Early intervention can positively change the trajectory of depression or bipolar disorder. If you are suffering, don’t delay asking for help. The sooner you get treatment, the better the chances of a successful outcome.
Untreated depression or bipolar disorder creates havoc in people. In most instances, a unipolar or bipolar depressive illness tends to creep up insidiously and then spreads, corroding lives, opportunities and relationships. Yet the decision to seek professional help is not easy. It is difficult to admit that you are not coping with your life. There is trepidation: the fear of being seen as weak, and that you are not capable of managing your own emotions or in control of your mind. It is also very confronting to have to explain your innermost feelings to a stranger, particularly when you might not know the nature of the problem yourself, and thus lack the words to say it.
Medication Medication used to treat depression and bipolar disorder includes antidepressants, mood stabilisers and tranquillisers. There is no general rule applied to any individual about the need to take medication. Someone who presents with a non-melancholic depression whose depression commenced after a major stressor such as a break up in a relationship or loss of a job, will often do quite well without the need for antidepressant medication. If however the person has melancholic or psychotic depression, it would clearly be better to trial an antidepressant.
There are several separate families of antidepressants and various antidepressant drug classes whose effectiveness differs across the depressive subtypes. Whilst most antidepressants have multiple actions, many work by inhibiting the reuptake or reabsorption of one or more different neurotransmitters (including serotonin, noradrenaline and dopamine) at the nerve synapses thus increasing the concentration of the neurotransmitter. Research at the Black Dog Institute has established that if medication is likely to be effective, evidence of at least some improvement should appear in the first ten days or so, whether it be an improvement in mood, sleep or other features. It is important to challenge the myth that antidepressants need to be trialled for many weeks or months so as to ensure that patients are not left on an antidepressant for an extended period with the view that it might start working after two or three months.
Psychological There are various types of psychological therapies including cognitive behavioural therapy, interpersonal therapy and psychotherapy. People who develop depression particularly those who develop non-melancholic depression often have an ongoing negative view of themselves, even when they are not depressed. They distort their experiences through a negative filter and develop thinking patterns that are so entrenched they don’t even notice the errors of judgment caused by thinking irrationally. CBT deals with this by correcting such thinking patterns and extend that thinking into new behavioural patterns. Interpersonal therapy makes no assumption about the origin of the depression and uses the connection between the onset of depressive symptoms and current interpersonal problems as a treatment focus. The underlying assumption is that depressive symptoms and interpersonal problems are interrelated. There are various kinds of psychotherapy all with varying emphasis and approaches. By definition, psychotherapy comprises a working relationship between a trained therapist and a patient. Psychotherapy emerged from psychoanalytic techniques that included encouraging patients to ‘free associate’. The therapist would then progressively clarify and interpret links between the past and the present.
ECT Electric Convulsive Therapy (ECT) is a modern psychiatric treatment that is effective for a range of psychiatric disorders. Patients are given a general anaesthetic to bring about sleep. They are given oxygen and medication to relax their muscles. Next, electrical stimulation is applied through electrodes attached to one or both sides of the scalp. This causes a brief convulsion. The resulting activity in the nerve cells helps to release chemicals that restore normal functioning of the brain. The changes in the nerve impulses and neurotransmitters that occur are similar to those seen during antidepressant treatment.
Those who have not responded to other treatments may benefit from ECT however it is also used as a first line treatment for patients who have responded well to it previously or have severe psychotic depression, severe melancholic depression (where the patient is too ill to eat or drink, is unable to take antidepressant or antipsychotic medications or presents an immediate risk of suicide, life threatening mania (with exhaustion and delirium) or severe postnatal depression.
A sample of patients assessed by the Black Dog Institute who had recovered from severe depression, rated ECT as the most effective treatment for their illness. More than 80 per cent of patients who had undergone ECT are willing to receive treatment again. That said, many patients are reluctant to start a course of ECT.*
Seeking expert help…
After several fruitless encounters with my GP, I reached my own diagnosis. Around four long months later, I went to a different GP and got a referral to a psychiatrist. I can remember sitting in the psychiatrist’s waiting room thinking my life could never get any lower than this moment. It was the ultimate confirmation that I was completely stuffed, beyond help, never to be myself again.
I was really lucky that she and I clicked straight away. I trusted her and then I trusted her decisions. She recommended medication. I stalled, finally agreeing. She knew when to take charge and when to let me find my own way through.**
My psychiatrist knows that when I tumble into ‘my sane logical reality’, he has to help me sort my thoughts and keep me away from my treacherous danger zone. He is my safety net, even when I don’t realise I need one. It’s his job to take on the burden of helping me get well. It’s a burden I can’t allow my friends to assume. I need a professional who knows how I am, and what I need to live well. I need to be able to cry, scream, show anger, feel guilt or misery. I need to be able to explain where I’m at, talk through my fears, celebrate small achievements, and acknowledge my failings. I need to feel no pressure to be the perfect someone I was for others, because I am not. I need to understand my illness, argue my perceptions, and express my thoughts without fear of reprisals. I need medications monitored, my compliance in taking them to be worthwhile, and my constant suspicions allayed. The people who love me aren’t qualified to be all of this for me. Their instinct is to want to ‘fix me’ and I despair when they think they have nothing to offer me. They don’t see that our bond might crumble if I depend on them, as I do my psychiatrist. I feed on their love to help me live with this illness, but it’s my psychiatrist who provides me with what I need to live productively, happily even.
To live with depression, you do what you have to. Sometimes, it’s just enough to survive through one more day. When my entrenched survival skills deserted me, I called in an expert. I know that he is there when I need a steady hand. He is the commitment I make to myself to get well and I know that I deserve that solid, uncompromising belief from him – that I am special enough.**