Wednesday, October 29, 2014

No GPS for Grieving, and Sometimes Help is Needed

Grieving the loss of a loved one can't be planned or mapped. At one time, the belief was that grief occurred in a set pattern of five stages. It's now known to be more complicated.  I was going over the July issue of Mayo Clinic Health Letter covers common feelings and physical symptoms associated with grief, ways to cope, and signs that indicate help from a trained professional would be beneficial.

In the early days after a significant loss, many people say they feel numb. As numbness wears off, people often experience more intense and painful feelings of loss. Physical symptoms may arise that include upset stomach, loss of appetite, chest tightness, trouble sleeping, exhaustion and difficulty breathing. For weeks and months, waves of distress may occur that can include restlessness, anxiety and anger. In time, this normal process subsides and letting go begins.

Options to help cope with grief include:
Sharing the experience: Talking with a close friend or family member can be helpful.
Writing feelings down: Writing a letter to a deceased loved one or journaling are ways to share happy memories or regrets about what was never said.

Self-care: Daily physical activity, healthy foods, time with friends and physical pleasures — baths, massages or even naps — can ease distress.
Support groups: Sharing the grief experience reduces feelings of isolation and can be a source of practical advice.


Some people benefit from professional help as they grieve. An inability to stop thinking about the death and its circumstances is a signal that expert help is needed. A primary care doctor is a good place to start. Treatment might include medications to improve sleep and ease anxiety or referral to a counselor or therapist.

Risk Factors

The Risk Factors after a loss are not thought of during any complicated loss in our lives. Many of us do not know when and where to locate the proper treatment, since society does not educate us to knowing these primary factors to procure treatments in Complicated Grief and even knowing we do have a Complicated Risks in such event in our lives. 
Important point to remember is continue to have a Mental Health Provider that you are able to arrange to meet with on a periodical  basis, when you feel a significant life transformation. 
Dr. Nicholas Losito, Ph.D, CISM, is also available to provide assistance to your significant moment in your life.  
Factors that may increase the risk of developing complicated grief include:
  • An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one
  • Death of a child
  • Close or dependent relationship to the deceased person
  • Lack of a support system or friendships
  • Past history of depression or other mental health issues
  • Traumatic childhood experiences, such as abuse or neglect
  • Lack of resilience or adaptability to life changes
  • Other major life stressors
When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you'll ever pick up the pieces and heal your wounds — yet not feel as if you're betraying your loved one's memory.
There are no quick fixes for the grief and anguish that follow a loved one's death. As you face your grief, acknowledge the pain and know that it's part of the healing process. Take good care of yourself, and seek support from friends and loved ones.
Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new "normal" can help you reconcile your losses and move on with your life.
Continue to see out assistance from your local Primary Care Mental Health Provider and you are to contact Dr. Nicholas Losito, Ph.D, CISM, at Hand of Compassion.

Treatments and Drugs

Your doctor or mental health provider will determine what treatment is likely to work best for you based on your particular symptoms and circumstances.

Psychotherapy

Complicated grief is sometimes treated with a type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). Other counseling approaches also may be effective.
During therapy, you may:
  • Explore such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life's goals
  • Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by images and thoughts of your loved one
  • Explore and process emotions
  • Improve coping skills
  • Reduce feelings of blame and guilt

Medications

There's little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.

Coping with reminders after a loss

When a loved one dies, you might be faced with grief over your loss again and again — sometimes even years later. Feelings of grief might return on the anniversary of your loved one's death, birthday or other special days throughout the year.
These feelings, sometimes called an anniversary reaction, aren't necessarily a setback in the grieving process. They're a reflection that your loved one's life was important to you.
To continue on the path toward healing, know what to expect — and how to cope with reminders of your loss.

Reminders can be anywhere

Certain reminders of your loved one might be inevitable, especially on holidays, birthdays, anniversaries and other special days that follow your loved one's death.
Reminders aren't just tied to the calendar, though. They can be tied to sights, sounds and smells — and they can ambush you. You might suddenly be flooded with emotions when you drive by the restaurant your partner loved or when you hear your child's favorite song. Even memorial celebrations for others can trigger the pain of your own loss.

What to expect when grief returns

Anniversary reactions can last for days at a time or — in more extreme cases — much longer. During an anniversary reaction you might experience:
  • Sadness
  • Loneliness
  • Anger
  • Anxiety
  • Trouble sleeping
  • Fatigue
  • Pain
Anniversary reactions can also evoke powerful memories of the feelings and events surrounding your loved one's death. For example, you might remember in great detail where you were and what you were doing when your loved one died.

Tips to cope with reawakened grief

Even years after a loss, you might continue to feel sadness when you're confronted with reminders of your loved one's death. As you continue healing, take steps to cope with reminders of your loss. For example:
  • Be prepared. Anniversary reactions are normal. Knowing that you're likely to experience anniversary reactions can help you understand them and even turn them into opportunities for healing.
  • Plan a distraction. Schedule a gathering or a visit with friends or loved ones during times when you're likely to feel alone or be reminded of your loved one's death.
  • Reminisce about your relationship. Focus on the good things about your relationship with your loved one and the time you had together, rather than the loss. Write a letter to your loved one or a note about some of your good memories. You can add to this note anytime.
  • Start a new tradition. Make a donation to a charitable organization in your loved one's name on birthdays or holidays, or plant a tree in honor of your loved one.
  • Connect with others. Draw friends and loved ones close to you, including people who were special to your loved one. Find someone who'll encourage you to talk about your loss. Stay connected to your usual support systems, such as spiritual leaders and social groups. Consider joining a bereavement support group.
  • Allow yourself to feel a range of emotions. It's OK to be sad and feel a sense of loss, but also allow yourself to experience joy and happiness. As you celebrate special times, you might find yourself both laughing and crying.

When grief becomes overly intense

There's no time limit for grief, and anniversary reactions can leave you reeling. Still, the intensity of grief tends to lessen with time.
If your grief gets worse over time instead of better or interferes with your ability to function in daily life, consult a grief counselor or other mental health provider. Unresolved or complicated grief can lead to depression and other mental health problems. With professional help, however, you can re-establish a sense of control and direction in your life — and return to the path toward healing.



Thursday, October 2, 2014

How can I help a child deal with the death of a loved one?

How can I help a child deal with the death of a loved one?


Children grieve just as adults do. Any child old enough to form a relationship will experience some form of grief when a relationship is severed. Adults may not view a child behavior as grief as it is often demonstrated in behavioral patterns which we misunderstand and do not appear to us to be grief such as "moody," "cranky," or "withdrawn." When a death occurs children need to be surrounded by feelings of warmth, acceptance and understanding. This may be a tall order to expect of the adults who are experiencing their own grief and upset. Caring adults can guide children through this time when the child is experiencing feelings for which they have no words and thus can not identify. In a very real way, this time can be a growth experience for the child, teaching about love and relationships. The first task is to create an atmosphere in which the child's thoughts, fears and wishes are recognized. This means that they should be allowed to participate in any of the arrangements, ceremonies and gatherings which are comfortable for them. First, explain what will be happening and why it is happening at a level the child can understand. A child may not be able to speak at a grandparent's funeral but would benefit greatly from the opportunity to draw a picture to be placed in the casket or displayed at the service. Be aware that children will probably have short attention spans and may need to leave a service or gathering before the adults are ready. Many families provide a non-family attendant to care for the children in this event. The key is to allow the participation, not to force it. Forced participation can be harmful. Children instinctively have a good sense of how involved they wish to be. They should be listened to carefully.

How can I help an adult friend or family member deal with the death of a loved one?

Someone you know may be experiencing grief - perhaps the loss of a loved one, perhaps another type of loss - and you want to help. The fear of making things worse may encourage you to do nothing. Yet you do not wish to appear to be uncaring. Remember that it is better to try to do something, inadequate as you may feel, than to do nothing at all. Don't attempt to sooth or stifle the emotions of the griever. Tears and anger are an important part of the healing process. Grief is not a sign of weakness. It is the result of a strong relationship and deserves the honor of strong emotion. When supporting someone in their grief the most important thing is to simply listen. Grief is a very confusing process, expressions of logic are lost on the griever. The question "tell me how you are feeling" followed by a patient and attentive ear will seem like a major blessing to the grief stricken. Be present, reveal your caring, listen. Your desire is to assist your friend down the path of healing. They will find their own way down that path, but they need a helping hand, an assurance that they are not entirely alone on their journey. It does not matter that you do not understand the details, your presence is enough. Risk a visit, it need not be long. The mourner may need time to be alone but will surely appreciate the effort you made to visit. Do some act of kindness. There are always ways to help. Run errands, answer the phone, prepare meals, mow the lawn, care for the children, shop for groceries, meet incoming planes or provide lodging for out of town relatives. The smallest good deed is better than the grandest good intention.

How can I deal with the death of a loved one?

Bereavement is a powerful, life-changing experience that most people find overwhelming the first time. Although grief is a natural process of human life, most of us are not inherently able to manage it alone. At the same time, others are often unable to provide aid or insight because of discomfort with the situation and the desire to avoid making things worse. The following passage explains how some of our "normal" assumptions about grief may make it more difficult to deal with.

Five Assumptions That May Complicate

  1. Life prepares us for loss. More is learned about loss through experience than through preparation. Living may not provide preparation for survival. Handling grief resulting from the death of a loved one is a process that takes hard work. The fortunate experience of a happy life may not have built a complete foundation for handling loss. Healing is built through perseverance, support and understanding. The bereaved need others: Find others who are empathetic.
  2. Family and friends will understand. If a spouse dies children lose a parent, a sibling loses a sibling, a parent loses a child and a friend loses a friend. Only one loses a spouse. Each response is different according to the relationship. Family and friends may not be capable of understanding each other thoroughly. Consider the story of Job's grief in the Bible. Job's wife did not understand his grief. His friends did their best work the first week when they just sat and did not speak. It was when they began to share their judgements of Job and his life that they complicated Job's grief. Allowance must be made so that grief may be experienced and processed over time. The bereaved need others: Find others who are accepting.
  3. The bereaved should be finished with their grief within one year or something is wrong. During the first year the bereaved will experience one of everything for the first time alone: anniversaries, birthdays, occasions, etc. Therefore grief will last for at least one year. The cliche, "the healing hands of time," does not go far enough to explain what must take place. The key to handling grief is in what work is done over time. It takes time and work to decide what to do and where to go with the new and changed life that is left behind. The bereaved need others: Find others who are patient.
  4. Along with the end of grief's pain comes the end of the memories. At times, the bereaved may embrace the pain of grief believing it is all they have left. The lingering close bond to the deceased is sometimes thought to maintain the memories while, in fact, just the opposite is true. In learning to let go and live a new and changed life memories tend to come back more clearly. Growth and healing comes in learning to enjoy memories. The bereaved need others: Find new friends and interests.
  5. The bereaved should grieve alone. After the funeral service is over the bereaved may find themselves alone. They may feel as though they are going crazy, painfully uncertain in their world of thoughts and emotions. The bereaved begin to feel normal again when the experience is shared with others who have lost a loved one. Then, in reaching out, the focus of life becomes forward. The bereaved need others: Find others who are experienced.

What Every Woman Should Know - Cultural Considerations

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in ten other countries all over the world. Men and women have about the same rate of bipolar disorder (manic-depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments.
A variety of factors unique to women's lives are suspected to play a role in developing depression. Research is focused on understanding these, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. And yet, the specific causes of depression in women remain unclear; many women exposed to these factors do not develop depression. What is clear is that regardless of the contributing factors, depression is a highly treatable illness.

The Many Dimensions of Depression in Women

Investigators are focusing on the following areas in their study of depression in women:

The Issues of Adolescence

Before adolescence, there is little difference in the rate of depression in boys and girls. But between the ages of 11 and 13 there is a precipitous rise in depression rates for girls. By the age of 15, females are twice as likely to have experienced a major depressive episode as males. This comes at a time in adolescence when roles and expectations change dramatically. The stresses of adolescence include forming an identity, emerging sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. Studies show that female high school students have significantly higher rates of depression, anxiety disorders, eating disorders, and adjustment disorders than male students, who have higher rates of disruptive behavior disorders.

Adulthood: Relationships and Work Roles

Stress in general can contribute to depression in persons biologically vulnerable to the illness. Some have theorized that higher incidence of depression in women is not due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. How these factors may uniquely affect women is not yet fully understood.
For both women and men, rates of major depression are highest among the separated and divorced, and lowest among the married, while remaining always higher for women than for men. The quality of a marriage, however, may contribute significantly to depression. Lack of an intimate, confiding relationship, as well as overt marital disputes, have been shown to be related to depression in women. In fact, rates of depression were shown to be highest among unhappily married women.

Reproductive Events

Women's reproductive events include the menstrual cycle, pregnancy, the postpregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood; a specific biological mechanism explaining hormonal involvement is not known, however.
Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), the changes typically begin after ovulation and become gradually worse until menstruation starts. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.
Postpartum mood changes can range from transient "baby blues" immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated.
Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, motherhood may be a time of heightened risk for depression because of the stress and demands it imposes.
Menopause, in general, is not asssociated with an increased risk of depression. In fact, while once considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. The women more vulnerable to change-of-life depression are those with a history of past depressive episodes.

Specific Cultural Considerations

As for depression in general, the prevalence rate of depression in African American and Hispanic women remains about twice that of men. There is some indication, however, that major depression and dysthymia may be diagnosed less frequently in African American and slightly more frequently in Hispanic than in Caucasian women. Prevalence information for other racial and ethnic groups is not definitive.
Possible differences in symptom presentation may affect the way depression is recognized and diagnosed among minorities. For example, African Americans are more likely to report somatic symptoms, such as appetite change and body aches and pains. In addition, people from various cultural backgrounds may view depressive symptoms in different ways. Such factors should be considered when working with women from special populations.

Victimization

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who have been raped as adolescents or adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. There may be biological and environmental risk factors for depression resulting from growing up in a dysfunctional family. At present, more research is needed to understand whether victimization is connected specifically to depression.

Poverty

Women and children represent seventy-five percent of the U.S. population considered poor. Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depressive illnesses are more prevalent among those facing environmental stressors such as these.

Depression in Later Adulthood

At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home and they were confronted with "empty nest syndrome" and experienced a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.
As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Most important, depression should not be dismissed as a normal consequence of the physical, social, and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.
About 800,000 persons are widowed each year. Most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. However, a third of widows/widowers do meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to standard antidepressant treatments, although research on when to start treatment or how medications should be combined with psychosocial treatments is still in its early stages.













Even severe depression can be highly responsive to treatment. Indeed, believing one's condition is "incurable" is often part of the hopelessness that accompanies serious depression. Such individuals should be provided with the information about the effectiveness of modern treatments for depression in a way that acknowledges their likely skepticism about whether treatment will work for them. As with many illnesses, the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. Of course, treatment will not eliminate life's inevitable stresses and ups and downs. But it can greatly enhance the ability to manage such challenges and lead to greater enjoyment of life.
The first step in treatment for depression should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be made aware of any medications being used. If a physical cause for the depression is not found, a psychological evaluation should be conducted by the physician or a referral made to a mental health professional.

Types of Treatment for Depression

The most commonly used treatments for depression are antidepressant medication, psychotherapy, or a combination of the two. Which of these is the right treatment for any one individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, one or both of these treatments may be useful, while in severe or incapacitating depression, medication is generally recommended as a first step in the treatment.3 In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the opportunity to learn more effective ways of handling problems.

Antidepressant Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications-chiefly the selective serotonin reuptake inhibitors (SSRIs)-and the tricyclics and monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit-forming. Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken regularly for at least 4 weeks and, in some cases, as many as 8 weeks, before the full therapeutic effect occurs. To be effective and to prevent a relapse of the depression, medications must be taken for about 6 to 12 months, carefully following the doctor's instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.
The prescribing doctor will provide information about possible side effects and, in the case of MAOIs, dietary and medication restrictions. In addition, other prescribed and over-the-counter medications or dietary supplements being used should be reviewed because some can interact negatively with antidepressant medication. There may be restrictions during pregnancy.
For bipolar disorder, the treatment of choice for many years has been Lithium, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one can be relatively small. However, lithium may not be recommended if a person has pre-existing thyroid, kidney, or heart disorders or epilepsy. Fortunately, other medications have been found helpful in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol®) and valproate (Depakene®). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Studies conducted in Finland in patients with epilepsy indicate that valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. 11 Therefore, young female patients should be monitored carefully by a physician. Other anticonvulsants that are being used now include lamotrigine (Lamictal®) and gabapentin (Neurontin®); their role in the treatment hierarchy of bipolar disorder remains under study.
Most people who have bipolar disorder take more than one medication. Along with lithium and/or an anticonvulsant, they often take a medication for accompanying agitation, anxiety, insomnia, or depression. Some research indicates that an antidepressant, when taken without a mood stabilizing medication, can increase the risk of switching into mania or hypomania, or of developing rapid cycling, in people with bipolar disorder. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.
To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight-week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one-third to a commonly prescribed SSRI, and one-third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression.13 Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.
Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.

Psychotherapy for Depression

Several types of psychotherapy-or "talk therapy"-can help people with depression.
In mild to moderate cases of depression, psychotherapy is also a treatment option. Some short-term (10 to 20 week) therapies have been very effective in several types of depression. "Talking" therapies help patients gain insight into and resolve their problems through verbal give-and-take with the therapist. "Behavioral" therapies help patients learn new behaviors that lead to more satisfaction in life and "unlearn" counter-productive behaviors. Research has shown that two short-term psychotherapies, interpersonal and cognitive-behavioral, are helpful for some forms of depression. Interpersonal therapy works to change interpersonal relationships that cause or exacerbate depression. Cognitive-behavioral therapy helps change negative styles of thinking and behaving that may contribute to the depression.

Electroconvulsive Therapy

For individuals whose depression is severe or life threatening or for those who cannot take antidepressant medication, electroconvulsive therapy (ECT) is useful.3 This is particularly true for those with extreme suicide risk, severe agitation, psychotic thinking, severe weight loss or physical debilitation as a result of physical illness. Over the years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. At least several sessions of ECT, usually given at the rate of three per week, are required for full therapeutic benefit.

Treating Recurrent Depression

Even when treatment is successful, depression may recur. Studies indicate that certain treatment strategies are very useful in this instance. Continuation of antidepressant medication at the same dose that successfully treated the acute episode can often prevent recurrence. Monthly interpersonal psychotherapy can lengthen the time between episodes in patients not taking medication.

The Path to Healing

Reaping the benefits of treatment begins by recognizing the signs of depression. The next step is to be evaluated by a qualified professional. Although depression can be diagnosed and treated by primary care physicians, often the physician will refer the patient to a psychiatrist, psychologist, clinical social worker, or other mental health professional. Treatment is a partnership between the patient and the health care provider. An informed consumer knows her treatment options and discusses concerns with her provider as they arise.
If there are no positive results after 2 to 3 months of treatment, or if symptoms worsen, discuss another treatment approach with the provider. Getting a second opinion from another health or mental health professional may also be in order.
Here, again, are the steps to healing:
  • Check your symptoms against this list.
  • Talk to a health or mental health professional.
  • Choose a treatment professional and a treatment approach with which you feel comfortable.
  • Consider yourself a partner in treatment and be an informed consumer.
  • If you are not comfortable or satisfied after 2 to 3 months, discuss this with your provider. Different or additional treatment may be recommended.
  • If you experience a recurrence, remember what you know about coping with depression and don't shy away from seeking help again. In fact, the sooner a recurrence is treated, the shorter its duration will be.
Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless. Such feelings make some people want to give up. It is important to realize that these negative feelings are part of the depression and will fade as treatment begins to take effect.

Self-Help for Treatment of Depression

Along with professional treatment, there are other things you can do to help yourself get better. If you have depression, it may be extremely difficult to take any action to help yourself. But it is important to realize that feelings of helplessness and hopelessness are part of the depression and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin treatment, negative thinking will fade.
To help yourself:
  • Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social or other activities.
  • Set realistic goals for yourself.
  • Break up large tasks into small ones, set some priorities and do what you can as you can.
  • Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
  • Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
  • Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Remember that positive thinking will replace negative thoughts as your depression responds to treatment.