When you’re depressed and your self-esteem is low, you may feel like making excuses to stop your self-esteem from falling any further. If you work hard to avoid that temptation, you’re more than likely to be rewarded in the long-run.
Putting it all into practice
Now that you know about the three techniques of Taking Ownership, Making the Message Palatable, and Defusing, you may want to see them in action. You can then fully appreciate the value of these communication strategies.
But first, we show you how difficult communication can be without using the three techniques. Ruth and Dennis are having a disagreement about housework. Here’s how their conversation goes:
Ruth: You never help me with any of the housework. I’m getting absolutely sick and tired of it.
Dennis: Yes I do. I mowed the lawn last week. Just what do you want out of me?
Ruth: The lawn’s your job, not mine. I’m talking about the laundry, the cooking, the household shopping, and the washing up. You don’t do any of these. My list’s twice as long as yours. Face it, if it wasn’t for me, this place would look even more like a pigsty than it already does.
Dennis: Look, I earn more money than you. I’m shattered when I get home. When we got married, you said if I was the main bread winner, you’d take care of the house. This just isn’t fair!
Ruth: Fair? What are you talking about? I’m also working, you know. Why can’t you can’t even talk about a simple thing like housework without shouting!
Not a very productive discussion, is it? Both Dennis and Ruth resort to criticism, defensiveness, and anger. Nothing is solved, and the bad feelings worsen. Now we’re going to take the same conversation and insert the Taking Ownership, Making the Message Palatable, and Defusing techniques.
Ruth: Help me see your take on this. (Making the Message Palatable). I feel a little overwhelmed with the housework (Taking Ownership), and it kind of seems like you’re not doing as much as I’d like.
Dennis: Well, I agree that you do more of the housework (Defusing). I’m sorry that I’ve made you feel so overwhelmed. I guess I come home so tired that I often don’t think about housework, but maybe I should (Taking Ownership). What do you need most?
Ruth: Sometimes I feel like I do everything (Taking Ownership). But maybe I’m overreacting (Making the Message Palatable). If you could help with the dishes after dinner, that would feel ever so much better.
Dennis: (Defusing) I can see why you’d like that. Let’s face it, we’re a big family which means a whole lot of dishes (Defusing). I’m just shattered after dinner (Taking Ownership). How about I do the washing at the weekend instead? And perhaps we start getting the kids’ help with the dishes. They’re old enough now.
Ruth: Well, that’s a reasonable compromise, I suppose. Thanks for listening and hearing my concern.
That turned out a little better, didn’t it? When you use the Defusing technique, you focus more on finding something to agree with (or even apologise for some aspect of the complaint), and you pay less attention to conjuring up defensive excuses. Making the Message Palatable allows you to express concerns in a gentle, non-confrontational manner. Taking Ownership keeps the focus on your concerns and stops you from blaming your partner. You can apply all three techniques to communicating with your partner as well as in other important relationships.
After reading the conversations between Ruth and Dennis, think about writing down a conversation that you’ve had with someone that didn’t go too well. Then rewrite the conversation inserting as many Defusing, Making the Message Palatable, and Taking Ownership messages as possible. Putting the three techniques into practice means that your communication skills are just going to get better and better.
Part V
Full-Bodied Assault: Biological Therapies to Fight the Physical Foe
In this part . . .
Every year, new treatments for depression are trumpeted. Evaluating all your options can be overwhelming. We bring you the latest information about medication for treating depression. More importantly, we help you make a decision as to whether medication is the right choice for you.
Other alternatives for treating depression also exist. In the following pages, you can read about natural alternatives such as herbs or light therapy. And finally, we discuss electric shock treatment and other biologically based treatments for treating difficult cases of depression.
Chapter 15
Maximising Medication Benefits
In This Chapter
Deciding how to deal with depression
Looking at why people take, or don’t take, medication
Figuring out how medication works
Describing drugs
Many people used to believe that depression was triggered by a character flaw or weakness. Because of that belief, those suffering from depression often didn’t seek treatment. Feeling embarrassed, guilty, and worthless, they went on suffering in horrible silence. Or worse, ended their pain with suicide. But the antidepressant medication that’s available nowadays is easing suffering for millions. Research is showing that there are biological factors underpinning your mood.
In this chapter, we help you decide your best treatment option(s) – psychological help, medication, or a combination of both. We tell you about where to get help, how long you may have to take medication, and when combining psychological therapy with medication may be your best choice, helping you get better faster than just following one treatment on its own. Finally, we give you information about the most common prescription drugs.
Barry is reluctantly seeing his GP, having tried in vain for several months to ‘just snap out of it’ ‘I’m sorry if I’m wasting your time. I’m a bit of a fraud in a way, but I haven’t the foggiest idea what’s wrong with me. I just feel absolutely awful, from the moment I wake up to when I finally fall asleep. Every night it takes ages to drop off, but then I’m wide awake by 4 a.m. and can’t get back to sleep. I’m restless all the time, and everyone and everything irritates me. My whole body feels painful, but it’s like it’s all over, not anywhere in particular. Do you think it’s a brain tumour?’
After a complete check up and some further discussion, the doctor decides that Barry is suffering from severe depression. She explains to Barry that he has a ‘chemical imbalance’, and she prescribes antidepressants. Slightly puzzled as to how his brain chemicals have got out of synch but willing to give the drugs a go, Barry takes the prescription to his local chemist.
The pharmacist encourages Barry to read the information leaflet on the commonly-used antidepressant his doctor prescribed. But the more Barry reads about possible side effects, the more he worries. Headaches, dry mouth, dizziness, stomach upsets, and – oh no! – sexual dysfunction. Barry wonders whether to just forget the whole idea and wait for things to improve by themselves. But after some thought, he decides to give the medication a try because his depression’s making him feel so awful. Besides, Barry works out that if he experiences bad side effects, his GP may be able to suggest an alternative that won’t affect him in that way. Barry makes the right decision. To his enormous relief; his depression starts lifting within a couple of weeks.
Depression is an illness that affects both body and mind. Left untreated, it can banish happiness, and also take a physical toll. (For more detail on these aspects of depression, refer to Chapter 1.) Do get help if you’re feeling depressed. Trying to ignore depression and hoping it’s going to go away all by itself just isn’t the answer.
Selecting the Best Weapons to Fight Depression
The greater part of this book provides techniques you can use to improve your mood and defeat depression. Most of these are from the fields of cognitive behavioural therapy (a combination of cognitive therapy reviewed in Part II and behaviour therapy discussed in Part IV). We want to encourage you to adopt healthy thinking and behaviour as your first line of defence in your battle against the blues. But no way is psychological therapy the only tool!
There’s a huge
body of studies available comparing prescribed medication with psychological therapy, mainly cognitive behavioural therapy (CBT), for the treatment of depression. Most studies agree that both types of therapy are equally effective for the treatment of depression. And several studies suggest that a combination of the two brings even better results.
Combining medication with therapy appears to give a slight edge over using only the one form of treatment, allowing a person taking antidepressant medication to make better use of psychological therapy.
Ultimately, it’s your decision whether to take medication for your depression. If you choose to stick to self-help using psychological therapy, you need to work conscientiously through the exercises provided in this self-help book, and/or work with a therapist. Don’t expect to get better without a lot of effort. With work, you can expect that the skills you develop are likely to help you against any future struggles with depression. But for many people, medication is one important part of the solution – and for good reason.
Whatever path you choose, don’t forget that depression is an illness that can be treated successfully. If the initial solution you’ve gone for doesn’t work, don’t give up hope. Be patient, get help, and try something different.
Exploring the Medication Option
Given all the evidence that psychological therapy works, why do people choose to take medication? Well, there are a range of views, with some studies suggesting that for about 90 per cent of depressed people, a single medication or a combination of medicines can lessen symptoms or completely cure depression. Other studies suggest that medication is only effective in around one third of cases, and partially effective in another third, with the final third getting very limited or no benefit at all. With such differing opinions, making a decision is even more difficult, especially as a depressed person is often troubled by uncertainty and doubt!
The following sections sum up common reasons why people take medication, or choose not to.
Awarding drugs the thumbs up
Doctors agree that the medication route is best when:
You have serious suicidal thoughts or plans. In this case, you need help now. First, see a mental health professional to decide on the best treatment for you. Sometimes antidepressant medication can start to have an effectfaster than cognitive behavioural therapy and other psychological therapies.
You have bipolar disorder or depression with psychotic features. Medication is a particularly important element of treatment those with bipolar disorder or people whose depression is so severe that they are hearing voices or seeing things that aren’t really there (refer to Chapter 2). However, the addition of psychological therapy often helps to stabilise mood even further, encouraging people to continue taking their medication and so preventing relapses.
You’ve given cognitive behavioural therapy (CBT) or interpersonal therapy (IPT) a good try and your depression keeps recurring. Evidence shows that untreated depression becomes more severe, frequent, and resistant to treatment. If your depression keeps recurring, consider including long-term medication along with other treatment. (See Chapter 4 ‘What Works? The effective therapies’, for more information on CBT and IPT)
Your symptoms of depression are mostly physiological. For example, you have problems with your appetite or sleep, or you feel overwhelming fatigue, forgetfulness, and poor concentration. Caution: Not everyone with the physical symptoms of depression responds better to medication, and some of those with physical symptoms may be trying to avoid examining their feelings and thoughts. So, if medication doesn’t work, seeing a therapist may be a very good idea.
Depression takes control of your life. If severe symptoms cause you to neglect the important tasks of everyday living, you may need medication to get you going again. But, after you’re feeling a bit better, consider self-help or cognitive behavioural therapy to keep up your improvement.
Medical conditions cause your depression. Sometimes people with other illnesses become depressed. (Refer to Chapter 2 for more on causes of depression). Different physical conditions may lead to depression in a number of different ways, sometimes by affecting the brain directly. Medication may be the quickest way to overcome this type of depression.
Panic or anxiety accompanies depression. You may have too much on your plate to wait for the benefits of psychological therapy. Again, when the medication starts taking effect, you may have more mental energy available to tackle anxiety and depression in therapy or with the aid of of self-help books like this one or another of our titles, Overcoming Anxiety For Dummies by Elaine Iljon-Foreman, Laura Smith, and Charles Elliott (Wiley).
Psychological therapy doesn’t work. A few people just don’t seem to benefit from psychological therapy, or they may have complicated issues that need a very long period of therapy. In this case, medication may be a good choice.
Your depression has lasted most of your life. Some evidence suggests that chronic depression (such as dysthymia; refer to Chapter 2) may benefit a great deal from medication plus psychological therapy.
You don’t have time for psychological therapy. For some people, such therapy is too time consuming. If your schedule is already overfull, we hope you at least put some time aside within your busy day to read through this book.
You are having difficulty accessing psychological therapy on the NHS, and can’t afford to pay for private therapy. Your local communality mental health team may not offer a service to people with your problem or level of depression, and there can be a lengthy wait to receive psychological therapy through your GP practice, assuming it does provide this service. You can try a combination of self-help, along with medication to support you.
Many people even today feel guilty about taking medication for depression, telling themselves it’s the ‘easy way out’. Be honest. If you’re diabetic, do you think you ought to feel bad about taking insulin? And if you have an infection, don’t you take antibiotics? And have you never, ever, taken pain relief for a headache? So what’s so special and different about taking antidepressant medication?
Giving medication the thumbs down
If taking medication works, then where’s the problem? Why doesn’t everyone try it? Here are some common reasons why people may choose not to take prescription medications for depression:
Getting scared by bad press: Some of the earlier antidepressant drugs had a bad image. This is summed up in lyrics like the Rolling Stones’ ‘No more running for the shelter of a mother’s little helper. They just helped you on your way, through your busy dying day.’ But a great deal has changed since those days, both in respect of the chemical formulae of many drugs, as well as doctors’ knowledge and prescribing practices.
Being put off by side effects: More than a third of people prescribed antidepressant medication stop taking it, mainly because of the side effects, which can include nausea, headaches, insomnia, dry mouth, weight gain, feelings of apathy, and sexual dysfunction.
Avoiding drugs while pregnant or breastfeeding: Research about the effects of antidepressant medication on the foetus or infant comes from animal studies or case examples, so ithere’s not enough information available to judge the safety of most antidepressant medications. Talk to your doctor if you’re planning on getting pregnant, might be pregnant, or are breastfeeding. In most of these cases, psychological therapy is a better choice than medication.
Depression after the birth of a baby is a common problem that can become serious if left untreated, and can have lasting effects on your baby’s emotional development. Please get help if you experience more than a couple of days of baby blues (Refer to Chapter 2 for more on postnatal depression).
Worrying about long-term effects: If you have more than one major depressive episode, if depression was severe or long-lasting, if you have bipolar disorder (refer to Chapter 2), or your depression has never completely lifted, your doctor may recommend long-term medication to prevent recurrence. Although long-term use of antidepressant medication appears to have little
risk, some research highlights concerns about the lack of evidence proving the safety of taking antidepressants long-term.
Just saying no: Some people don’t want to take medication, for a variety of reasons, including religious and philosophical ones. If that’s you, please get help for your depression through cognitive behavioural or interpersonal therapy techniques. Depression does require treatment. If your mood doesn’t improve within a few months of self-help or if your depression is severe, do go to a mental health professional for assistance (refer to Chapter 4 for information on finding professional help).
Overcoming Depression For Dummies Page 33
