What And Where To Go

[first1timer]

Hi

I have had a deep depression for a quite awhile now.

Can anyone give me any adviceses.

Any specific doctor I should go to ?

Any brands to avoid (many side effects) ?

Good brands (avaiable in Thailand) ?

I haven't used anti depressive before, I

don't know if this is relevant.

Thanks.

first1timer

[nick2k]

Hi

I have had a deep depression for a quite awhile now.

Can anyone give me any adviceses.

Any specific doctor I should go to ?

Any brands to avoid (many side effects) ?

Good brands (avaiable in Thailand) ?

I haven't used anti depressive before, I

don't know if this is relevant.

Thanks.

first1timer

advice?

if you have a bunch of friends who complain all the time, get rid of them. find some happy people who like to talk about happy things all the time. ..be sure they are not into drugs.

AND when you find these new friends, don't ruin it by becoming the complainer.

you asked for advice. you got advice. good luck.

[ColPyat]

Hi

I have had a deep depression for a quite awhile now.

There is a difference between being a bit down, and having a depression. A depression is a clinical problem, and needs to be diagnosed and treated by a qualified psychiatrist. Anti-depressants are not sweets, they are addictive drugs with severe side effects, and should only be taken under supervision.

There are several hospitals here specialized in mental health problems, such as the Somdej Chao Praya Hospital (very good reputation for Thailand).

[kankaroo]

PLEASE think long and hard if you are going to put yourself on mind altering and severely addictive chemical drugs. The way the media portrays these things now it is as if they are a "pick me up" when feeling down.

Also note that some people can never come off these drugs after once going on them.

Others report that they have changed them forever - some in a positive way, and some in a very negative way.

Please be careful and gave it thought.

Hope this helps in some way, & good luck !

[qwertz]

I wouldn't recommend LOS if there's any chance of you suffering a relapse. Germany would be be better for getting you head straight and there's plenty of good clinics here as bipolar is at epidemic proportions.

[solo siam]

Lots of scaremongering about Anti-Depressants here, makes me wonder if anyone actually has experience of SSRI's which are really the only anti-depressants prescribed nowadays.

Wondering if the two posters commenting on addictiveness have any actual first hand experience of this? I'm doubting it and I guess the "addiction" is more to do with a fear that things will go back to being worse when stopping the drug.

Nick2k's comments were very on the ball, but if you're really depressed it would be hard to go out and make a whole new set of friends etc... thats where supervised anti-depressant treatment might help by lifting the fog whilst you sort out your issues, current situation and environment - This may involve therapy and/or changing the way you think about things or getting something out of your system.

Clinical depression is generally brought on by negative thought processes, fears and memories/issues you have not fully resolved in your mind, taking anti-depressants without any sort of therauputic framework is a bad idea, they don't simply make you happy and initially can make you feel even worse for the first couple of weeks.

[kankaroo]

Lots of scaremongering about Anti-Depressants here, makes me wonder if anyone actually has experience of SSRI's which are really the only anti-depressants prescribed nowadays.

Wondering if the two posters commenting on addictiveness have any actual first hand experience of this? I'm doubting it and I guess the "addiction" is more to do with a fear that things will go back to being worse when stopping the drug.

Nick2k's comments were very on the ball, but if you're really depressed it would be hard to go out and make a whole new set of friends etc... thats where supervised anti-depressant treatment might help by lifting the fog whilst you sort out your issues, current situation and environment - This may involve therapy and/or changing the way you think about things or getting something out of your system.

Clinical depression is generally brought on by negative thought processes, fears and memories/issues you have not fully resolved in your mind, taking anti-depressants without any sort of therauputic framework is a bad idea, they don't simply make you happy and initially can make you feel even worse for the first couple of weeks.

Didn't know you were a mental health physician Ben???, and why do you "doubt it"? If you want to know I was prescribed SSRI drugs a while ago as a wrong diagnosis. An unfortunate series of bad events in my life led me to feel very down for a while and thus start drinking too much. As soon as I greatly reduced the alcohol intake I felt a LOT better. Unfortunately I was hooked on these drugs and it was hel_l on earth coming off them ie : severe panic attacks (which I never had before) night & day sweats similar to a fever, hallucinations and a distinct feeling of becoming completely detached from myself and my surroundings. The list goes on. The severe side effects lasted for weeks and I would not wish it on ANYBODY. However I continued to have milder side effects for months.

Also whilst on these drugs my mood didn't shift one bit. My solution was a simple as cutting out the sauce and time - the greatest healer.

So yes I would say that I am qualified to talk about it. The side effects were so severe I even started doubting my own sanity - which led me to do extensive research on the specific brand of SSRI I was on. Countless people on forums were experiencing the EXACT same effects I was and the general consensus was that unless the person is VERY disturbed they should be well left alone.

I would like to think that in many cases the individual - not a stranger - is best qualified to know if there particular condition merits SSRI treatment or not.

But what would I know eh.

BTW Ben, my hand to God as soon as I saw your name in this post I was expecting some self righteous crap from you, and you are the only person on the board that I could honestly say that about.

first1timer - please feel free to PM me if you think I could help you,

Kankaroo.

[kankaroo]

Just a couple of links supporting what I mentioned earlier :

http://www.drugs-forum.co.uk/forum/showthread.php?t=16763

http://forums.macnn.com/89/macnn-lounge/302529/permanent-ssri-antidepressant-induced-sexual-disfunction/

But don't get me wrong......for the thousands that have nightmarish times with these drugs there are also thousands that they will help.

I am only trying to help.

BTW many Thai hospitals will not have doctors who will understand or be able to help. Your best bet is Bumrumgrad if you need to see someone.

[solo siam]

Didn't know you were a mental health physician Ben???, and why do you "doubt it"? If you want to know I was prescribed SSRI drugs a while ago as a wrong diagnosis. An unfortunate series of bad events in my life led me to feel very down for a while and thus start drinking too much. As soon as I greatly reduced the alcohol intake I felt a LOT better. Unfortunately I was hooked on these drugs and it was hel_l on earth coming off them ie : severe panic attacks (which I never had before) night & day sweats similar to a fever, hallucinations and a distinct feeling of becoming completely detached from myself and my surroundings. The list goes on. The severe side effects lasted for weeks and I would not wish it on ANYBODY. However I continued to have milder side effects for months.

Firstly I expressly advised seeking medical help, I'll quote myself here "taking anti-depressants without any sort of therauputic framework is a bad idea, they don't simply make you happy and initially can make you feel even worse for the first couple of weeks." and "thats where supervised anti-depressant treatment might help by lifting the fog whilst you sort out your issues, current situation and environment - This may involve therapy and/or changing the way you think about things or getting something out of your system." - I fail to see how that is bad advice

Strange that those exact same same symptoms you mention are among the exact symptoms used by mental health professionals to diagnose Depression. It sounds more like a case of you previously masking those symptoms by using Alcohol (very common), and when you cut down the alcohol and stopped taking anti-depressants they reared up which is very common also. Couldn't it simply be that the depression was at its most when masked by (and possibly semi-induced) by alchohol and when you stopped drinking and taking the tablets you were then forced to deal with the issues that probably led to excessive alchohol consumption in the first place.

Also wouldn't it be fair to say that these "withdrawal symptoms" could have come from stopping drinking, seeing as alcohol is VERY addictive,both physically and mentally - whereas your proof of addiction to SSRI's comes from a couple of forums of people who are going through or have gome through mental illness which can exasperate feelings of paranoia, dislocation etc...

I'm not a mental health physician and neither are you - As far as I'm aware almost all mental health professionals have a use for anti-depressants, are they all wrong and you correct? It would be a shame if even one person didn't receive the medical help they needed because they read your post.

Edited May 9, 2007 by Ben@H3-Digital

[kankaroo]

I said :

"But don't get me wrong......for the thousands that have nightmarish times with these drugs there are also thousands that they will help"

You said :

"It would be a shame if even one person didn't receive the medical help they needed because they read your post."

He said We said She said ......................

C'mon lets just not turn this into some sort of bickering match and leave it at that. As I said I am only trying to help.

But as I said I was wrongly diagnosed as the doctor was well aware of how much alcohol I was currently consuming and that I had absolutely no prior problems in this area. You also tended to trivialise when you mentioned "a couple of forums" that was just the first page or results from a simple google search, the list is endless and the main one's that I researched were respected medical forums.

Please lets just leave this at this.

Kankaroo

[Maizefarmer]

You can get professional help - any of the big hospitals in Bkk (that is where u r isn't it?) - they all have psychologists - and if you r down and out and really in a mess with not a penny to your name - PM me (there are projects that will/can help u - irresepctive of your financial circumstances).

MF

[Pepe']

Hi

I have had a deep depression for a quite awhile now.

Can anyone give me any adviceses.

Any specific doctor I should go to ?

Any brands to avoid (many side effects) ?

Good brands (avaiable in Thailand) ?

I haven't used anti depressive before, I

don't know if this is relevant.

Thanks.

first1timer

-------------------------------------

Is your health good otherwise? Do you have a good diet and get some regular exercise.

Before stating with any kind of anti depressant you you should really have a thyroid panel done and check adrenal function as well.

If either of these glands are hypo-functioning they are notorious for causing problems that mimic clinical depression.

CBC and chem panel should be the standard blood draw done at the same time. You want to take close look at white blood cells as well. Irregularities in this area can indicate Epstein Barr Syndrome, CFS or Fibromyalgia.

All of which can make you feel quite depressed even though you may have "normal" brain chemistry.

One last note. If you are in Thailand and so inclined, find some Buddhists monks that can speak English and talk with them about how you're feeling.

I guarantee you will feel better after spending time with them...

Good Health

[kmart]

Seek professional advice from a doctor or psychiatric expert. There are not many in Thailand, - especially on internet forums. Good luck

[leisurely]

I would nip over to the health forum. There is a list of mental health help pinned there. Good luck, whatever is 'wrong' with you I doubt that you'll find the answer on a forum such as this. You will find pointers, but each person is different.

[sbk]

I'll move this thread over to the Health forum, there are several health professionals who frequent that forum

[jumnien]

Don't self-diagnose or self-medicate. Years of working in the mental health field in the US I've seen a few remarkable turn-arounds begin with the use of anti-depressants. I've also seen horrendous confusion, stagnation, side affects beyond belief and various negative factors as a common occurence that I would approach these medications cautiously under rigid supervision from trained and trustworthy medical experts.

As others have stated, begin with a nutritious diet and regular exercise, good friendships and participation in meaningful social activities. Reduce or omit cigarettes, alcohol, caffeine and sugar from your daily intake and over a short period of time (30 days) note your difference in mood.

[Sheryl]

Sorry to hear about your difficulties, I have also suffered from depression (well controlled now on medication) and understand what it is like. People who have not personally experienced clinical depression or had a close relative with it really do not undderstand what it is and one often gets well meant but useless or even harmful advice.

The first priority is to be sure that depression is what you are suffering from. You are probably correct in your self-diagnosis, but it is important to be sure. Most of the negative stories one hears about SSRIs arise from their having been misprescribed, i.e. given to someone who had a different problem. In mental health as in physical health, different problems require different treatments.

Important things to rule out include physical diseases (especially thyroid disease) which can cause depression but are better treated by correcting the disease rather than giving an anti-depressent, and bipolar disorder, for which giving anti-depressents alone can be dangerous.

For this purpose I would suggest either the psych department at Samitivej, which offers a wide range of pyschological testing and diagnosis, or you couldtry the newly opened international pysch facility in Bkk, see www.manarom.com. I have not experience with Manarom Hosp nor have I heard any feedback on it as it just opened but website looks good.

The same place that diagnoses you can start you on medication if indicated. Basically nowadays it is an SSRI that is prescribed. I tend to favor Zoloft (Sertraline) for several reasons: it is pretty quick acting, which means relief is quicker plus much easier to adjust dosage; it is widely avaialble over the counter in Thailand; it has been around for a long time so more is known about its effects than for the newer SSRIs, and it will come off patent fairly soon, which means that the price will come way down. This last is important since these drugs need to be taken for a long time...absolute minimum is 6 months, and most people need longer. Some people need them indefinitely. However other equally rapid acting SSRIs like Paxil are also effective. I do not recommend Prozac because it is very slow to take effect, this makes it very hard to adjust the dosage and also the patient can become discouraged (even suicidal) while waiting for it to kick in.

Although it is very much advisable to get a proper diagnosis and physical exam to rule out physical causes before starting an anti-depressent, if you are in a situation where you cannot get yourself diagnosed soon and are really feeling desperate you can go ahead, with caution, and try self-medication provided (1) you are otherwise in good health and (2) you have no signs of anything other than simple depression, i.e. you don't have changes of mood to one that is either euphoric or anxious/hostile with racing thoughts and restlessness. If you have that you could be bipolar and anti-depressents could trigger an episode of mania. Note that I do not suggest self-medication as the best approach, only if it is not possible for you to get seen by a qualified pyschiatrist or clinical pyschologist soon and you are really incapacitated or suicidal.

Used correctly for the right problem, anti-depressents can make the difference between a living death and a normal life...and even between life and death. So don't be put off by the scare mongerers, but don't underestimate the need to ensure they are taken for the right problem in the right way, either. And don't forget to get a physical check up. In addition to checking your thyroid to rule out that as a cause (in which case simple thyroid replacement may do the trick and avoid need for an anti-depressent) it will establish baseline liver and kidney function, which is important; these drugs (like most drugs) can affect the liver and should not be taken by people with any liver or kidney problems except under a doctors careful supervision.

Severe depression usually responds best to a combination of some form of counselling/therapy plus medication. In mild cases, therapy alone may be enough, and if you are not feeling suicidal and are still able to function reasonably well you might hold off on medication until you are in therapy and see how that goes first. See the pinned list of mental health resources for places that offer counselling to expats.

Good luck and let me know if there is anything I can do to help

Edited May 10, 2007 by Sheryl

[JR Texas]

Don't self-diagnose or self-medicate. Years of working in the mental health field in the US I've seen a few remarkable turn-arounds begin with the use of anti-depressants. I've also seen horrendous confusion, stagnation, side affects beyond belief and various negative factors as a common occurence that I would approach these medications cautiously under rigid supervision from trained and trustworthy medical experts.

As others have stated, begin with a nutritious diet and regular exercise, good friendships and participation in meaningful social activities. Reduce or omit cigarettes, alcohol, caffeine and sugar from your daily intake and over a short period of time (30 days) note your difference in mood.

JR Texas: Hi......I have a close friend who has bipolar disease. I have been through a lot with her over the past three years. Please allow me to present some observations and give you some advice.

First, know that you are not alone and that many people suffer from depression. Also, lots of famous people have had the disease (and it is a disease) and lived successful lives (e.g., Ted Turner).

In Thailand, Bangkok-Pattaya Hospital has a ward devoted to mental disease (it is very expensive).

Medications: This is a call only you and the doctor can make. Be aware that medications for depression have side effects. Some can magnify thoughts of suicide (especially during the first few months of taking them).......so, be extremely aware of this and NEVER take thoughts of suicide lightly........go tell a good friend and your doctor immediately.

Personal advice: Try focusing on solutions and not on problems (most people do the opposite). Exercise frequently, even if it means taking short walks (preferably in a relaxing place......or places that make you feel good and at peace). Eat healthy foods and do not drink alcohol and do not smoke cigarettes. Try to be around healthy, positive people as much as possible.

Avoid watching too much TV, especially TV news, as it is designed to generate learned helplessness and that is not good for depression. TV focuses on problems and almost never presents solutions. Newspapers do the same. As I said earlier, try focusing on solutions.

Read Awaken the Giant Within by Anthony Robbins and learn how to control your thoughts and the importance of thoughts in terms of decision-making and action. You can, literally, talk yourself in and out of some forms of depression. How you think, what you think, and even how you speak and move can influence depression.

I wish you luck!

[BalthazarBeefheart]

I won't try to give you advice on what you should or not do regarding your deep depression as you seem to be getting enough of that already. All I can say is that I have seen a psychiatrist at BNH Hospital periodically and I have found him to be a practical down-to-earth character who has served me well with sound advice. I myself prefer to get professional advice from qualified practitioners about serious medical problems - there are numerous medical websites where one can check out the effects of any medication that may be recommended. There is also a lot of bullshit sprouted on forums so beware.

The psychiatrist is Dr Thani BNH Hospital 0632-05550 - as i remember the cost is very reasonable. If you are suffering from clinical depression then I would suggest you have continuity with your practitioner and it is also good to know that help is only a call away if your situation deteriorates.

Hope that helps BB

[benw]

Sorry to hear about your difficulties, I have also suffered from depression (well controlled now on medication) and understand what it is like. People who have not personally experienced clinical depression or had a close relative with it really do not undderstand what it is and one often gets well meant but useless or even harmful advice.

SNIP

Good luck and let me know if there is anything I can do to help

I think that the feedback and suggestions from mdeland and Sheryl are right on and I agree with them completely (full disclosure: yet another mental health professional speaking).

There are many ways to free oneself from depression; meds are one available tool with proven effectiveness (as well as variable side effects). The mistake I see most commonly is for people to go see a psychiatrist, start on meds, and not continue seeing the psychiatrist. As people already said, it's important to use psych meds while seeing a psychiatrist, so they can help you monitor the situation, deal with side effects, change meds if/when necessary, provide an effective combination of meds when things are more complex (for example, addiction and depression), make small adjustments, etc etc.

There are many steps to take: seeking professional help, finding social supoort, using your current social system, increasing your activity level (recent research is beginning to suggest that this alone may be as effective as meds for unipolar Major Depression, if interested, google behavioral activation and depression), and others -- what's important is somehow finding something inside to take some step.

Also- check out the list of mental health resources available in Bangkok pinned at the top of the health forum. If you're German, please be aware that the German Embassy is developing a resource/response team for their nationals with mental health problems- give them a call. In another nationality, you can PM me and I can tell which therapists/counselors in Bangkok speak your native language, if any.

[LaReina]

Watch and then try and practice the "secret".

Then if that does not work.. there is lexapro. If you smoke and want to quit at the same time there is Zyban.. and then there is prozac..