I am concerned about the side effects (including depression and suicidal tendencies) and the lack of scientific evidence connected with anti-depressant drugs. What non-drug alternatives might you recommend for treating depression? Bruce Boyers, Glendale, California
There is a mass of first class scientific evidence that antidepressant drugs work when correctly prescribed to those people whose form of depression indicates their use.
There was a television programme about six weeks ago in the UK which investigated 1,300 complaints from patients about the side effects of one particular antidepressant drug. When the case histories were submitted to independent psychiatrists nominated by the Royal College of Psychiatry, in no case was it thought that the drug was an inappropriate one for the treatment of that patient.
Patients with what, 40 years ago, would have been called endogenous depression, with all the classic symptoms - feelings of hopelessness, despair, the loss of self-esteem, guilt, early morning waking, diurnal variation (variation of mood throughout the day), loss of libido, loss of appetite and suicidal thoughts - do very well on antidepressants.
Antidepressants don’t always help patients who are depressed as the result of a personality disorder, and some antidepressants make some patients worse, as these patients are very sensitive to side effects. They can actually be dangerous when taken by patients with evidence of some of the psychotic diseases. Although these patients are genuinely and seriously and sometimes dangerously depressed, the first line of attack on their condition must be with an atypical anti-psychotic.
The only non-drug alternative which has been shown to work, and then only in mild depressive states, is St John’s wort. Some other natural products ease anxiety and they may ease the depression, but they don’t cure it.
Since the difficult birth of my son three years ago I have had constant anxiety with regard to his welfare, which stops me sleeping. My son is in perfect health. I have been waiting for it to get better, but this has not happened. Can post-natal depression last this long or lead to an anxiety disorder? And can I do anything about this? Name and address withheld
You raise one or two very good points – thank you for your question. Post-natal depression can last three years. It may not even start for 18 months or slightly longer. There is always an association between anxiety and depression. In some people the depressive state predominates the anxiety state. I obviously cannot discuss your particular case, as I have not met you, but irrational anxieties may often be masking an underlying depression, and you should certainly discuss this with your doctor. Anti-depressants can help to lift the mood, and thereby banish unnecessary worries. Good luck and do go and see your doctor. There is bound to be something that can be done, or prescribed, to help you.
Getting up in the morning is so difficult - please don't dismiss this as the usual kinds of moan. How can I make it more bearable - especially considering that I have to get up at 5.15am and it is very dark? Sarah Pennington, London
I know just how you feel. For nearly 20 years I used to have to get up at 4 o’clock in the morning four days a week and it was, as you say, very dark. It is no good suggesting that the reward for facing all those dark mornings is the pleasure of the summers when one is up and around just after dawn.
The secret is not to go to bed too late and to establish a regular regime whereby you get your six hours' sleep and still set the alarm to 5.15am. Obviously life is better if you have a bright cheery bedroom with good lighting; a morning bath may help, and it well help to take some coffee and a bun in the morning, if nothing else, before you venture out into the world. It is necessary to make certain that you are not describing the diurnal variation which depressed patients feel, so that life seems unbearable on first waking up (probably after having had either a very short or very disturbed night). It is certainly worth a visit to your doctor to discuss this.
Why is it that when I was younger with a family to get off to school, I did not get at all depressed at the short, dark days? Now they seem so grim and hopeless. How can I get over this? Name and address withheld
I am not at all surprised by your story. When you are responsible for other people, minor degrees of depression are obscured, as there is just no time to think about them. Now that you are alone, or anyway with your children at school, the lights and shades of your day have gone, so life seems grim and hopeless and your underlying depressive nature is fully exposed. This degree of moderate depression is usually worse in the short, dark winter days. If your mood is in any way interfering with your social or professional life, and everything does seem grim and hopeless, you should certainly see your doctor because many cases like this respond very well to antidepressants. Do go and have a chat with your doctor.
It is so unnatural for my body rhythm to carry on my daily summertime routine. Why can't I be allowed to hibernate for the winter? Name and address withheld
This is an interesting theory but if we all went into hibernation for the winter, the national economy, as well as family life, would collapse. Fortunately, there isn’t a clearly defined difference in our metabolism in summer and winter, and there is no evidence that we have evolved to be one of the animals which hibernate during the cold, dark months. The only evidence that the body rhythm is different in some people in summer and winter is seasonal affective disorder (SAD) and if that really does stop you living your normal life, it is worthwhile seeking treatment. Conversely, if you are rich enough, you can either take the winter off or, if very rich, go and bask in the sun of the southern hemisphere. Only one month to go and we will be beyond the shortest day. Some patients with SAD suffer hypermania – over exuberance in the spring.
Dr Stuttaford’s book, What’s Up, Doc? Understanding Some Common Symptoms, is published by Little Books, £6.99, and available from Times Books Direct
