Depression has been recognised as a major health issue in Australia but there are concerns that some GP's are over prescribing medications as they struggle to cope. As Peta Newbold reports antidepressants work for many people but others may find they work better in combination with non-drug therapies.

When the Federal government announced its 'Beyondblue' initiative to boost awareness of depression and find ways for it to be detected and treated earlier, it was a strong signal that it was taking the problem seriously. Now the NSW government has decided to fund it's own scientific research with the 'Black Dog Institute', claiming that it is justified in going out on its own by the sheer scale of the problem.

Depression is the third most common illness managed by Australian GPs according to the Report on Government Services 2001, released in January this year, and it's a worldwide phenomenon. The World Health Organisation (WHO) has predicted that by the year 2020 depression will be the second biggest health problem in the world.

Antidepressant use in Australia

Another study published in the 6 November 2000 issue of the Medical Journal of Australia (MJA) found that the number of antidepressant prescriptions had risen from 5.1 million in 1990 to 8.2 million in 1998.

This may not mean that Australians are becoming more depressed. The authors suggested it might reflect an increased awareness of the problem, and the availability and promotion of new antidepressant medications.

On the other hand an editorial in the same edition of the MJA suggested it might also be a symptom of doctors practising 'time and cost efficiency'.

Too many antidepressant 'scripts?

Clinical psychologist Dr Timothy Sharp says that prescribing antidepressants is sometimes the only option for those GPs who have little more than 10-15 minutes with each patient.

"Medications are quick and easy to prescribe within the limited time available to most GPs and that time factor tends to rule out other treatment options that more adequately address the complex psychosocial issues that are often contributing to the depression. However medications do work for some people."

However it should be noted that many GPs use those ten or 15 minutes to refer their patient to a psychiatrist or psychologist for further analysis, rather than simply prescribing them drugs.

Facts about depression medication

Studies suggest that people don't like taking antidepressants and believe that they are addictive. That is not true and here are some more facts:

The two most common families of antidepressant medications are:

• The "Tricyclic antidepressants"
• The SSRIs or Selective Serotonin Reuptake Inhibitors.

Both of them basically work by changing the balance of neurotransmitters or chemical substances that transmit nerve impulses in the brain. The "Tricyclic antidepressants work by increasing the levels of certain neurotransmitters while the SSRIs, specifically increase serotonin, a brain chemical that regulates certain body processes. It does this by stopping its "reuptake" or reabsorption from the synapse, and as a result keeps more of the chemical in the synapse (the synapse is the junction where two cells communicate). Hence messages are able to flow freely and communicate with other nerve cells.

What works for you?

You may need to try different antidepressants to find the right one and it normally takes at least 3 weeks to see an improvement because the drug needs to accumulate in the brain to work.

Like any drug, antidepressants can have side effects, most of which will go away within a few weeks. If you find any side effects intolerable, see your doctor ASAP.

Medication misconception

Anti-depressants are non-addictive. The dose will usually be reduced slowly once your doctor believes you no longer need them. This needs to be closely supervised as you may find the depression returning, and need to continue on the original dose for a longer period.

Sometimes you may find some side effects when you are coming off the drug, such as vertigo. This is not because you are addicted; it is just your brain re-adjusting to the absence of the drug.

The non-drug approach

The editorial in the 6 November 2000 issue of the MJA states: "Any prescription of an antidepressant should be one component of a pluralistic approach, with the prescriber appreciating the patient's world and predicaments, and providing counselling to assist the patient to come to terms with depression's manifestations, consequences and 'meanings'.

The most effective of the non-pharmacological treatment options for depression is cognitive therapy (CT) or cognitive therapy combined with behaviour therapy, known as cognitive behaviour therapy (CBT).

• 'Cognitive' deals with the thought patterns that lead to depression by challenging them with statements like 'Just because you think it, it doesn't mean it's true', and questions like 'What is the worst thing that can happen?'
• The 'behaviour' part challenges behaviours that lead to depression. If say the person finds it difficult to get out of bed, the therapist will 'push' them into an activity schedule that might involve say, a regular walk to the shops.

Dr Sharp said, "This psychological treatment has been proven to be just as, if not more, effective as medications. It has no real side-effects and people who have undergone a course of CT or CBT are less likely to relapse."

How long will it take?

People who are depressed usually need between 10-20 sessions in total to get over depression, but it can sometimes take a little longer.

According to Dr Sharp one of several important differences between medications and cognitive therapy is that CT doesn't just medicate the depressive symptoms but it specifically teaches people active skills for dealing with difficult situations and problems.

He said, "Not only do they learn how to cope with their current problems but just as importantly, CT teaches people how to deal with other problems they might face in the future.

Are you depressed?

To find out there's a simple checklist you can fill in. It's located at the Beyond Blue site and is based on a manual used by health professionals to make a diagnosis of depression.If you feel you may be depressed the next step is to see your GP who may refer you to a psychiatrist or a psychologist for help.

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References:

Dr Timothy Sharp's 'Making Changes' website

MJA editorial page

MJA Recent trends in the use of antidepressant drugs in Australia, 1990-1998 site