alt.support.depression FAQ
Part
3 of 5
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**Medication** (cont.)
- If an antidepressant
has produced a partial response, but has not
fully eliminated depression,
what can be done about it?
**Electroconvulsive Therapy**
- What
is electroconvulsive therapy (ECT) and when is it used?
- Exactly what
happens when someone gets ECT?
- How do individuals who have had ECT feel
about having had the
treatments?
- How long do the beneficial
effects of ECT last?
- Is it true that ECT causes brain damage?
- Why is there so much controversy about ECT?
**Substance Abuse**
- May I drink alcohol while taking antidepressants?
- If I plan to drink
alcohol while on medication, what precautions
should I take?
-
What's the relationship between depression and recovery from
substance
abuse?
- What does the term "dual-diagnosis" mean?
- Is
it safe for a person recovering from substance abuse to take
drugs?
- How do you know when depression is severe enough that help should be
sought?
**Getting Help**
-Where should a person go for
help?
-Where can I find help in the United Kingdom?
-Where can I
find out about support groups for depression?
-How can family and friends
help the depressed person?
**Choosing A Doctor**
-What should
you look for in a doctor? How can you tell if he/she really
understands
depression?
**Self-care**
- How may I measure the effects my
treatment is having on my
depression?
Medication (cont.)
------------------
Q. If an antidepressant has produced a partial response,
but has not fully eliminated depression, what can be done about it?
There
are many techniques to help an antidepressant work more completely. The simplest
is to increase the dose until relief is experienced or side- effects are severe.
If the dose can not be increased, lithium can be added to any antidepressant to
augment its effect. With all antidepressants it is possible to add small doses
of stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or dextroamphetamine
(Dexedrine) to augment the antidepressant effect.Selective serotonin re-uptake
inhibitors often work better when small doses of desipramine (Norpramin) or nortriptyline
(Aventyl and Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel)
may be used to augment any antidepressant. At times combinations of these techniques
may be utilized.
Electroconvulsive Therapy
-------------------------
Q. What is electroconvulsive therapy (ECT) and when is it used?;
ECT is an effective form of treatment for people with depressions and other
mood disorders. ECT may be used when a severely depressed patient has not responded
to antidepressants, is unable to tolerate the side effects of antidepressants,
or must improve rapidly. Some depressed people simply do not respond to antidepressants
or mood controlling drugs, and ECT is a way for such people to be effectively
treated. ECT is utilized in the treatment of both mania and depression. There
are some people who because of severe physical illness are unable to tolerate
the side-effects of the medications used to treat mood disorders. Many of these
people can be successfully be treated with ECT. Pregnant women and people who
have recently had heart attacks can be safely treated with ECT. Because of
time pressure regarding occupational, social, or family events, some people do
not have the time to wait for antidepressants or mood regulating medications to
become effective. As ECT quite regularly brings about improvement within two or
three weeks, people who are under such time pressure are also excellent candidates
for ECT.
Q. Exactly what happens when someone gets ECT?
The physician must fully explain the benefits and dangers of ECT, and
the patient give consent, before ECT can be administered. The patient
should
be encouraged to ask questions about the procedure and should
be told that
consent for treatments can be withdrawn at any time, and
in the event that
this happens, the treatments will be stopped. After
giving consent, the
patient undergoes a complete physical
examination, including a chest x-ray,
electrocardiogram, and blood
and urine tests. A series of ECTs usually
consists of six to twelve
treatments. Treatments can be administered to
either in-patients or
out-patients. Nothing should be taken by mouth for
8-hours prior to a
treatment. An intravenous drip is started and through
it medications
to induce sleep, relax the muscles of the body, and reduce
saliva are
given. Once these medications are fully effective, an electrical
stimulus is administered through electrodes to the head. The
electrical
stimulus produces brain wave (EEG) changes that are
characteristic of a
grand mal seizure. It is believed that this
seizure activity leads to the
clinical improvement seen after a
series of ECT. About 30-minutes after
the treatment the patient
awakens from sleep. While confused at first,
the patient is soon
oriented enough to eat breakfast, and return home if
the treatments
are being done in an outpatient setting.
Q.
How do individuals who have had ECT feel about having had the
treatments?
In studies of people treated with ECT it has been found that 80%
of
such people report that they were helped by the treatments. About 75%
say that ECT is no more frightening than going to the dentist.
Q. How long do the beneficial effects of ECT last?;
While ECT is
a highly successful way of helping people come out of
depressions, it has
to be followed by antidepressant therapy. If
antidepressants are not administered
after a series of ECTs, there is
a 50% relapse rate within 6-months.
Q. Is it true that ECT causes brain damage?;
There is no scientific
evidence that ECT causes brain damage. A woman
who had over 1,000 ECT died
of natural causes, and her brain was
examined for evidence of ECT-induced
brain damage. None was found.
ECT does cause memory problems. These memory
problems may take a
number of months to clear. A small number of people
who have received
ECT complain of longer lasting memory problems. Such
problems do not
show up on psychological tests, it is not clear what causes
them.
Q. Why is there so much controversy about ECT?
There
is little controversy about ECT among psychiatrists. Much of
the opposition
to ECT seems political in nature and originates in the
anti-psychiatry
groups that oppose the use of Ritalin for the
treatment of children with
attention deficit disorder, and who oppose
the use of Prozac for the treatment
of depressed people.
Substance Abuse
---------------
Q. May I drink alcohol while taking antidepressants?
There are a number
of problems with the mixture of alcohol and
antidepressants. First, antidepressants
may make you especially
susceptible to the intoxicating effects of alcohol.
Second, if you
drink more than three or four drinks a week, the effects
of alcohol
may prevent the antidepressants from working. Many people who
seem
not to benefit from antidepressants, do so, if they reduce or
eliminate their intake of alcohol. Third, you may be taking along
with
the antidepressant a drug such as clonazepan (Klonopin) with
which one
should not drink at all.
Q. If I plan to drink alcohol while on
medication, what precautions
should I take?
There is much misinformation
about drinking while on anti-
depressants. Alcohol can prevent antidepressants
from being
effective. This is not so much because it interferes with the
absorption of antidepressants, it is because of the effects of
alcohol
upon brain chemistry. Antidepressants can also increase one's
susceptibility
to the intoxicating effects of alcohol. Also, both
alcohol and some anti-
depressants (especially Wellbutrin) increase
the possibility of seizures.
If you are determined to drink despite taking antidepressants you
should discuss the matter with your psychiatrist. If you get
permission
you might want to determine the extent to which the
medication has made
you more sensitive to the alcohol. You might
start by seeing what are the
effects of half a glass of wine. You
might then experiment with a full
glass. Remember, a 4 oz glass of
wine, a 12 oz bottle of beer, and 1 oz
of "hard stuff" all contain
the same amount of alcohol.
Q. What's the relationship between depression and recovery from
substance abuse?
It is not unusual for people who have recently
been withdrawn from
alcohol, or other abusable drugs to become depressed.
These
depressions are often self-limited, and clear in about 8-weeks. If
depression has not cleared by the end of that period, anti-depressant
therapy should be started.
Q. What does the term "dual-diagnosis"
mean?
Dual-diagnosis is a phrase used to indicate the combination
of
substance abuse and a psychiatric disorder. A path to alcohol or
other substance abuse is an attempt to self- medicate uncomfortable
symptoms such as depression, anxiety, agitation or feelings of
emptiness.
The psychiatric disorders that cause such symptoms are
often diagnosed
in substance abusers.
Q. Is it safe for a person recovering from
substance abuse to take
drugs?
People recovering from substance
abuse can safely take many kinds of
psychiatric drugs. Most psychiatric
drugs are unable to be abused.
The best evidence for this is that there
are not street markets for
such drugs. On the other hand, The benzodiazepines
(diazepam
[Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
[Desoxyn],
and Ritalin [methylphenidate]) are quite abusable.
For people active
in AA please read the pamphlet "The AA
Member--Medications & Other
Drugs." This outlines AA's official
attitude toward medication--that
it is necessary for certain
illnesses including depression. Too many depressed
people who have
been talked out of taking antidepressants by members of
their AA
groups have killed themselves as a result.
Q. How
do you know when depression is severe enough that help should be
sought?
Professional help is needed when symptoms of depression arise without
a clear precipitating cause, when emotional reactions are out of
proportion
to life events, and especially when symptoms interfere
with day-to-day
functioning.. Professional help should definitely be
sought if a person
is experiencing suicidal thoughts.
Getting Help
------------
Q. Where should a person go for help?
If you think you might
need help, see your internist or general
practitioner and explain your
situation. Sometimes an actual physical
illness can cause depression-like
symptoms so that is why it is best
to see your regular physician first
to be checked out. Your doctor
should be able to refer you to a psychiatrist
if the severity of your
depression warrants it.
Other sources
of help include the members of the clergy, local
suicide hotline, local
hospital emergency room, local mental health
center.
Q. Where
can I find help in the United Kingdom?
The following are places one
might find help in Great Britain:
Depressives Associated
PO Box 1022
London SE1 7QB
Depressives Anonymous
36 Chestnut Avenue
Beverley
Humberside
HU17
9QU
MIND (National association for mental health)
22
Harley Street
London W1N 2ED
To find a psychiatrist/ psychologist
near you, call or write:
Royal College of Psychiatrists
17
Belgrave Square
London SW1X 8PG
Q. Where can I find out about
support groups for depression?
The following is a list of national
organizations dealing with the
issues of depression. Please note: Model
groups are not national
organizations and should be contacted primarily
by persons wishing to
start a similar group in their area. Also, please
enclose a
self-addressed stamped envelope when requesting information from
any
group. When calling a contact number, remember that many of them are
home numbers, so be considerate of the time you call. Keep in mind
the
different time zones.
[Reprinted from The Self-Help Sourcebook, 4th
Edition, 1992. American
Self-Help Clearinghouse, St.Clares' Riverside Medical
Center,
Denville, New Jersey 07834]
**Depressed Anonymous**
Int'l. 8 affiliated groups. Founded 1985.
12-step program to help depressed
persons believe & hope they can
feel better. Newsletter, phone support,
information & referrals, pen
pals, workshops, conference & seminars.
Information packet ($5),
group starting manual ($10.95).Newsletter. Write:
1013 Wagner Ave.,
Louisville, KY 40217. Call Hugh S. 502-969-3359.
**Depression After Deliver** National. 85 chapters. Founded 1985.
Support & Information for women who have suffered from post-partum
depression. Telephone support in most states, newsletter, group
development
guidelines, pen pals, conferences. Write: PO. Box 1281,
Morrisville, PA
19067. Call 215-295-3994 or 800-944-4773 (to leave
name & address for
information to be sent).
**Emotions Anonymous** National. 1200 chapters.
Founded 1971.
Fellowship sharing experiences, hopes & strengths with
each other,
using the 12-step program to gain better emotional health.
Correspondence program for those who cannot attend meetings. Chapter
development guidelines. Write: PO. Box 4245, St. Paul, MN 55104. Call
612-647-9712.
**National Depressive & Manic-Depressive Association** National.
250
chapters. Founded 1986. Mutual support & information for
manic-depressives, depressives & their families. Public education on
the biochemical nature of depressive illnesses. Annual conferences,
chapter
development guidelines. Newsletter. Write: NDMDA, 730
Franklin, 501, Chicago,
IL 60610. Call 800-82-NDMDA or 312-642-0049.
**National Foundation
for Depressive Illness**. An informational
service, which provides a recorded
message of the clear warning signs
of depression and manic-depression,
and instructs how to get help and
further information. Call 1-800-239-1295.
For a bibliography and
referral list of physicians and support groups in
your area, send $5
(if you can afford it) and a self-addressed, stamped
business-size
envelope with 98 cents postage to, NAAFDI, PO. Box 2257,
New York, NY
100116.
NOSAD (**National Organization for Seasonal
Affective Disorder**)
National. groups. Founded 1988. Provides information
& education re:
the causes, nature & treatment of Seasonal Affective
Disorder.
Encourages development of services to patients & families,
research
into causes & treatment. Newsletter. Write: PO. Box 451, Vienna,
VA
22180. Call 301-762-0768.
(Model) **Helping Hands** Founded
1985. A comfortable & homey
atmosphere for people with manic-depression,
schizophrenia or clinical
depression who seek an environment that makes
them more aware of
themselves & eliminates a negative attitude. Group
development
guidelines. Write: c/o Rita Martone, 86 Poor St, Andover, MA
01810.
Call 508-475-3388.
(Model) MDSG-NY (**Mood Disorders
Support Group, Inc.**) Founded
1981. Support & education for people
with manic-depression or
depression & their families & friends.
Guest lectures, newsletter, rap
groups, assistance in starting groups.
Write: PO. Box 1747, Madison
Square Station, New York, NY 10159. Call 212-533-MDSG.
Q. How can family and friends help the depressed person?
The most important things anyone can do for depressed people is to
help
them get appropriate diagnosis and treatment. This may involve
encouraging
a depressed individual to stay with treatment until
symptoms begin to abate
(several weeks) or to seek different
treatment if no improvement occurs.
On occasion, it may require
making an appointment and accompanying the
depressed person to the
doctor. It may also mean monitoring whether the
depressed person is
taking medication.
The second most important
thing is to offer emotional support. This
involves understanding, patience,
affection, and encouragement.
Engage the depressed person in conversation
and listen carefully. Do
not disparage feelings expressed, but point out
realities and offer
hope. Do not ignore remarks about suicide. Always report
them to the
doctor. Invite the depressed person for walks, outings, to
the
movies, and other activities. Be gently insistent if your invitation
is refused. Encourage participation in some activities that once gave
pleasure, such as hobbies, sports, religious or cultural activities,
but
do not push the depressed person to undertake too much too soon.
The depressed person needs diversion and company. but too many
demands
can increase feelings of failure. Do not accuse the depressed
person of
faking illness or laziness or expect him or her to "snap
out of it."
Eventually, with treatment, most depressed people do yet
better. Keep that
in mind, and keep reassuring the depressed person
that with time and help,
he or she will feel better.
Choosing A Doctor
-----------------
Q. What should you look for in a doctor? How can you tell if he/she
really understands depression?
If you are looking for a psychopharmacologist
to prescribe
medications to help control your depression there are a number
of
things to check. If you are in psychotherapy, it is important to ask
prospective doctors about their opinions on the psychotherapeutic
treatment
of depression. Psychopharmacologists who are hostile to
psychotherapy are
difficult to deal with while you are in therapy.
It is always legitimate
to ask any professionals you are thinking
about seeing regularly about
their understanding of depression, their
beliefs about the causes of depression
and their philosophy of
treatment. You might ask about how often the prospective
doctor has
worked with people who have had your particular variety of
depression. If you have a rapidly cycling Bipolar depression, for
example,
you should seek a doctor who has much experience dealing
with people who
have this problem. Prior to the first visit it is
important to clarify
with the doctor or the secretary the fee of the
initial and subsequent
visits, the doctor's policy regarding
missed and changed appointments,
whether the doctor will accept
assignment from insurance companies. If
you have Medicare or
Medicaid it is important to make sure that the doctor
sees people
with these forms of medical coverage.
Another aspect
of the style of doctors is the extent to which they
include their patients
in the decision-making process. You might ask
"How do you go about
deciding which treatment is right for me?" See
if you are comfortable
with the method the doctor describes. Much can
also be learned from how
doctors respond to questions such as these.
There is much difference between
a doctor who welcomes such questions
and answers them fully and one who
is annoyed by them and answers
them superficially.
Self-care
---------
Q. How may I measure the effects my treatment is having on
my depression?
If one completes the following scale each week, and
keeps track of the
scores, one would have a detailed record of one's progress.
Name _________________________ Date _________
The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling
one of the numbers that follows it. Use the following scale:
0
= Not at all
1 = Just a little
2 = Somewhat
3 = Moderately
4 = Quite a lot
5 = Very much
_______________________
1. I do things slowly............................0 1 2 3 4 5
2. My future seems hopeless......................0 1 2 3 4 5
3. It is hard for me to concentrate on reading...0 1 2 3 4 5
4. The pleasure and joy has gone out of my life..0 1 2 3 4 5
5. I have difficulty making decisions............0 1 2 3 4 5
6. I have lost interest in aspects of life that
used to be important
to me...................0 1 2 3 4 5
7. I feel sad, blue,
and unhappy.................0 1 2 3 4 5
8. I am agitated
and keep moving around..........0 1 2 3 4 5
9. I feel fatigued...............................0
1 2 3 4 5
10. It takes great effort for me to do simple
things.......................................0 1 2 3 4 5
11. I feel that I am a guilty person who
deserves to be punished......................0
1 2 3 4 5
12. I feel like a failure.........................0
1 2 3 4 5
13. I feel lifeless--more dead than alive.........0
1 2 3 4 5
14. My sleep has been disturbed:
too little,
too much, or broken sleep........0 1 2 3 4 5
15. I spend
time thinking about HOW I might
kill myself..................................0
1 2 3 4 5
16. I feel trapped or caught......................0
1 2 3 4 5
17. I feel depressed even when good things
happen to me.................................0 1 2 3 4 5
18.
Without trying to diet, I have lost,
or gained, weight............................0
1 2 3 4 5
Note: This scale is designed to measure changes
in the severity of
depression and it has been shown to be sensitive
to the changes
that result from psychotherapeutic or psychopharmacologic
treatment. These scales are not designed to diagnose the presence
or absence of either depression or mania.
Copyright (c) 1993 Ivan
Goldberg
