Hospital treatment for depression
Have you heard all sorts of myths and prejudices about:
- Being admitted into psychiatric care?
Many of the myths date back to the days when psychiatric hospitals were feared institutions. Conditions in psychiatric units are much better now; these days you are likely to be looked after in a one- or two-bed room facility in pleasant surroundings.
There have been major advances in the treatment of depression over the last 30 years and these days we have access to effective treatments that can cure or alleviate depression in just a few weeks.
Who needs hospital treatment?
Your doctor or a specialist can treat most types of depression. But in some cases your depression will get worse and it may be necessary to admit you into psychiatric care. You should be admitted into care if you have
If you have a milder form of depression and have been treated with antidepressants by a doctor or a specialist without any success, you may be admitted so that your treatment can be improved.
Treatment with antidepressants can prove problematic if you have a serious physical illness and you will therefore need to be put under close observation. This will be possible only if you are admitted. During your time in hospital both of your illnesses can be observed and treated at the same time. If you are taking several different types of medication, access to expertise on any problems that this may cause will be important.
What is acute treatment?
We generally wait for up to a week before treating you when you are admitted with depression for the first time. This enables us to make a correct diagnosis and give you the best possible treatment. People often find that going into hospital brings relief. You no longer have to struggle with things that you find impossibly stressful because you are depressed. These may include everyday activities such as:
- Cooking
- Working
- Cleaning
- Shopping
- Looking after your children
After you have been admitted into psychiatric care you will be examined and treated in several different ways at the same time. It is seldom possible to adopt this approach outside a hospital environment. The treatment comprises the following key elements:
- Counselling
- Treatment with medication
- Observation to make the right diagnosis
- Care and protection against any self-harming behaviour
- Physiotherapy and occupational therapy to maintain your physical functions
- Psycho education training and counselling, perhaps psychotherapy
- In severe cases ECT (Electroconvulsive Therapy) treatment may be used
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Should you have psycho educative training?
Yes, if you have been admitted into hospital you should have psycho education. This means that we "educate" you and teach you about:
- What it means to suffer from depression
- How the illness typically progresses
- The various treatment options
- The effect and side effects of the medication, etc.
This training often involves many sessions and works well because you gain insight into your illness. You also understand your illness and how to treat it.
Should you have psychotherapy?
In some cases we will choose to treat you with psychotherapy. However, in the case of severe depression we cannot use this form of therapy right away. When suffering from severe depression, you feel so bad that you find it hard to take part in normal conversation, which is why it is even harder to take an active role in psychotherapy.
There are several methods used in psychotherapy. We often choose cognitive therapy, which is available from the following:
You can have psychotherapy individually or in groups.
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Should you take medication?
If your depression requires that you have to be admitted into psychiatric care, the use of medication is almost always necessary. We differentiate between two types of medication:
- Antidepressants
- Support medication (e.g. anxiety-reducing medicines, sleeping pills, antipsychotic medicines and lithium)
Antidepressants are effective in the treatment of depression - they get rid of the symptoms of depression in just a few weeks. But the treatment works only if you continue with the medication. This is extremely important - perhaps the following analogy will help you to remember to take your medication:
Diabetics don't have any symptoms at all when they take their insulin. But the illness is lying in wait below the surface if they stop.
Unlike diabetes, depression may improve on its own in six to twenty-four months. If you stop taking your medication during this period the symptoms may return.
Antidepressants can often be gradually scaled down without the symptoms flaring up. However, some people with recurrent depression need to take their medication for several years, perhaps even the rest of their lives.
We choose antidepressants on the basis of:
- Your physical health
- The side-effects of the medication
- The effectiveness of the medication
Which treatment should you have?
Often, patients are treated with one of the older tricyclic antidepressants .
There is some evidence that tricyclic antidepressants are better than SSRIs for treating patients with severe depression in hospital.
You will need to take your medication for two to four weeks before you notice any positive difference. If you suffer from severe anxiety and have major problems sleeping, you may need to use "support" medication.
The use of support medication is to be kept to a minimum as large doses can worsen your depression. Support medication can also prolong your treatment unnecessarily.
Some forms of support medication e.g. benzodiazepines can be addictive if not used properly. It is therefore important that your support medication is scaled down as your depression improves.
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Should you have ECT treatment?
There is a chance that you may be among the few people who don't respond to antidepressants. A few people cannot tolerate antidepressants. If this is the case, you may be given ECT treatment, which:
- Works faster than medication
- Is effective if you are seriously contemplating suicide
As this treatment requires you to be under a general anaesthetic you will almost always have to be admitted to the hospital to have it.
What about after-care?
You will often need to carry on taking your medication to prevent your underlying depression from returning. You may also need long-term treatment.
Your doctor can offer you treatment. However, in complicated cases you will need to go to:
- Outpatient clinics: If you have been in hospital, you may be offered after-care at an outpatient clinic where you will see a doctor from the psychiatric unit. This is similar to going to your own doctor, but a psychiatrist who specialises in treating psychiatric disorders will care for you.
- Community Mental Health Centers: Most psychiatric units work very closely with Community Mental Health Centers. These are centres for patients with chronic mental disorders who may have spent time in hospital. A Community Mental Health Center is similar to an outpatient clinic, but may offer more services and also work closely with the psychiatric unit. If you are manic-depressive or have had particularly difficult bouts of depression you may be offered treatment at one of these centers.
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