Thursday 13 December 2018

Dear Dr Jennifer: Are pills the only way to treat my husband's depression?

Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.
Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dr Jennifer Grant

Dear Doctor, my husband recently started on a course of antidepressants after becoming down following the loss of his father, on top of troubles at work. He feels better, but has no sex drive and is piling on weight. I'm on the fence about the efficacy of these pills - what other options can we explore?

I can understand why you are conflicted about your husband's recent antidepressant use. It is reassuring that his mood has lifted and he is feeling better, however the side effects of weight gain and loss of libido suggests a change is warranted.

The general approach to sexual impairment following commencent of antidepressants involves waiting two to four weeks for spontaneous remission. The next step it to try reducing the dose. This might strike the much needed balance between treating the depression and preventing the sexual impairment. The third option is to switch to a medication in the same class or a different class of antidepressant medication altogether.

In terms of the other options you would like to explore, treating depression without medication typically involves some form of psychotherapy. Cognitive behavioural therapy (CBT) and interpersonal therapy have been studied the most in depression and the evidence suggests that the combination of medication with psychotherapy has better results versus medication or psychotherapy alone.

As a first step, I wonder if your husband would consider attending a counsellor for a few sessions. A counsellor will help guide him through self-help websites, CDs or workbooks. The prospect of minimal intermittent contact with a counsellor who can monitor progress and provide direction might appeal to him.

Finally, regular cardiovascular exercise and/or resistance training, aiming for three to five sessions per week, ranging from 25-45 minutes per session, is a great add-on therapy and will provide additional health benefits and help him shed those extra pounds.

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