Saturday, July 30, 2016

"I'm depressed. Should I pop a pill, go for therapy, or both?"

This is a very good question, and there is no quick and easy answer. There are about 20 different antidepressants on the market and dozens of different types of therapy. Choosing what works for you, can therefore be a challenge.
   
When you are depressed, there are two broad approaches to getting help.
   
First, there's going to see a medical doctor and taking antidepressants. These typically take a couple of weeks to a couple of months to kick in.
   
If the first prescription doesn't work, or isn't working well enough, you go back and your doctor will adjust the dosage, prescribe a different pill, add in an extra pill or suggest you keep taking the pill but also go for some therapy.
   
Generally speaking, about half the people who take this route are happy with the results.
   
Some have to go back again, and need to explore more treatment options. In general, about 70% of people find that this approach eventually works for them.
   
The results of a recent British study that involved 3,671 people trying this approach is described here and the journal article is here.
   
Therapists are typically not doctors and in most places cannot prescribe drugs. They help manage depression with the help of talk therapy. Again, there are lots of different approaches, all with their pros and cons.
   
Generally speaking, studies that compare this approach to antidepressants find they are roughly equally effective. You can read a good journal article reporting on this here and you should take a look at the special issues facing researchers trying to figure this issue out by reading this paper here.
   
It can be hard to talk about treatment approaches, because many people become very evangelical about their favourite methods. Extremes run from "feel better through chemicals" to "drug companies are evil".
   
To further confuse everyone, not all studies are published. We all have biases, and unfortunately, there are people who have buried studies that show the failings of antidepressants as well as people who have buried studies that show the failings of talk therapy.
   
Me, I think that it's best to be sensible and to understand that at the moment, we don't have enough information. We are lucky in that we have some approaches that work for many people, but we have to recognise that what works for one person, may not work for another.
 
So:
  • Some people find therapy works for them.
  • Some people take an antidepressant and they feel good again.
  • Some people have to try out different drugs in order to find one that works for them.
  • Some people find they need a mix of antidepressants and therapy.
I think it's important to explore all your options, and to figure out what works best for you. Ideally, you'll talk to a doctor and a therapist, do some reading and then make an informed decision.
   
Unfortunately, this can be difficult if you are depressed. When you're already feeling bad, and the first thing you try doesn't work, it's very tempting to say to yourself, "Nothing will work for me!" and to give up.
   
While there are people who have a very tough time finding help, I'd say you have to remind yourself that there's no reason why you should be in that number. It may take a while but please don't give up and think you can't be helped!
   
Read peer reviewed journals and when something won't work for you, talk to your family doctor to ask what else she recommends.
   
Ellen Whyte is a counselling psychologist based in Malaysia who works over Skype and Facetime with international clients. You can contact her through lepak.com.
   
You may also want to check out Ellen's Flipboard magazines for collections of media articles about depression, stress and happiness. Also, there's a happy pets magazine, guaranteed to make you smile.
     

How to find a therapist in Malaysia or other developing nation

It's not easy to find a qualified mental health practitioner in Malaysia. There aren't many of them, and there are very few laws that govern the professions.
   
If you want a psychiatrist, a medical doctor who specializes in the diagnosis and treatment of mental disorders, you're okay. There's an association and everyone who's a psychiatrist has to join.
   
There's a counselor association but not everyone who joins has the same kind of training and not everyone practices.  Also, they don't accept foreign trained professionals, or those who want to practice online.

   
In Malaysia the term counselor is legally restricted (although not enforced, from what I see) but there are no laws that cover the terms psychologist, therapist and other mental health worker descriptions.
   
In a word, it's chaos. I have a friend with an Australian counseling degree who can't join the professional organisation here unless she retakes the whole thing in a local school, and there's a quack with no training whatsoever who advertises psychology services in the newspapers. We also have people with fake degrees practicing.
   

My clients from the Middle East, Africa and Far East tell me they have exactly the same issues in their countries, so I believe that Malaysia is the rule rather than the exception.

I don't expect matters to improve soon because accreditation is a problem everywhere. First, groups tend to be exclusive rather than inclusive. This means that if your degree says 'psychology', you may not be able to join a counseling organization, and visa versa. Second, working cross borders is a complete nightmare. In the European Union, a Polish degree works only in Poland; in the USA licenses tend to cover just a single state.
   
What does it mean for you? If you live in a country where mental health practice is still fairly new and unregulated, and you want help, I suggest you do this:
   
1. Ask your family doctor or GP to list the practitioners she knows. She may not know straight off, but she'll know how to sort out the quacks and cons.
   
2. Go to a government hospital and ask for recommendations. They tend to be better at screening than for-profit hospitals.

3. Ask a psychiatrist for reliable associations and practitioners. They should know who to talk to but they tend to be awfully busy so be prepared for a bit of a wait. If the practice has a nurse or receptionist, ask her or him.
   
Good luck!
   
Ellen Whyte is a counselling psychologist based in Malaysia who works over Skype and Facetime with international clients. You can contact her through lepak.com.
   
You may also want to check out Ellen's Flipboard magazines for collections of media articles about depression, stress and happiness. Also, there's a feel good pets magazine, guaranteed to make you smile.
 

Is therapy addictive?


“How long will this take?” People who are new to therapy are often understandably cautious about what is involved.  They worry that it may take years, and that they'll have to spend a fortune.

If you work with me, we spend our first session listing the issues you want to work on, figuring out your goals and then setting out a therapy plan that details how we're going to reach your goals.
   
Although I deal with a variety of issues, most of my work involves teaching techniques that help manage stress and depression. Generally speaking, my typical treatment plan consists of six to ten sessions that take place over two to three months. Very sometimes, the plan is longer.

 What I won't do, is take on a client without a treatment plan.
   
Why is this? Because it is my opinion that therapy can be addictive.
   
First, when was the last time you sat and talked exclusively about yourself for an entire hour? Also, throw in that therapists tend to be focused on being supportive, and you can see why the me-me-me can become an indulgence that's sweeter than chocolate.
   
Second, have you ever thought that if only you could take a really good look at yourself, and at the turning points in your life, that you could somehow unravel it all and make sense of it?
   
If you have, then you might be tempted to get into therapy and talk-talk-talk in the hope of finding psychological nirvana. While I would love to think this was possible, it is more likely that you will spend all your time (and money!) focusing on the past and over-analyzing every bit of your life, and forgetting to enjoy yourself.
   
Therapy plans aren't a guarantee of success. However, I think that if you have a plan with solid goals and a method for achieving them, you're less likely to get caught up in an endless therapy cycle.
   
For me, the principle, Do No Harm, includes a therapy plan.
   
Ellen Whyte is a counselling psychologist based in Malaysia who works over Skype and Facetime with international clients. You can contact her through lepak.com.
   
You may also want to check out Ellen's Flipboard magazines for a collection of media articles about depression, stress and happiness. Also, there's a feel good pets magazine, guaranteed to make you smile.