Treatments and Support for Loved Ones with Depression
Psychotherapy (often referred to as “talk therapy” or just “therapy”) has been found to be an effective treatment for mild to moderate forms of depression and can be used in combination with medication to treat all degrees of depression. There are several types of psychotherapy, but all include a collaborative and confidential relationship with a mental health professional. This can be a psychiatrist, psychologist, clinical social worker, mental health counselor or psychiatric nurse practitioner. Sessions are typically 45 to 50 minutes in length and scheduled once a week. However, more frequent sessions may be advisable at the beginning or during an especially difficult period.
Two forms of psychotherapy for which there is solid evidence of effectiveness in treating depression are cognitive behavioral therapy and interpersonal psychotherapy. Both are generally considered short-term therapies, ranging from about five to 20 sessions. (Some people may choose to continue therapy after recovering from their depressive episode in order to deal with other concerns and to reduce the risk of another depressive episode.)
The objective of this therapy is to help people identify and then modify unhealthy negative thoughts and behaviors. Therapists and patients work together in a collaborative fashion to develop an understanding of the problem(s) and to develop a treatment strategy. Past experiences are not ignored, but greater emphasis is placed on the present — the beliefs and behaviors that are contributing to and maintaining the depression.
Interpersonal psychotherapy is a short-term (usually 12 to 16 sessions) evidence-based approach to treatment of depression. It can help patients gain a better understanding of difficult interpersonal issues, work through the emotions associated with these issues, and develop the strategies and skills that can lead to improved interpersonal relationships and social functioning. Like cognitive-behavioral therapy, interpersonal psychotherapy focuses largely on the present, with the therapist taking an active role that may include suggesting changes in relationship patterns, brainstorming new interpersonal options and role-playing with the patient.
Antidepressant medications can be effective in relieving the painful symptoms of depression and helping restore people to their normal level of functioning, but it’s important to understand how these medications are used and what to expect.
Antidepressants do not provide immediate relief. While people may feel a modest improvement in their mood during the first couple of weeks, it can take four to six weeks before there is a significant therapeutic benefit. During this period, it is important for people to take the medication exactly as prescribed, stay in regular contact with their health care practitioner, and report any unpleasant side effects or other reasons why they are concerned about the drug (e.g., cost). Fortunately, there are several types of antidepressants and options within each class. Practitioners likely can find another option if a side effect or the cost of the medication is a problem. If side effects are not a problem but there seems to be little or no improvement in mood after several weeks, providers likely will adjust the dosage or substitute another type of antidepressant.
Once people have experienced relief from all of their symptoms, they will need to talk with their practitioner about exactly when and how the medication should be discontinued. Although patients are often tempted to discontinue antidepressants as soon as they feel they have recovered, it is generally recommended to continue taking the medication for another six to 12 months to reduce the risk of depression returning.
It is important for people recovering from depression to take good care of themselves. The following is recommended.
- Take your medications as prescribed. If they are causing unpleasant side effects or do not seem to be helping, share this information with your practitioner. If the medication has proved effective and you no longer have symptoms of depression, discuss with your practitioner when and how to discontinue the medication.
- Make effective use of your psychotherapy sessions. If you feel they are not helping, share this with your therapist, along with any other concerns or questions.
- Establish healthy sleeping habits. Going to bed and getting up at the same time regularly is generally helpful. If your medication seems to be interfering with your sleep, mention this to your practitioner. He or she may be able to adjust the dosage, have you take it at a different time or switch you to a different medication.
- Eat a healthy, balanced diet and try not to skip meals. You may want to check with your practitioner for specific suggestions, but healthy diets generally emphasize fruits, vegetables, whole grains and lean proteins.
- Make some form of physical activity a part of your daily routine. You can start small, perhaps with just a slow walk around the block. You may want to enlist the support of a family member or friend who can accompany you during the activities.
- Stay connected with others, but be selective. Spend time with people who understand what you are going through and who want to be supportive. As much as possible, avoid or limit your time with those who are critical or judgmental.
- If you feel overwhelmed by tasks at work or home, break them down into smaller ones and set priorities. And don’t be reluctant to ask for assistance.
- Build into your daily schedule some time to do something you know you can enjoy. That could be listening to music, reading a book or watching a particular television program.
- Do not self-medicate with alcohol or with drugs not prescribed for you. They can interfere with the medications you have been prescribed and may even make your depression worse.
- Postpone major life decisions until you feel better and are more confident about yourself and the future.
- Be patient and gentle with yourself. Depression is a serious illness, and it will take time to recover.
The National Institute of Mental Health offers the following suggestions:
- Offer support, understanding, patience and encouragement.
- Never ignore comments about suicide, and report them to your loved one’s health care practitioner or therapist.
- Invite him or her out for walks, outings and other activities
- Help the person adhere to their treatment plan, such as by setting reminders to take prescribed medications.
- Ensure that transportation is available to therapy appointments.
- Remind the person that, with time and treatment, the depression will lift.
- Educate yourself about depression and the treatment(s) recommended.
- Take the initiative to check on your loved one regularly. Do not wait for him or her to call you.
- Stay in touch with other family members and friends who are involved in supporting the person.
Self-Care for Family Members and Friends
It can be difficult to live with or care for someone who is seriously depressed. In many respects, it’s like being with a different person. So much about the person who you have known and enjoyed seems to have disappeared. And it’s not unusual to feel rejected when your loved one says absolutely nothing in life is good. It can be especially painful when depression affects intimate relationships, as it often does. It’s also easy for family members to blame themselves for the problems their loved one is experiencing, even though they are doing their best to support the person. This is why it is important for people who live with or care for people who are depressed to make a special effort to also care for themselves.
- Develop your support system. This is the time to contact a good friend who can support you and help you with a “reality check” when your loved one says or does hurtful things.
- Consider joining a support group, such as the ones offered by NAMI for people who have a loved one with a mental health condition.
- Maintain a healthy lifestyle, including eating balanced meals, performing regular physical activities or exercise, and getting enough sleep.
- Set aside as much time for yourself as possible, and continue with some of the activities you find rewarding and renewing.
Remember: If you do not take good care of yourself, you won’t be able to take good care of someone else.