Medication
- Jake K. Newell
- Aug 15, 2019
- 8 min read
Warning: This post addresses the use of medication as a means of coping with depression and/or anxiety. Please use your medication sensibly and as directed/prescribed by your doctor. This post is not intended to be treated as medical advice; it merely explains different types of medication and my experiences. The best people to consult are those who are medically trained in the field.
One thing that I've been planning on posting about is medication, and its relevance to conditions such as depression and anxiety. Over the past few years, there has been an increase in the use of medication for depression and anxiety, which is most likely linked to two things: an increase in diagnosis and a better understanding/awareness of the conditions in question. In this piece, I'll explain what medication(s) is available for both conditions, before turning my focus on anti-depressants in particular. I'll explain how anti-depressants work and provide some general tips of things to consider when taking them. Once again, I'll then turn to my experiences of medication and the relationship it has for my anxiety and depression.
"No, it's not what I want but it had to be, I spent 6 months just recharging my battery, imagine me quitting, what a travesty that'd be" - Mike Shinoda (Lift Off)
What medications (or alternatives) are available?
So the first big question is this: what medication is available to help with anxiety and depression?
Anti-Depressants
Anti-depressants are, arguably, one of the most commonly prescribed medication for mental health problems.
Anti-depressants are a type of medicine used to treat clinical depression.
They can also be used to treat a number of other conditions, including: obsessive compulsive disorder, (OCD) generalised anxiety disorder, and post-traumatic stress disorder (PTSD).
There are several types of anti-depressants, but for the purposes of this particular post, I won't dive into them as they don't really further the piece.
For a fantastic summary of each type of anti-depressants available in the UK, helpfully supplied by MIND, please click here.
To compare (and if there is one link you click on today, I recommend it be this one) different types of anti-depressants, click here. The linked page contains comparison tables, presenting all anti-depressants in the UK by: name and key characteristics, type of antidepressant, length of half-life, available form, and dietary information.
Lithium
Usually used if a patient has tried several different anti-depressants and seen no improvement. Much like anti-depressants, Lithium is usually used in conjunction with other treatments. It is crucial that once you start taking Lithium, you do not stop without speaking to your doctor first, as per the NHS.
There are issues surrounding the use of Lithium: should the level of Lithium in your blood become too high, it can become toxic and therefore dangerous.
Patients are often required to undertake blood tests every few months to check their lithium levels. Furthermore, your kidney and thyroid function will also need to be checked during this time.
During the time a patient is taking Lithium, they will need to avoid eating a low-salt diet. The reason for this is simple: this can also cause Lithium to become toxic. For any concerns, do speak to your GP.
Electric Shock Treatment
Sometimes, electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments have failed.
During ECT, you'll first be given an anaesthetic and medicine to relax your muscles.
Then you'll receive an electric current to your brain through electrodes placed on your head. The frequency usually sees ECT being administered twice a week for 3 to 6 weeks.
Recent studies suggest it may help reduce connections in an area of the brain linked to depression. For most people, ECT is good for relieving severe depression, but the beneficial effect tends to wear off after several months.
It is crucial to understand that some people do get very unpleasant side effects. However, these risks need to be balanced against the risks of other treatments and the effects of not treating depression.
Therapy
A running theme in this blog is the importance and usefulness of therapy.
It is possible to use Cognitive Behaviour Therapy (CBT) and Counselling as a means of addressing anxiety and depression.
For further information on the types of therapy available, please do visit E's post, here.
Exercise
The science behind this is relatively straightforward: exercise helps boost levels of chemicals in the brain, which can lift your mood. Exercising on a regular basis can therefore boost self-esteem and confidence, which can in turn, help to relieve symptoms of depression.
I've written about how I've found sport useful in the past, which can be accessed, here.
Anti-Depressants - How do they work?
Here's an interesting fact for you to start off with: according to the NHS, it's not known exactly how antidepressants work. The main line of thinking is this (I'll try to keep this as simple as possible):
Anti-depressants work by increasing levels of chemicals in the brain called 'neurotransmitters'.
Some of these so-called 'neurotransmitters', have significant links to our moods and emotions.
It is thought that these 'neurotransmitters' are able to assist in regulating our bodies and help to alter our moods.
There is a significant overlap in the application of anti-depressants to both depression and anxiety. As has been noted in previous posts, anxiety and depression generally go hand in hand, so it's helpful to know that they can be addressed together. For depression: the anti-depressants in question might help to lift your mood so you feel more able to do all those things. For anxiety sufferers: the anti-depressants in question could help you feel: calmer, more able to deal with other problems, and more able to benefit from alternative treatments.
Now, it is important for us to understand that anti-depressants can treat the symptoms of depression. It does not follow that they always address its causes. It is because of this, anti-depressants are used as part of a combination of treatments, such as therapy (click here to see my experiences; and click here to see E's fantastic breakdown on the types of therapy) to treat more severe cases of depression and anxiety.
General Tips
I'll cover the two big things that are probably on everyone's minds here: effectiveness and the course of treatment.
Starting with the effectiveness of anti-depressants, you can appreciate that everyone is different and therefore, the reactions to mainstream medications may differ from person to person. There is research which suggests anti-depressants can be helpful for people with moderate or severe depression. Usually, anti-depressants are not recommended for mild depression, unless other treatments such as therapy have failed to address the problem. For a ballpark figure of effectiveness, the Royal College of Psychiatrists estimates that as many as 50 to 65% of people treated with an anti-depressant for depression will see an improvement. It's therefore, not guaranteed that you'll see an improvement, but there is a considerable chance they will help. It is also worth remembering that anti-depressants are not the only option available.
Secondly, the length of treatment and dosages. Usually, anti-depressants are taken as a tablet, to be consumed with water. My personal experience (and a few others on the same medication as I, Sertraline, have found taking the medication dry can cause a heartburn-like sensation). When anti-depressants are prescribed, you'll start on the lowest possible dose, the reason for this is practical: a gradual increase is required. There is also a bit of lag time with anti-depressants and feeling their presence. A lot of people fall into this trap and are surprised when they're told anti-depressants usually take between 1 or 2 weeks (without missing a dose) before their benefits are noticeable. As per the NHS, it's important not to stop taking them if you get some mild side effects early on, as these effects usually wear off quickly. Usually, a course of treatment lasts at least 6 months in length. Many people have periodic reviews (I, myself am one) to touch base to ensure that there are no issues. It should also be noted that for some people with recurrent depression, they may be advised to take anti-depressants indefinitely. If you are looking to come off of anti-depressants or lowering your dosage, it's really important you speak to your GP first before doing this: a gradual decrease is needed.
My Experiences
As many of you know, I was diagnosed with depression and anxiety in 2017. Immediately after my diagnosis, I was prescribed with an anti-depressant called Sertraline. I've been on the lowest dosage since then, which is 50mg a day. I'll admit, there have been times where I've tried to resist taking anti-depressants and there are also times where I've discussed increasing my dosage.
I'll start with the times I've tried resisting them. Basically: don't. Don't try and put on a brave face by ignoring the medication you need to take. It doesn't work. Trust me, I've been there, done that, and gotten the t-shirt (so to speak). I tried out of some stupid sense of pride that I didn't need to take them and that they were the sign of weakness. There were two major consequences of that decision: first, I relapsed back into my old ways very quickly. That in itself was bad enough, because as you'll appreciate from my post explaining what anxiety and depression are, they're both pretty dark places to find one's self in. In retrospect, I don't think the circumstances I found myself in helped the situation in terms of having finished the Bar exams and just coming out of my first significant relationship. Secondly, and more worryingly for me at the time, I actually experienced withdrawal symptoms (further info by anti-depressant, here). This is a well-documented phenomenon. At the time, I didn't realise that like going on anti-depressants, coming off of them required patience. Patients are generally advised to avoid quitting anti-depressants immediately, and you really do have to take your time. For me, it felt like a massive relapse, I went through each of the following (some still occur, but much less frequently): poor concentration, depressive episodes, anxiety attacks, crying spells, a sense of feeling detached and a messed up sleep cycle. Needless to say, I managed to 'get a grip' and start taking the medication. I've found by taking my dose every day, the conditions are well maintained and I'm generally less freaked out over things.
There have been other times, more recently so, that I've spoken with the relevant medical and psychological professionals about a potential increase in my dosage from 50mg a day to 100mg a day. There was a time I was set on it, but now, having settled into a bit of a rhythm, I'm reconsidering that move. The first thing that worries me is the potential side effects. I have been warned by my doctor that the increase could potentially see some negative fallout. I completely get that doctors have to warn you about that in order to avoid all sorts of legal issues (don't worry, I won't be diving into law here, but this may make an interesting point for my law blog!), but it did make me think. At the moment, I'm writing my dissertation. I didn't want to jeopardise my grades by risking the occurrence of adverse side effects; I've made the decision to wait until all of the papers are in, then, I'll make the decision. I'd recommend anyone considering doing the same to also think about whether there are important things coming up that you're not prepared to sacrifice; all of those factors need to be considered. The second thing that worried me is what I would say is more of an ungrounded fear: I'm terrified of the prospect of feeling nothing as a result of the medication. I really don't know how to explain it apart from the fact that in life, there are down moments for all of us and we need to be able to feel negative emotions because they are natural. Without feeling bad, we can't gauge what feeling good is like. That said, I'm definitely not advocating feeling awful 24/7. I think, if anything, it's a bit of indecisiveness in my mind at the moment.
Before I round off, as usual, here are some fantastic links which I hope will be of use to you over the course of your lifetimes:
Remember: you are a beautiful human being. You are loved. You matter. You have so much good that you can offer this world.
Until next time,
J x
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