It is not uncommon for
people to wonder just when it is necessary to seek help for depression.
Sometimes we hear people casually say, "I'm depressed," when they
have had a bad day at work or a fight with their spouse. Typically, these kinds of feelings pass or lessen within
a short period of time. In cases such as these, we are not really "depressed,"
but we experience normal and temporary feelings of sadness, frustration,
or stress. These normal feelings are different than the more extreme and
pervasive feelings associated with clinical depression. However, if depressive
symptoms persist for a period of two weeks or more, or they are particularly
distressing, then it is probably time to consult a mental health professional
or a physician.
If you have any doubts or questions about seeking help for depression,
it is better to be on the safe side and go ahead and speak with a professional.
Left untreated, depression can continue for weeks, months, or years. Over
time it can become worse and may be more difficult to treat successfully.
Untreated depression can also increase a person's risk of suicide. Up
to 15% of those who are clinically depressed die by suicide.
If you have
any doubts or questions about seeking help for depression, it is better
to be on the safe side and go ahead and speak with a professional. Left
untreated, depression can continue for weeks, months, or years. Over time
it can become worse and may be more difficult to treat successfully. Untreated
depression can also increase a person's risk of suicide. Up to 15% of those
who are clinically depressed die by suicide.
The following individuals or organizations can often provide treatment
services and/or make referrals for service:
- Family doctors and other physicians
- Mental health professionals: psychiatrists, psychologists, social
workers, counselors
- Your insurance provider
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- Hospital emergency rooms in times of crisis
- University- or medical school-affiliated programs
- State hospital outpatient clinics
- Family service/social agencies
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
Helping
Yourself When You Are Depressed
Depressive
disorders make one feel exhausted, worthless, helpless, and hopeless. Such
negative thoughts and feelings make some people feel like giving up. It
is important to realize that these negative views are part of the depression
and typically do not accurately reflect the situation. Negative thinking
fades as treatment begins to take effect. In the meantime:
- Set realistic goals and assume a reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and do what
you can as you can.
- Try to be with other people and to confide in someone; it is usually
better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating in
religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling better
takes time.
- It is advisable to postpone important decisions until the depression
has lifted. Before deciding to make a significant transition--change
jobs, get married or divorced--discuss it with others who know you well
and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they can
feel a little better day by day.
- Remember, positive thinking will replace the negative thinking that
is part of the depression and will disappear as your depression responds
to treatment.
- Let your family and friends help you.
Helping
a Relative or Friend Who is Depressed
The most
important thing anyone can do for the depressed person is to help him or
her get an appropriate diagnosis and treatment. This may involve encouraging
the individual to stay with treatment until symptoms begin to abate (several
weeks), or to seek different treatment if no improvement occurs. On occasion,
it may require making an appointment and accompanying the depressed person
to the doctor. It may also mean monitoring whether the depressed person
is taking medication. The depressed person should be encouraged to obey
the doctor's orders about the use of alcoholic products while on medication.
The second most important thing is to offer emotional support. This involves
understanding, patience, affection, and encouragement. Engage the depressed
person in conversation and listen carefully. Do not disparage feelings
expressed, but point out realities and offer hope. Do not ignore remarks
about suicide. Report them to the depressed person's therapist. Invite
the depressed person for walks, outings, to the movies, and other activities.
Be gently insistent if your invitation is refused. Encourage participation
in some activities that once gave pleasure, such as hobbies, sports, religious
or cultural activities, but do not push the depressed person to undertake
too much too soon. The depressed person needs diversion and company, but
too many demands can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness,
or expect him or her "to snap out of it." Eventually, with treatment,
most depressed people do get better. Keep that in mind, and keep reassuring
the depressed person that, with time and help, he or she will feel better.
Treatment
for depression includes:
Psychotherapy
Medication
Electroconvulsive Therapy
Psychotherapy
Psychological
treatment of depression (psychotherapy) assists the depressed individual
in several ways. First, supportive counseling helps ease the pain of depression,
and addresses the feelings of hopelessness that accompany depression. Second,
cognitive therapy changes the pessimistic ideas, unrealistic expectations,
and overly critical self-evaluations that create depression and sustain
it. Cognitive therapy helps the depressed person recognize which life problems
are critical, and which are minor. It also helps him/her to develop positive
life goals, and a more positive self-assessment. Third, problem solving
therapy changes the areas of the person's life that are creating significant
stress, and contributing to the depression. This may require behavioral
therapy to develop better coping skills, or Interpersonal therapy, to assist
in solving relationship problems.
Medication
Except in
the more severe depressions, and bipolar depression, medication is usually
an option, rather than a necessity. Antidepressant medication does not cure
depression, it only helps you to feel better by controlling certain symptoms.
If you are depressed because of life problems, such as relationship conflicts,
divorce, loss of a loved one, job pressures, financial crises, serious medical
problems in yourself or a family member, legal problems, or problems with
your children, taking a pill will not make those problems go away.
Electroconvulsive
Therapy (ECT)
In situations
where medication, psychotherapy, and the combination of these interventions
prove ineffective, or work too slowly to relieve severe symptoms such as
psychosis (e.g., hallucinations, delusional thinking) or suicidality, electroconvulsive
therapy (ECT) may be considered. ECT is a highly effective treatment for
severe depressive episodes. The possibility of long-lasting memory problems,
although a concern in the past, has been significantly reduced with modern
ECT techniques. However, the potential benefits and risks of ECT, and of
available alternative interventions, should be carefully reviewed and discussed
with individuals considering this treatment and, where appropriate, with
family or friends.
How
Depression is Treated
The first
step to getting appropriate treatment for depression is a physical examination
by a physician. Certain medications as well as some medical conditions such
as a viral infection can cause the same symptoms as depression, and the
physician should rule out these possibilities through examination, interview,
and lab tests. If a physical cause for the depression is ruled out, a psychological
evaluation should be done, by the physician or by referral to a psychiatrist
or psychologist.
A good diagnostic evaluation will include a complete history of symptoms,
i.e., when they started, how long they have lasted, how severe they are,
whether the patient had them before and, if so, whether the symptoms were
treated and what treatment was given. The doctor should ask about alcohol
and drug use, and if the patient has thoughts about death or suicide. Further,
a history should include questions about whether other family members have
had a depressive illness and, if treated, what treatments they may have
received and which were effective.
Last, a diagnostic evaluation should include a mental status examination
to determine if speech or thought patterns or memory have been affected,
as sometimes happens in the case of a depressive or manic-depressive illness.
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 depressive disorders. Some people with milder forms may 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, including depression.
Depending on the patient's diagnosis and severity of symptoms, the therapist
may prescribe medication and/or one of the several forms of psychotherapy
that have proven effective for depression.
Electroconvulsive therapy (ECT) is useful, particularly for individuals
whose depression is severe or life threatening or who cannot take antidepressant
medication. ECT often is effective in cases where antidepressant medications
do not provide sufficient relief of symptoms. In recent years, ECT has been
much improved. A muscle relaxant is given before treatment, which is done
under brief anesthesia. Electrodes are placed at precise locations on the
head to deliver electrical impulses. The stimulation causes a brief (about
30 seconds) seizure within the brain. The person receiving ECT does not
consciously experience the electrical stimulus. For full therapeutic benefit,
at least several sessions of ECT, typically given at the rate of three per
week, are required.
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