Medication can help depression but it won’t solve the underlying problem
Counselling, diet, yoga, self-help books... how to really beat mental health issues
DEPRESSION and anxiety are the two most common mental health presentations. Indeed, Aware, the organisation that supports awareness of and solutions to depression, estimates that 450,000 are affected in Ireland — the equivalent of one in ten people — at any one time.
On top of this are the tens of thousands who are restricted and exhausted by disabling anxiety. Often depression and anxiety travel together, just like a train with different coaches attached.
Irish doctors are not slow to prescribe medication. More than two million prescriptions for the top five anti-depressant and antianxiety drugs are written every year. In Co. Limerick prescriptions were written for 10 per cent of the total population — the highest rate in the country.
These statistics enter therapy rooms up and down the country when people have the ‘medication’ conversation with their counsellor or psychologist. It’s a very common discussion. What’s intriguing is that, as counsellors or psychologists, we don’t prescribe anything, yet the medication conversation is more common in the therapy room than in the surgery room of prescribing doctors. I think this is due to practicality — time is crunched with a GP but in the therapy room there is space to explore concerns.
I am often asked, ‘Eddie, what’s your stance on medication? Are you against it?’
I see medication like a life-jacket in stormy water, which can be helpful for some people. Counselling tries to figure out how you fell out of the boat and provides you with some strong swimming strokes that give you the choice to swim back to the boat or to new shores. The key point is that it’s important for someone to develop a healthy replacement for any life - jacket (defence) before removing it.
In my practice, there are three common questions that I am asked regarding medication.
1. Mary says: ‘I am on medication for anxiety and am planning to come off it. What do you think?’ IT’S wise to discuss this decision with your prescribing doctor. It would be very helpful for Mary to build her skill base to tackle her anxiety, for example by avoiding alcohol, exercising, addressing her diet, doing cognitive behavioural therapy (CBT) and practising yoga and mindfulness.
2. Joe says: ‘I have been given a prescription for depression. It is in my pocket. Should I start taking the pills?’ FOR many, starting medication can be difficult because they judge themselves as weak. Joe said to me, ‘I can’t believe it’s come to the point where I have to take medication, I thought I was a strong person.’ Many factors come into play here: ÷Is the depression severe? ÷ Have you experience of taking medication and, if so, what were the side-effects? ÷ Have you previously tried therapy? If so, what type? 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?
3. Joan says: ‘I was prescribed medication for my depression, but I have come off it. Was this a good idea?’ DON’T stop taking your medication as soon as you feel better without discussing it with your prescribing doctor. This can cause unpleasant withdrawal symptoms including agitation, crying spells, fatigue, depression, anxiety. Stopping abruptly is not advised. Ideally, choose a time when there are fewer stressful life events happening and plenty of stability at home, at work and in your relationships.
The key thing about medication is to have trusting and open conversations with your GP or prescriber and your therapist. Working in collaboration, all three individuals — the most important person being you — can reach the best solution.
I don’t believe in ‘forever medication’. There are excellent options that can tackle emotional difficulties and get you to a point where you can move towards mental health and then to mental fitness, where you are resilient.
Just as we are having conversations about reducing antibiotic use, we need to come up with alternatives to anti-depressants, especially for mild to moderate depression.
These i nclude the f ollowing: ÷Use self-help books for therapeutic purposes. Find Book Prescription Schemes in local libraries. ÷ Try an online CBT programme such as Moodgym ( moodgym.anu. edu.au). ÷Exercise. There is increasing evidence to support the role of exercise in overcoming mild to moderate depression. Walking, jogging, cycling, dancing or swimming all help to release ‘ feel- good’ hormones, called endorphins. ÷ Book a workshop. I am running Transforming Stress, Depression And Anxiety In Hope And Freedom on Saturday, May 23, in Portarlington, Co. Laois. Attendees will be asked no questions, they just sit and listen. For details, see the Dr Eddie Murphy Facebook page or email ÷ Reach higher. Medication alone is not enough. It may reduce symptoms, but it doesn’t address what’s keeping the problem going. Countless studies show that therapy works just as well as medication to treat depression and anxiety and, significantly, that it’s better at preventing a relapse.
Medication is something external. But imagine being able to carry all the tools you need to take on your depression or anxiety inside you.
That’s what my ethos is about. Tools that aren’t made of chemicals and that have no side-effects, that can empower you, give you confidence and that fundamentally say, ‘I trust you to be able to manage your life.’