clinical depression ?

Q.I've been diagnosed with clinical depression. 3 weeks ago I was put on sertaline and there was improvment until today when I feel as black as the ace of spades. Can anybody tell me much about clinical depression - medication generally and how I can help myself out of this dark hole. I have noticed that this group has a Cambridge meet. I am moving there next month.

A.Get therapy, even if you have to pay for it. The drugs are effective - after a delay of at least a month - but they do not cure depression on their own. They will, however, lift it off you for a while and this will save your life - not necessarily in the sense of averting suicide, but in the sense of giving you some life back. Be warned that the initial lifting of depression is accompanied by a re-emergence of character and a strengthening of resolve that allows some depressed people to finally make the decision and carry through their suicide. At the very least, the depression will lift unevenly and sporadically, and you'll *never* have felt so vulnerable. All of the problems associated with early-stage SSRI treatment, as you will have seen and heard about in the media, arise in a failure to engage in the *treatment* of depression by careful assessment, diagnosis, counselling and monitoring. Standard clinical practice in the UK is "Take the pills and bugger off" and the usual outcome is a lifting and stabilisation of mood that lasts for about a year, in which some patients get their lives back together and the rest will slip back into deep depression after wasting a window of opportunity in which therapy might have done some good. Which is another way of saying: Get therapy, even if you have to pay for it. Part of the character that re-emerges will the bit of you that's a right bastard. We all have it - some more than others - but that bit of you will have been depressed too, and as you get better it'll come back. Possibly more than you wanted! Be positive: people will stop treating you as a doormat, and if that adjustment is painful for them, so much the better. You'll get side-effects: everybody does. You won't like them, and maybe you'll have to tell your doctor that you can't live with it, and maybe he'll prescribe something else. Me, I was lucky and got nothing all that different to the physical symptoms of acute depression and anxiety... which I was getting already. Nausea, vomiting, sleep disturbances, the shakes, mood swings - nothing I could honestly say that I wasn't already enjoying, and arguably nothing even close to being worse than untreated depression. Which is the argument you'll use when you weigh up the disadvantages of the medication. As for the advantages... six to eight weeks is the time it'll take for the medication to settle down, and for any clear benefit to emerge. Sometimes, no clear benefit emerges. Sometimes an increase in dosage is required - note that GP's will rarely prescribe 100mg/day or more of Sertraline, and I didn't get the full benefit until a consultant raised the dosage to 150mg. Sometimes no benefit emerges at all and a different drug is required, and you're off on another six weeks' of side effects and delayed or nonexistent improvement. It's reassuring, in a way, that no two people react the same way to the meds: I like to think that everyone's mind is different. Bear that in mind when you wish for a clean and simple pill that'd clear out the depression the way antibiotics used to work on bacteria.- because you *will* find yourself wishing for that. We all do.

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