Deciding what's right for you in the treatment of your depression

What is the right treatment for depression? If I knew the answer, I'd be a rich woman. There are numerous experts who advocate different treatements from different types of therapy, exercise, change of diet, supplements, medication and self-help books. I am only certain of one thing - you should always exercise your right to choose or refuse treatment offered. Yes I know that sounds ridiculously simple and in the face of pressure from the medical profession and loved ones who think they know best, it can be difficult to refuse treatment that you don't want or give up on something that isn't working for you. (Almost impossible when you're sectioned I know - but even then you/or someone on your behalf should be fighting for what is right for you).

Tip: Don't agree to anything without doing some of your own research. I'm not being glib here. If you can't do it - then you need someone else to. Even the best professionals can try and blind you with science. Check it out, ask for a second opinion if necessary - but don't blindly agree to something unless you feel that you have enough information and feel comfortable enough to give it a go.

I mention support structures even though I know that depression can be a very isolating and lonely illness. Some people are lucky enough to have wonderful understanding friends and families and others are not. My mother recently told me that she hoped my husband would one day get over his depression just like I had. Bless her - I didn't let on that I was recently sectioned for a month and that I am trying to recover from my fifth breakdown.It's one of the advantages of living a long way away.

However, despite my experiences, I can recognise the benefits of having some sort of support structure behind you. That might be some sort of self help group, sepcialist phone support from organisations like the Samaritans or an advocate.

Tip: Find someone who can be your advocate. Your partner/spouse is not always the best person to fight your corner. You need someone who is articulate, has good listening skills and can talk for you or query things as appropriate. There are specialist advocates if you don't have or would prefer not to use someone close to you. You may not need to call on someone all the time, but it's nice to know that there is someone available.

We all have different views of medication and its usefulness and of course whether you are prescribed it will depend on the severity of your depression. If it works for you that's great. My only view here is that whatever medication you're taking or are advised to take you should know as much as you can about it. As well as being totally honest about your own medical history, and your families, there are a number of questions that you should be asking.

• What's the medication supposed to do for me?
• What times do I need to take it?
• What happens if I forget to take it?
  
• Do I have take anything with the medication?
  
• What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
• What are the expected side effects, and what should I do if they occur?
• Is there any written information available about the medication?
• How long will I be taking the medication?

Tip: If a medication doesn't suit you - don't suffer in siience. Get a change if necessary. Many people will have experienced a range of unpleasant side effects from medication. Doctor's will often assure you if you raise it that in a few days the symptons will disappear. Well they might ...but they might not. I recently was prescribed a drug that made be feel f as if someone was suffocating me or two hours every night. This was not my imagination but one of the recognised side effects, though it was supposed to be for about twenty minutes. When I said I wasn't happy,  I was told that the sensation would disappear if I persevered for two weeks. Having once had a boyfriend who almost succeeded in suffocating me, this was something that I really wasn't prepared to put up with. Despite my GP, Consultant and nurses I refused to carry on with it and insisted it was changed.  Rememer it is not them who has to cope with the side effects. Only you know what you are prepared to put up with.

Some people swear by taking a natural supplements instead of prescribed drugs or to take with their prescribed drugs. There are many supplements available, such as St John's Wort, Vitamin B, Ginseng and Gingko Biloba, Lavender, Flaxeed Oil, Selenium, Green Tea Extract ....Research them, talk to a herbalist and then discuss with your doctor.

Mind has a very good booklet available "Makig sense of herbal remedies"

There are a range of different types of therapies and whether you have them will depend on how severe your depression is, what's available in your locality, how long you may have to wait for treatment or cost if you have to pay. There are psychological therapies, known as 'talking therapies or talking treatments, counselling, cognitive behavioural therapy (CBT), problem-solving therapy and some forms of psychotherapy among others. There are some excellent guides detailing different forms of therapy on the NHS Choice website

Tip: Yet again ask questions. Make sure you understand why a particular therapy is suitable for you over another one.

It is very important that if you are going to work with a therapist, it's someone that you can have a good relationship with.  Of course if your doctor 'sends' you to someone you don't have a lot of choice.  However, there are still a number of questions that you should be asking, such as "what is the format of the sessions", " How many will we have?", "Can I choose to opt out".  I would also recommend that you ask them things like 'How long have they been practicing and do they belong to any professional body?"  These questions should apply to everyone, but if you found the therapist yourself and you're paying - it would be unwise not to ask.

Tip: Write a list of things that you want to know before you start any sort of therapy.  Make sure you feel comfortable with the person. Don't be afraid to say you can't work with someone.  Remember it is your choice.

Whether you suffer from depression or not, eating the wrong food (eg high fat/high sugar) will contribute to you feeling sluggish. The medical profession believe that mild and medium depression can be helped by eating health food. The Mental Health Foundation has a useful booklet which can be download for free.

Tip: Look at your diet. There's all sorts of questions to ask yourself. Are you eating too much, too little, the wrong things? If depression is your primary illness it can be very easy to develop secondary health issues. If eating is an issue for you consider consulting a dietician. It may help to get a more rounded picture of what is going on.

The benefits of exercise to help with depression are becoming more widespread among doctors and mental health professionals. It can help people in different ways, such as boosting self esteem, providing something specific to focus on, increase in the endorphins in the brain which help to make people happy and opportunities to interact with other people

The Chief Medical Officer (2004) stated that physical activity which lasts between 20 and 60 minutes can help to improve psychological well-being.

The type of exercise you choose will be very much down to personal choice but according to the Mental Health Foundation the most effective for treating depression include areobic activities such as brisk walking, cycling, swimming, dancing, jogging.

Tip. Break an exercise goal into the smallets manageable componenets. if you are struggling to get started. Even walking to the end of your street and back is a good start and it could be extended as your confidence grows. If you can't get out the house walk up and down three stairs. One of my friends swears by this and she has done it for half an hour a day for the last eight years!

The theaputic benefits of dogs and cats have become well documented and it is becoming more common in the UK to see them being taken into hospitals. Have a look at the Pets as Therapy website. Fascinating.

It may be that you want to consider getting a dog. This works for some people, but you really need to think about carefully. We originally got a dog so my husband would get some exercise taking him for a walk. Guess what? For five years I paid out £50 per week for a dog walker to take the dog out when I was always out at work. For some people it works and really helps. We should have thought about it more carefully. And of courses there are a lot of things to think about before you get a dog. Have a look at my hub on issues to think about before you commit.

Tip:  Volunteer as a dog walker. If you would like contact with dogs but couldn't commit to having one, many sancturies need dog walkers.  It doesn't have to be every day, but it might be theraputic if you have some contact.

If you have the ability to concentrate then meditation is a natural remedy that is certainly worth considering. It doesn't suit everyone and there have been warnings that for some people "to meditate when they are clinically depressed can result in an intensification of feelings of despondecy, hopelessness and negativity" (anon, 2006). The positives are that you can do it for yourself and although you may need some help to get started there should be ongoing costs.  There are different types of meditation and Nan Little has written an interesting article on 'Types of Medication' that is simple and accessible.

Tip  Do some research and consult your doctor.

Chinese medicine has had some bad press recently. However, information on how chinese medicine can be used to treat depression is available from Mind and Dr Shen's website

Tip: Make sure you visit a reputable Chinese Herbalist

Secondary Health Issues - If you have any secondary health issues and many people with depression do - do not ignore them, and do not let your doctor fob you off with 'well you're depressed'. I know you can be too depressed to care but it's important. Learn from me. I am now being treated for fibro myalgia, eczema, severe anaemia, gynae problems and a swallowing problem coupled with choking fits. All these conditions I have had for more than seventeen years and have been in pain every day. I did mention it, but my GPs were always more interested in my chronic depression.

Tip:  If you have other medical issues talk to your doctor.  It is not always obvious what is a primary or secodary issue and it is unlikely they need the same treatment as the depressionf!

It's important to remember that even when you are in the darkest of places it is sometimes possible to do things for yourself that can help towards if not getting rid of it, but at least helping to control it rather than it continuously controlling you. None of these things are necessarily easy- you might have tried and found it difficult or think they are all ridiculous.

My tips

1. Be honest with yourself. It can be easy to think one has never been motivated, never been happy for even five minutes. Perhaps this is true, but for the majority of people, even if it is buried in your subconcious there will be something positive at least one moment in time. Try and recall what you felt at the good times and see if you can recall how you felt. I'm not suggesting it's easy or that it will help for any length of time but it can be helpful for some.
   
2. Don't let people put you down - It's all to easy to believe negative things that can come from so called friends of family. However sometimes I wonder why we choose to put up with that. We have a choice. My sister has depression and finds my mother very difficult. But you know what? She's there every couple of days, round there for lunch on Sunday and speaks daily on the phone. I never advocated that she should cut off contact, or have a screaming row - she would never do that, but I do question her need to have so much contact with my mother when it makes her depression worse.
   
3. Try to minimise negative self talk - Almost impossible.I know. When I was in hospital years ago having group therapy the Psychotherapist asked us all to say one thing that we liked about ourselves. The 16 people in the room looked horrified, but the therapist insisted and said we had all afternoon to think about it. I actually was first. I said I had preety feet. My mother used to say what big feet I had (UK 8!), but I knew she was being horrid. , my feet are narrow and slender (unlike the rest of me), my toes are perfect (despite being a former athlete) with beautiful nails on each one and the skin is not dry or scarred like much else of my body. It may be a very small thing and sound really stupid, but you know it's important even in the darkest of moments to have something that you can tell yourself.
   
4. Be open to trying something new - I know one can think "Been there, tried it, got the T- Shirt, not going to try anything else". I've said this loads of time which is why despite being quite ill, I refused medication or any type of therapy for 18 years (and I've never regretted that, because it was my choice). However, I still believe that it is important to keep an open mind to something different. I recently trained as a Neuro-Linguistic Practitioner. I hated the first four of the seven days and none of the other people spoke to me unless we were doing an activity. My fault, I was too depressed to want to even make an effort and every time the trainer started to talk I took a nap. The last three I went through the experience, but as I don't really do enjoyment I won't lie and say it was outstanding. However, I did learn some techniques that on some days can help to improve things. I need to keep reminding myself that there may be something out there that will help and I need to be open to that idea.
   

I recently disagreed with a consultant psychiatrist over some suggested treatment and her face was a picture. She was particularly furious when I pointed out that I had just as much knowledge as she did. After all no one is a better expert than me about my depression and the effect that it has had for forty five years. I respect other people's knowledge (just), I listen and then I make my own choices.

Perhaps reading this you think I should have spent more time listening to the professionals if I've had depression for so long. Well I did listen for the first twenty years or so and the result was I gained eight stone in weight because of the medication, suffered all sorts of other unpleasant side effects, and listened to some bullying professionals who frankly were so abusive they should have been prosecuted. They succeeded in making me more depressed and feeling utterly inadequate. And that's why I now I do it my way!