After receiving a diagnosis of major depression, you may be relieved to have a name for your emotional pain and overwhelmed by the deal at hand. However, you are not alone. Between 10 and 25 percent of women and 5 to 12 percent of men have a major depressive disorder in their lifetime. And, even if it seems impossible at first, depression is effectively treated and your mood and life will improve.
Here’s a summary of what you can expect from treatment, how to increase your chances of effective treatment and general tips for achieving relief and recovery.
Diagnosis of depression
Before understanding how the treatment works, it is important to ensure that you received the correct diagnosis through a comprehensive evaluation. This normally consists of a careful interview, including questions about symptoms and current stressors, a standardized questionnaire (such as the Patient Health Questionnaire or PHQ; Beck Depression Inventory or BDI), and suicide assessment. The doctor may also perform related blood tests to rule out a medical condition.
Although depression is very common, misconceptions abound. Here are some of the most common myths:
Depression is not a serious illness. Many people mistakenly view depression as a “moral failure,” said Allen J. Dietrich, MD, co-chairman of the MacArthur Foundation’s Initiative on Depression and Primary Care, whose goal is to help primary care physicians diagnose and treat depression. Others also view being depressed as a weakness, said Christopher Martell, Ph.D, a depression researcher and clinical psychologist in Seattle.
However, depression is a serious clinical disorder “Characterized by a complex integration of biological and environmental vulnerabilities, life events, and patterns of thought and behavior that lead to the clinical presentation,” Martell said. The cause may vary for each person. But whatever the contributing causes of your depression, all professionals agree that depression requires treatment.
I should toughen up and accept it
It’s important to realize that “Depression is not a natural consequence of living life, it’s an aberration that doesn’t have to be tolerated,” said Steven D. Hollon, Ph.D, a clinical psychologist and researcher at Vanderbilt University.
I’m going to get out of it
Leaving depression untreated in the hope that it will go away may actually make the episode worse, make it last longer, and increase the risk of suicide.
I’m going to be like this forever
The biggest mistake patients make is thinking that their feelings of depression, fatigue, irritability, inability to concentrate and loss of interest will last forever, that there is no relief in sight, said Rosalind S. Dorlen, Psy.D, ABPP, New Jersey clinical psychologist and New Jersey public education coordinator for the American Psychological Association. Fortunately, however, thanks to effective treatment, patients find relief and recovery.
Tell others about your diagnosis
Many people wonder how much they should disclose about their depression to each of their loved ones or co-workers. “The level of intimacy in responses is an individual decision,” said Mark E. Oakley, Ph.D, director and founder of the Center for Cognitive Therapy in Beverly Hills, California.
You can reveal more details to loved ones who are supportive. To co-workers or anyone who is less than supportive, you can simply say that you’re “going through a tough time,” and don’t hesitate to offer “as little information as possible,” Martell said. It may also mean that the problem is being worked on. Sometimes people feel like they need to make suggestions about what to do. Saying you’re getting help or working through your problems may minimize that response, he said.
What to expect from the treatment
Treatment may consist of medication, psychotherapy, or a combination of the two. Various professionals, including psychologists, psychiatrists, professional counselors and social workers, and primary care physicians can treat depression. Which professional and which treatment you choose is up to you.
“In our experience, half of the patients can be controlled exclusively in primary care. Many others would benefit from a mental health consultation and some may need or prefer mental health management,” said Dr. Dietrich. Taking the medication “Can work on its own, is more accessible to many people, and may require less frequency,” he said.
However, as Hollon points out, medication does not correct the underlying tendency for depression or address negative thinking and behavior. This can be especially problematic for patients with chronic depression.
Whatever the limits of medication and psychotherapy, each is effective in reducing symptoms of depression. Some research has shown that a combination of the two is particularly powerful.
There are many types of psychotherapy, however, not all approaches are equal. So it is important to understand what approach your therapist will use. While generic talk therapy has not been shown to be effective in treating depression, research consistently shows that cognitive-behavioral and interpersonal therapy approaches are successful.
“Depressed patients often make specific errors in thinking and engaging in unproductive behavior patterns that lead to, maintain, and can worsen depression,” Oakley said. When they walk in the door, customers often have a lot of evidence that they’ve screwed up and tend to blame themselves, Hollon said. It is these errors and tests that cognitive-behavioral approaches deal with.
Contrary to popular belief, these therapies do not focus on the power of positive thinking. “I would rather see people be realistic rather than falsely optimistic,” Hollon said.
A large part of the cognitive-behavioral approaches investigates a large amount of negative evidence from patients. “Patients learn to examine the accuracy of their own beliefs, so they’re not left with self-fulfilling prophecies,” Hollon said. For example, instead of saying, “I didn’t go to college because I’m stupid,” a patient examines the evidence and might find that he won’t be accepted because he only applied to one school or didn’t complete the application correctly.
The length of treatment ultimately depends on the severity of the depression, but cognitive behavioral therapy (CBT) typically lasts 12 to 24 sessions. “Patients can usually be expected to see incremental changes in mood usually by the 12th session,” Oakley said.
In Hollon’s experience, patients typically begin to feel better after a week or two, although the gains are not lasting. If Hollon doesn’t see “a good improvement within four to six sessions” (if the depression isn’t severe or chronic), he wonders what’s missing. If you’re not getting better, always ask why and don’t blame yourself, Hollon said. “It could be that your therapist is not pushing forward.”
How to Overcome Common Obstacles in Psychotherapy
Various obstacles can impede progress in therapy. Here’s how to overcome them.
Be honest . Although it’s difficult to open up to someone you don’t know about your innermost feelings, being honest with your therapist helps you make progress. If you don’t feel comfortable disclosing information to your therapist, ask yourself why. If it’s the therapist who makes you uncomfortable, you may want to see someone else.
Be willing. It is important to enter therapy with an open mind. For example, even though you may experience a loss of interest in all activities, your therapist will encourage you to experiment with “Things that previously brought joy, a sense of meaning, or accomplishment,” Oakley said. Be willing to try these and other activities.
Remember that you are a team. The success of the treatment involves both the patient and the therapist, it is a collaborative process. “Patients take an active role in treatment, and assignments that are designed to build skills are an integral part of effective treatment,” Oakley said.
Talk. A common obstacle to CBT is when patients do not complete their assignments between sessions. “If your therapist is suggesting that homework seems like too much, talk to your therapist, who will most likely be open to feedback and will work with you to make the work between sessions manageable,” Martell said.
Consider your belief system. For some people, an ingrained belief system can prevent treatment. For example, a person may feel that he is doomed to a life of depression because of a family history of the disorder.
Pick up the mood from the driver’s seat. A common pitfall for people with depression is that they are not motivated to participate in activities that improve their mood. “They become inactive and tired, which worsens and maintains their depression,” Oakley said. That’s why it’s key not to let your feelings dictate what you do, he added.
Research shows that antidepressants are effective in reducing symptoms of depression. But it is important to understand that drugs does not work instantly or produce dramatic results. Most people will feel a positive impact in a week or two, but they won’t experience the full impact for a month or two, Dr. Dietrich said.
In the meantime, while he waits for the medication to start working, Dr. Dietrich suggests disciplining yourself to do activities you once enjoyed. For example, if you enjoyed visiting friends before your depression, keep inviting some friends.
Keep in mind that the first drug you try may not be the right one for you. “Most people who start on one hypertension medicine will need to take a different or an additional medicine. It’s not very different for depression,” Dr. Dietrich said. In fact, trying various antidepressants and adjusting the dosage is something doctors look forward to. So it’s important not to get discouraged if the first medicine doesn’t work.
Common concerns about medication
Be sure to discuss any concerns about taking the medication with your doctor. Some common concerns are listed below.
They have significant side effects. All medications, whether they are for depression, hypertension, or the common cold, have side effects. However, “There are enough different drug options to find a minimal pattern of side effects” for each individual, Dr. Dietrich said. Also, your doctor can help reduce the impact of some of the side effects. For example, if you have troubles sleeping, your doctor might recommend that you take your medicine in the morning.
I’m going to have to take them for life. It’s actually less common for people to take the medication long-term. Instead, for most people depression is an acute, intermittent episode, requiring medication for six to nine months, Dr. Dietrich said. Those who have experienced more than one depressive episode may need a longer course of medication.
People who “Achieve remission stay there for a period of time. If two or three years later, life becomes difficult, you just have to take the treatment again,” said Dr. Dietrich.
They are addictive. These drugs do not cause dependence or physical or psychological abstinence symptoms. However, stopping medication abruptly can lead to “discontinuation syndrome,” which occurs in about 20 percent of patients who take antidepressants for at least six weeks, according to the American Family Physician.
Discontinuation syndrome is a series of symptoms such as flu-like symptoms, anxiety, dizziness, insomnia, blurred vision, and hallucinations. The severity of these symptoms varies from person to person.
They increase the risk of suicide. Antidepressants carry a black box warning, indicating an increased risk of suicidal thoughts and behavior. However, this appears to be true for patients in their teens and 20s and less so for adults, Dr. Dietrich said. Although patients should be closely watched, he believes the risk is “Short – term, not very common and exaggerated.”
What you can do to ensure effective treatment
There are several ways you can increase the chances that your medication will work more effectively.
Take medications as directed. Follow your doctor’s specific instructions about taking your medication. Also, because the newer antidepressants have tolerable side effects and work so well, patients tend to want to stop taking them, Hollon said. Stopping medication abruptly on your own, however, can be dangerous: you may feel depressed again and go through discontinuation syndrome. If you are interested in stopping, check with your doctor, so he or she can properly guide you through tapering off your medication.
Talk. Raise any concerns or questions with your doctor. Tell your doctor if the medication is working. Do you feel better or worse? What kind of side effects are you having? Being open helps your doctor give you the best treatment.