Are there any alternatives to anti-depressants for severe depression and anxiety?
Hi Dr, I am a 26 female and i think i have suffered from depression for about a period of close to 2 years. Not much interest in anything and just cant find a solution to it. Life is meaningless to me. Have tried visiting the psychologist and psychiatrist at SGH but they dont seem to help so have decided to stop going..Not too receptive to the idea of anti-depressants too as i afraid it might affect my work. I am really struggling with life each day not knowing when my depression/anxiety will go out full-blown. What should i do?
Thanks for your question, and I’m very sorry to hear that you are going through such a horrible time.
I can only imagine how tough it must be, as I had a really close doctor flat mate in London who had depression for over two years as well.
Before I answer further, I’m going to give the caveat that it’s next to impossible to offer advice about any psychiatric problem without seeing you face to face, or at the very least, having all the salient information about mood, sleep, suicidal ideation etc.
I’m going to assume off the bat that the diagnosis of depression has been established by the doctors you’ve seen. Contrary to what most people think, depression isn’t just a “mood problem”, but a full fledged medical condition diagnosed if you’ve experienced for longer than 2 weeks at least 1 of the following 3 key criteria of:
1) Low mood
2) Loss of interest and pleasure
3) Loss of energy
From what you’ve told me, it certainly sounds like you fulfil all the criteria.
There are some other medical conditions which can mimic depressive symptoms, e.g. Thyroid disorders etc – which is why it’s important that you’ve also had all of that ruled out by doctors (easily done with a few blood tests). Again, I assume your doctor has done all of these.
Moving on to your next point – you feel that “the psychologist and psychiatrist are not helping”. Yet, you mention that you’ve not been receptive to the idea of anti-depressants that they’ve suggested. I can understand why you don’t want to take medications, due to a fear of reliance and side effects. This is especially common in Singapore, I guess due to culture.
Having said that, how “effective” a doctor is, is also limited by how open you are to his treatment and treatment methods – the best surgeon in the world will be useless if you don’t agree to a potentially life saving treatment that he’s suggested.
Anti-depressants have a great evidence base. Having uncontrolled depression is far more debilitating than any side effect of an antidepressant that you may be worried about (according to my doctor flat mate with depression himself). There are also several different types that can be switched around by your doctor, depending on how well you tolerate each anti-depressant’s side effects.
They are also not addictive, although they do need to be stopped gradually to prevent rebound effects. The thing to bear in mind is that it will take time to work: weeks to months. So even if it feels like it’s not working, it’s crucial for you to persist. I know that’s easier said than done, when every day with depression can feel like a week!
In a nutshell, my suggestion, if I were in your shoes, would be to continue seeing your psychiatrist, and to persist with a trial of antidepressants as proposed by your psychiatrist. Things may get worse initially, but they will almost certainly get better after a few weeks. And you’ll have your psychiatrist and psychologist to support you every step of the way.
Thank you for your interesting question and I'm sure its a problem that many of us face these days. Sadly, you are not alone and if you scratch under the skin of most people, they will be having similar issues, but they may have been brave enough to seek help.
I won't try to replicate Dr Ethan's excellent post, but I was reading through and I thought I would add a line about exercise.
You see, exercise has been proven to be an effective treatment in mild-moderate depression, either as a stand alone treatment (https://jamanetwork.com/journals/jama/fullarticle/1881295) or in conjunction with others.
I know it seems like an epic amount of effort to exercise when things do not seem to be going right around you, but please do consider it.
I hope you start to feel better soon.