GETTING HELP FOR DEPRESSION

Treatment Strategies

The first step to getting appropriate treatment for depression is a physical exam by a physician. Certain medications as well as some medical conditions can cause the same symptoms as depression, and a physician should rule out these possibilities. If a physical cause is ruled out, a diagnostic evaluation should be done. This is frequently done by referral to a psychiatrist or other mental health professional such as a psychologist or clinical social worker.
Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depression. Some people with milder forms do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems.

Recovery and Treatment

As you continue in treatment, you will see that your mood and energy level will improve. The symptoms of your depression will start to disappear. As you begin to feel better, it will become easier to live a normal life again.

At this point many people make the mistake of thinking their depression is cured. They may stop taking their medicine. They may stop going to therapy. However, it is important that you continue treatment. If you don't, the chances that your symptoms of depression will return are high. This is called a relapse. Relapses are discouraging because the symptoms you have worked hard to overcome reappear. Usually, treatment must start all over again.

Stages of Recovery

Feeling better. Recovery occurs in stages. There may be a time when some or all of your symptoms of depression have disappeared. You may seem to be your previous self. It may seem as though your depression has been successfully treated. However, it is important to continue your medication or therapy to avoid a relapse. Talk with your doctor or therapist about the improvements you notice. Discuss if and how your treatment will change as a result of your improvement.

How long should antidepressant treatment continue? Depression can be treated, but it takes time. How long it will take should be discussed with your doctor. Recent treatment guidelines suggest that for a first episode of depression, medication should be taken for at least 9 months. One reason for this recommendation is that people who have been treated for depression are at risk for a relapse. You can lower this risk by taking medications exactly as your doctor prescribes.

If this is your first episode, at about 7-9 months you and your doctor should discuss the process for stopping medication. Stopping medications should be done slowly over a period of weeks. Stopping medications all at once can result in side effects. When stopping medications, you should watch for the return of any symptoms of depression. If any symptoms begin to reappear, talk to your doctor. Close monitoring by your doctor will make sure that medication can be started again before you develop a full relapse.

Medication for depression is taken to help symptoms and to prevent the depression from recurring. If you have been treated for past episodes of depression, medications may be prescribed for a longer time. Your doctor may even recommend that you continue using antidepressant medication indefinitely.

How long should therapy continue? You and your therapist should discuss ending treatment together. Both of you can determine which areas have improved. You can also see which areas need further work. You and your therapist can decide if you both agree that treatment is no longer necessary.

Some therapists may recommend having fewer therapy sessions. This is done as part of the process of stopping treatment. You need to maintain newly developed ways of thinking, feeling, behaving, and relating throughout this less frequent treatment. Therapists are also willing to restart treatment at a later date, if necessary.

Risk of relapse and maintaining improvements. About half of the people who are diagnosed with depression have only one episode. For the other half, depression is a recurring illness. For most people with recurrent depression, the symptoms disappear completely between episodes. However, some people have lingering symptoms between episodes. Maintenance treatment is the long-term use of medications or therapy for people who have had more than one episode of depression. The more episodes of depression you have had, the more likely you are to have a recurrence. In such cases, your doctor may recommend treatment for several years or indefinitely.

In addition to continuing treatments, there are many things that you can do to slowly ease yourself back to normal. Keep in mind that these things are important as you begin to feel better. They are even more important in maintaining your improved feelings.

If you don't feel better. Treatment of depression takes time and patience. If you do not notice any improvement or changes after several months in treatment, do not get discouraged. Talking with your doctor or therapist about your lack of improvement will be important in finding a treatment that works for you. Speak with your doctor or therapist about any symptoms which you continue to have. Discuss your expectations for change.

If you are not already taking medications, you and your doctor or therapist should discuss whether medications may be appropriate. If you are currently in psychotherapy and unhappy with the treatment, speak with your therapist before deciding to stop or go elsewhere for treatment. There are different approaches to treating depression and most therapists know how to work with several of these. If one doesn't work, together you can find one that will.

Managing Your Medication

How you manage your medications is important to a fast and successful recovery from depression.

Take your medication regularly and exactly as prescribed. Take your medications even if you begin to notice that your depression is going away. Develop a reminder system so you don't forget to take your medications. For example, place all your medications in a pillbox. This will remind you which medications to take each day.

Communicate with your doctor. Ask questions. Mention any reactions to the medication. Keep a record of any side effects. Tell your doctor how your treatment is working. Do not take any new medication until you talk with a pharmacist or the doctor who prescribed your antidepressant medication. This includes over-the-counter medications.

Keep all appointments with your doctor. Meet with your doctor whenever you are scheduled to. Even if you feel well, it is important to keep all appointments with your doctor.

Make sure that you do not run out of medications. Plan your prescription refills.

Do not drink alcohol while taking antidepressants. Avoid drinking alcohol. Avoid the use of all drugs. If you do choose to use any of these substances, make sure to speak to your doctor about it.

Taking Care of Yourself

During the first few months when you feel better, you should think about areas of your life which may have led to, or worsened, your depression. Think about the changes that need to be made. You may already know what kinds of changes are necessary.

While you are recovering you will continue to have daily demands on your time and effort. This may be overwhelming at times. Be sure to care for yourself in the following ways:

Increase the amount of structure in your daily life. Maintain a consistent daily schedule. Set small, realistic goals. Do one thing at a time. This way, tasks won't feel so overwhelming. Reward yourself for each goal you reach.

Practice thinking positively. People who are depressed often have gloomy or negative thoughts about themselves. Blaming yourself, feeling hopeless, and expecting failure in the smallest tasks are examples of such negative thoughts. Begin to overcome these negative thoughts.

Challenge your negative beliefs. Don't just accept them. If you find yourself thinking a negative thought about yourself, try to look at it another way. Often depression makes people think the worst. Stepping away from the problem and looking at it realistically can help you understand how your depression affects your outlook. Write the problem down. Think about it. You will see that your negative beliefs do not make sense.

Notice good things about yourself. Noticing good things will help you put your negative thoughts in perspective. The negative thoughts you have may not be as accurate as you think.

Write down good things. Write down even the small things that you feel good about. Write down the nice things other people say to you. Carry this list with you as a reminder that there are many things that you can do well.

Avoid making major life decisions when you feel depressed. Depression changes how you think about yourself. Depression changes how you feel about situations. The decisions you make when you feel depressed may be clouded. Such decisions may not be in your best interest. If you must make a major decision about your life, ask your doctor, your therapist, or someone you trust to help you think about things. Once you start feeling better, begin making decisions again. But be sure to return to your responsibilities slowly and gradually.

Ask for help when you need it. Depression changes the way you think about yourself. It is easy to think that no one wants to hear about your problems. It is easy to believe that you may be a burden to the people you talk to. However, there are people who want to help you. They want to understand what you are feeling. Your doctor, therapist, family members, and friends all want you to be well. Don't be afraid to ask people for help.

Don't criticize yourself when things go wrong. Accept the fact that there will be setbacks. Feeling better takes time. Making positive changes in your life takes time. Sometimes changes can only be accomplished with trial and error. Allow yourself to be patient. Be sure to notice improvements.

Consider taking stress management or assertiveness courses. These courses offer skills that may help you overcome your depression. These courses can help you deal with stress and relationship problems. These kinds of courses help with the issues that cause depression.

Consider joining a self-help group. Join a group that is for people who have had trouble with depression. It will be helpful to talk to people who have had the same problems as you.

Get help for problems that make depression treatment more difficult. If you or a family member have concerns about your alcohol or drug use, talk to your doctor or therapist. Therapy, a self-help group, or drug-rehabilitation is important for long-term success in treating any depression.