Health: When April really is the cruellest month

The joys of spring can bring nothing but misery if you suffer from depression, writes Virginia Ironside

"IN THE Spring, a livelier iris changes on the burnished dove; In the Spring a young man's fancy lightly turns to thoughts of love," wrote Tennyson. But there is a group for whom spring is a time of dread and whose minds turn more to suicide than love - they are depressives.

No one knows why there are more suicides in the spring than at any other time of the year, or why agony aunts' postbags are bulging and psychiatrists' diaries are full. There is vague talk of a change of light having a depressive effect; others feel that the gulf between reality and the depressive mind widens when spring comes. Everything may be full of hope, but this can make the depressive feel worse not better.

As a consequence, with the exception of sufferers from SAD (Seasonal Affective Disorder), who look forward to the healing sunlight of a new year, spring can be a difficult time for those one in 20 people with a tendency to depression. But what help can they expect if they go to see their doctor? These days, most psychiatrists agree that there isn't just one answer. They try to treat depression on three fronts: through counselling or cognitive therapy, change in circumstance, or medical intervention.

Counselling or cognitive therapy may help patients get to the root of the depression and sadness and find the tools to fight it on their own. A change in circumstances - a single parent whose father has just died and whose child has Down's Syndrome, for example, may be understandably depressed and could be helped with extra care.

The other form of treatment is anti-depressants. Many people baulk at a chemical cure, but if you take 100 people with depression and give them anti-depressants, 70 will make a good recovery. Their reluctance is partly because they do not really understand these drugs. We take antibiotics if we have a sceptic throat, we gobble down painkillers if we hurt, but anti-depressants confuse us and, it must be added, confuse a lot of GPs.

This is partly due to the fact that we confuse non-addictive anti-depressants with addictive tranquillisers (which are quite a different ball game), and partly because there appear to be so many of them - 28 different medicines licensed for use as anti-depressants, to be precise.

In the Seventies and Eighties, there was a great deal of prejudice about anti-depressants. Since one of the symptoms of depression is that "everything is my fault", people flocked to counsellors to try to sort out it out.

Counselling can be excellent, but no amount of talking can cure a depression with a chemical base. Any depression, with its classic symptoms of sleep problems, waking up in the morning feeling frightful and improving during the day, loss of sexual interest, a feeling that life is pointless, is really worth trying to treat medically.

I am a jangling mess of daily medication - a cocktail of five different drugs and eight pills a day - but the medication stops me from feeling suicidal. You may not have to take the tablets for more than six months, but it's absolutely crazy not to give them a whirl.

In fact, there are only a few basic families of anti-depressants and it is worth remembering that none of them work by adding anti-depressant chemicals to the brain alone.

The symptoms of depression are thought to be caused by some natural brain chemicals, noradrenaline and serotonin, becoming underactive. Anti-depressants work by increasing the level of these chemicals in the brain, or decreasing others. They usually take between two and three weeks to work, so it is worth persisting with them.

But if they don't work, there is no point just giving up on anti-depressants altogether, because an anti-depressant that lifts one person's depression might have no effect on another sufferer.

Since GPs have only got a basic knowledge of what is available, it is worth asking for a referral to a psychiatrist if what the GP prescribes doesn't work, simply because he or she knows their subject so much better.

Sometimes a depressed person may be given a cocktail of the drugs described on the right, one of which may work to enhance the action of the other.

Lithium is usually prescribed for cases of manic depression, when people feel incredibly low for a few months and then go into a manic high, often resulting in over-spending, high sex-drive, or wild ideas for new and totally impractical new businesses. If you have lithium, your mood swings should lessen - but you will need regular blood tests to make sure the dosage you are on continues to be safe.

If the anti-depressive drugs fail, there is always ECT - Electro-Convulsive Therapy. Again, people cringe at the thought of it, imagining that they will be in the hands of mad doctors who will shoot volts of electricity through their brains when they don't know what they're doing. Up to a point, this is true - because they don't know what they are doing. But the other truth is that when someone is so unreachable or acutely depressed that all other treatments have failed, ECT can have miraculous effects.

A friend of mine who suffered from post-puerperal psychosis and was, quite simply, a zombie, had a few shots and was back to her old energetic self within weeks. With the aid of muscle relaxants, the only convulsions may involve a couple of toes twitching. Any memory loss is nearly always short term.

This treatment works for eight out of 10 people and requires a patient's written consent, unless he or she is so bad that relatives need to sign on their behalf. Anti-depressants: Tricyclic anti-depressants: Amitriptilyne (Tryptizol); imipramine (Tofranil); clomipramine (Anafranil); Dothiepin (Prothiaden); Lofepramine (Gamanil). These have been around for about 30 years and are sometimes given for anxiety or to help people sleep.

SSRIs - selective seratonin reuptake inhibitors: Fluvoxamine (Faverin); sertraline (Lustral); paroxctine (Seroxat);

fluoxetine (Prozac).

These anti-depressants have only been available in the UK since 1988. They can be used to treat eating disorders as well as depression. Prozac is the most famous, but though it works marvellously for some people, it may have no effect on others or produce unpleasant side-effects.

MAOIs - monoamine oxidase inhibitors:

Isocarboxazid (Marplan); phenelzine (Nardil);

tranylcypromine (Parnate).

These have been available for about 30 years and work by deactivating an enzyme in the brain called monoamine oxidase. They also affect other parts of the body, so it is wise not to eat anything with tyramine in it, such as pickled herrings, caviar, Marmite, Chianti, or cheese or broad bean pods.

Other anti-depressants: Ventafaxine (Efexor); L-trytophan (Optimax), a naturally occurring chemical that we all take in small quantities in our diet; and flupenthixol (Fluanxol), a major tranquilliser which also acts as an anti-depressant.

anti-depressants