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REPOST: FAQ Part 3[5]

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Archive-name: alt-support-depression/faq/part3
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07

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Part 3 of 5

  **Medication** (cont.)
   - If an antidepressant has produced a partial response, but has not
     fully eliminated depression, what can be done about it?

  **Electroconvulsive Therapy**
   - What is electroconvulsive therapy (ECT) and when is it used?
   - Exactly what happens when someone gets ECT?
   - How do individuals who have had ECT feel about having had the
   - How long do the beneficial effects of ECT last?
   - Is it true that ECT causes brain damage?
   - Why is there so much controversy about ECT?

  **Substance Abuse**
   - May I drink alcohol while taking antidepressants?
   - If I plan to drink alcohol while on medication, what precautions
     should I take?
   - What's the relationship between depression and recovery from
     substance abuse?
   - What does the term "dual-diagnosis" mean?
   - Is it safe for a person recovering from substance abuse to take
   - How do you know when depression is severe enough that help should be

  **Getting Help**
   -Where should a person go for help?
   -Where can I find help in the United Kingdom?
   -Where can I find out about support groups for depression?
   -How can family and friends help the depressed person?

  **Choosing A Doctor**
   -What should you look for in a doctor? How can you tell if he/she really
    understands depression?

   - How may I measure the effects my treatment is having on my

Medication (cont.)
Q. If an antidepressant has produced a partial response, but has not
   fully eliminated depression, what can be done about it?

   There are many techniques to help an antidepressant work more
   completely. The simplest is to increase the dose until relief is
   experienced or side- effects are severe. If the dose can not be
   increased, lithium can be added to any antidepressant to augment its
   effect. With all antidepressants it is possible to add small doses of
   stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or
   dextroamphetamine (Dexedrine) to augment the antidepressant effect.
   Selective serotonin re-uptake inhibitors often work better when small
   doses of desipramine (Norpramin) or nortriptyline (Aventyl and
   Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel)
   may be used to augment any antidepressant. At times combinations of
   these techniques may be utilized.

Electroconvulsive Therapy

Q. What is electroconvulsive therapy (ECT) and when is it used?; 

   ECT is an effective form of treatment for people with depressions and
   other mood disorders. ECT may be used when a severely depressed
   patient has not responded to antidepressants, is unable to tolerate
   the side effects of antidepressants, or must improve rapidly. Some
   depressed people simply do not respond to antidepressants or mood
   controlling drugs, and ECT is a way for such people to be effectively
   treated. ECT is utilized in the treatment of both mania and
   depression. There are some people who because of severe physical
   illness are unable to tolerate the side-effects of the medications
   used to treat mood disorders. Many of these people can be
   successfully be treated with ECT. Pregnant women and people who have
   recently had heart attacks can be safely treated with ECT. Because of
   time pressure regarding occupational, social, or family events, some
   people do not have the time to wait for antidepressants or mood
   regulating medications to become effective. As ECT quite regularly
   brings about improvement within two or three weeks, people who are
   under such time pressure are also excellent candidates for ECT. 

Q. Exactly what happens when someone gets ECT?

   The physician must fully explain the benefits and dangers of ECT, and
   the patient give consent, before ECT can be administered. The patient
   should be encouraged to ask questions about the procedure and should
   be told that consent for treatments can be withdrawn at any time, and
   in the event that this happens, the treatments will be stopped. After
   giving consent, the patient undergoes a complete physical
   examination, including a chest x-ray, electrocardiogram, and blood
   and urine tests. A series of ECTs usually consists of six to twelve
   treatments. Treatments can be administered to either in-patients or
   out-patients. Nothing should be taken by mouth for 8-hours prior to a
   treatment. An intravenous drip is started and through it medications
   to induce sleep, relax the muscles of the body, and reduce saliva are
   given. Once these medications are fully effective, an electrical
   stimulus is administered through electrodes to the head. The
   electrical stimulus produces brain wave (EEG) changes that are
   characteristic of a grand mal seizure. It is believed that this
   seizure activity leads to the clinical improvement seen after a
   series of ECT. About 30-minutes after the treatment the patient
   awakens from sleep. While confused at first, the patient is soon
   oriented enough to eat breakfast, and return home if the treatments
   are being done in an outpatient setting.

Q. How do individuals who have had ECT feel about having had the

   In studies of people treated with ECT it has been found that 80% of
   such people report that they were helped by the treatments. About 75%
   say that ECT is no more frightening than going to the dentist.  

Q. How long do the beneficial effects of ECT last?; 

   While ECT is a highly successful way of helping people come out of
   depressions, it has to be followed by antidepressant therapy. If
   antidepressants are not administered after a series of ECTs, there is
   a 50% relapse rate within 6-months.  

Q. Is it true that ECT causes brain damage?; 

   There is no scientific evidence that ECT causes brain damage. A woman
   who had over 1,000 ECT died of natural causes, and her brain was
   examined for evidence of ECT-induced brain damage. None was found.
   ECT does cause memory problems. These memory problems may take a
   number of months to clear. A small number of people who have received
   ECT complain of longer lasting memory problems. Such problems do not
   show up on psychological tests, it is not clear what causes them.  

Q. Why is there so much controversy about ECT? 

   There is little controversy about ECT among psychiatrists. Much of
   the opposition to ECT seems political in nature and originates in the
   anti-psychiatry groups that oppose the use of Ritalin for the
   treatment of children with attention deficit disorder, and who oppose
   the use of Prozac for the treatment of depressed people.

Substance Abuse

Q. May I drink alcohol while taking antidepressants?

   There are a number of problems with the mixture of alcohol and
   antidepressants. First, antidepressants may make you especially
   susceptible to the intoxicating effects of alcohol. Second, if you
   drink more than three or four drinks a week, the effects of alcohol
   may prevent the antidepressants from working. Many people who seem
   not to benefit from antidepressants, do so, if they reduce or
   eliminate their intake of alcohol. Third, you may be taking along
   with the antidepressant a drug such as clonazepan (Klonopin) with
   which one should not drink at all.

Q. If I plan to drink alcohol while on medication, what precautions
   should I take?

   There is much misinformation about drinking while on anti-
   depressants. Alcohol can prevent antidepressants from being
   effective. This is not so much because it interferes with the
   absorption of antidepressants, it is because of the effects of
   alcohol upon brain chemistry. Antidepressants can also increase one's
   susceptibility to the intoxicating effects of alcohol. Also, both
   alcohol and some anti- depressants (especially Wellbutrin) increase
   the possibility of seizures.

   If you are determined to drink despite taking antidepressants you
   should discuss the matter with your psychiatrist. If you get
   permission you might want to determine the extent to which the
   medication has made you more sensitive to the alcohol. You might
   start by seeing what are the effects of half a glass of wine. You
   might then experiment with a full glass. Remember, a 4 oz glass of
   wine, a 12 oz bottle of beer, and 1 oz of "hard stuff" all contain
   the same amount of alcohol. 

Q. What's the relationship between depression and recovery from
   substance abuse?

   It is not unusual for people who have recently been withdrawn from
   alcohol, or other abusable drugs to become depressed. These
   depressions are often self-limited, and clear in about 8-weeks. If
   depression has not cleared by the end of that period, anti-depressant
   therapy should be started.

Q. What does the term "dual-diagnosis" mean? 

   Dual-diagnosis is a phrase used to indicate the combination of
   substance abuse and a psychiatric disorder. A path to alcohol or
   other substance abuse is an attempt to self- medicate uncomfortable
   symptoms such as depression, anxiety, agitation or feelings of
   emptiness. The psychiatric disorders that cause such symptoms are
   often diagnosed in substance abusers.

Q. Is it safe for a person recovering from substance abuse to take

   People recovering from substance abuse can safely take many kinds of
   psychiatric drugs. Most psychiatric drugs are unable to be abused.
   The best evidence for this is that there are not street markets for
   such drugs. On the other hand, The benzodiazepines (diazepam
   [Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
   psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
   [Desoxyn], and Ritalin [methylphenidate]) are quite abusable.

   For people active in AA please read the pamphlet "The AA
   Member--Medications & Other Drugs." This outlines AA's official
   attitude toward medication--that it is necessary for certain
   illnesses including depression. Too many depressed people who have
   been talked out of taking antidepressants by members of their AA
   groups have killed themselves as a result.

Q. How do you know when depression is severe enough that help should be

   Professional help is needed when symptoms of depression arise without
   a clear precipitating cause, when emotional reactions are out of
   proportion to life events, and especially when symptoms interfere
   with day-to-day functioning.. Professional help should definitely be
   sought if a person is experiencing suicidal thoughts. 

Getting Help

Q. Where should a person go for help?

   If you think you might need help, see your internist or general
   practitioner and explain your situation. Sometimes an actual physical
   illness can cause depression-like symptoms so that is why it is best
   to see your regular physician first to be checked out. Your doctor
   should be able to refer you to a psychiatrist if the severity of your
   depression warrants it.

   Other sources of help include the members of the clergy, local
   suicide hotline, local hospital emergency room, local mental health

Q. Where can I find help in the United Kingdom?

   The following are places one might find help in Great Britain:

      Depressives Associated 
      PO Box 1022
      London SE1 7QB

      Depressives Anonymous
      36 Chestnut Avenue
      HU17 9QU

      MIND (National association for mental health)
      22 Harley Street
      London W1N 2ED

   To find a psychiatrist/ psychologist near you, call or write:
      Royal College of Psychiatrists
      17 Belgrave Square
      London SW1X 8PG

Q. Where can I find out about support groups for depression?

   The following is a list of national organizations dealing with the
   issues of depression. Please note: Model groups are not national
   organizations and should be contacted primarily by persons wishing to
   start a similar group in their area. Also, please enclose a
   self-addressed stamped envelope when requesting information from any
   group. When calling a contact number, remember that many of them are
   home numbers, so be considerate of the time you call. Keep in mind
   the different time zones.

   [Reprinted from The Self-Help Sourcebook, 4th Edition, 1992. American
   Self-Help Clearinghouse, St.Clares' Riverside Medical Center,
   Denville, New Jersey 07834]

   **Depressed Anonymous** Int'l. 8 affiliated groups. Founded 1985.
   12-step program to help depressed persons believe & hope they can
   feel better. Newsletter, phone support, information & referrals, pen
   pals, workshops, conference & seminars. Information packet ($5),
   group starting manual ($10.95).Newsletter. Write: 1013 Wagner Ave.,
   Louisville, KY 40217. Call Hugh S. 502-969-3359.

   **Depression After Deliver** National. 85 chapters. Founded 1985.
   Support & Information for women who have suffered from post-partum
   depression. Telephone support in most states, newsletter, group
   development guidelines, pen pals, conferences. Write: PO. Box 1281,
   Morrisville, PA 19067. Call 215-295-3994 or 800-944-4773 (to leave
   name & address for information to be sent).

   **Emotions Anonymous** National. 1200 chapters. Founded 1971.
   Fellowship sharing experiences, hopes & strengths with each other,
   using the 12-step program to gain better emotional health.
   Correspondence program for those who cannot attend meetings. Chapter
   development guidelines. Write: PO. Box 4245, St. Paul, MN 55104. Call

   **National Depressive & Manic-Depressive Association**  National. 250
   chapters. Founded 1986. Mutual support & information for
   manic-depressives, depressives & their families. Public education on
   the biochemical nature of depressive illnesses. Annual conferences,
   chapter development guidelines. Newsletter. Write: NDMDA, 730
   Franklin, 501, Chicago, IL 60610. Call 800-82-NDMDA or 312-642-0049.

   **National Foundation for Depressive Illness**. An informational
   service, which provides a recorded message of the clear warning signs
   of depression and manic-depression, and instructs how to get help and
   further information. Call 1-800-239-1295. For a bibliography and
   referral list of physicians and support groups in your area, send $5
   (if you can afford it) and a self-addressed, stamped business-size
   envelope with 98 cents postage to, NAAFDI, PO. Box 2257, New York, NY

   NOSAD (**National Organization for Seasonal Affective Disorder**)
   National. groups. Founded 1988. Provides information & education re:
   the causes, nature & treatment of Seasonal Affective Disorder.
   Encourages development of services to patients & families, research
   into causes & treatment. Newsletter. Write: PO. Box 451, Vienna, VA
   22180. Call 301-762-0768.

   (Model) **Helping Hands** Founded 1985. A comfortable & homey
   atmosphere for people with manic-depression, schizophrenia or clinical
   depression who seek an environment that makes them more aware of
   themselves & eliminates a negative attitude. Group development
   guidelines. Write: c/o Rita Martone, 86 Poor St, Andover, MA 01810.
   Call 508-475-3388.

   (Model) MDSG-NY (**Mood Disorders Support Group, Inc.**) Founded
   1981. Support & education for people with manic-depression or
   depression & their families & friends. Guest lectures, newsletter, rap
   groups, assistance in starting groups. Write: PO. Box 1747, Madison
   Square Station, New York, NY 10159. Call 212-533-MDSG.

Q. How can family and friends help the depressed person?

   The most important things anyone can do for depressed people is to
   help them get appropriate diagnosis and treatment. This may involve
   encouraging a depressed individual to stay with treatment until
   symptoms begin to abate (several weeks) or to seek different
   treatment if no improvement occurs. On occasion, it may require
   making an appointment and accompanying the depressed person to the
   doctor. It may also mean monitoring whether the depressed person is
   taking medication. 

   The second most important thing is to offer emotional support. This
   involves understanding, patience, affection, and encouragement.
   Engage the depressed person in conversation and listen carefully. Do
   not disparage feelings expressed, but point out realities and offer
   hope. Do not ignore remarks about suicide. Always report them to the
   doctor. Invite the depressed person for walks, outings, to the
   movies, and other activities. Be gently insistent if your invitation
   is refused. Encourage participation in some activities that once gave
   pleasure, such as hobbies, sports, religious or cultural activities,
   but do not push the depressed person to undertake too much too soon. 

   The depressed person needs diversion and company. but too many
   demands can increase feelings of failure. Do not accuse the depressed
   person of faking illness or laziness or expect him or her to "snap
   out of it." Eventually, with treatment, most depressed people do yet
   better. Keep that in mind, and keep reassuring the depressed person
   that with time and help, he or she will feel better. 

Choosing A Doctor

Q. What should you look for in a doctor? How can you tell if he/she
   really understands depression?

   If you are looking for a psychopharmacologist to prescribe
   medications to help control your depression there are a number of
   things to check. If you are in psychotherapy, it is important to ask
   prospective doctors about their opinions on the psychotherapeutic
   treatment of depression. Psychopharmacologists who are hostile to
   psychotherapy are difficult to deal with while you are in therapy.

   It is always legitimate to ask any professionals you are thinking
   about seeing regularly about their understanding of depression, their
   beliefs about the causes of depression and their philosophy of
   treatment. You might ask about how often the prospective doctor has
   worked with people who have had your particular variety of
   depression. If you have a rapidly cycling Bipolar depression, for
   example, you should seek a doctor who has much experience dealing
   with people who have this problem. Prior to the first visit it is
   important to clarify with the doctor or the secretary the fee of the
   initial and subsequent visits, the doctor's policy regarding
   missed and changed appointments, whether the doctor will accept
   assignment from insurance companies. If you have Medicare or
   Medicaid it is important to make sure that the doctor sees people
   with these forms of medical coverage.

   Another aspect of the style of doctors is the extent to which they
   include their patients in the decision-making process. You might ask
   "How do you go about deciding which treatment is right for me?" See
   if you are comfortable with the method the doctor describes. Much can
   also be learned from how doctors respond to questions such as these.
   There is much difference between a doctor who welcomes such questions
   and answers them fully and one who is annoyed by them and answers
   them superficially.


Q. How may I measure the effects my treatment is having on my depression?

   If one completes the following scale each week, and keeps track of the
   scores, one would have a detailed record of one's progress.

Name  _________________________                           Date  _________

The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Use the following scale: 

     0 = Not at all
     1 = Just a little
     2 = Somewhat
     3 = Moderately 
     4 = Quite a lot 
     5 = Very much

 1.  I do things slowly............................0   1   2   3   4   5

 2.  My future seems hopeless......................0   1   2   3   4   5

 3.  It is hard for me to concentrate on reading...0   1   2   3   4   5

 4.  The pleasure and joy has gone out of my life..0   1   2   3   4   5

 5.  I have difficulty making decisions............0   1   2   3   4   5

 6.  I have lost interest in aspects of life that 
      used to be important to me...................0   1   2   3   4   5

 7.  I feel sad, blue, and unhappy.................0   1   2   3   4   5

 8.  I am agitated and keep moving around..........0   1   2   3   4   5
 9.  I feel fatigued...............................0   1   2   3   4   5

10.  It takes great effort for me to do simple
      things.......................................0   1   2   3   4   5
11.  I feel that I am a guilty person who
      deserves to be punished......................0   1   2   3   4   5
12.  I feel like a failure.........................0   1   2   3   4   5
13.  I feel lifeless--more dead than alive.........0   1   2   3   4   5
14.  My sleep has been disturbed: 
      too little, too much, or broken sleep........0   1   2   3   4   5
15.  I spend time thinking about HOW I might
      kill myself..................................0   1   2   3   4   5
16.  I feel trapped or caught......................0   1   2   3   4   5
17.  I feel depressed even when good things 
      happen to me.................................0   1   2   3   4   5
18.  Without trying to diet, I have lost,
      or gained, weight............................0   1   2   3   4   5

Note: This scale is designed to measure changes in the severity of
      depression and it has been shown to be sensitive to the changes
      that result from psychotherapeutic or psychopharmacologic
      treatment. These scales are not designed to diagnose the presence
      or absence of either depression or mania.

      Copyright (c) 1993  Ivan Goldberg


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