Breaking Free from Depression
Pathways to Wellness
By Jesse H. Wright, Laura W. McCray
The Guilford Press Copyright © 2012 The Guilford Press
All rights reserved.
* Going on the offense against depression
* Diagnosing depression
* Measuring depression and charting your progress
If you have experienced depression, you know how much it hurts. You've suffered from low moods and difficulty enjoying life. Probably there have been strings of days filled with worries and many nights of troubled sleep. You may even have passed through some especially difficult times when it seemed like your problems were too much to bear.
Perhaps you have already had some success in your battle against depression. Or maybe you are still struggling to learn how to get symptoms under control. Wherever you are in your path to recovery, you're probably searching for answers on how to beat this disease and keep your life headed in a positive direction.
We wrote this workbook to help people find the answers that work best for them and develop practical and effective recovery plans. For most people, these plans will include getting professional help. But as practicing doctors we know that our patients who spend time outside treatment sessions learning about depression and taking actions to combat this disease often have better results.
Because you have decided to read this book, you may be like so many of our patients who want to do more than simply take a pill for depression. Even if an antidepressant is a cornerstone of your treatment, you will want to know more about how it works, how to manage side effects if they occur, and which medications to consider if the current prescription isn't fully effective. And if you are like most people with depression, you will have personal stresses, self-doubts, relationship issues, physical illnesses, or a variety of other concerns that may play a role in the depression. Addressing these types of problems can be an important part of the recovery process.
This book will help you learn about the best treatments available today and how to put them into action. The starting point for our work together is to lay out an overall strategy for overcoming depression.
Going on the Offense against Depression
Depression can sap energy and motivation, make it harder to accomplish tasks, and lead to a sense of defeat and demoralization. People who have had depression for a while often feel that they are only playing defense—just hanging on in the face of a sea of problems. When we see people with depression in our medical practices for the first time, we try our best to appeal to their fighting spirit, to somehow get them back on offense.
There are three key actions that you can take to break out of depression and regain control of your life.
Action 1: Build Skills
Our patients who recover from depression often acquire a number of useful depression-fighting skills along the way. You may already have some of these skills and are putting them into action. However, for most people there is usually room to add to and sharpen their tools for getting depression under control.
If you wanted to build your skills in a sport, a hobby, or an area of work performance, you would need to practice. You would build your competence gradually as you learned the basics and then gained more and more experience. The same process holds true for becoming skilled in managing depression.
Sometimes when people who are depressed first hear about the prospect of learning skills to manage the disease they have thoughts such as: "It will be too much work ... I don't have the energy to do anything ... I'd rather just take a pill." Are you having any similar thoughts about the difficulty of building your abilities to combat this disease? If so, the negative and pessimistic thinking style of depression may be clouding your vision. You may be having trouble seeing that you do have the capacity to grow your strengths and learn new ways of moving from depression to wellness. Later in the book (in Chapter 4, "Fighting Negative Thinking") we'll help you learn how to recognize and change the depressive thinking that may be standing in the way of your recovery.
The process of building skills does not have to be too hard. You can target a few things that you want to learn the most or think may have the biggest payoff, and you can take it at your own pace. Or, if you are feeling very positive about getting involved in the learning process and are excited to get to work, you can stake out a more ambitious agenda. Either way, we believe that you have the potential for gaining valuable skills that can help you on your path to wellness.
Some of the depression-fighting skills that we teach in this book are listed in the first exercise. You can use the checklist to get a preliminary picture of what you might like to accomplish.
We have included a number of learning exercises in this book that we hope will be interesting, stimulating, and helpful in building your skills for overcoming depression. You may want to go through the book in sequence, taking each chapter in turn. Or you may decide you want to focus only on certain topics such as "Getting the Most from Antidepressants" (Chapter 8) or "Restoring Energy and Enjoying Life" (Chapter 5). In Chapter 3, we will help you take an inventory of your interests and potentials and then plot a course for effective change.
Action 2: Plan for Recovery
Treatment for depression works, but many people are not getting the full benefit of the useful therapies that are available. One of the most startling statistics we have seen is that only 20% of people in the United States who have depression are receiving adequate treatment for it. Could you be one of those people who are missing out on therapy methods that could offer answers?
You may be thinking, "How can I know which treatments are effective and which may be the best for me?" In Chapter 3, we outline the most important approaches to depression and explain the concept of "evidence-based" therapy—relying on scientifically tested interventions for the core of your treatment program. In later chapters, we also suggest guidelines for giving treatment a full opportunity to work. For example, you will learn about the optimal dose and duration for treatment with antidepressants and what to do if the first medication doesn't give you full relief.
Sometimes the path to recovery from depression can follow a single track. One possibility is that people can have a superb response to the first medication they try; the antidepressant seems to do the trick, and nothing more is needed. Other people may choose to focus exclusively on psychotherapy (talk therapy) and find this method relieves depression for them. Still others may opt for alternative, nontraditional approaches and have success. Yet for most people a more comprehensive plan for recovery may lead to the best outcome.
We have several reasons for recommending that you look at more than one option for building your plan for recovery from depression.
1. Although people with depression usually have similar symptoms, everyone has a unique blend of personal history, current concerns, strengths, and preferences. Instead of a "one size fits all" approach, many people with depression, and their doctors and therapists, prefer an individualized, multifaceted plan.
2. Research has shown that there can be a wide variety of contributors to depression, such as genetics, medical illnesses, psychological influences, and social stresses. And there is scientific evidence that diverse treatment approaches can be effective.
3. More than 30 years of studies on medication and psychotherapy for depression have found that combining the two treatments can provide a greater overall treatment benefit than receiving medication or psychotherapy alone.
To give an example of how a comprehensive recovery plan might be developed, we'll introduce you to Kate, a woman who had been struggling with depression but eventually had success in overcoming this problem.
Kate's depression had been dragging on for more than 6 months. It seemed to have been triggered by a relationship breakup that rocked her self-esteem and drained her energy and motivation. As so often happens with depression, she gradually pulled away from many of the activities and relationships that used to give her enjoyment and a sense of purpose. It was as if the depression were driving her into a shell.
Kate was still able to go to work, but when she came home she spent much of her time alone, staring at the TV or doing "mindless" tasks. After Kate had made repeated excuses for avoiding social activities, many of her friends either called her only infrequently or had stopped calling her altogether. As the gloom of depression intensified, Kate began to think of herself as a "failure" and a "loser."
Prior to becoming depressed, Kate had led a fairly healthy lifestyle. She took yoga classes, rode a bicycle two or three times a week, or went to the gym to do aerobic exercise. She sang in a choir and attended church services regularly. Now, however, the only activity she enjoyed outside of work was having dinner with her family on Sunday evenings. Kate had tried dating again about 3 months ago, but the relationship foundered. Now she had decided that she was "better off alone."
When Kate first consulted one of us for treatment of depression, she mentioned that she had tried an antidepressant for about 4 weeks, but it didn't seem to help. She had also had three counseling sessions with an employee assistance professional. However, Kate had not yet had the opportunity to benefit fully from therapies that have been proven scientifically, and there appeared to be several promising opportunities for helping her overcome depression.
There were other encouraging signs that suggested a good outcome was likely. Kate was very interested in learning how to control her symptoms. She had many strengths to use in the fight against depression, as we describe in the next section of the chapter. And she appeared much more hopeful after we worked together to sketch out some plans to help get her life back on track.
If you have read other books on depression or have been coached on depression by a doctor or therapist, you may be starting to get some ideas about what Kate might need to do to get better. Even if you're just starting to learn about depression, you may be thinking of options for helping Kate. Is an antidepressant the only answer? Or are other possibilities coming to mind? If Kate was starting to develop a comprehensive plan to fight depression, what might she consider including in the plan? As you work through this book, we hope you'll get lots of good ideas for tackling depression. If you're in Kate's position, we hope you'll be able to collaborate effectively with your doctor or therapist to find solutions that lead to recovery.
The treatment plan that Kate developed included several different strategies. We briefly outline the plan here. Later in the book, you will learn more about how to organize multifaceted plans for overcoming depression.
1. Identify and use personal strengths. As happens so frequently with depression, all Kate had been able to see was her problems and her frailties. She had been downplaying or ignoring many personal strengths, such as her musical interest and talents, excellent work performance, an ability to be a good friend, a sense of humor, and a variety of interests in activities such as cooking, bicycling, and gardening. Part of her plan was to recognize and tap her personal strengths as she fought depression.
2. Give medication another try. After learning more about the possible benefits and risks of antidepressant therapy, Kate decided to become more aggressive in using medication to fight depression. Although the first medication that we chose didn't lead to a full recovery, she stuck with treatment and within 10 weeks was able to find a medication plan that worked well.
3. Start cognitive-behavior therapy (CBT). This form of psychotherapy has specialized methods for depression and has been shown to be effective in more than 300 randomized research studies (in which the study participants receive a treatment as opposed to a placebo or a control therapy). CBT targets negative thinking in depression (for example, low self-esteem, unproductive self-talk, hopelessness) and behaviors that make the depression worse (for example, inactivity, isolation, helplessness, procrastination)—problems that Kate had been experiencing over the past few months. The methods are usually easy to understand and often can be learned fairly rapidly. CBT also encourages use of self-help to amplify the benefits of treatment. Because CBT is such a powerful approach to depression, we draw heavily from its methods in this workbook (see, for example, Chapter 4, "Fighting Negative Thinking," and Chapter 5, "Restoring Energy and Enjoying Life").
4. Gradually resume exercise and other healthy activities. Exercise has been shown to be an effective treatment for depression, and it obviously has many other health benefits as well. Kate's participation in CBT helped her reengage in exercise and also gave her tools for rekindling interest in things that could give her a sense of meaning and pleasure. Resuming stimulating activities, especially ones that involve increased contact with people, is often a key element of successful recovery plans.
If you want to develop your own comprehensive plan, you can explore the possibilities by talking with a doctor, a therapist, a spiritual counselor, or someone else who has experience in helping people. And you can use this book to learn about different strategies for coping with depression. Your plan does not have to be complex, but it should have several good prospects for how to fight symptoms. In Chapter 3 we will help you recognize your best opportunities for change.
Take a moment now to do another self-help exercise. Use the worksheet on page 8 to record some of the treatments or strategies that you may have tried for depression. Then do a bit of brainstorming about some methods that you think might help. As you read through this book, you'll be able to investigate whether these ideas are worth pursuing.
Checklist of Ways to Fight Depression
Instructions: A partial list of commonly used strategies for fighting depression is provided in this worksheet. Place check marks in the columns to indicate whether you have tried this approach, whether it has helped, and whether it may have potential to help. Please remember that things you tried in the past may not have been given a full opportunity to work. For example, maybe you had some counseling sessions that weren't useful, but a different therapist or a more specific therapy for depression could lead to a breakthrough.
Action 3: Monitor Symptoms and Measure Progress
Research has shown that using rating scales to measure symptoms helps both patients and doctors stay on course toward reaching goals. Also, studies of the effectiveness of efforts to change behavior, such as sticking with an exercise plan or a diet, have solidly supported the value of self-monitoring or logging (keeping a written record). One example of the value of monitoring and measuring is the program at the gym where one of us works out on a regular basis. This gym uses a computerized recording system that keeps track of all of the exercise done on both aerobic and strength training machines and gives regular feedback to users on their progress. Seeing these reports strengthens motivation and provides guidance for taking positive steps to move forward.
There are three core opportunities to use measuring and monitoring techniques to strengthen treatment plans for depression.
1. Use rating scales or questionnaires to help define the problem. Do I have depression? What type of depression is it? How severe are the symptoms? Your doctor will ask questions to help define the problem because it is very important to know the diagnosis before suggesting a treatment plan. An example of the importance of making an accurate diagnosis is that a common type of mood disorder called "major depression" often responds very well to antidepressant medication. But antidepressants may be of little value for less severe forms of depression.
Some doctors use rating scales routinely, but research has shown that doctors don't employ these valuable tools as often as they might. In the next section of this chapter, you will be able to use a rating scale to give you a better idea of what your symptoms mean. (Continues...)
Excerpted from Breaking Free from Depression by Jesse H. Wright, Laura W. McCray. Copyright © 2012 The Guilford Press. Excerpted by permission of The Guilford Press.
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