Take control of depression The best care series by Manulife
Each day, many people struggle with the persistent low mood and other symptoms that characterize depression. There is good news! With the right treatment, support and self-care a person can recover from depression and take back control of their life.
What is depression?
Everyone feels sad from time to time - it’s a normal part of navigating the challenges and disappointments of everyday life. Sometimes it’s a reaction to the breakup of a relationship, a problem at work or a change in health. These feelings are very common.
Clinical depression is more than a low mood. It can affect a person’s thinking, relationships, ability to carry out family and work responsibilities and physical health. Clinical depression is different from normal sadness. It consumes day-to-day living, interferes with the ability to sleep, eat, work, study, interact with others and have fun. The feelings of helplessness, hopelessness and worthlessness can be intense; it can feel as if there is no relief and that these feelings will never end.
The causes of clinical depression are likely to be different for different people. There is evidence that suggests that many factors may play a part, such as biological and genetic factors, environmental, social and cultural influences and/or childhood or developmental events.
It is not easy to know the exact causes of depression for a particular individual. For instance, an individual may be more at risk for developing depression if they have a first-degree relative with depression (e.g., parent, sibling, offspring).There may also a be a psychological/emotional influence that stems from how they think of themselves, their level of self-esteem and their usual way of reacting to and thinking about things. Examples of environmental influences might include going through a divorce or losing a job. Any of these factors - alone or in combination - might make this person more vulnerable and put them at greater risk for developing depression than someone who does not have such influences.
We also know that sometimes serious depression can appear suddenly and for no apparent reason, while other times it can follow significant life events such as trauma, chronic illness and/or losing a loved one (e.g., grief).
Symptoms of depression
Having the following symptoms continuously for more than two weeks may warrant seeking medical assistance or advice, such as talking to a health care provider (e.g., family doctor or mental health specialist). No single symptom is a diagnosis of depression. All of these symptoms should be taken seriously and can be treated.
- Feeling sad, discouraged, worthless, empty, hopeless or numb (no feeling)
- Loss of pleasure from activities you normally enjoy
- Guilty feelings
- Inability to make decisions, trouble concentrating
- Daily activities are enormously effortful to do (e.g., taking care of yourself or your family)
- Changes in sexual desire
- Change of appetite
- Suicidal thoughts
- Change in sleeping patterns
- Increased use of substances to alter mood (e.g., drinking alcohol)
- Withdrawal from family, social interactions
- Over-focus on work or inability to focus on work
Regardless of what causes depression, the most important thing is to recognize that it may be happening and to understand that professional help may be needed.
If a person feels that life is no longer worth living, and is thinking about or planning suicide, it is critical that they seek immediate help. Crisis lines and crisis services are available in many communities. Help may also be obtained by visiting the emergency department at a local hospital. Reaching out to family and friends - and other people that you trust - may make a big difference.
Antidepressant medication and psychotherapy may be very effective treatments for depression. Medications are typically prescribed by physicians and psychiatrists, while psychotherapy, or counselling, is provided by mental health professionals (e.g., psychologists or counsellors). It is important to make sure the health care provider is licensed to practice and trained to treat depression and that self-care and treatment/therapy recommendations are continued between sessions.
Antidepressant medications are used to help manage episodes of depression. There are many available antidepressant medications, for example: fluoxetine (e.g. Prozac©), citalopram (e.g., Celexa®), amitryptaline (e.g. Elavil®), duloxetine (e.g. Cymbalta©), atomoxetine (e.g. Strattera) and others. A treating physician will prescribe the most suitable treatment medication, if necessary.
Questions to ask a health care provider about medication
It is important to be educated about any medications that are taken for any illness, and it is no different for medications taken for anxiety. Here are some general questions to ask a doctor or pharmacist:
- How long will it take before I feel better?
- How often, and how much, do I take?
- What are the possible side effects, if any, and what can I do to best manage them?
- Will this medication interfere with other medication(s) or herbal remedies that I take?
- Do I have allergies to this medication?
- What should I do if I don't feel better or if I miss a dose?
- Is there any written information I can get about this medication?
- Is there anything I should not do when I take this medication (e.g., operate heavy machinery, consume alcohol)?
A doctor or pharmacist should be consulted if there are any questions about medication.
Psychotherapy and counselling
Antidepressant medications may help improve mood. However, the personal, family, or workplace situations that may have contributed to low mood and other depression symptoms may still be there. Typically, treatment for depression may involve medication, psychotherapy/counselling, as well as lifestyle changes.
Psychotherapy and counselling may help:
- Pinpoint life problems that contribute to depression.
- Review options and goals to enhance well-being.
- Identify thinking patterns and negative thoughts that contribute to feelings of sadness, powerlessness and hopelessness.
- Help the individual find ways to re-engage with life in ways that are rewarding and pleasurable.
As with medication, there are different kinds of psychotherapy that have been shown to help persons living with depression. Some of the most commonly used approaches include:
Cognitive behavioural therapy (CBT). This therapy helps to identify and change unrealistic and negative thinking that can contribute to depression and its symptoms. Additionally, cognitive therapy helps with the development of healthy behaviours and problem-solving skills.
Interpersonal therapy. This therapy helps with the development of new skills for creating healthy and satisfying relationships with partners, friends, co-workers and family. It may assist with understanding the connection between depression and life events (e.g., grief, conflict at work).
Mindfulness. Mindfulness-based interventions may also be integrated into therapy and are becoming increasingly common. Mindfulness refers to developing the ability to connect to the present moment rather than dwelling on regrets about the past or worries about the future. Connecting to the present allows you to create new and healthier ways to respond to life's challenges.
Psychotherapy may take the form of one-on-one sessions with a therapist; however group therapy may be very useful in depression treatment as well.
In individual therapy, you are building a strong relationship with one person (your therapist). Some people feel more comfortable sharing sensitive information with one person than with a group.
Group therapy has benefits too. Listening to peers going through the same struggles may validate your experiences and help build self-esteem. In groups, participants are often at different stages of recovery, so you might get tips from others about how they have worked through their own process at different points on the path to wellness. Sharing ideas and inspiration may be very beneficial, and group therapy has the added bonus of increasing your social activities and support network.
Which treatment option is best?
Medication and psychotherapy both have an important role to play in treating the symptoms of depression and in promoting recovery. These therapies are sometimes used alone or in combination. The choice of which particular therapy is best for depression is always done in consultation with a health care provider. Every individual is different and the approach that works best will be different, depending on particular circumstances.
When thinking about treatment options, your health care provider will likely consider:
- Is there a medical reason to avoid certain medications (e.g., pregnancy, breast feeding)?
- Is there a history of depression and treating it before? If so, what worked?
- Age and general health.
- Severity of the depression.
- Personal preferences and likelihood of completing the therapy (e.g., taking medication as prescribed, attending counselling sessions).
- Other life stressors that are present which may be worsening the depression symptoms or complicating the recovery process.
The importance of self-care
When a person experiences depression, a healthy lifestyle can suffer - diet, physical activity levels and sleep. By the same token, maintaining adequate nutrition, regular physical activity and sticking to a proper sleep schedule may help relieve tension, and make a person less vulnerable to depression and mood changes.
Here are some self-care activities that may help relieve symptoms of depression, prevent depression from recurring and help other treatments work more effectively.
Stick to a regular sleep schedule:
- Establish a regular, consistent time for sleeping and waking.
- Do something relaxing before going to sleep like reading (in a different room) or taking a warm bath.
- Don't use the bedroom for non-sleep activities (e.g., watching TV or eating in bed).
- Avoid strenuous exercise, caffeine, alcohol or tobacco a few hours before bedtime.
- Avoid naps during the day. Get outdoors for some activity (e.g., a short walk) to refresh.
- Talk to a health care provider about using a sleep medication.
- Choose activities that are enjoyable.
- Plan activities for the times when they can be performed consistently.
- Be active on a regular basis. Aim for 10 minutes of continuous activity, three times a week, as a start. As fitness increases, the duration and intensity of activity can be increased.
- Take advantage of opportunities to be more active by making small changes each day (e.g., take stairs instead of an elevator, exit a bus one stop earlier than a destination and walk).
Keep up with proper nutrition:
- Meals should be eaten at regular times (breakfast, lunch, dinner with a mid-morning and a mid-afternoon snack).
- Include a variety of healthy foods at mealtimes (e.g., whole grains, dark green vegetables, brightly coloured fruits, lean proteins, milk products). Avoid food with added fats, sugar and salt.
- Drink alcohol and caffeine in moderation.
- Drink several glasses of water each day (five to eight glasses is a good goal).
It is always easier to make positive lifestyle changes with the support of others. Involving friends and family in a “get-better” plan may be helpful if you are comfortable discussing your goals and treatment plan. For example, exercise with a friend, make healthy recipes for the entire family at mealtimes and participate in group activities.
Maintain gains and prevent setbacks
Every individual has a unique recovery journey. The road to well-being is a process that is supported by hope, inner strength, perseverance, and the involvement and support of others.
If you are living with depression, it’s important to remember that you can and should be an active participant in your own treatment and recovery.
- Maintain perspective. With appropriate care your symptoms can be managed and you can learn to cope more effectively. Believing in yourself is important to your recovery and to staying well. Be hopeful.
- Educate yourself. Be informed about your illness, recognize the signs and symptoms, understand what your treatment involves and learn about the importance of self-care strategies. Having this knowledge will make it easier for you to make informed decisions about your life - in ways that will contribute to the success of your treatment plan and help you to stay well.
- Take personal responsibility for keeping yourself on an even keel. Follow recommended treatment regimens, use self-care strategies, don’t hesitate to seek help if you need it. Be a friend and an advocate for yourself. Make sure you get the help you need so you can live your life the way you envision it. Good lifestyle habits can make a big difference: stick to a regular sleep schedule, exercise and stay active, eat a variety of nutritious foods, limit or avoid alcohol, avoid recreational drugs. Do things you enjoy. Learn to manage stressors.
- Learn from and lean on others. Support from other people you trust, including family and friends, your health care team, and others may help you to stay centred, positive, and hopeful. You might want to create a “Mood 911” plan by developing a list of warning signs that can be shared with family and trusted friends, and have a plan ready to deal with stressful situations that may trigger a depressive episode. Know that you are not alone.
Make the return to work easier
It is not unusual for an individual living with depression to require time away from work to access treatment and stabilize their condition. If there has been an absence from work, developing a plan to return to work and eventually returning to work are essential steps on the path to recovery. These tips will help ensure the return is successful:
- Think about what helps the most. Each person is different. Some people need more flexible work arrangements (e.g., reduced hours, modified job duties) and others feel capable of returning to full capacity immediately.
- Clearly understand the return to work plan and be an active participant in its creation. What are the hours? What are the expectations, roles and responsibilities? Who needs to be informed?
- Understand privacy rights and be prepared for any disclosure (if necessary). Details of an absence are private and confidential. However, there may be workplace policies that require that certain information be reported (e.g., safety sensitive positions, information needed for job accommodation purposes). If any disclosure is required, plan what to say and how much information to share. Questions about who to disclose information to, and how much information to disclose, should be directed to a third party such as a human resources representative or employee health professional.
- Learn about support options. Good support is essential to a successful return. Find out what resources are available in your workplace through your employer/human resources department.
- Continue self-care efforts. Be alert to changes in your mental and physical well-being, seek medical care when needed, use the skills and strategies you learned in psychotherapy or counselling and get support from people you trust.