Depression. Pills, talk, or exercise?

According to the latest figures from the Health Insurance Board (CVZ), nearly one million Dutch people take antidepressants, especially drugs such as Prozac, Exefor and Seroxat. Of the users, 45 percent are between 45 and 65 years old and 20 percent are 65 and older. Another remarkable figure: two thirds are women.

The effectiveness of antidepressants has been overestimated by doctors for years. The latest state of research is that antidepressants are only useful in very severely depressed patients. However, it is not known how many people that is and how many Dutch people take the pills for nothing.
“Antidepressants do indeed help people with severe depression, but by no means everyone,” says Claudi Bockting, psycho- and behavioral therapist and senior lecturer at the University of Groningen. “It can take time to find the most effective drug. With the first treatment with an antidepressant, about 18 percent of patients no longer feel depressed and half feel significantly better. After various types of treatments, about 40 to 60 percent are fully recovered.”

Antidepressants do not appear to be harmful to health and are not addictive, as many people think. But an antidepressant is not a medicine; it only suppresses the symptoms of depression. The possible side effects in the first weeks and during tapering are also not wrong. They range from apathy, drowsiness, blurred vision, vertigo and nausea to headaches, sweating, palpitations and a slump in libido. The disadvantages and costs of antidepressants must therefore be weighed against the benefits.
Because once you have started swallowing, you will do so for a longer period of time. Otherwise it has no result. Bockting: “You’re stuck with it for at least six to nine months, and if you’ve experienced depression before, sometimes even for a lifetime to prevent new depressions.”Unnecessary swallowing

Of the 300,000 people who receive a prescription for the first time every year, a quarter do not touch the prescribed antidepressants, according to research by Utrecht University. In fact, people often don’t even pick up their pills at the pharmacy. The reasons are fear of side effects, aversion to drug use, fear of addiction, or people feel better now. Often those pills are not necessary at all. In the case of mild or moderate depression, according to the Depression Center (the knowledge center for depression of the Psychiatric Health Fund), you are often helped with minimal aids, such as good information about depression or Problem Solving Therapy: a short-term treatment to gain more control over the depression. complaint.

“Even with severe depression, you can choose another treatment that often works just as well,” says Bockting. “This concerns alternative pills, running therapy (running) or psychotherapy (in the form of cognitive behavioral therapy). These treatments have been well researched.”

In addition, a variety of alternative therapies are available. But because good research is lacking, there is no proven effect. An example of this is Reiki. An entirely new treatment for depression is Transcranial Magnetic Stimulation (TMS). The activity in the brain is stimulated with magnets. In any case, the first research results offer hope for people for whom medicines do not help.

Alternative 1: St. John’s Wort

St. John’s wort has been shown to be as effective as an antidepressant in people with severe depression and has fewer side effects. However, this over-the-counter herbal remedy should only be used in consultation with the doctor, because it can reduce the effect of other medicines, such as anticoagulants. Bockting: “It is therefore not a harmless remedy. If you ask through your doctor, you also have the guarantee of a correct dosage. It is unclear whether St. John’s wort also helps with mild and moderate depression.”

Alternative 2: running

Working up a sweat stimulates the production of endorphins or happiness hormones in the brain. And that restores the severely depressed mind. In the short term, running for half an hour three times a week is just as helpful as taking medication.
In the long run, people who continue to run are even better off, as they rarely relapse into depression.
Running also helps with mild or moderate depression, according to research by Ruud Bosscher, lecturer in Human Movement Sciences at the VU University in Amsterdam. Claudi Bockting: “Running therapy is definitely recommended. In theory you can do it on your own. But hey, if you’re healthy, it’s hard to get yourself to exercise. When you are depressed, of course you have a lot of trouble with that.”
Running therapists throughout the Netherlands therefore offer depressed people intensive training. It is not the intention to win the half marathon, but to slowly build up the condition without getting out of breath.

Alternative 3: psychotherapy

The most researched form of psychotherapy is cognitive behavioral therapy (CBT). It works just as well as antidepressants, in both severe and mild forms of depression. With this therapy – unlike with psychoanalysis – you don’t have to go back to your past. With CBT you gain insight into the negative thoughts and feelings you have right now. Bockting: “You learn to deal with that differently. You learn to change those thoughts into more balanced ones. With twelve to sixteen one-hour sessions, you often get rid of your melancholy.”Prevent relapse

The risk of relapse after depression is high. According to figures from the National Institute for Public Health and the Environment (RIVM), the depression returns in 40 percent of people within two years. The current general practitioner guideline therefore recommends the use of antidepressants for all forms of depression for six to nine months. Bockting: “People who have been depressed before are advised to take it for two years to life as a maintenance treatment.”
But pills are not the only option in preventing relapse either. Other possibilities are:

• Mindfulness Based Cognitive Therapy (MBCT). Helps with relapse just as well as antidepressants. In eight weeks you learn to live in the here and now with meditation exercises and to let go of automatic negative thoughts.
• Cognitive behavioral therapy. Also works preventively. Bockting conducted research into this: “Eight meetings after recovery from a depression offer a high level of protection against recurrence of the depression. Only one in twelve of the test subjects relapsed in five and a half years.”
• To run. Also counteracts relapse; even better than drugs, according to a study by the American Duke University. After one year, 38 percent of the pill-swallowers were depressed again, among the runners that was only
8 percent.

Hopeful

Finally, the best news: If you have not known depression before, it is unlikely that you will develop depression later in life. People aged 57 and older are not more likely to be depressed than younger people, according to research from Erasmus University in Rotterdam. If older people do become depressed, they have been depressed earlier in their lives.
And another boost from Claudi Bockting: “A third of all people with depression recover without any form of treatment. Even people who have been depressed for more than two years can recover spontaneously.”

Cycling brings my existence back

Name: Maarten van Buuren (60)
Occupation: Professor of French literature at Utrecht University.
Depressed since: “Spring 2000. My existence was dissolved, I was reduced to nothing. The light had gone out.”
Swallowed: “Seroxat. When the drugs kicked in, I was lifted out of a very deep well. That was a blessing.”
Other treatments: “Psychotherapy, light therapy (which regulates the production of the hormone melatonin and restores the day and night rhythm), St. John’s wort and extra vitamins.”
Swears by: “My fourteen-speed racing bike.”
Because: “After twenty minutes on the bike, my body’s engine kicks in and I get out of the rigidity into which the depression lets me sink every day. Exercising brings my existence back.”
The bright spot: “When the diagnosis of depression was made. Finally I could give a name to what has bothered me all my life.”
Out of the valley: “Pills, talking and cycling made something happen that I never thought could happen: having pure fun.”
Wrote: ‘Frog goes cycling’ (Ed. Lemniscaat, €19.50)

Reiki opened the way to recovery

Name: Katy Castañon (50)
Occupation: Secretary.
Got depressed in: “2000. It was a tough battle. I didn’t want to live anymore, I didn’t feel worth anything anymore.”
Slikte: “During two years Prozac, among other things. That brought salvation in the beginning, but let the depression slumber. My head felt cloudy.”
Other treatment: “Psychotherapy. With the help of a naturopath, I got off the medication.”
Swears by: “Reiki.”
Because: “Reiki has the way for me
open to recovery and finding my own strength. By placing my hands on certain parts of my body, the life energy starts to flow.”
The bright spot: “Once the rain pattered on my face during my daily hour of walking. I thought: I now know what ‘being happy’ is.”
Out of the valley: “I have become stronger and have more self-confidence and fun in life than ever. I am very grateful for that.”
Wrote: ‘Out of the well, to the top!’
(Published Tattwa, €17.50)

More information

• #Problem Solving Therapy: Mental Health Fund, T 030-297 11 97 or www.psychischeGezondheid.nl
• Runningtherapy: Runningtherapie.nl, T 024-358 60 51 or www.runningtherapie.nl
• Cognitive behavioral therapy: Association for Behavioral Therapy and Cognitive Therapy, T 030-254 30 54 or www.vgct.nl
• Mindfulness Based Cognitive Therapy: MBCT Trainingen, T 074-266 60 90 or www.mbcttrainingen.nl