets imagine that there is a year long waiting list to see the local friendly dietician.

what should teh gp do?

should they not prescribe anti-hypertensives just because they cant deliver teh whole package of deitician also?

imagine that scenario - people walking around with untreated hypertension, and all teh attendant complications. there would be consequences for teh patient and damning indictments of the gp from all quarters when that patient had a heart attack or stroke.

put that is what people are proposing gp's do with depressed patients. the option to refer to psychologists simply IS NOT THERE.

so the gp's do what they can do.

to do nothing would be negligent.

depressed people deserve better than that.

Agonist wrote: »

If a patient needs any medication beyond mild tranquillisers and antidepressants I think they should be referred to a psychiatrist. QUOTE]

not necessarily.

gp's can manage a lot of cases in primary care. over-referring to the psychiatric servoces will only cause those already over-stretched services to burst at the seams.

sam34

seanybiker wrote: »

Gp put me on antidepressents years ago. Eventually I just got worse. Went to phsyciatrist all he done was asked me how I felt. Told him how I felt so he upped me dosage. Roughly 10 years later and Im after going through many different tablets and am back on ones I started on. Still no better. Well I have me ups and downs but roughly the same as I was.

ahem. without meaning to sound sarky, what exactly did you expect him to say or do?? fairly typical question for a psychiatrist to ask!

AmcD

Agonist wrote: »

That may not be directed at me but I seem to have generated a lot of discussion about linking to dodgy research and antipsychiatry motives being veiled by claims of ignorance. If my presence here derails the thread further I'll opt out. It's a very important subject.

This was not directed at you. Specific examples would be Kevin Myers on Newstalk, "The Spin" on 103.8, "The Inbox" on 98fm and whatever drivel is in the weekend rags- in summary descriptions of doctors having a laugh by trying to cause harm with anti-depressants.

soon30

sam34 wrote: »

ahem. without meaning to sound sarky, what exactly did you expect him to say or do?? fairly typical question for a psychiatrist to ask!

I went to a psyhciatrist last thursday and i must say that yes he asked me the obvious how i was feeling when i told him 7 or 8 out of 10 (10 being very good) he looked at me as if to say strange as feeling that good
would be good for anybody. he didnt see the fact that im sleeping from one end of the day to the other getting no work done and going broke
from it as being much of a problem as long as i felt good.
This kind of approach has to change feeling good when your life is flowing
down the drain is not what i would consider a good outcome.I sometimes feel im more out of touch with reality on antidepressants (effexor 150) than i was when i was very depressed.I have no energy i sleep through the day and can rarely fall asleep at night but when i do its
a deep and long sleep (ridiculosly long 12 hour plus).
there has to be more that can be done i feel the approach is poor and leaves a lot to be desired and i believe that a lot of psychiatrists take the
view that if the mood is improved their job is done not much good to me do as at this rate i wont be able to buy the effexor soon because my working hours have become so few.Hard to believe my mood is in check:)

sam34

soon30 wrote: »

I went to a psyhciatrist last thursday and i must say that yes he asked me the obvious how i was feeling when i told him 7 or 8 out of 10 (10 being very good) he looked at me as if to say strange as feeling that good
would be good for anybody. he didnt see the fact that im sleeping from one end of the day to the other getting no work done and going broke
from it as being much of a problem as long as i felt good.
This kind of approach has to change feeling good when your life is flowing
down the drain is not what i would consider a good outcome.I sometimes feel im more out of touch with reality on antidepressants (effexor 150) than i was when i was very depressed.I have no energy i sleep through the day and can rarely fall asleep at night but when i do its
a deep and long sleep (ridiculosly long 12 hour plus).
there has to be more that can be done i feel the approach is poor and leaves a lot to be desired and i believe that a lot of psychiatrists take the
view that if the mood is improved their job is done not much good to me do as at this rate i wont be able to buy the effexor soon because my working hours have become so few.Hard to believe my mood is in check:)

not the fault of teh psychiatrist or drugs, and not within the psych's remit to solve, to be fair.

if you feel over-sedated on the meds, bring it up with your psychiatrist. it may be teh drugs or it may be the original depression.

nesf

Effexor doesn't sedate people though no? Or at least I noticed no such effect versus drugs like Trileptal or anti-psychotics like Seroquel or Risperdal.

I sympathise the 12 hour sleeping curse, am going through a phase of that personally and it's hell. It makes getting anything done a bitch.

soon30

i think fatigue is a side effect of the drug but few seem to believe its along term. i keep getting told it should ware off or that its the deprssion itself but i was never this tired before and im on it two years now i tried to cut back to the 75 mg but the withdrawl symtoms i get are realy freaky and hard to take mostly when trying to fall asleep.my eyes still open i feel like im awake but then realise i cant move anything and force myself to wake.I know its weird but its what happens i never experienced it before i still hope i can get off the meds at some stage
I think it is the pschiatrists job to help with the drugs its what he is trained in what exactly is a pschiatrists remit if not to find the best outcome for me as regaurds what drugs/treatment i should get.The reason i work so few hours is due to sleeping and tiredness i have plenty of work to do.To anyone looking at me they must think im a wright lazy f***er
I know this is over simplifying but if you took your car to the garage because the engine didnt work it wouldnt be much good getting it back
with the engine fixed at the compromise of removing the gearbox your car
still would be no use. but yor engine is perfect and thats what you wanted isnt it:)

nesf

Don't whatever you do try to cut down the dose on your own without discussing it with your psychiatrist. (You don't make it clear whether your psychiatrist asked you to cut the dose or not!). The withdrawal effects can be nasty but they do pass. I went from 300mg to 0mg over three months, it was miserable but when it was done it was done and that was the end to it.

Fatigue could very easily be a symptom of the depression, honestly the person you need to chat to is your psychiatrist about this. There's nothing much that people on here can help you with unfortunately.

soon30

I dont change my dose without talking to my gp or psch and i would take any pill that will help me i dont have a problem taking them and i know no one on here can help me personaly im not looking for medical advice just sharing my side of the story plus im sure plenty of gp's and pschiatrists use the forum it might give some insight
I suffered from depression for nearly two years without medication
as i had seen my fathers quality of life drop when he was on them.
That said im all for antidepressants i think its a case of the wright
dose/mix of meds its hard to get it wright i know.
when i wasnt on meds i was depressed a lot of the time but still managed to function better than i am at the moment.It was headaches and
trouble keeping my eyes focused when driving that made my mind up to go on the antidepressants these symtoms disapeared after two weeks
on the meds even do my doc didnt seem to think my depression was causing it
It is my aim to get back my functionality(not sure if thats even a word) and i hope i can with the help of my gp and pschiatrist
but i defenatly feel i need a different approach and that these problems should be taken into account as well as the obvious depressed feelings
I sometimes think that depression is the wrong name for this illness
as that is only one side of the illness.yes i get depressed but i also
suffer from bad memory,anxiety.No one has ever asked me in a consultation how is my memory or is your fatigue improving but it seems that other than the depressed feeling and anxiety in general nothing else is treated certainly not memory but that would be back to the scientists looking for these cures.I certainly hope they do figure out this illness
but the mind is ridiculosly complicated so trial and error seems to be the
only option on meds pschiatrists must envy other doctors who can take
xrays run tests and then give a suitable treatment

nesf

Have you ever volunteered in a session that your memory is worse, that you are more fatigued, that your father didn't do well on medication? Honestly, it's as much about you volunteering information as answering questions. Write a list of what's bothering you and take it along and give it to your GP/psychiatrist (relying on one's memory to bring up certain topics doesn't always work from personal experience with memory issues).

I sympathise with your present condition. I've suffered from severe anxiety, memory issues and other problems with bipolar. Medication did help with the anxiety, it's pretty much gone for me these days despite the fatigue and sleeping issues remaining unresolved, though I did pay a price with the medication level required (for me it was a "heavy" dose of anti-psychotics that did the trick, just to point out that anti-depressants aren't the only class of drug used for these symptoms. I'm not suggesting that you might need to go on such drugs!). It's hard and there isn't a whole lot of support out there beyond what your GP/psychiatrist can provide I'm afraid if you're not one who finds self-help groups like Aware very good.

soon30

i have volunteered this information but to be fair i dont think there is a lot they can do for this in at the present time
I understand your issues with bi-polar as this is what my father was treated for.He was treated for depression first and then had a few hi periods where he spent a lot of money we didnt actually have and drank
a lot i blamed the drink completely at the time but when he started the litium it was like you flicked a switch and he was no longer interested
in alcohol so i guess the condition was driving him to drink more than being addicted to alcohol
I also have a brother who is schizophrenic and been hospitalised before for it he refuses to take any medication for that reason i am all for medication and would not recomend anyone not to take the advice of their doc his life would be much better and more relaxed if he would only open up to the help that is there for him we hive tried again and again but to no avail he just wont take the meds.I on the other hand will swallow any pill a doctor tells me is good for me but you would be a fool not to quiz the doc on why this med over another one. I do give as much information as i can and i am not afraid to ask questions of the doctors
what drew me to this forum was to see the alternatives debated
hopefully by people better informed than me but ive gone off on a bit of a tangent from the op but there haventh been many alternatives put forward really the internet is full of ridiculous alternatives that are either
no good or can even be harmfull
if i was born 200 years ago would things really have been so hopeless without any prozac's etc or was deprssion less of a problem
back then i know if you were very mentaly ill you were just locked away

JackReacher1980

Folkd, looking for a bit of advice here. ...<mod snip>

locum-motion

JackReacher1980 wrote: »

Folkd, looking for a bit of advice here. <...Mod snip...>

NO MEDICAL ADVICE IS GIVEN ON THIS FORUM

http://boards.ie/vbulletin/showthread.php?t=2055475288

Jack, please don't ask again.

JackReacher1980

Apologies, may have misphrased, was more looking for people to share their stories, not actual medical advice. Sorry

JuliusCaesar

nesf wrote: »

Starting from this post: http://www.boards.ie/vbulletin/showpost.php?p=61891103&postcount=137

I'm bored so I started it. From my limited understanding the alternatives range from very effective (with mild to moderate depression) to not very useful (in some of the more severe or unusual cases) in general and in specific cases you'll find exceptions to this. A psychiatrist would probably be able to expand on this in a lot more detail and I'm sure amacachi has more questions. I'd probably start with emphasising that there isn't a dichotomy between the two and they can be complimentary.

To be honest, it takes a lot of resources (money) to change the system. A psychiatrist sees X number of patients in an hour - say 4-6 patients; a psychologist/CBT therapist sees 1. In group therapy, there would be around 8 people in a group lasting an hour and a half, requiring 2 therapists. A psychiatrist costs x per hour, a psychologist y per hour, a nurse/OT for a group z per hour. The most cost effective way of delivering treatment is probably 2 nurses providing group therapy. BUT 1. a lot of people refuse group therapy and 2.there's no funding to train nurses in anything beyone their basic training.

Mental Health is way underfunded, even compared to other sections of our woefully underfunded health service. All I can say to a lot of patients is write to Mary Harney (please! please! please do write!)

Look at what is happening in the UK with the massive resources being pumped into the IAPT (Increasing Access to Psychological Therapies) programme.

in around 1978, Isaac Marks started training nurses in CBT in order to increase access to clients. Here, it was done on an ad hoc basis, which is why Donegal/Sligo has ended up with a higher proportion of nurseCBT therapists - thus increasing anyones' chances of getting CBT free of charge in the HSE - than anywhere else in Ireland.

It's a political matter rather than a health matter, unfortunately.

BTW, I'm all for working together in Mental Health, whatever our profession, as our aim is to help patients. So I'm not anti-medication in any way; but we need more resources in adjuctive therapies.

Odysseus

JuliusCaesar wrote: »

The most cost effective way of delivering treatment is probably 2 nurses providing group therapy. BUT 1. a lot of people refuse group therapy and 2.there's no funding to train nurses in anything beyone their basic training.

Mental Health is way underfunded, even compared to other sections of our woefully underfunded health service. All I can say to a lot of patients is write to Mary Harney (please! please! please do write!)

Look at what is happening in the UK with the massive resources being pumped into the IAPT (Increasing Access to Psychological Therapies) programme.

in around 1978, Isaac Marks started training nurses in CBT in order to increase access to clients. Here, it was done on an ad hoc basis, which is why Donegal/Sligo has ended up with a higher proportion of nurseCBT therapists - thus increasing anyones' chances of getting CBT free of charge in the HSE - than anywhere else in Ireland.

It's a political matter rather than a health matter, unfortunately.

BTW, I'm all for working together in Mental Health, whatever our profession, as our aim is to help patients. So I'm not anti-medication in any way; but we need more resources in adjuctive therapies.

I have hugh problem with this Julius, in my service they are trying to train up nurses in brief interventions, sorry but in my opinion that is a therapists job. What I see is a case of send them on a few basic courses and they will be fine.

I am generally left picking up the pieces when things go wrong. Also nurses find it hard to aloow the client to where they are, its often "well the Dr wants you to do this", here it turn into a type of moral therapy. For example it may take years for me to get a client to really look at their sunstance use, going in and trying to force it upon then generally results in DNAs. Alway they generally report everything to the dr so they are not trusted.

I have a rule I don't take bloods and I tell the nurses to leave the therapy to myself.

You know yourself how long it took you to train, imo its a different treatment format and the nurses should stay away from. It may be political in one sense, but for me its about the quality of service.

nesf

JuliusCaesar wrote: »

To be honest, it takes a lot of resources (money) to change the system. A psychiatrist sees X number of patients in an hour - say 4-6 patients; a psychologist/CBT therapist sees 1. In group therapy, there would be around 8 people in a group lasting an hour and a half, requiring 2 therapists. A psychiatrist costs x per hour, a psychologist y per hour, a nurse/OT for a group z per hour. The most cost effective way of delivering treatment is probably 2 nurses providing group therapy. BUT 1. a lot of people refuse group therapy and 2.there's no funding to train nurses in anything beyone their basic training.

Eh, the psychiatrist and the psychologist give very different treatments. Looking at them in terms of patients per hour is a bit pointless since you're not comparing like with like, ditto with group therapy vs individual. They're complimentary to one another but you can't replace psychiatrists with psychologists or vice versa and expect it to work, never mind replacing either with group therapy run by nurses so analysing it in such a way doesn't make a whole lot of sense.

Odysseus

nesf wrote: »

Eh, the psychiatrist and the psychologist give very different treatments. Looking at them in terms of patients per hour is a bit pointless since you're not comparing like with like, ditto with group therapy vs individual. They're complimentary to one another but you can't replace psychiatrists with psychologists or vice versa and expect it to work, never mind replacing either with group therapy run by nurses so analysing it in such a way doesn't make a whole lot of sense.

Its not that black and white, now of course you have the meds issues. However, some psychiatrists do over some form of psychotherapy and may not feel there is a need for meds, though not that many are trained therapists, but some are. Where as other I know will not offer a psychotherapeutic service.

So taking on board my previous post there is something to what Julius is saying.

nesf

Odysseus wrote: »

Its not that black and white, now of course you have the meds issues. However, some psychiatrists do over some form of psychotherapy and may not feel there is a need for meds, though not that many are trained therapists, but some are. Where as other I know will not offer a psychotherapeutic service.

So taking on board my previous post there is something to what Julius is saying.

Oh I appreciate all that, I'm just objecting to the economic analysis of the problem, given that's my area of expertise.

firesidechat

My recovery from depression and anxieties has been a two year process,
Although my recovery is still on going.I am in a far better place than i was two years ago.
I have a toolbox where i keep my tools for recovery.
It's contents include; medication,i was on 300mg efexxor and am down to 225mg at the moment. Another tool in my recovery box is GROW, I am a commited grow member,i attend group meetings every monday evening.
The final tool in my recovery toolbox is the Wellness Recovery Action Plan
( WRAP ).
Medication has it's place in my recovery but it is responsible for only ten%
or more.Medication will work but we cannot rely on meds alone. self responsibility is also required support groups like GROW OR AWARE are also part of my wellness toolbox.Wellness Recovery Action Plan takes up the most space in my toolbox.
I would advice anyone who is experiencing depression or anxieties to have a look at the Wellness Recovery Rction Plan. (WRAP).