DEPRESSION - Part 3

The first phase is one of comforting patients and helping convalesce.

Once the patient has recovered sufficiently, the second phase begins this involves using psychological therapies to help begin re-engaging with the world, gradually increasing their involvement in a wide range of activities and their interactions with other people.

"Drugs can be helpful for some people in the process of regrouping – telling them this drug is for short-term use to help you through a bad time is more honest than saying you've got depression and we are going to treat it through this drug." he said.

White -Hickie would prefer that other treatments were more readily available, he is relatively relaxed about the use of anti-depressants.

"People who don't use drugs for their depression tend to self-medicate anyway," he said. "Usually they use alcohol or paracetamol, sometimes they use illegal drugs. So anti-depressant drugs can actually help people stop abusing these other more dangerous drugs."

For all the problems anti-depressants can cause in a minority of patients, it should be recognised that they have allowed many people to rebuild their lives and have even saved lives by causing some people to cease considering suicide, Hickie said.

"The modern SSRI (selective serotonin reuptake inhibitor) drugs do work well for most depressed adults," he said.

"About 5 to 10 per cent of people taking these drugs will actually get more anxious or more agitated, and if this happened these patients should contact their doctors because the drugs may not be suitable for them. But for most people the side effects are not major and they go away after the first few weeks."

However, Hickie says doctors should be cautious about prescribing anti-depressant drugs for children and adolescents. He agrees with Jureidini that psychological therapies should be more widely used, but says most people can't afford them.

"Patients can't afford $100 an hour to see a psychologist or psychiatrist," Hickie said.

"Doctors and patients are not eager to resort to drugs but the alternatives aren't available.

"We seriously need governments to raise awareness and availability of other therapies, such as counselling and cognitive behavioural therapy."

Given widespread concerns over the use of antidepressants in young people and the growing rates of depression among the adolescents, this is an increasingly serious public health issue, he said.

"It's a real struggle to get health ministers or health department to focus on this

problem."

Nalin Singh, a physician and geriatrics specialist at Sydney's Royal Prince Alfred Hospital and Balmain Hospital, agrees that drugs should not be the first course of treatment for most patients, but his emphasis is on physical rather than psychological therapy.

"High-intensity exercise is as effective as drugs at fighting depression, but it doesn't have the negative side effects in fact all its side effects are positive," Dr Singh said.

Singh has now conducted two studies on the effects of exercise in treating depression in the elderly and believes the results are relevant to depressed people of all ages.

In 1997 he published a study involving 32 people, over 60 who had clinical depression.

Seventeen were randomly selected for weight-training, with three 45 minute sessions a week over 10 weeks, followed by another 10 weeks of unsupervised weight-training.

The control group of 15 attended three 45-minute health education classes a week. After 20 weeks, 80 per cent of the exercise group were no longer clinically depressed, compared with 38 per cent of the control group.

By James Charles

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