Depression Helpbook

Depression Helpbook

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Product Details

ISBN-13: 9781933503158
Publisher: Bull Publishing Company
Publication date: 07/01/2008
Edition description: Second Edition, Second edition
Pages: 228
Product dimensions: 5.90(w) x 8.90(h) x 0.60(d)

About the Author

Wayne Katon, MD, Evette Ludman, PhD, and Gregory Simon, MD, MPH, are affiliated with the Group Health Cooperative of Puget Sound Center for Health Studies and the University of Washington department of psychiatry. They all live in Seattle.

Read an Excerpt

The Depression Helpbook

By Wayne Katon, Evette Ludman, Gregory Simon

Bull Publishing Company

Copyright © 2008 Bull Publishing Company
All rights reserved.
ISBN: 978-1-933503-84-4


What Is Depression?

I had been having trouble sleeping and was tired all the time. It was getting harder and harder to keep up with my responsibilities at work because l couldn't concentrate. I felt people didn't want to be around me because I was gloomy and irritable. My physical health seemed to have taken a turn for the worse, which had me down in the dumps. So I went to see my doctor. When he asked if I was depressed, it took me completely by surprise.


Depression is a medical condition that is both physical and psychological. The primary symptoms are feelings of sorrow, dejection, despair, or irritability. Most people feel sad or blue occasionally, but when these feelings persist or worsen and begin to interfere with work or personal relationships, depression is suspected.

Learning how to identify depression in its early stages is important. Many people, even those who have been treated for depression in the past, don't realize that they are depressed (or that they're slipping back into a depression) until their depression is severe. If you can recognize depression when it first begins to come on, it is often much easier to manage.

Many of the symptoms of depression, such as headache, backache, or stomach trouble, are physical and may come on gradually, so it's often hard to recognize that depression is developing. A good way to find out is to review the Symptom Checklist For Recognizing Depression (opposite page). If you have been experiencing five or more of the symptoms on this list most of the time, including at least one of the first two symptoms, for at least two weeks, then depression is a likely explanation.


You probably know people who have been depressed in the past or several who are struggling with depression right now. Even highly accomplished and famous people experience depression from time to time. Television journalist Mike Wallace, President Abraham Lincoln, British Prime Minister Winston Churchill, and award- winning author William Styron are just a few of the well-known people who have battled depression.

Even so, when you're the one who's depressed, you often feel isolated. You may hesitate to tell others about your depression. Or, feeling that you should be able to overcome this illness on your own, you may wait to seek help until your depression becomes severe. Remember that depression is very common. One out of every four women and nearly one in seven men will suffer from at least one depressive episode sometime during their life.


Experts now believe that depression is due to a combination of biological susceptibility and an accumulation of life stresses. Depression tends to run in families, just like other medical conditions, such as diabetes, asthma, and hypertension, so depression probably has a genetic component, as do these other diseases. People who suffer from depression seem to have inherited a heightened sensitivity to changes in the levels of certain chemicals in the brain.

For some people, no specific event leads to their initial depression. For many others, certain experiences can trigger their first depressive episodes. It may be a painful physical illness or a traumatic event.

Major life stresses, such as divorce or death of a loved one, as well as positive changes like starting a new job, moving to another city, or having a new baby, can reduce the availability of key chemical messengers in the brain. These chemical messengers, called neurotransmitters, regulate sleep, energy, appetite, motivation, mood, and the ability to experience pleasure, to think, and to concentrate. For people who experience repeated episodes of depression, or who feel depressed most of the time, stress is more likely to lead to reductions in the levels of these chemicals.


When these essential chemical messengers are replenished, depressed people generally start to feel better. One way to restore these brain chemicals is by taking antidepressant medication. Another way is psychotherapy that treats depression by helping patients to improve their relationships with others, develop more constructive ways of thinking, and increase participation in more pleasant and rewarding activities. Psychotherapy is often combined with antidepressant medication.

Some people think they should be able to cope with depression on their own, without medications, psychotherapy, or any kind of outside help. But bear in mind that no one expects people with asthma or diabetes to overcome their illnesses simply by doing a better job of managing stress. The same should be true for depression. As soon as you recognize the problem, it makes sense to get help.

For people who experience repeated episodes of depression, long-term use of prescription antidepressant medicine can help prevent severe recurrences of the disease. Making the decision to use medication to combat depression is not a sign of weakness. Many people find that long-term use of antidepressants helps them feel and cope better day to day and prevents recurrences of severe depression. Taking medication may be an important part of your self-care and a sign that you are willing to do what works for you.


Each person who experiences depression is different, so it's not surprising that people with depression don't all experience it in the same way. The symptoms that bother you the most may not be so troubling for someone else.

People also differ in the circumstances that bring on depression. Sometimes depression occurs after a sudden stressful event such as a failed love affair, an illness, the loss of a job, or the death of someone close. Even positive events like getting a promotion can bring on depression.

Depression can result from long-term pressures: a difficult marriage, a stressful job, or a chronic illness. In some cases, depression comes on after what seems like a minor event, or even for no reason at all.

Chuck's story:

I started getting depressed around age 12. I missed 20 to 30 days of school a semester from junior high through high school. But I didn't realize what was wrong, so I didn't start getting help until I was 30 years old. I didn't want to admit I needed help. I wanted to do it myself.

Janet's story:

I was kind of relieved when the doctor said my problem was depression because I thought something was really wrong. Depression affects my colon, my gut-and that worried me because my dad died of cancer and I have lots of cancer in my family. But when I thought about what the doctor said, I realized that, yes, I am depressed.

Stanley's story:

Everything was going wrong. I was under a lot of stress. My shoulders started aching, and I got muscle spasms across my back. There was no reason for it. I'm usually very positive, but I wasn't being rational. I noticed I wasn't getting things done.

Types Of Depression

Depressions also differ in how severe they are, how long they last, and what the symptoms are. Each type of depression belongs to a specific category. Knowing the category helps guide medical professionals in recommending the right treatment.

Major depression consists of at least 5 symptoms on the checklist at the beginning of this chapter, such as sleep problems or feeling worthless, for 2 or more weeks.

Minor depression includes some depressive symptoms, but not enough to count as major depression. Sometimes minor depression continues after the worst part of a major depressive episode has passed.

Dysthymia is what mental health professionals call a chronic depression, involving just a few symptoms that may last for 2 years or longer. People with dysthymia often report that they have struggled with depressive moods for most of their lives.

Doctors used to believe there was a difference between reactive or situational depression and endogenous or biological depression. Now we know that there's not really a difference when it comes to what helps. Treatments for depression, either medication or psychotherapy, can both be helpful whether or not depression is related to some stressful life event.

Manic depression (also called manic-depressive illness or bipolar disorder) is a rarer form in which people suffer periods of major depression alternating with periods of euphoria and high energy. During the phases of "highs," people who are manic depressive experience euphoria, extraordinary vigor, and increased talkativeness and sociability and racing thoughts. They may also spend money extravagantly, be sexually promiscuous, and feel exceptionally powerful or creative. Manic depression requires different kinds of treatment from those described in this book.

Consult the Resource Guide at the back of this book for sources of further information on manic depression.


Don't delay getting help for depression because you hope it will go away on its own. Left untreated, a major depressive episode usually lasts 6-9 months, although 1 out of 3 depressed people do feel better after about 3 months, even without treatment.

Both antidepressant medications and the specific psychotherapies described in this book speed up the time to recovery. With medication, most people improve significantly in 2-4 weeks, and with psychotherapy, in 6-8 weeks. It is important to continue taking your antidepressant and attending psychotherapy sessions for as long as your doctor thinks necessary, even though you are feeling much better.

What If I Am Prone To Chronic Depression?

Controlling depression may be more difficult for people who are particularly vulnerable because of their genetic makeup or their childhood experiences. The tools described in this book (including antidepressant medications, developing more constructive ways of thinking, increasing positive activities, and improving interactions with others) can help anyone struggling to manage depression.


Reversing the Downward Spiral of Depression

About 6 weeks ago l got into a terrible accident. Afterward, my neck and back were really stiff and always hurting, and I couldn't sleep. I was really tired and couldn't concentrate on my work. I could tell that my boss was getting ticked off, but he didn't come out and say so. I avoided him any chance I could get. I used to play soccer after work, but now I would just go home and collapse on the couch. I was getting really irritable with my wife and kids, and then my wife got upset because I wasn't pulling my weight around the house. That's when I started to feel really down. My life was spinning out of control, and I didn't seem able to do anything about it.


Depression affects the whole person. It influences your physical well-being, your thoughts, and your feelings. People who are depressed usually stop doing things they once enjoyed, like talking to friends or getting projects done around the house. They also begin to have doubts about whether they can succeed in those things.

Depression can feed upon itself, making you feel worse and worse. For example, if you stop doing things you enjoy, you become unhappy. If you're unhappy, you might spend more time alone, which may make you feel depressed. As a result, you become less active and feel even more depressed — and so on. This cycle of worsening depression is sometimes called a negative downward spiral (Figure 2-1).

How does the spiral start? It's different for different people. Sometimes stressful events such as work or family problems can trigger a downward spiral. Physical problems such as chronic pain (headaches, backaches), insomnia, or lack or energy can also begin a spiral of depressed feelings. Persistent negative thought patterns or becoming less active or productive are other initial steps in a negative downward spiral.


The good news is that it's possible to break a cycle of worsening depression and turn a negative spiral into a positive upward spiral (Figure 2-2). Taking an antidepressant can help you begin a positive spiral. These medications increase your energy so that you'll feel like engaging in fun and rewarding activities. They can also restore normal sleep and decrease physical pain. Other strategies that can help you reverse the negative spiral of depression include

• Doing things you enjoy

• Learning to identify and interrupt negative thoughts

• Improving your relationships with friends and family

• Exercising regularly

• Establishing a regular sleep pattern

Some of these sound simple, but when you're depressed it can take a lot of effort to get involved in any activity — even if you think it will make you less depressed. Taking that first step to do something for yourself is often the hardest part. But it's worth the effort to reverse your downward spiral and start moving in an upward, positive direction again.

When I told my doctor about the problems I was having, he said he thought I had become depressed. He explained that injuries can lead to fatigue and demoralization that could bring on depression. Pain and injury can also make you stop doing fun things and make you irritable. He had me pegged! So he prescribed an antidepressant, and that helped me to sleep better right away. After a few weeks, my wife said that I seemed to have more energy and that I was less cranky and negative. I began to follow through on all those things that had piled up at work and around the house. I even went to soccer. As I began to do things again, I noticed that I felt better about myself. Best of all, I began to feel more in control. This page intentionally left blank


Making Your Own Decision About Treatment

After being laid off from my job, I began to feel blue, to worry about finances, and my energy and concentration both decreased. I started to exercise regularly and to schedule activities with friends since that usually helps improve my mood. But over the next month, I began to have trouble sleeping and I was so tired all the time, so I decided to see my doctor about antidepressant medication or counseling.


Good self-care is a central part of getting and staying well. For everyone who suffers from depression, developing and practicing the self-care skills described in Part 2 of this book is a good first step. Sometimes, though, good selfcare alone is not enough. In some cases, it may be clear in the beginning that treatment for depression is necessary. In other situations, you may decide to see a doctor or other professional about treatment if significant problems with depression persist despite your best self-care efforts. Depression that is more severe and more persistent (what doctors and therapists call major depression) is less likely to resolve completely with self-care alone — and more likely to need some professional treatment.


Several treatments for depression have been proven effective and safe. Treatment of depression is successful as often as (or more often than) treatment of most other significant health problems. Effective treatments include several types of psychotherapy specifically developed to treat depression as well as several effective antidepressant medications (more than 20 at the time this book was written). Before making a decision, you should take some time to consider these various options. This chapter includes 6 of this book include specific information about the various options available.


Excerpted from The Depression Helpbook by Wayne Katon, Evette Ludman, Gregory Simon. Copyright © 2008 Bull Publishing Company. Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Introduction: How to Use This Book     1
A Better Understanding     5
What Is Depression?     7
Reversing the Downward Spiral of Depression     17
Making Your Own Decision About Treatment     23
Working with Your Doctor     31
What You Should Know About Antidepressants     41
What You Should Know About Psychotherapy     55
When Is Treatment Finished     67
What Family and Friends Should Know     73
Plain Talk About Suicide     81
Depression and Your Body     85
Depression and Chronic Medical Illness     93
Depression and Women's Health     105
Food, Alcohol, and Drugs     115
Everyday Insights     123
Relaxing     125
Exercising     131
Getting a Good Night's Sleep     135
Making Time for Enjoyment     143
Thinking More Constructively     151
The Other People in Your Life     159
Intimacy and Sex When You Are Depressed     165
Managing at Work When You Are Depressed     171
Taking Charge     177
Managing Depression Day by Day     179
Planning for Better Living     185
Maintaining Gains and Preventing Relapse     191
Living Your Plan     209
A Primer on Antidepressants     215
Resource Guide     225
Worksheets     231
Index     241

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