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Understanding and Treating Depression

To understand depression, think of standing in a pool with the water level up to your lower lip. Moving through the pool is difficult because of the resistance from the water. Itís tiring, like the fatigue often associated with depression. Further, any little wave threatens to overwhelm you so you seek to avoid small ripples and get terrified about even the thought of a big splash coming your way. That is why depression and anxiety often go hand in hand. 

Antidepressant medication is akin to pulling the plug and lowering the water in the pool.

With the water level lower, say at your waist or knees, there is less resistance and you can move through the pool more easily. This equates to less fatigue. With the water level at your waist or knees, those same ripples or even waves just donít carry the same threat of engulfment. This lowers the sense of dread and anxiety. With the water level lower, depression and related anxiety diminishes. You get on with life. Antidepressant medication saves you from drowning.

When prescribed antidepressant medication, it is important to know that unlike almost any other medication, it doesnít work immediately. In fact, you may not feel the effect of antidepressant medication for a good six weeks, (plus or minus two).

Our brains have something called a blood-brain barrier. The role of the blood-brain barrier is to restrict the admittance of substances that are usually not of service to proper brain function. Given that antidepressant medication is not something that normally accesses the brain, the blood-brain barrier does its best to restrict the medicationsí access. That is why it takes this medication so long to work. The medication has to reach a certain level in order be effective and it does this little by little as it builds up in the brain over the course of treatment.

If you are one of the few who experiences a side effect from antidepressant medication, it will likely be along the lines of headache, nausea, upset stomach, dizziness or dry mouth. For most persons these side effects will go away within two to four weeks as your body adjusts and before you are likely to enjoy the benefits of the medications true action.

Because of how long it takes to really work and how side effects, if experienced, precede the therapeutic effect of antidepressant medication, many people quit using their prescription thinking it was of no benefit and only caused some distress. Those who tolerate the side effects typically begin to see them diminish just ahead of enjoying the therapeutic effect of the medication. It is important to be patient when using antidepressant medication and resist evaluating its effectiveness until at least about six weeks of usage.

Your doctor will likely start you on the lowest dose of this medication. That is to get you used to the medication and to avoid troubling side effects. This starter dose may not be sufficient though in terms of your therapeutic need. The dose any one person really needs can be guess work, determined only by each individualís response to the medication. Size and/or weight and/or level of depression can have nothing to do with which dose is just right for any one person. The right dosage will be determined after several months of usage and by discussing how you feel with your doctor on a month to month basis for about two to four months.

Counselling for you; and if you are in a relationship, your partner; and if in a family, your family, is an important part of treatment for depression. You and those around you need to understand the implications of living with depression. Counselling is educational in nature and if needed, can also address any other personal or relationship issue that contributes to your distress. Your counsellor can also help monitor your mood and provide that information to your doctor to help your doctor determine dosage.

You want to be well; your loved ones want you to be well; your doctor wants you to be well; and your counselor wants you to be well. Together, it is this team, working in unison, which provides the best approach to treating depression.


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Gary Direnfeld, MSW, RSW
(905) 628-4847  


Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead and the parenting columnist for the Hamilton Spectator. He is the author of Marriage Rescue as well as hundreds of other articles related to personal, family and married life. Gary maintains a private practice in Dundas Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.


Call Gary for your next conference and for expert opinion on family matters. Services include counselling, mediation, assessment, assessment critiques and workshops.


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27 Sina Street, Georgina, ON, Canada L4P 3E9 Tel: (905) 628-4847 Email: gary@yoursocialworker.com