Treatment

Firstly, try not to be alone at this time. Tell a family member or friend how bad you feel, and that you are having suicidal thoughts, and ask them to stay with you until you see your doctor. Get rid of any methods and stay away from the places you have considered for ending your life, so they do not continue to tempt you when you are feeling so defenceless. Consider getting out of the house, and going for a long walk or doing some activity outside the house, even going to a movie, only if it is safe for you to do so, and if it does not increase the temptation to harm yourself. If you are feeling desperate to stop the emotional pain and despair you feel, take any calming medication you have available, or has been prescribed by your doctor, in whatever dose is necessary but safe, so that you go to sleep for a few hours rather than harming yourself. A hot drink with the medication will help you to calm down and go to sleep more quickly.

It is very important you do not take very large doses of medication without medical advice, and it is very important also that you do not drink alcohol or take marijuana at this time, as they will further damage your ability to make clear decisions. Drinking heavily when you are distressed or when you have a depressive illness is a dangerous combination. Indeed, drinking heavily or smoking a lot of marijuana on a regular basis, makes you much more likely to have a whole range of problems in life and in particular affect your thinking. Often alcohol or drugs make the feeling of depression much worse than they were before you had these substances.

This depends on the severity of the illness, and on the predisposing factors. Mild illnesses may respond to discussing the stresses, and finding better ways to deal with them. Encouragement to think and act positively (cognitive therapy) may be helpful. Discussing relationship difficulties has also been shown by research to be effective (interpersonal therapy).

For more disabling or severe depressive illnesses, medication is usually necessary to repair the damaged chemistry, before dealing with the stresses and other factors. Deciding not to take medication at this stage runs the risk of prolonging the illness and the suffering. There is also recent research indicating the importance of curing depressive illness as soon as possible, to lessen the risks of it becoming resistant or relapsing. It is important to take adequately strong doses of antidepressants, and to remain on the medication for some months after recovery. Antidepressants are not addictive (unlike tranquillisers in some cases), and can only bring an individual’s mood back to a normal level (they are not "uppers").

A little known fact is that the chemical changes of depressive illness can be measured in about fifty per cent of cases by a blood test. This discovery was made by an Australian Psychiatrist, Dr Bernard Carroll, in the University of Melbourne about twenty years ago. Your doctor can order this blood test, known as the Dexamethasone Suppression Test. (See diagnosis)

With regard to treatment, the fastest and most effective treatment for depressive illness is the use of prescribed antidepressant medication. Prescription antidepressants are not addictive, as they do not produce immediate changes in how you feel, which all addictive agents do. In other words, antidepressants are not uppers and are not tranquillisers, but are slowly working antidotes to the chemical changes of depressive illness. Antidepressants were discovered by accident (as was Penicillin), nearly 50 years ago. Antidepressants have been used worldwide by millions of people since then, without any problem with addiction in that time.

Unfortunately (especially if you stop your antidepressants early), you have a 50% chance of it recurring in the future, so watch for early signs, such as memory or concentration problems, or severe tiredness.

The most important role is to understand the illness and indeed the suffering that goes on under the seemingly healthy surface in patients with depressive illness. You cannot give answers to the illness, but a vital aid to recovery is to express understanding and sympathy, while reminding the depressed person that they will recover, despite their own pessimism and fears.

The idea that you or someone close to you has an illness which is not visible, and does not respond to simply being logical, can be very frustrating and perhaps frightening. Unfortunately, people still do not fully understand depressive illnes, just as people did not understand epilepsy and TB before medical science could explain it. In time, depressive illness will also lost its stigma, but meanwhile, rumours and fears will continue about the illness and its treatment.

We still do not fully understand how antidepressants work, but we do know that any antidepressant, will cure about 75% of depressive illnesses. Yes, 3 out of 4 cases of depressive illness will be cured by any antidepressant. If you do not respond or do not recover completely, you may need a higher dose, or you may need to be prescribed an alternative antidepressant by your doctor. At present we cannot predict which medication will suit any individual patient, so the choice is based on the range of symptoms you are suffering, and the usual side-effects of various antidepressants. New antidepressants developed in the past 10 years have very few side-effects in most people.

If you have depressive illness, and your doctor or non-medical practitioner do not offer you the benefits of antidepressant medication in addition to whatever other treatment they provide, you should discuss this issue with them. Treating depression without medication is like treating diabetes without insulin, especially when it is severe.

Literally billions of dollars of research worldwide over the past 50 years have produced antidepressant medications which cure the vast majority of depressive illnesses quickly, are non-addictive and have few side-effects, so you need to be clear about why you are not being offered such medications. Keep in mind that non-medically qualified therapists are not allowed to prescribe medication for you, even though they often provide other very useful forms of therapy. However, research also repeatedly shows that the combination of antidepressants with certain types of therapy produces better treatment outcomes than either therapy or medication used alone.