In-Depth: Living with Depression
Common Concerns about Medication
Be sure to discuss with your doctor any concerns about taking medication. Some common worries are listed below.
- They have significant side effects. All medications, whether they’re for depression, hypertension or the common cold, have side effects. However, “there are enough different choices of medication to find a minimal pattern of side effects” for each individual, Dr. Dietrich said. Also, your doctor can help shrink the impact of some side effects. For instance, if you have trouble sleeping, the physician might advise you to take your medication in the morning.
- I’ll have to take them for life. It’s actually less common for people to take medication long-term. Instead, for most people depression is an acute, intermittent episode, which requires 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.
Individuals who “achieve remission stay there for a period of time. If two to three years later, life becomes difficult, you just need to have treatment again,” Dr. Dietrich said.
- They’re addictive. These medications don’t cause physical or psychological dependence or withdrawal symptoms. However, abruptly stopping medication can result in “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 by person.
- They increase the risk for suicide. Antidepressants do carry a black box warning, indicating an increased risk for suicidal thoughts and behaviors. However, this seems to be true for patients in their teens and early 20s and less true for adults, Dr. Dietrich said. Though patients should be monitored closely, he believes this risk is “short term, not very common and overplayed.”
What You Can Do To Ensure Effective Treatment
There are several key ways you can increase the chances that your medication will work more effectively.
- Take medication as prescribed. Follow your doctor’s specific instructions on taking your medicine. Also, because newer antidepressants have tolerable side effects and work so well, patients tend to want to stop taking them, said Hollon. Discontinuing medication abruptly on your own, however, can be risky: You can return to feeling depressed and go through discontinuation syndrome. If you’re interested in discontinuing, talk with your doctor, so he or she can properly guide you through tapering off the medication.
- Speak up. Raise any concerns or questions with your doctor. Tell your doctor about how the medication is working. Are you feeling any better or worse? What kind of side effects are you experiencing? Being open helps your doctor provide you with the best treatment.
General Tips To Overcome Depression
In addition to medication and psychotherapy, there are many things you can do during and after your treatment to boost your results and prevent future episodes.
- Try doing the opposite. “If things aren’t going the way you want them to go, do the opposite,” said Hollon. He’s referring to Dr. Marsha Linehan’s concept of “opposite action,” part of dialectical behavior therapy, which teaches patients how to change their emotions. For instance, instead of isolating yourself because you’re feeling sad, call a friend, have dinner with a loved one or invite company over.
- Establish and maintain relationships. Build a social network and surround yourself with meaningful relationships.
- Practice good self-care. Many know that a healthy lifestyle — including eating well, exercising, getting enough sleep and resting — is important for our mental health. The same is true for discouraging depression. If these habits seem overwhelming at first, take it step by step. Think about small changes such as cutting out junk food, taking a 20-minute walk or aiming for an extra hour of sleep every night.
- Build your resilience. The APA defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress — such as family and relationship problems, serious health problems, or workplace and financial stressors. It means “bouncing back” from difficult experiences.”
The APA lists 10 ways to cultivate your resilience so you’re better prepared to bounce back after trying times. Some of these suggestions include changing how you view and respond to stressful events; developing realistic goals; finding opportunity in obstacles; and nurturing your confidence in solving problems.
- Help others. Whether it’s assisting at the food bank or reaching out to a loved one who’s going through a difficult time, it’s important to support others in addition to yourself.
- Put things into perspective. “Even when facing very painful things, look at the situation in a broader framework,” said Dorlen. Similarly, avoid catastrophizing, or anticipating that negative events will occur. This kind of thinking creates harmful self-fulfilling prophecies: If you think you’ll fail, you just might help yourself get there.
- Maintain a routine. “A routine gives life structure,” said Dorlen, who works with her patients to keep daily routines. For instance, your morning routine might consist of enjoying a brisk walk, reading the paper while you eat breakfast and taking a shower before you head to work.
- Have a psych checkup. People have regular medical and dental checkups, but a psychological checkup also is essential, Dorlen said. For instance, after having cancer treatment, a patient is never just sent on her way with a goodbye and good luck; she goes in for regular checkups, Dorlen said. You can conduct the check-up yourself. Consider how you’ve been feeling lately. Are you taking good care of yourself? Have you fallen into bad habits?
You can see a mental health professional for this if you prefer. It’s not uncommon for Dorlen to see her patients for an occasional “tuneup,” which typically lasts several sessions. By “keeping tabs on yourself, you don’t wait until it’s too late, till you’re lying in bed unable to do anything,” Dorlen said.
- Use your tools. Rather than retiring the tools and concepts you’ve learned in treatment once you’re in remission, make sure to practice them regularly.
- Watch for signs. Similar to your psych checkup, “keep your eyes open to early symptoms to stave off a real serious episode,” Dorlen said.
- Purge your perfectionism. Originally, depression was defined as “anger directed inward,” said Dorlen, who commonly sees the devastating effects of self-criticism and perfectionism. Learning to be less critical and cutting yourself some slack tremendously helps individuals, she said.
The MacArthur Initiative on Depression & Primary Care includes handouts about treatment for both clinicians and patients.
Families for Depression Awareness helps families recognize the warning signs of depressive disorders and manage them.
Depression Is Real aims to help people living with depression, their loved ones and the public understand the facts about depression.
National Alliance on Mental Illness focuses on support, education and advocacy in helping people with mental illness and their families.