Frequently Asked Questions About Depression

How does depression feel?

The symptoms of depression vary greatly from person to person, and men and women commonly experience it very differently. The official clinical diagnosis looks for the coexistence of things like significant changes, either up or down, in appetite and sleep patterns, feelings of inexplicable sadness or irritability, loss of energy, inability to concentrate, and inability to take pleasure in things you used to really enjoy. These are fairly vague descriptors, though. Some things that you may notice in everyday life are what you might be calling a lack of motivation--it may be tough to get out of bed in the morning, to face any social situation where you'll have to deal with people, to get yourself to start a project for school or work, or to get yourself to go out and exercise. You might start putting off things like paying bills or answering emails, and when you do get started, basic tasks seem to take forever. You might stop caring about your appearance, what you wear, or whether your surroundings are a mess.

A lot of people have been through this, and a lot of people have expressed what depression feels like far more eloquently than I ever could:

I wasn't steering anything, not even myself. I just bumped from my hotel to work and to parties and from parties to my hotel and back to work like a numb trolleybus. I guess I should have been excited the way most of the other girls were, but I couldn't get myself to react. I felt very still and very empty, the way the eye of a tornado maust feel, moving dully along in the middle of the surrounding hullabaloo. (Sylvia Plath, The Bell Jar)
I felt a kind of numbness, an enervation, but more particularly an odd fragility--as if my body had actually become frail, hypersensitive and somehow disjointed and clumsy, lacking normal coordination. And soon I was in the throes of a pervasive hypochondria. Nothing felt quite right with my corporeal self; there were twitches and pains, sometimes intermittent, often seemingly constant, that seemed to presage all sorts of dire infirmities. (William Styron, Darkness Visible)
I can remember lying frozen in bed, crying because I was too frightened to take a shower and at the same time knowing showers are not scary....I knew that for years I had taken a shower every day. Hoping that someone else would open the bathroom door, I would, with all the force in my body, sit up; turn and put my feet on the floor; and then feel so incapacitated and frightened that I would roll over and lie face down. I would cry again, weeping because the fact that I could not do it seemed so idiotic to me. At other times, I have enjoyed skydiving: it is easier to climb along a strut toward the tip of a plane's wing against an eighty-mile-an-hour wind at five thousand feet than it was to get out of bed those days. (Andrew Solomon, "Anatomy of Melancholy," The New Yorker)
Mysteriously, and in ways that are totally remote from any normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately identifiable pain, like that of a broken limb. It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the individual begins to think ceaselessly of oblivion. (William Styron, Darkness Visible)

How common is depression?

That depends on the type of depressive illness.

Major depressive disorder (unipolar depression) strikes 5-12% of men and 10-20% of women; half of these people will have more than one episode, and 15% will commit suicide.
Seasonal Affective Disorder (SAD) affects 3-4% of the population, with a higher incidence rate at high latitudes, where there is very little sunlight during the winter. 15-20% of the U.S. population reports some symptoms, but for most they are not debilitating.
Bipolar disorder, or manic-depressive illness, is the least common form of depression, affecting about 1% of the population (which is still a lot of people). It is equally prevalent in men and women, and is strongly linked with artistic creativity. Artists, writers, composers, and musicians are ten times more likely than the general population to have manic depression.
Vincent van Gogh, Virginia Woolf, Sylvia Plath, Ernest Hemingway, Jack London, Albert Camus, Abraham Lincoln, Winston Churchill, Leo Tolstoy, William Faulkner, F. Scott Fitzgerald, Peter Tchaikovsky, Sergey Rachmaninoff, Dylan Thomas, Edgar Allan Poe, Irving Berlin, Cole Porter, Marilyn Monroe, Kurt Cobain of Nirvana, Michael Hutchence of INXS, Tori Amos, Alan Turing, Ted Turner, Roseanne Arnold, James Taylor--all these and many, many more suffered from major depression or bipolar disorder.

What causes depression?

That is not clearly understood. In most cases, the first episode of a major depression can be linked to some life event--death of a spouse or loss of a job, for example. But recurrences are frequently not triggered by any specific event.

There is without question a strong genetic component in both bipolar and unipolar disorders. There is an 80% concordance rate among identical twins with manic depression. With major depression, the concordance rates are 70% for identical twins and 13% for fraternal twins.

Q. What is depression?

Being clinically depressed is very different from the down type of
feeling that all people experience from time to time. Occasional
feelings of sadness are a normal part of life, and it is
that such feelings are often colloquially referred to as
"depression." In clinical depression, such feelings are out of
proportion to any external causes. There are things in everyone's
life that are possible causes of sadness, but people who are not
depressed manage to cope with these things without becoming
incapacitated.

As one might expect, depression can present itself as feeling sad or
"having the blues". However, sadness may not always be the dominant
feeling of a depressed person. Depression can also be experienced as
a numb or empty feeling, or perhaps no awareness of feeling at all.
A depressed person may experience a noticeable loss in their ability
to feel pleasure about anything. Depression, as viewed by
psychiatrists, is an illness in which a person experiences a marked
change in their mood and in the way they view themselves and the
world. Depression as a significant depressive disorder ranges from
short in duration and mild to long term and very severe, even life
threatening.

Depressive disorders come in different forms, just as do other
illnesses such as heart disease. The three most prevalent forms are
major depression, dysthymia, and bipolar disorder.


Q. What is major depression?

Major depression is manifested by a combination of symptoms (see
symptom list below) that interfere with the ability to work, sleep,
eat; and enjoy once-pleasurable activities. These disabling episodes
of depression can occur once, twice, or several times in a lifetime.


Q. What is dysthymia?

A less severe type of depression, dysthymia, involves long-term,
chronic symptoms that do not disable, but keep you from functioning
at "full steam" or from feeling good. Sometimes people with dysthymia
also experience major depressive episodes.


Q. What is bipolar depression (manic-depressive illness)?

Another type of depressive disorder is manic-depressive illness, also
called bipolar depression. Not nearly as prevalent as other forms of
depressive disorders, manic depressive illness involves cycles of
depression and elation or mania. Sometimes the mood switches are
dramatic and rapid, but most often they are gradual. When in the
depressed cycle, you can have any or all of the symptoms of a
depressive disorder. When in the manic cycle, any or all symptoms
listed under mania may be experienced. Mania often affects thinking,
judgment, and social behavior in ways that cause serious problems and
embarrassment. For example, unwise business or financial decisions may
be made when in a manic phase.


Q. What is Seasonal Affective Disorder (SAD)?

SAD is a pattern of depressive illness in which symptoms recur every
winter. This form of depressive illness often is accompanied by such
symptoms as marked decrease in energy, increased need for sleep, and
carbohydrate craving. Photo therapy - morning exposure to bright, full
spectrum light - can often be dramatically helpful.


Q. What is Post Partum Depression?

Mild moodiness and "blues" are very common after having a baby, but
when symptoms are more than mild or last more than a few days, help
should be sought. Post part depression can be extremely serious for
both mother and baby.


Q. How is bereavement different from depression?

A full depressive syndrome frequently is a normal reaction to the
death of a loved one (bereavement), with feelings of depression and
such associated symptoms as poor appetite, weight loss, and insomnia.
However, morbid preoccupation with worthlessness, prolonged and
marked functional impairment, and marked psychomotor retardation are
uncommon and suggest that the bereavement is complicated by the
development of a Major Depression. The duration of "normal"
bereavement varies considerably among different cultural groups.


Q. What is Endogenous Depression?

A depression is said to be endogenous if it occurs without a
particular bad event, stressful situation or other definite, outside
cause being present in the person's life. Endogenous depression
usually responds well to medication. Some authorities do not consider
this to be a useful diagnostic category.


Q. What is atypical depression?

"Atypical depression" is not an official diagnostic category, but it
is often discussed informally. A person suffering from atypical
depression generally has increased appetite and sleeps more than usual.
An atypical depressive may also be able to enjoy pleasurable
circumstances despite being unable to seek out such circumstances.
This contrasts with the "typical" depressive, who generally has
reduced appetite and insomnia, and who is often unable to find
pleasure in anything. Despite its name, atypical depression may in
fact be more common than the other kind.

Symptoms
--------

Q. What are the typical symptoms of depression?

A depressive disorder is a "whole-body" illness, involving your body,
mood, and thoughts. It affects the way you eat and sleep, the way you
feel about yourself, and the way you think about things. A depressive
disorder is not a passing blue mood. It is not a sign of personal
weakness or a condition that can be willed or wished away. People
with a depressive illness cannot merely "pull themselves together" and
get better. Without treatment, symptoms can last for weeks, months, or
years. Appropriate treatment, however, can help over 80% of those who
suffer from depression. Bipolar depression includes periods of high
or mania. Not everyone who is depressed or manic experiences every
symptom. Some people experience a few symptoms, some many. Also,
severity of symptoms varies with individuals.

Symptoms of Depression:

* Persistent sad, anxious, or "empty" mood
* Feelings of hopelessness, pessimism
* Feelings of guilt, worthlessness, helplessness
* Loss of interest or pleasure in hobbies and activities that you
once enjoyed, including sex
* Insomnia, early-morning awakening, or oversleeping.
* Appetite and/or weight loss or overeating and weight gain
* Decreased energy. fatigue, being "slowed down"
* Thoughts of death or suicide, suicide attempts
* Restlessness, irritability
* Difficulty concentrating, remembering, making decisions
* Persistent physical symptoms that do not respond to treatment, such
as headaches, digestive disorders, and chronic pain

Symptoms of Mania:

* Inappropriate elation
* Inappropriate irritability
* Severe insomnia
* Grandiose notions
* Increased talking
* Disconnected and racing thoughts
* Increased sexual desire
* Markedly increased energy
* Poor judgment
* Inappropriate social behavior

Q. What are the diagnostic criteria for depression?

Depression comes in many forms and in many degrees. Below, you will
find some of the most common depressive types, along with some of the
diagnostic criteria from the DSM-III-R (the official diagnostic and
statistical manual for psychiatric illnesses).

**Major Depression:** This is a most serious type of depression. Many
people with a major depression can not continue to function normally.
The treatments for this are medication, psychotherapy and, in extreme
cases, electroconvulsive therapy (ECT).

Diagnostic criteria:
A. At least five of the following symptoms have been present during
the same two-week period and represent a change from previous
functioning; at least one of the symptoms is either (1) depressed
mood, or (2) loss of interest or pleasure. (Do not include
symptoms that are clearly due to a physical condition, mood-
incongruent delusions or hallucinations, incoherence, or marked
loosening of associations.)
1. depressed mood most of the day, nearly every day, as indicated
either by subjective account or observation by others
2. markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated
either by subjective account or observation by others of apathy
most of the time)
3. significant weight loss or weight gain when not dieting (e.g.
more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of
restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely self-
reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness
nearly every day (either by subjective account or as observed
by others)
9. recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt
or a specific plan for committing suicide
B. (1) It cannot be established that an organic factor initiated and
maintained the disturbance (2) The disturbance is not a normal
reaction to the death of a loved one
C. At no time during the disturbance have there been delusions or
hallucinations for as long as two weeks in the absence of
prominent mood symptoms (i.e..- before the mood symptoms
developed or after they have remitted).
D. Not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder

**Dysthymia:** This is a mild, chronic depression which lasts for two
years or longer. Most people with this disorder continue to function
at work or school but often with the feeling that they are "just
going through the motions." The person may not realize that they are
depressed. Anti-depressants or psychotherapy can help.

Diagnostic criteria:
A. Depressed mood (or can be irritable mood in children and
adolescents) for most of the day, more days than not, as indicated
either by subjective account or observation by others, for at
least two years (one year for children and adolescents)
B. Presence, while depressed, of at least two of the following:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficult making decisions
6. feelings of hopelessness
C. During a two-year period (one-year for children and adolescents)
of the disturbance, never without the symptoms in A for more than
two months at a time.
D. No evidence of an unequivocal Major Depressive Episode during the
first two years (one year for children and adolescents) of the
disturbance.
E. Has never had a Manic Episode or an unequivocal Hypo manic
Episode.
F. Not superimposed on a chronic psychotic disorder, such as
Schizophrenia or Delusional Disorder.
G. It cannot be established that an organic factor initiated or
maintained the disturbance, e.g., prolonged administration of an
antihypertensive medication.

**Adjustment Disorder with Depressed Mood:** This is the type of
depression that results when a person has something bad happen to
them that depresses them. For example, loss of one's job can cause
this type of depression. It generally fades as time passes and the
person gets over what ever it was that happened.

Diagnostic criteria:
A. A reaction to an identifiable psycho social stressor (or multiple
stressors) that occurs within three months of onset of the
stressor(s).
B. The maladaptive nature of the reaction is indicated by either of
the following:
1. impairment in occupational (including school) functioning or in
usual social activities or relationships with others
2. symptoms that are in excess of a normal and expectable reaction
to the stressor(s)
C. The disturbance is not merely one instance of a pattern of
overreaction to stress or an exacerbation of one of the mental
disorders previously described (in the entire DSM).
D. The maladaptive reaction has persisted for no longer than six
months.
E. The disturbance does not meet criteria for any specific mental
disorder and does nor represent Uncomplicated Bereavement.

Causes
------

Q. What causes depression?

The group of symptoms which doctors and therapists use to diagnose
depression ("depressive symptoms"), which includes the important
proviso that the symptoms have manifested for more than a few weeks
and that they are interfering with normal life, are the result of an
alteration in brain chemistry. This alteration is similar to
temporary, normal variations in brain chemistry which can be
triggered by illness, stress, frustration, or grief, but it differs
in that it is self-sustaining and does not resolve itself upon
removal of such triggering events (if any such trigger can be found
at all, which is not always the case.)

Instead, the alteration continues, producing depressive symptoms and
through those symptoms, enormous new stresses on the person:
unhappiness, sleep disorders, lack of concentration, difficulty in
doing one's job, inability to care for one's physical and emotional
needs, strain on existing relationships with friends and family.
These new stresses may be sufficient to act as triggers for
continuing brain chemistry alteration, or they may simply prevent the
resolution of the difficulties which may have triggered the initial
alteration, or both.

The depressive brain chemistry alteration seems to be self-limiting
in most cases: after one to three years, a more normal chemistry
reappears, even without medical treatment. However, if the alteration
is profound enough to cause suicidal impulses, a majority of
untreated depressed people will in fact attempt suicide, and as many
as 17% will eventually succeed. Therefore, depression must be thought
of as a potentially fatal illness. Friends and relatives may be
deceived by the casual way that profoundly depressed people speak of
suicide or self-mutilation. They are not casual because they "don't
really mean it"; they are casual because these things seem no worse
than the mental pain they are already suffering. Any comment such as,
"You'd be better off if I were gone," or "I wish I could just jump
out a window," is the equivalent of a sudden high fever; the
depressed person must be taken to a professional who can monitor
their danger. A formulated plan, such as, "I'm going to jump in front
of the next car that comes by," is the equivalent of sudden
unconsciousness: an immediate medical emergency which may require
hospitalization.

Depression can shut down the survival instinct or temporarily
suppress it. Therefore, depressed suicidal thinking is not the same
as the suicidal thinking of normal people who have reached a crisis
point in their lives. Depressive suicides give less warning, need
less time to plan, and are willing to attempt more painful and
immediate means, such as jumping out of a moving car. They may also
fight the impulse to suicide by compromising on self-injury --
cutting themselves with knives, for example, in an attempt to
distract themselves from severe mental pain. Again, relatives and
friends are likely to be astonished by how quickly such an impulse
can appear and be acted upon.

..

Q. What initiates the alteration in brain chemistry?

It can be either a psychological or a physical event. On the physical
side, a hormonal change may provide the initial trigger: some women
dip into depression briefly each month during their premenstrual
phase; some find that the hormone balance created by oral
contraceptives disposes them to depression; pregnancy, the end of
pregnancy, and menopause have also been cited. Men's hormone levels
fluctuate as deeply but less obviously.

It is well known that certain chronic illnesses have depression as a
frequent consequence: some forms of heart disease, for example, and
Parkinsonism. This seems to be the result of a chemical effect rather
than a purely psychological one, since other, equally traumatic and
serious illnesses don't show the same high risk of depression.


Q. Is a tendency to depression inherited?

It seems there are some people whose brain chemistry is predisposed
to the depressive response, and others who are at much lower risk of
depression even if exposed to the same physical or psychological
triggers. The genetic relations of manic-depressives are at a higher
risk for unipolar depression than the population at large or their
adopted/by marriage relations. There seems to be a link between high
creativity and the gene for manic-depression: artists and writers
often are not manic-depressive themselves, but have a family member
who is. Studies of families in which members of each generation
develop manic-depressive illness found that those with the illness
have a somewhat different genetic make-up than those who do not get
ill. However, the reverse is not true: not everybody with the genetic
make-up that causes vulnerability to manic-depressive illness has the
disorder. Apparently additional factors, possibly a stressful
environment, are involved in its onset.

Major depression also seems to occur, generation after generation, in
some families. However, depression can occur in people with no family
history of any form of mental illness. And I would be reluctant to
suggest that there is any human who is entirely immune to depression
under all possible conditions.

Psychological triggers: many, if not most, people with depression can
point to some incident or condition which they believe is responsible
for their unhappiness. Of course, people with severe depression are
prone to astonishingly virulent and inappropriate guilt and
self-hatred.

The (genuine) life events that most often appear in connection with
depression are various, but there is one distinguishing feature that
appears in many cases, over and over: loss of self-determination, of
empowerment, of self-confidence. More profoundly: a loss of self, of
the abilities or activities that a person identifies with herself.
Stereotypically: a man loses the job that had defined him to himself
and others, whether that definition was "executive" or "breadwinner";
a woman who had spent her whole life preparing for and living the
role of wife, supporter, caretaker, is suddenly left alone by divorce
or death. In general, any life change, often caused by events beyond
one's control, which damages the structure that gave life meaning.

The ability of a person to respond to such an event will depend on
many factors, including genetic predisposition, support from friends,
physical health, even the weather. It can also depend on internal
psychological factors which may best be explored in talk therapy: why
is the person's self-esteem so bound up in the position or state that
has been lost? Can she find a new source of self-esteem? Therapy can
be immensely helpful here.

Obviously, not everyone to whom this sort of event happens becomes
depressed, and not every person who becomes depressed has had this
sort of catastrophe befall them. In fact, if a person suffers a loss
and then becomes depressed, it may well be that they weathered the
loss in fine style and then succumbed to a much less obvious trigger,
psychological or physical.

Some depressions may well be caused by a spontaneous aberration in
brain chemistry, with no trigger that we can currently identify, just
as a seizure or migraine may have an obvious trigger or be apparently
spontaneous.

However, once the depressive state has set in, both physical and
psychological problems will be generated in abundance. What faster
way to lose a job or a spouse than to be too depressed to work or to
communicate? What worse psychological state for coping with a blow to
identity can there be than a chemically promoted, pathological
self-hatred? And what can be worse for self-esteem than watching
one's appearance and household disintegrate as one loses the
motivation to shower, straighten up, wash dishes or laundry, or
choose attractive clothes? Health deteriorates as well: some
depressed people can't sleep or eat, others sleep constantly (a real
help on the job!) and eat incessantly, sometimes in order to stay
awake, sometimes because it's the only thing that gives a little
pleasure or comfort. (Carbohydrates induce production of serotonin,
so there may be an element of self-medication here); almost no one
has the impulse to exercise or get fresh air and sunshine. Most if
not all of these effects form feedback loops, increasing in magnitude
and becoming triggers for further depression.

The question, "Is depression mostly physical or psychological," is
rather beside the point. Depression may be triggered by either
physical or psychological events. Most commonly, both seem to be
involved, though it is often difficult to separate the two when one
is talking about psychology and neurochemistry. But however it
begins, depression quickly develops into a set of physical and
psychological problems which feed on each other and grow. This is why
a combination of physical and psychological intervention has been
shown to give the best results for most patients, regardless of any
classifications that doctors may have tried to impose on their
depression and its cause.

Treatment
---------

Q. What sorts of psychotherapy are effective for depression?

Two effective methods of psychotherapy for people with depressions
are cognitive therapy and interpersonal therapy. Both psychoanalysis,
and insight oriented psychotherapy have not been shown to be
effective treatments for people with a depressive disorder. Cognitive
(and cognitive-behavioral) therapists can be found in most major
cities.


While many therapists call themselves cognitive therapists and
interpersonal therapists, only a few have had proper training.


Medication
----------

Q. Do certain drugs work best with certain depressive illnesses? What
are the guidelines for choosing a drug?

There are very few kinds of depression for which there are specific
antidepressant treatments. When it comes to people with Bipolar
Disorder who are depressed there are some major problems. Most
importantly, with any antidepressant, there is a possibility that the
antidepressant treatment will cause depressed bipolar people not just
to come out of their depressions, but to develop manic episodes. The
possibility of an antidepressant causing mania is least when the
antidepressant is bupropion (Wellbutrin). The possibility of mania is
greatly reduced if depressed bipolar folks are on a mood stabilizer
such as lithium, Tegretol or Depakote when they are started on an
antidepressant.


Q. How do you tell when a treatment is not working? How do you know when
to switch treatments?

Antidepressant treatment is clearly not working when the individual
receiving the treatment remains depressed or becomes depressed again.
When a recently started antidepressant fails to cause improvement,
the depressed individual often asks that the medication be stopped,
and a new one started. It generally does not make sense to change
antidepressants until 8-weeks at the maximum tolerated dose have
elapsed. With some tricyclic antidepressants, it is important to
check the blood level of the antidepressant before it is stopped. The
blood test can tell if the amount in the blood has been adequate.
Only after an adequate trial of one antidepressant should another be
tried. To have been on four antidepressants in an 8-week period means
that one has not had an adequate trial on any of them.


Q. How do antidepressants relieve depression?

There are several classes of antidepressants, all of which seem to
work by increasing levels of certain neurotransmitters (most commonly
serotonin, norepinephrine, and dopamine) in the brain. It is not
entirely clear why increasing neurotransmitter levels should reduce
the severity of a depression. One theory holds that the increased
concentration of neurotransmitters causes changes in the brain's
concentration of molecules, receptors, to which these transmitters
bind. In some unknown way it is the changes in the receptors that are
thought responsible for improvement.


Q. Are Antidepressants just "happy pills?"

No matter what their exact mode of action may be, it is clear that
antidepressants are not "happy pills." There is no street-market in
antidepressants, for unlike "speed" which will improve the mood of
almost everybody, antidepressants only improve the mood of depressed
people. Also unlike the almost instant effects of speed, the
mood-improving effects of antidepressants develop slowly over a
number of weeks. "Speed" induces a highly artificial state,
antidepressants cause the brain to slowly increase its production of
naturally occurring neurotransmitters.


Q. What percentage of depressed people will respond to antidepressants?

Generally, about 2/3 of depressed people will respond to any given
antidepressant. People who do not respond to the first antidepressant
they have taken, have an excellent chance of responding to another.


Q. What does it feel like to respond to an antidepressant? Will I feel
euphoric if my depression responds to an antidepressant?

The most common description of the effects of antidepressants is that
of feeling the depression gradually lift, and for the person to feel
normal again. People who have responded to antidepressants are not
euphoric. They are not unfeeling automatons. The are still able to
feel sad when bad things happen, and they are able to feel very happy
in response to happy events. The sadness they feel with
disappointments is not depression, but is the sadness anyone feels
when disappointed or when having experienced a loss. Antidepressants
do not bring about happiness, they just relieve depression. Happiness
is not something that can be had from a pill.

Q. What are the major categories of anti-depressants?

There are many classes of antidepressants. Two kinds of
antidepressants have been around for over 30 years. These are the
tricyclic antidepressants and the monoamine oxidase inhibitors. While
there are newer antidepressants, many with fewer side-effects, none
of the newer antidepressants has been shown to be more effective than
these two classes of drugs. In fact, many people who have not
responded to newer antidepressants have been successfully treated
with one of these classes of drugs.

The tricyclic antidepressants (TCAs) include such drugs as imipramine
(Tofranil, amitriptyline (Elavil), desipramine (Norpramin),
nortriptyline (Aventyl and Pamelor).

The monoamine oxidase inhibitors (MAOIs) include tranylcypromine
(Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has
recently been taken off the market in the U.S.A. for marketing rather
than safety or efficacy reasons.

One of the popular new classes of antidepressants are the selective
serotonin reuptake inhibitors (SSRIs). The first of these drugs to be
marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and
paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is
scheduled to be marketed in late 1994, or early 1995.

Bupropion (Wellbutrin) is the only drug in its class, as is trazodone
(Desyrel). The most recently marketed antidepressant (4/94) is
venlafaxine (Effexor), the first drug in yet another class of drugs.


Q. What are the side-effects of some of the commonly used
antidepressants?

Below is a list of some of the more frequently prescribed
antidepressants, and their most common side effects. The figure
following each side effect is the percentage of people taking the
medication who experience that side effect.

Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
Weakness-fatigue (10); Tremor (10).

Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
Dry mouth (20); Insomnia (20); Constipation (15).

Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
(30); Constipation (25); Sweating (20).

Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
rate (25); Lowered blood pressure (20); Sedation (15); Over
stimulation (10);

Norpramin (desipramine): dry mouth (15); increased pulse (15);
constipation (10); reduced blood pressure (10).

Pamelor - see Aventyl

Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
Sedation (15).

Paxil (paroxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
Insomnia (15)

Prozac (fluoxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
Insomnia (15); Diarrhea (15).

Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
Lowered blood pressure (25); Constipation (25); Sweating (20).

Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
Constipation (20), Difficulty with urination (15).

Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
(20); Decreased appetite (20);

Zoloft (sertraline): Decreased sexual interest and/or problems
achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
Insomnia 15); Dry mouth (15); Sedation (15).


Q. What are some techniques that can be used by people taking
antidepressants to make side effects more tolerable?

Listed below are some frequent side effects of antidepressants, and
some techniques to reduce their severity:

Dry mouth: Drink lots of water, chew sugarless gum, clean teeth
daily, ask the dentist to suggest a fluoride rinse to prevent
cavities, visit the dentist more often than usual for tooth and gum
hygiene

Constipation: Drink at least six 8-ounce glasses of water every day,
eat bran cereals, eat salads twice a day, exercise daily (walk for at
least 30 minutes a day), ask your doctor about taking a bulk
producing agent such as Metamucil, also ask about taking a stool
softener such as Colace, be sure to avoid laxatives such as Ex-Lax.

Bladder problems: The effects of some antidepressants, especially the
tricyclic medications may make it difficult for you to start the
stream of urine. There may be some hesitation between the time you
try to urinate and the time your urine starts to flow. If it takes
you over 5-minutes to start the stream, call your doctor.

Blurred vision: The tricyclic antidepressants may make it difficult
for you to read. Distant vision is usually unaffected. If reading is
important to you the effects of the antidepressant can be compensated
for by a change in glasses. As you may compensate for the change in
your vision, try to postpone getting new glasses as long as possible.

Dizziness: Dizziness when getting out of bed or when standing up from
a chair, or when climbing stairs may be a problem when taking
tricyclic antidepressants and monoamine oxidase inhibitors. Changing
posture slowly may help prevent this kind of dizziness. Drinking
adequate amounts of liquid and eating enough salt each day is
important. Be sure to speak to your doctor if this side-effect is
severe.

Drowsiness: This side effect often passes as you get used to taking
the antidepressant that has been prescribed for you. Ask your doctor
if it is safe for you to increase your intake of caffeine, and if so,
by how much. If you are drowsy be sure not to drive or operate
dangerous machinery.


Q. Many antidepressants seem to have sexual side effects. Can anything
be done about those side-effects?

Both lowered sexual desire and difficulties having an orgasm, in both
men and women, are particularly a problem with the selective
serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and
the monoamine oxidase inhibitors (Nardil and Parnate). There is no
treatment for decreased sexual interest except lowering the dose or
switching to a drug that does not have sexual side effects such as
bupropion (Wellbutrin). Difficulty having orgasms may be treated by a
number of medications. Among those medications are: Periactin,
Urecholine, and Symmetrel. None of these are over-the-counter drugs
and they must be prescribed by a physician. Unfortunately, many
psychiatrists are not familiar with using these medications to treat
the sexual side-effects of antidepressants.


Q. What should I do if my antidepressant does not work?

Many people decide that their antidepressant is not working
prematurely. When one starts an antidepressant the hope is for rapid
relief from depression. What must be remembered is that for an
antidepressant to work, you must be on an adequate dose of the drug
for an adequate length of time. A fair trial of any antidepressant is
at least two months. Prior to a two month trial the only reason to
abandon an antidepressant trial is if the medication is causing
severe side effects. With many antidepressants the dose has to be
increased at intervals far above the starting dose. Unfortunately,
the two-month period mentioned above, refers to two months following
the most recent increase in the dose, not the time from starting the
particular antidepressant.

..

Medication (cont.)
------------------

Q. If an antidepressant has produced a partial response, but has not
fully eliminated depression, what can be done about it?

There are many techniques to help an antidepressant work more
completely. The simplest is to increase the dose until relief is
experienced or side- effects are severe. If the dose can not be
increased, lithium can be added to any antidepressant to augment its
effect. With all antidepressants it is possible to add small doses of
stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or
dextroamphetamine (Dexedrine) to augment the antidepressant effect.
Selective serotonin re-uptake inhibitors often work better when small
doses of desipramine (Norpramin) or nortriptyline (Aventyl and
Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel)
may be used to augment any antidepressant. At times combinations of
these techniques may be utilized.


Electroconvulsive Therapy
-------------------------

Q. What is electroconvulsive therapy (ECT) and when is it used?;

ECT is an effective form of treatment for people with depressions and
other mood disorders. ECT may be used when a severely depressed
patient has not responded to antidepressants, is unable to tolerate
the side effects of antidepressants, or must improve rapidly. Some
depressed people simply do not respond to antidepressants or mood
controlling drugs, and ECT is a way for such people to be effectively
treated. ECT is utilized in the treatment of both mania and
depression. There are some people who because of severe physical
illness are unable to tolerate the side-effects of the medications
used to treat mood disorders. Many of these people can be
successfully be treated with ECT. Pregnant women and people who have
recently had heart attacks can be safely treated with ECT. Because of
time pressure regarding occupational, social, or family events, some
people do not have the time to wait for antidepressants or mood
regulating medications to become effective. As ECT quite regularly
brings about improvement within two or three weeks, people who are
under such time pressure are also excellent candidates for ECT.


Q. Exactly what happens when someone gets ECT?

The physician must fully explain the benefits and dangers of ECT, and
the patient give consent, before ECT can be administered. The patient
should be encouraged to ask questions about the procedure and should
be told that consent for treatments can be withdrawn at any time, and
in the event that this happens, the treatments will be stopped. After
giving consent, the patient undergoes a complete physical
examination, including a chest x-ray, electrocardiogram, and blood
and urine tests. A series of ECTs usually consists of six to twelve
treatments. Treatments can be administered to either in-patients or
out-patients. Nothing should be taken by mouth for 8-hours prior to a
treatment. An intravenous drip is started and through it medications
to induce sleep, relax the muscles of the body, and reduce saliva are
given. Once these medications are fully effective, an electrical
stimulus is administered through electrodes to the head. The
electrical stimulus produces brain wave (EEG) changes that are
characteristic of a grand mal seizure. It is believed that this
seizure activity leads to the clinical improvement seen after a
series of ECT. About 30-minutes after the treatment the patient
awakens from sleep. While confused at first, the patient is soon
oriented enough to eat breakfast, and return home if the treatments
are being done in an outpatient setting.


Q. How do individuals who have had ECT feel about having had the
treatments?

In studies of people treated with ECT it has been found that 80% of
such people report that they were helped by the treatments. About 75%
say that ECT is no more frightening than going to the dentist.


Q. How long do the beneficial effects of ECT last?;

While ECT is a highly successful way of helping people come out of
depressions, it has to be followed by antidepressant therapy. If
antidepressants are not administered after a series of ECTs, there is
a 50% relapse rate within 6-months.

Q. Is it true that ECT causes brain damage?;

There is no scientific evidence that ECT causes brain damage. A woman
who had over 1,000 ECT died of natural causes, and her brain was
examined for evidence of ECT-induced brain damage. None was found.
ECT does cause memory problems. These memory problems may take a
number of months to clear. A small number of people who have received
ECT complain of longer lasting memory problems. Such problems do not
show up on psychological tests, it is not clear what causes them.

Q. Why is there so much controversy about ECT?

There is little controversy about ECT among psychiatrists. Much of
the opposition to ECT seems political in nature and originates in the
anti-psychiatry groups that oppose the use of Ritalin for the
treatment of children with attention deficit disorder, and who oppose
the use of Prozac for the treatment of depressed people.


Substance Abuse
---------------

Q. May I drink alcohol while taking antidepressants?

There are a number of problems with the mixture of alcohol and
antidepressants. First, antidepressants may make you especially
susceptible to the intoxicating effects of alcohol. Second, if you
drink more than three or four drinks a week, the effects of alcohol
may prevent the antidepressants from working. Many people who seem
not to benefit from antidepressants, do so, if they reduce or
eliminate their intake of alcohol. Third, you may be taking along
with the antidepressant a drug such as clonazepan (Klonopin) with
which one should not drink at all.


Q. If I plan to drink alcohol while on medication, what precautions
should I take?

There is much misinformation about drinking while on anti-
depressants. Alcohol can prevent antidepressants from being
effective. This is not so much because it interferes with the
absorption of antidepressants, it is because of the effects of
alcohol upon brain chemistry. Antidepressants can also increase one's
susceptibility to the intoxicating effects of alcohol. Also, both
alcohol and some anti- depressants (especially Wellbutrin) increase
the possibility of seizures.

If you are determined to drink despite taking antidepressants you
should discuss the matter with your psychiatrist. If you get
permission you might want to determine the extent to which the
medication has made you more sensitive to the alcohol. You might
start by seeing what are the effects of half a glass of wine. You
might then experiment with a full glass. Remember, a 4 oz glass of
wine, a 12 oz bottle of beer, and 1 oz of "hard stuff" all contain
the same amount of alcohol.


Q. What's the relationship between depression and recovery from
substance abuse?

It is not unusual for people who have recently been withdrawn from
alcohol, or other abusable drugs to become depressed. These
depressions are often self-limited, and clear in about 8-weeks. If
depression has not cleared by the end of that period, anti-depressant
therapy should be started.


Q. What does the term "dual-diagnosis" mean?

Dual-diagnosis is a phrase used to indicate the combination of
substance abuse and a psychiatric disorder. A path to alcohol or
other substance abuse is an attempt to self- medicate uncomfortable
symptoms such as depression, anxiety, agitation or feelings of
emptiness. The psychiatric disorders that cause such symptoms are
often diagnosed in substance abusers.


Q. Is it safe for a person recovering from substance abuse to take
drugs?

People recovering from substance abuse can safely take many kinds of
psychiatric drugs. Most psychiatric drugs are unable to be abused.
The best evidence for this is that there are not street markets for
such drugs. On the other hand, The benzodiazepines (diazepam
[Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
[Desoxyn], and Ritalin [methylphenidate]) are quite abusable.

For people active in AA please read the pamphlet "The AA
Member--Medications & Other Drugs." This outlines AA's official
attitude toward medication--that it is necessary for certain
illnesses including depression. Too many depressed people who have
been talked out of taking antidepressants by members of their AA
groups have killed themselves as a result.


Q. How do you know when depression is severe enough that help should be
sought?

Professional help is needed when symptoms of depression arise without
a clear precipitating cause, when emotional reactions are out of
proportion to life events, and especially when symptoms interfere
with day-to-day functioning.. Professional help should definitely be
sought if a person is experiencing suicidal thoughts.




..

Getting Help
------------

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
-----------------

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
---------

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

Self-care (cont.)
-----------------

Q. How can I help myself get through depression on a day-to-day basis?

On a day-to-day basis, separate from, or concurrently with therapy or
medication, we all have our own methods for getting through the worst
times as best we can. The following comments and ideas on what to do
during depression were solicited from people in the
alt.support.depression newsgroup. Sometimes these things work,
sometimes they don't. Just keep trying them until you find some
techniques that work for you.

* Write. Keep a journal. Somehow writing everything down helps keep
the misery from running around in circles.

* Listen to your favorite "help" songs (a bunch of songs that have
strong positive meaning for you)

* Read (anything and everything) Go to the library and check out
fiction you've wanted to read for a long time; books about
depression, spirituality, morality; biographies about people who
suffered from depression but still did well with their lives
(Winston Churchill and Martin Luther, to name two.

* Sleep for a while

* Even when busy, remember to sleep. Notice if what you do before
sleeping changes how you sleep.

* If you might be a danger to yourself, don't be alone. Find people.
If that is not practical, call them up on the phone. If there is no
one you feel you can call, suicide hotlines can be helpful, even if
you're not quite that badly off yet.

* Hug someone or have someone hug you.

* Remember to eat. Notice if eating certain things (e.g. sugar or
coffee) changes how you feel.

* Make yourself a fancy dinner, maybe invite someone over.

* Take a bath or a perfumed bubble bath.

* Mess around on the computer.

* Rent comedy videos.

* Go for a long walk

* Dancing. Alone in my house or out with a friend.

* Eat well. Try to alternate foods you like ( Maybe junk foods) with
the stuff you know you should be eating.

* Spend some time playing with a child

* Buy yourself a gift

* Phone a friend

* Read the newspaper comics page

* Do something unexpectedly nice for someone

* Do something unexpectedly nice for yourself.

* Go outside and look at the sky.

* Get some exercise while you're out, but don't take it too seriously.

* Pulling weeds is nice, and so is digging in the dirt.

* Sing. If you are worried about responses from critical neighbors,
go for a drive and sing as loud as you want in the car. There's
something about the physical act of singing old favorites that's
very soothing. Maybe the rhythmic breathing that singing enforces
does something for you too. Lullabies are especially good.

* Pick a small easy task, like sweeping the floor, and do it.

* If you can meditate, it's really helpful. But when you're really
down you may not be able to meditate. Your ability to meditate will
return when the depression lifts. If you are unable to meditate,
find some comforting reading and read it out loud.

* Feed yourself nourishing food.

* Bring in some flowers and look at them.

* Exercise, Sports. It is amazing how well some people can play
sports even when feeling very miserable.

* Pick some action that is so small and specific you know you can do
it in the present. This helps you feel better because you actually
accomplish something, instead of getting caught up in abstract
worries and huge ideas for change. For example say "hi" to someone
new if you are trying to be more sociable. Or, clean up one side of
a room if you are trying to regain control over your home.

* If you're anxious about something you're avoiding, try to get some
support to face it.

* Getting Up. Many depressions are characterized by guilt, and lots
of it. Many of the things that depressed people want to do because
of their depressions (staying in bed, not going out) wind up making
the depression worse because they end up causing depressed people
to feel like they are screwing things up more and more. So if
you've had six or seven hours of sleep, try to make yourself get
out of bed the moment you wake up...you may not always succeed,
but when you do, it's nice to have gotten a head start on the day.

* Cleaning the house. This worked for some people me in a big way.
When depressions are at their worst, you may find yourself unable
to do brain work, but you probably can do body things. One
depressed person wrote, "So I spent two weeks cleaning my house,
and I mean CLEANING: cupboards scrubbed, walls washed, stuff given
away... throughout the two weeks, I kept on thinking "I'm not
cleaning it right, this looks terrible, I don't even know how to
clean properly", but at the end, I had this sparkling beautiful
house!"

* Volunteer work. Doing volunteer work on a regular basis seems to
keep the demons at bay, somewhat... it can help take the focus off
of yourself and put it on people who may have larger problems (even
though it doesn't always feel that way).

* In general, It is extremely important to try to understand if
something you can't seem to accomplish is something you simply CAN'T
do because you're depressed (write a computer program, be charming
on a date), or whether its something you CAN do, but it's going to
be hell (cleaning the house, going for a walk with a friend, getting
out of bed). If it turns out to be something you can do, but don't
want to, try to do it anyway. You will not always succeed, but try.
And when you succeed, it will always amaze you to look back on it
afterwards and say "I felt like such *#!*#!*#!*#!, but look how well I
managed to...!" This last technique, by the way, usually works for
body stuff only (cleaning, cooking, etc.). The brain stuff often
winds up getting put off until after the depression lifts.

* Do not set yourself difficult goals or take on a great deal of
responsibility.

* Break large tasks into many smaller ones, set some priorities, and
do what you can, as you can.

* Do not expect too much from yourself. Unrealistic expectations will
only increase feelings of failure, as they are impossible to meet.
Perfectionism leads to increased depression.

* Try to be with other people, it is usually better than being alone.

* Participate in activities that may make you feel better. You might
try mild exercise, going to a movie, a ball game, or participating
in religious or social activities. Don't overdo it or get upset if
your mood does not greatly improve right away. Feeling better takes
time.

* Do not make any major life decisions, such as quitting your job or
getting married or separated while depressed. The negative thinking
that accompanies depression may lead to horribly wrong decisions.
If pressured to make such a decision, explain that you will make the
decision as soon as possible after the depression lifts. Remember
you are not seeing yourself, the world, or the future in an objective
way when you are depressed.

* While people may tell you to "snap out" of your depression, that is
not possible. The recovery from depression usually requires
antidepressant therapy and/or psychotherapy. You cannot simple make
yourself "snap out" of the depression. Asking you to "snap out" of a
depression makes as much sense as asking someone to "snap out" of
diabetes or an under-active thyroid gland.

* Remember: Depression makes you have negative thoughts about
yourself, about the world, the people in your life, and about the
future. Remember that your negative thoughts are not a rational way
to think of things. It is as if you are seeing yourself, the world,
and the future through a fog of negativity. Do not accept your
negative thinking as being true. It is part of the depression and
will disappear as your depression responds to treatment. If your
negative (hopeless) view of the future leads you to seriously
consider suicide, be sure to tell your doctor about this and ask for
help. Suicide would be an irreversible act based on your
unrealistically hopeless thoughts.

* Remember that the feeling that nothing can make depression better
is part of the illness of depression. Things are probably not
nearly as hopeless as you think they are.

* If you are on medication:
a. Take the medication as directed. Keep taking it as directed
for as long as directed.
b. Discuss with the doctor ahead of time what happens in case of
unacceptable side-effects.
c. Don't stop taking medication or change dosage without discussing
it with your doctor, unless you discussed it ahead of time.
d. Remember to check about mixing other things with medication. Ask
the prescribing doctor, and/or the pharmacist and/or look it up
in the Physician's Desk Reference. Redundancy is good.
e. Except in emergencies, it is a good idea to check what your
insurance covers before receiving treatment.

* Do not rely on your doctor or therapist to know everything. Do some
reading yourself. Some of what is available to read yourself may be
wrong, but much of it will shed light on your disorder.

* Talk to your doctor if you think your medication is giving
undesirable side-effects.

* Do ask them if you think an alternative treatment might be more
appropriate for you.

* Do tell them anything you think it is important to know.

* Do feel free to seek out a second opinion from a different
qualified medical professional if you feel that you cannot get what you
need from the one you have.

* Skipping appointments, because you are "too sick to go to the
doctor" is generally a bad idea..

* If you procrastinate, don't try to get everything done. Start by
getting one thing done. Then get the next thing done. Handle one
crisis at a time.

* If you are trying to remember too many things to do, it is okay to
write them down. If you make lists of tasks, work on only one task
at a time. Trying to do too many things can be too much. It can be
helpful to have a short list of things to do "now" and a longer
list of things you have decided not to worry about just yet. When you
finish writing the long list, try to forget about it for a while.

* If you have a list of things to do, also keep a list of what you
have accomplished too, and congratulate yourself each time you get
something done. Don't take completed tasks off your to-do list. If
you do, you will only have a list of uncompleted tasks. It's useful
to have the crossed-off items visible so you can see what you have
accomplished

* In general, drinking alcohol makes depression worse. Many cold
remedies contain alcohol. Read the label. Being on medication may
change how alcohol affects you.

* Books on the topic of "What to do during Depression": "A Reason to
Live," Melody Beattie, Tyndale House Publishers, Wheaton, IL. 167
pages. This book focuses on reasons to choose life over suicide,
but is still useful even if suicide isn't on your mind. In fact, it
reads a lot like this portion of the FAQ. An excerpt:

* Do two things each day. In times of severe crisis, when you don't
want to do anything, do two things each day. Depending on your physical
and emotional condition, the two things could be taking a shower and
making a phone call, or writing a letter and painting a room.

* Get a cat. Cats are clean and quiet, they are often permitted by
landlords who won't allow dogs, they are warm and furry.

[Juls]

Wow MG,

Thanks for the great post and all the information. I'm going to sticky it for future reference.

Juls

[Lilya]

Magnificent thread, Morning Glory!

Many, many thanks. What a gift! You sure made a difference in my life today.

Kisses,

Use adversity

to the top

[liveweyerd]

Morning Glory,

thank you so very much. Depression is me I realized a couple of months ago that my antidepressants had "worked" because I was functionable again But there is more than being functioning. I had my dosage of Lexapro doubled. A happy decision!! This post has made me think about addressing some things. Particularly the 2 things a day. Mine was 15 and off days it felt like too much so I did zero. My bedroom is so messy I deal with it by closing the door. What if I did 2 things a day?
Bless you, ma'am!!!!