Depression Treatment

  • Treatment

    People who have extreme signs of depression or are in danger of suicide must receive prompt psychiatric attention Table 06.

    Approximately 15% of people with mood disorders ultimately commit suicide. Those who have persistent suicidal thoughts or definite plans for carrying out a suicide must receive psychiatric care at once. Such individuals may require hospitalization in a mental health facility until medications and counseling have taken effect and the danger has passed.

    Depressed patients for whom outpatient care has been unsuccessful or who show signs of acute psychosis, continue to abuse drugs or alcohol, show a severe deterioration in self-care, or engage in behavior that is alienating to their families should be hospitalized Table 06.

    Table 6.  Warning Signs Requiring Urgent Care

    Desire to hurt themselves
    Evidence of plans to carry out suicide: stash of pills, a weapon
    Extreme agitation
    Extreme weight loss
    Hallucinations or delusions (imaginary thoughts or beliefs, such as hearing voices or believing one has ?superhuman? powers)

    Maintain a regular pattern of exercise and activity Table 07.

    Regular exercise has been found to elevate mood and relieve some symptoms of depression. The fatigue that sometimes accompanies depression may make it difficult to start an exercise regime; however, even short exercise periods (such as walking for 15 minutes) can help to enhance mood Table 07.

    Avoid alcohol and illegal drugs.

    Many people with depression try to relieve their symptoms with illegal drugs or alcohol. These substances can worsen depression and interfere with prescribed medications. They can cause problems in work and home life, thus making it harder to recover from depression.

    Eat a healthy diet.

    There are no specific recommended diets to help treat depression; however, eating a balanced diet can alleviate some symptoms of depression or keep them from getting worse. It is also important to maintain a healthy diet because the appetite changes associated with depression can lead to poor nutrition or weight changes.

    Schedule activities that you enjoy and that give you a sense of accomplishment.

    Simple activities such as visits with family or friends, shopping trips, or going to the movies can provide pleasant diversions from daily routines and help relieve some of the symptoms of depression. Participating in an activity that allows you to achieve a goal or an objective can help you feel more in control of your life.

    Keep taking your medication, even if it doesn't seem to be working or you experience initial side effects.

    Antidepressant medications typically require a few weeks to take effect, so keep taking your medication as prescribed unless instructed otherwise by your clinician. In addition, side effects generally go away within a few days or a few weeks, or are at the very least tolerable. Therefore, keep taking your medication even if you experience initial side effects.

    Try to sleep at least 7 or 8 hours every night, and follow a regular sleep schedule.

    Erratic or inadequate sleep can make symptoms of depression worse. Also, being depressed can make it more difficult to maintain normal sleep patterns. Setting a schedule and following a sleep routine can help you feel better and more rested.

    Consider joining a support group, and resist the temptation to withdraw from friends and family.

    Your clinician can recommend a support group in your area that is right for you.

    Call your clinician immediately if you feel suicidal.

    Be aware of what types of psychiatric emergency services are available in your area. If your clinician is unreachable, go to the emergency department.

    Concentrate on good experiences in your life, and try to develop an attitude that will help you get better.

    Depression is often characterized by recurrent negative thoughts of self. It is important to try to avoid thinking negatively about yourself and your life.

    Make a daily effort to tend to grooming and personal hygiene.

    Taking care of yourself can help boost your mood and your energy as you recover from depression. Also, you are less likely to isolate yourself from family and friends if you feel comfortable with your grooming and appearance.

    Learn as much about depression as you can.

    Your clinician can recommend local resources and support groups that may help you learn about depression. National resources available include:

    • Depression and Bipolar Support Alliance (DBSA): Toll-free: 1-800-826-3632 www.dbsalliance.org
    • American Psychiatric Association: Toll-free:1-888-357-7924 www.psych.org
    • National Institute of Mental Health: Toll-free:1-800-421-4211 www.nimh.nih.gov

    Table 7.  Caring For Yourself While Recovering From Depression

    Take your medication(s) as directed by your clinician. If you have intolerable side effects, contact your clinician before stopping the medication.
    Remember that antidepressant medications usually take a few weeks to start working; do not stop your medication because it does not seem to be effective.
    Remember that most patients have some side effects after starting an antidepressant medication; however, the side effects can usually be tolerated and tend to go away within a few days or weeks.
    Maintain a healthy diet, and avoid drinking alcohol or taking unnecessary or recreational drugs.
    If you are taking an antidepressant medication, contact your clinician before starting any other prescription medication, nonprescription medication, herb, or alternative (natural) product. Remember, some of these medications or products may have a bad interaction with your antidepressant.
    Exercise at least three or four times a week. Even walking for as little as 15 minutes every other day is helpful.
    Try to sleep at least 7-8 hours every night, and try to follow a regular sleep schedule. Inadequate amounts of sleep or irregular sleep habits may worsen depressive symptoms.
    Concentrate on thinking about good experiences in your life and on developing an attitude that you will get better.
    Work with your clinician to learn positive ways to solve problems.
    Consider joining a support group, and frequently talk to your friends and family. Do not allow yourself to withdraw from contact with other people.
    If you feel suicidal, contact your clinician right away.
    Try hard every day to take care of your grooming and personal hygiene.
    Identify activities that make you feel better and try to participate in them regularly, even when you do not feel up to it.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Counseling can be used by itself or along with drug treatment.

    Counseling can help depressed individuals develop a more positive view of themselves and can improve relationships. A counselor, psychologist, or psychiatrist can also help you develop effective coping strategies for life's inevitable stresses. If counseling does not help within 2 to 3 months, medications should be tried.

    People with seasonal depression may benefit from going outside more often or using a special lightbox in the winter.

    For those who develop depression during seasons of reduced sunlight, clinicians recommend a daily walk or lunch outdoors for an hour each day. If this does not help, regularly timed treatments with a phototherapy lightbox have been found to be helpful. Lightboxes can be purchased for home use.

    Electroconvulsive shock treatment (ECT) is sometimes necessary for severe depression.

    ECT may be used for people with severe depression who are unresponsive to medication. The procedure involves passing an electric current through electrodes placed on the head to induce a seizure. It is typically given in a series of five to eight treatments, with one treatment given on alternate days. Muscle soreness may result because of the seizure-induced muscle contractions, and temporary memory loss may occur. Because the treatment is done under general anesthesia, it involves risks similar to those of other minor medical procedures involving anesthesia, including a very small risk of death.

    Despite generalized fears of ECT, most psychiatrists regard it as a safe and effective treatment that works more rapidly than medications or counseling. It is most commonly used for individuals who are at extreme risk for suicide, for people who have lost a dangerous amount of weight, or for those who are extremely agitated.

    Exercise, acupuncture, massage, and relaxation techniques may help treat depression.

    St. John's wort may help alleviate some symptoms of mild to moderate depression.

    St. John's wort has been shown in some studies to improve mood and mental health functioning in some cases of mild or moderate depression. Because St. John's wort interacts badly with many other medicines, it is important to consult your clinician before taking St. John's wort. People with bipolar illness should avoid St. John's wort unless closely monitored by a clinician.

    Alternative therapies should not be used as a substitute for medical care. You should always tell your clinician or pharmacist what medicines you are taking, such as prescription or non-prescription medicines, herbs, vitamins, or other supplements.

    Alternative therapies may react poorly with some prescribed or nonprescription medicines. Taking herbs, vitamins, or other supplements may interfere with lab tests or healing after surgery or illness, or may worsen some illnesses and health conditions. Your clinician and pharmacist can help you choose the complementary therapies or supplements that are right for you.

    Most people can be helped with medications and counseling. However, people who have had a major depression are at risk for future episodes.

    Depression usually starts in young adulthood, and recurrences over time are likely. About half of those who have had one episode of depression will have another. Of those who have a second depressive episode, about 70% will have a third; of those who have a third, 90% will have a fourth.

    If untreated, a major depressive episode may last from months to years. Treatment helps to alleviate depression in about 80% of cases. Medications can be taken indefinitely to prevent repeat episodes of depression.

    Death rates of depressed people are increased.

    Studies have shown that heart attack patients with depression are more likely to die than heart attack patients without depression. Another study reported that patients with depression admitted to nursing homes had higher death rates in the first year than patients without depression. Suicide also increases the death rate from this disorder.

    Schedule regular doctor appointments to monitor progress as well as side effects of medications.

    See your clinician regularly after beginning new medications to treat your depression. Be sure to tell your clinician if symptoms worsen or do not improve, or if you develop symptoms that may be side effects of medications.

    Keep in mind that many medications take two to four weeks to start working, and it is common to need some minor dose adjustments. Do not quit taking the medicine when you start feeling better. You may need to be on your medicine for months or years.

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