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Getting Help
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Q. Where should a person go for help?
If you think you might need help, see your internist or general
practitioner and explain your situation. Sometimes an actual physical
illness can cause depression-like symptoms so that is why it is best
to see your regular physician first to be checked out. Your doctor
should be able to refer you to a psychiatrist if the severity of your
depression warrants it.
Other sources of help include the members of the clergy, local
suicide hotline, local hospital emergency room, local mental health
center.Q. How can family and friends help the depressed person?
The most important things anyone can do for depressed people is to
help them get appropriate diagnosis and treatment. This may involve
encouraging a depressed individual to stay with treatment until
symptoms begin to abate (several weeks) or to seek different
treatment if no improvement occurs. On occasion, it may require
making an appointment and accompanying the depressed person to the
doctor. It may also mean monitoring whether the depressed person is
taking medication.
The second most important thing is to offer emotional support. This
involves understanding, patience, affection, and encouragement.
Engage the depressed person in conversation and listen carefully. Do
not disparage feelings expressed, but point out realities and offer
hope. Do not ignore remarks about suicide. Always report them to the
doctor. Invite the depressed person for walks, outings, to the
movies, and other activities. Be gently insistent if your invitation
is refused. Encourage participation in some activities that once gave
pleasure, such as hobbies, sports, religious or cultural activities,
but do not push the depressed person to undertake too much too soon.
The depressed person needs diversion and company. but too many
demands can increase feelings of failure. Do not accuse the depressed
person of faking illness or laziness or expect him or her to "snap
out of it." Eventually, with treatment, most depressed people do yet
better. Keep that in mind, and keep reassuring the depressed person
that with time and help, he or she will feel better.
Choosing A Doctor
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Q. What should you look for in a doctor? How can you tell if he/she
really understands depression?
If you are looking for a psychopharmacologist to prescribe
medications to help control your depression there are a number of
things to check. If you are in psychotherapy, it is important to ask
prospective doctors about their opinions on the psychotherapeutic
treatment of depression. Psychopharmacologists who are hostile to
psychotherapy are difficult to deal with while you are in therapy.
It is always legitimate to ask any professionals you are thinking
about seeing regularly about their understanding of depression, their
beliefs about the causes of depression and their philosophy of
treatment. You might ask about how often the prospective doctor has
worked with people who have had your particular variety of
depression. If you have a rapidly cycling Bipolar depression, for
example, you should seek a doctor who has much experience dealing
with people who have this problem. Prior to the first visit it is
important to clarify with the doctor or the secretary the fee of the
initial and subsequent visits, the doctor's policy regarding
missed and changed appointments, whether the doctor will accept
assignment from insurance companies. If you have Medicare or
Medicaid it is important to make sure that the doctor sees people
with these forms of medical coverage.
Another aspect of the style of doctors is the extent to which they
include their patients in the decision-making process. You might ask
"How do you go about deciding which treatment is right for me?" See
if you are comfortable with the method the doctor describes. Much can
also be learned from how doctors respond to questions such as these.
There is much difference between a doctor who welcomes such questions
and answers them fully and one who is annoyed by them and answers
them superficially.
Self-care
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Q. How may I measure the effects my treatment is having on my depression?
If one completes the following scale each week, and keeps track of the
scores, one would have a detailed record of one's progress.
Name _________________________ Date _________
The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Use the following scale:
0 = Not at all
1 = Just a little
2 = Somewhat
3 = Moderately
4 = Quite a lot
5 = Very much
_______________________
1. I do things slowly............................0 1 2 3 4 5
2. My future seems hopeless......................0 1 2 3 4 5
3. It is hard for me to concentrate on reading...0 1 2 3 4 5
4. The pleasure and joy has gone out of my life..0 1 2 3 4 5
5. I have difficulty making decisions............0 1 2 3 4 5
6. I have lost interest in aspects of life that
used to be important to me...................0 1 2 3 4 5
7. I feel sad, blue, and unhappy.................0 1 2 3 4 5
8. I am agitated and keep moving around..........0 1 2 3 4 5
9. I feel fatigued...............................0 1 2 3 4 5
10. It takes great effort for me to do simple
things.......................................0 1 2 3 4 5
11. I feel that I am a guilty person who
deserves to be punished......................0 1 2 3 4 5
12. I feel like a failure.........................0 1 2 3 4 5
13. I feel lifeless--more dead than alive.........0 1 2 3 4 5
14. My sleep has been disturbed:
too little, too much, or broken sleep........0 1 2 3 4 5
15. I spend time thinking about HOW I might
kill myself..................................0 1 2 3 4 5
16. I feel trapped or caught......................0 1 2 3 4 5
17. I feel depressed even when good things
happen to me.................................0 1 2 3 4 5
18. Without trying to diet, I have lost,
or gained, weight............................0 1 2 3 4 5
Note: This scale is designed to measure changes in the severity of
depression and it has been shown to be sensitive to the changes
that result from psychotherapeutic or psychopharmacologic
treatment. These scales are not designed to diagnose the presence
or absence of either depression or mania.
Copyright (c) 1993 Ivan Goldberg
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