What is it?

Depression is a medical illness defined by mood depression, lack of appetite, and reluctance to experience ordinary life. These features last more than one month and have a detrimental effect on your everyday work. To feel depressed over a loved one’s demise is no sadness.

Depression is common. From a survey in 2013, 14.8% of the respondents had complaints that could indicate depression. Depression is divided into mild, moderate, and severe forms. Depressions can sometimes be a long time, and it can be difficult to get out of.

The treatment of depression is based on 2 pillars: psychological support and medication. The choice of one of the two pillars or both pillars together depends on the severity of the depression. The treatment always consists of psychological support by a general practitioner, psychologist, or psychiatrist. This guidance takes place individually or in groups, in consultation with the treating therapist (s), and according to the person’s wishes with depression. The environment (family, friends, work…) is also involved in the treatment. Scientific research shows that intensive and active support is more effective than medication alone. This guidance is often sufficient for mild and moderate depression. The benefit of medication-assisted treatment increases with the severity of the depression. Medication may be necessary, especially in severe forms.

When is non-drug treatment indicated?

The treatment is always multidisciplinary, with collaboration between the person with depression, the general practitioner, the psychologist, the home nurse, the physiotherapist, the family, and the informal carers. For mild and moderate depression, a treatment plan is drawn up with a day structure and activity plan, supported by psychological counseling. Preference is given to cognitive behavioral therapy, with an emphasis on changing behavioral patterns. The goal is to re-perform meaningful activities according to a fixed schedule. That way, you are taken out of the listlessness and the depression, and you regain interest in normal daily activities so that you can learn to enjoy them again. You will be closely monitored by your doctor and / or psychologist: you will be seen every 2 weeks, for example, depending on the severity of the depression.

You can also request psychiatric home care. For example, mobile psychological teams can provide outpatient psychological support. If the results are good, the checks are more spread over time. The ultimate goal is to resume your normal life and work.

Usually, no medication is needed for mild to moderate depression. Because some people with depression are prone to anxiety and sleep disorders, a sedative is occasionally prescribed at the beginning of treatment and for a short period of time. If possible, this is limited to a maximum period of 4 weeks because of habituation risk.

This treatment schedule is also used for severe depression; only the follow-up is more intensive and longer. Even after recovery, psychological support is usually continued, as individuals with severe depression often relapse. In that case, more attention is also paid to possible problems, eg, other psychiatric disorders such as psychoses (delusions) and the risk of suicide. If necessary, the help of a psychiatrist is sought. The psychological support is often combined in this case with antidepressants.

When is medication started?

In severe depression, an antidepressant is usually always prescribed unless the patient refuses. Medication is usually not necessary for mild and moderate depression. It is prescribed in the following cases:

• If mild or moderate depression has lasted for more than two years;
• If you have already had moderate to severe depression and medication helped well then;
• If you do not respond sufficiently to other (non-drug) treatments.

The effectiveness of antidepressants depends on the other concomitant treatment (psychotherapy). Psychotherapy and antidepressants are best combined. If you don’t like this approach, then psychotherapy is preferred. Psychotherapy is as effective as short-term antidepressants and even more effective in the long term. Therefore, antidepressants should not be prescribed alone.

How long will you be treated with medication?

The purpose of medication is to eliminate the symptoms of depression. Two-thirds of people with severe depression respond well to antidepressants. In almost half, the symptoms even disappear completely.

The impact of antidepressants will take up to 6 weeks to see. When there is little change, the dosage is typically raised, or a move to another antidepressant form is made. When the depression is regulated, keep the drug for an additional 6 to 9 months at the same dosage. The medication is performed individually: too small a dose has little effect, and too high a dose does not cause more side effects.

The medication is gradually tapered while monitoring the possible symptoms of recurring depression. If you had depression before and then responded well to the medication, maintenance treatment may be necessary even for several years. This is certainly the case after multiple depressions. The doctor will discuss with you whether the treatment will be continued or not. Stopping the medication is always done gradually according to a tapering schedule. If you cannot do it without your medication, the dose will be increased again.

What medication can you take?

Antidepressants

There are 2 main antidepressants: selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCA).

The SSRIs are usually the first choice because they are easy to use, have few side effects (especially in the elderly ), and are relatively harmless. No build-up phase is required with gradual dose adjustment. The dose that is started with is also the right dose.

Since SSRIs are not sleep-inducing, a sedative may be required at the start of treatment in exceptional cases. Use this medication for as short a period of time as possible.

SSRIs’ most common side effects are nausea, loss of appetite, diarrhea , sleep disturbances , nervousness, restlessness, and anxiety. Suicidal ideation may increase early in treatment in people under 30 years of age. The doctor will pay special attention to this.

The impact of antidepressants will take up to 6 weeks to see. When there is little change, the dosage is typically raised, or a move to another antidepressant form is made. When the depression is regulated, keep the drug for an additional 6 to 9 months at the same dosage. The medication is performed individually: too small a dose has little effect, and too high a dose does not cause more side effects.

A major problem in the elderly is that they often do not tolerate these types of antidepressants very well. Therefore the dose should be increased gradually until the effective dose is reached.

Side effects include dry mouth, constipation, failure to urinate, rise in weight, drowsiness, and reduced blood pressure while standing or sitting. Therefore, tricyclic antidepressants are only prescribed in aged persons where there is no option.

Some antidepressants, such as MAO antagonists, mirtazapine, mianserin, and trazodone, are included in these two broad classes. However, because of the high possibility of adverse effects and reactions with other medications, these agents are not the first to manage depression.

Natural Medicines

St. John’s Wort is used for mild to moderate depression sometimes. However, we are not very sure of the efficacy of the extract, particularly in the event of extreme depression, or its long-term protection and doses. St. John’s wort will decrease co-medicinal drugs’ potency (including contraception tablets, some antibiotics and anticoagulants). This is why it is not recommended, especially without your doctor’s consultation.

What should you do before you start taking medication?

Speak to the psychiatrist before you begin some depression medication. It can sometimes not be mixed with drugs you already use. The dosage also has to be changed for patients with liver or kidney failure. Epileptic patients can also often first see their doctor, as such medications can cause further conclusions.