‘I had been hold­ing on so tightly for so long, white-knuck­ling this alone my whole life’

Marie Claire (South Africa) - - HEALTH REPORT -

within a few days or weeks and can be tol­er­ated by most peo­ple. Dr Pi­eter Cil­liers, a psy­chi­a­trist in Cape Town, says the best thing a pa­tient strug­gling with side e ects or a lack of im­prove­ment can do is ‘com­plain, com­plain and com­plain’ to their doc­tor to en­sure a re-eval­u­a­tion and a pos­si­ble switch to a di er­ent med­i­ca­tion or dosage.

In­te­rior de­signer and yoga teacher Lisa Wel­ter, 38, started tak­ing an­tide­pres­sants when she was 16 ‘in an e ort to not want to kill my­self ’. She says some of the med­i­ca­tions came with side e ects, in­clud­ing tremors and a rapid heart­beat, but she has even­tu­ally found one that makes her feel ‘able to get out of bed’ in the morn­ing. She says she once skipped her med­i­ca­tion for four days and ‘crashed into a deep hole’ of de­pres­sion.

Jo­han­nes­burg psy­chi­a­trist Rykie Lieben­berg says it’s im­por­tant to be con­sis­tent when tak­ing an­tide­pres­sants. ‘They are a long term treat­ment for a se­ri­ous ill­ness. They should not be taken on a whim.’

The ques­tion is, then, how does a pa­tient know when he or she is ready to stop tak­ing an­tide­pres­sants? My psy­chi­a­trist asks why I would want to stop some­thing that is clearly work­ing; I tell him it is the de­sire to see what I am like in my pure state, unin uenced by chem­i­cals.

The Wall Street Jour­nal re­ports that pa­tients who’ve had one episode of de­pres­sion have a 50% chance of hav­ing a sec­ond, and those with two episodes have an 80% chance of an­other. Last year, the Jour­nal of Clin­i­cal Psy­chi­a­try pub­lished a re­view of 15 clin­i­cal tri­als which re­ported that tak­ing an­tide­pres­sants un­til a doc­tor rec­om­mends stop­ping could cut the risk of re­lapse in half.

For treat­ment du­ra­tion, the con­sen­sus is one year of treat­ment for a rst episode of de­pres­sion last­ing un­der six months. If a rst episode lasts be­tween six months and a year, Pi­eter rec­om­mends two years of treat­ment. How­ever, if the pa­tient has ex­pe­ri­enced symp­toms of de­pres­sion for over a year, the med­i­ca­tion should be taken on an on­go­ing ba­sis un­til the doc­tor de­cides it can be stopped.

An­toinette says most pa­tients who start tak­ing an­tide­pres­sants feel bet­ter within six to eight weeks – when many are tempted to stop their med­i­ca­tions. Pi­eter points out that the brain only starts to re­cover af­ter long-term treat­ment.

‘A pa­tient should dis­cuss with their doc­tor when the best time to come o their an­tide­pres­sants will be. This de­pends on the length of treat­ment, the num­ber and sever­ity of their pre­vi­ous episodes, the cur­rent stres­sors in their lives and their abil­ity to use other cop­ing strate­gies to help in emo­tional times,’ An­toinette says.

Af­ter a few more episodes of de­pres­sion and anx­i­ety, a new GP recog­nised there was a pat­tern to Grace’s episodes and rec­om­mended she see a psy­chi­a­trist. Af­ter a bar­rage of tests, Grace was di­ag­nosed with type II bipo­lar dis­or­der and is now on a mood sta­biliser and an an­tide­pres­sant. ‘I wish I’d got the bipo­lar di­ag­no­sis sooner,’ she says. ‘It was such an ex­treme re­lief. I had been hold­ing on so tightly for so long, white-knuck­ling this alone my whole life, and then I had some­one tell me it was all right and help me loosen my grip.’

While an­tide­pres­sants of­ten yield pos­i­tive re­sults, ex­perts rec­om­mend com­bin­ing them with talk ther­apy. ‘I com­pare the med­i­ca­tion to a plas­ter, which can be used to help the symp­toms quickly while you work through the un­der­ly­ing is­sues in talk ther­apy,’ says An­toinette. ‘Med­i­ca­tion can­not solve re­la­tion­ship prob­lems or x un­der­ly­ing per­son­al­ity char­ac­ter­is­tics and pat­terns that can lead to a re­cur­rence of de­pres­sion or anx­i­ety if not ad­dressed by some form of ther­apy.’

Au­thor and men­tal health ac­tivist An­drew Solomon agrees, writ­ing in his book The Noon­day De­mon: An At­las of De­pres­sion: ‘… it is ter­ri­bly dan­ger­ous to put talk­ing ther­apy on the back burner. Ther­apy al­lows a per­son to make sense of the new self he has ac­quired on med­i­ca­tion, and to ac­cept the loss of self that oc­curred dur­ing a break­down. You need to be re­born af­ter a se­vere episode, and you need to learn the be­hav­iours that may pro­tect against a re­lapse.’

As for the wine, I’ve dis­cov­ered that gen­er­ous quan­ti­ties mixed with my med­i­ca­tion leave me feel­ing anx­ious and de­pressed the fol­low­ing day, and as sweaty as a Bulls rugby player in sum­mer. I try to stick to the shot-glass prin­ci­ple nowa­days. When liv­ing life on an­tide­pres­sants, sacri ces need to be made, but I’m grate­ful I can now revel in the good times when, eight years ago, tak­ing a bath seemed over­whelm­ing.

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