Tuesday, August 30, 2011

Treating Depression

wild grass and moths
Depressed mood or sadness lasting two weeks or more requires treatment. We all feel depressed, sad, or ‘blue’ occasionally. Moods and feelings change in response to events in our external environment. Usually depressive feelings or sadness last for a day or two; longer in case of loss or bereavement. However, if these feelings of sadness and hopelessness persist for more than 2 weeks and interfere with daily life, it indicates a clinical depression.
Depression is the fourth highest contributor to the global burden of disease. 
Clinical depression is a treatable illness. Many people never seek treatment due to lack of awareness, lack of access to mental health care, ignorance, or shame.

Signs and Symptoms

The hallmark of Clinical Depression is a pervasive depressed mood. This depressed mood is not responsive to positive events. There is associated slowness of thinking and movement; and there are thoughts related to guilt, self-blame, hopelessness and suicide . These features of constitute the classical triad of symptoms for the diagnosis of Clinical Depression. For a more formal diagnosis some or all of the symptoms below are used
  1. Persistent sadness. Frequent crying, irritability, ‘emotional outbursts’
  2. Slowing of movement and thoughts
  3. Feelings of guilt - ‘I shouldn’t have done that’, ‘it is all my fault’
  4. Worthlessness - ‘I haven’t achieved anything’, ‘I let my parents down’, ‘what I do has no value’
  5. Hopelessness - ‘What’s the point?’, ‘I don’t see things getting better’
  6. Thoughts of dying and suicide - ‘I would be better off dead’
  7. Loss of interest in activities and hobbies that were once pleasurable
  8. Difficulty concentrating, remembering details, making decisions
  9. Insomnia, early morning wakefulness, excessive sleeping.
  10. Change in appetite – appetite loss or overeating.
  11. Fatigue, lethargy, decreased energy
  12. Headache, cramps or digestive problems that are not relieved by treatment

How is depression treated?

The first step to treatment is to visit a psychiatrist. Your psychiatrist is the only mental health professional qualified to prescribe medication and provide psychotherapy. Your psychiatrist will take a detailed history of your symptoms, and will ask you to complete some questionnaires to assess their severity. He will also do a physical examination and may get some tests done (thyroid disorders and blood glucose related problems can cause similar symptoms).

The treatment of depression rests on two pillars
  1. Pharmacotherapy (medication)
  2. Psychotherapy (counselling, CBT)
Medication (pharmacotherapy) is required for moderate and severe depressions. Formal psychotherapy is started later once concentration and thinking improve. Your psychiatrist will prescribe an appropriate antidepressant. Antidepressants are not addicting. Side effects if any occur during the initial phase of treatment, they should not make you feel worse. Antidepressants must be taken for 4-6 weeks before they have a full effect. Later you should continue the medication even if you are feeling better to prevent a relapse. Suddenly stopping antidepressants can precipitate a relapse. Medication should be tapered gradually under your doctor’s supervision. If you follow your doctor's advice regarding follow up visits your treatment will be optimal.

Psychotherapy alone may be used in mild depression. Usually it is combined with medication for moderate and severe depressions. Psychotherapy is of two types:
  1. Cognitive Behaviour Therapy (CBT) identifies self-defeating, ‘negative thoughts’ and behaviours that perpetuate clinical depression in a vicious cycle. Your therapist then works with you to replace these thoughts and behaviours with ‘positive’ ones to help you recover from the illness.
  2. Interpersonal Therapy (IPT) helps people understand and work through troubled relationships that may be at the root of depression or making it worse.

How can I help a friend or family member who is depressed?

  1. Listen carefully.
  2. Offer support, understanding and encouragement.
  3. Never dismiss feelings, but point out realities and offer hope.
  4. Encourage them to go out for walks, outings and other simple activities. Don’t push too hard but keep trying.
  5. Make sure they keep appointments with the psychiatrist and stay in therapy.
  6. Never ignore suicide comments
    • Gently correct blatantly ‘negative’ thoughts. Help the person form an action plan to resolve the problem
    • DON'T LEAVE THEM ALONE until they OK the plan. 
    • Accompany them to a known responsible person or a doctor or mental health professional. You could save a life.

What can I do when I am depressed?

  1. Stay active. Exercise; go out for a movie, or any event you previously enjoyed.
  2. Eat regular meals. Don’t skip them even if you are not hungry.
  3. Go to bed at a regular time. Don’t wait until you are extremely tired so you can get sleep. Insomnia is the first symptom to respond to antidepressant medication
  4. Set realistic goals for yourself.
  5. Break up large tasks into smaller ones and do what you can.
  6. Spend time with others, confide in a trusted friend or relative.
  7. Postpone important decisions such as getting married/divorced, changing jobs until you are feeling better.
  8. Do not wait too long to get treatment.
  9. Expect your mood to improve gradually. Sleep and appetite will improve before your mood changes.
  10. Keep your appointments with your psychiatrist and do not stop your medication suddenly.

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