Aware, the organisation that supports solutions to depression, estimates 450,000 people are affected in Ireland, or one in 10, at any one time.
Tens of thousands more are restricted and exhausted by disabling anxiety, the most common mental health difficulty along with depression.
Often depression and anxiety go together like a train engine and carriage. The challenge as a psychologist is to figure out which one is leading the train and target treatment.
When it comes to prescribing medication in Ireland, we are not slow. Over two million prescriptions for the top five anti-depressant and anti-anxiety drugs are written per year. In Limerick, prescriptions were written for 10 percent of the total population, the highest in the country.
This affects the therapy room. As counsellors or psychologists we don’t prescribe medication, but I think the ‘medication’ conversation is more common in the therapy room than in the surgery of the prescribing doctor. I figure this is because of practical reasons as the GP’s time is very short.
I see medication as a life-jacket in stormy water. Counselling tries to figure out how you fell out of the boat and give you some strong swimming strokes so you can swim back to the boat or on to new shores.
However it is important to develop a healthy replacement for medication before removing that life-jacket.
In my practice, three common queries pop up.
“I am on medication for anxiety and want to come off it. What do you think?”
Discuss this with your prescribing doctor. It is helpful to first build skills to tackle anxiety, ie not drinking, exercising, yoga, nutrition, CBT and mindfulness.
“I have been given a prescription for depression tablets. Should I start on them?”
Starting medication can be difficult, as many people sit in judgment of themselves as being weak. Many factors come into play.
Is the depression within the severe range?
Have you taken medication before and, if so, what were the side-effects?
Have you tried therapy before? Was it passive counselling in the talk-and-listen format or dynamic active psychotherapy that gave you lifelong skills?
What strategies have you tried to manage your depression?
If you decide to go on anti-depressants, will you also be committing to therapy?
The third common question I get is “I was prescribed medication for my depression, and I have come off it. What do you think?”
Don’t stop your medication as soon as you feel better, without first discussing it with your doctor. It can cause unpleasant withdrawals symptoms, such as agitation, crying spells, fatigue, depression. Ideally choose a time when there is a lot of stability in your home, work and relationships.
The key with medication is to have trusting and open conversations with your GP and your therapist,to figure out how you “fell out of the boat” and to develop strong swimming strokes.
I don’t believe in ‘Forever medication’. Just as society is talking about reducing antibiotic use, we need to have conversations about alternatives to antidepressants particularly for mild to moderate depression.
They can include:
Self-help books such as Prescription Schemes, in your local library.
Online cognitive behavioural therapy programmes. - see www.moodgym.anu.edu.au
Any exercise from walking to dancing helps to release endorphins, our body’s ‘feel good’ hormones.
Avoiding alcohol. Alcohol is a depressant, digging a deeper pit for your depression.
Medication alone is not enough. It may reduce the symptoms of depression and anxiety, but it doesn’t address what’s keeping the problem going. Therapy is just as effective and is better for preventing relapses once treatment ends. Medication is external to you. But imagine being able to carry all the tools needed to take on your depression or anxiety inside of you. Tools that aren’t made of chemicals and have no side-effects, that empower you to manage your life.