By Louise from her own experience with depression
Written for Internet Mental Health
The following are gentle suggestions for psychiatrists who may be treating
the severely depressed. These arise from my own experience with depression.
The suggestions are given in order to make the time of treatment and recovery
as painless as possible for the depressed individual.
- First encounter. Treat the patient with the utmost
dignity and respect. The depressed person may be exceedingly despondent
or agitated. The person may be fearful and panic-stricken. The patient
may find eye contact difficult. But what the person is in this depressed
state is not what the recovered person will be. People sometimes assume
a luxury with the sick. In a way they imagine that they can treat the
sick person any way they please. This does great harm, preventing in some
degree the patient's ability to assume once again a position of respect.
The depressed person inwardly cries out: “I am not what you see.” Friends
may have come to avoid the depressed individual. Some people may have
been positively insulting. If psychiatrists treat the depressed as they
would an ill member of their own family, they may have started their recovery.
The psychiatrist should assume that the depressed person needs to have
the nature of depression fully explained. The patient needs to hear that
depression is a chemical imbalance in the brain. It is a disease that
simply happens to someone. The length of a depression may last months
or years, if it is a severe episode. Depression is a major cause of suicide.
The psychiatrist should then suggest that the best form of treatment for
depression is the use of antidepressants.
The psychiatrist next should counter a whole range of misapprehensions
that the depressed person may have. It is highly likely that this person
has shared his or her condition with others and has received much advice.
This person may also have read a large number of books dealing with depression.
The following aspects should be described.
- Right-thinking or visualization cannot heal a
depression. The depressed person may hope that this is possible but the
physical nature of the disease should be emphasized.
- Will-power cannot remove depression. People may
have made the depressed person feel totally inadequate by suggesting that
only strength of will is needed.
- Diet has little or nothing to do with depression.
- Faith may help someone through depression and
provide an important anchor during the suffering of this disease. But
it cannot right the balance in the brain.
- Exercise helps with general health but cannot
- Meditation and relaxation techniques help bring
calm but cannot heal depression.
- The psychiatrist should then describe in detail the
side-effects of the antidepressants. The depressed person needs to know
that these side-effects can be rather upsetting. The drugs do not act
quickly. The depression itself continues and may even worsen in this first
stage of treatment. The patient must receive much encouragement to stay
on the medication.
- The depressed person should be allowed to come at
least weekly during the early stages of treatment. Much gentleness and
patience are needed. The patient may rebel at the side-effects that are
being experienced. Suicidal tendencies may become stronger. The depressed
person needs much affirmation of worth. Hope of recovery should be emphasized.
If the depressed person has a supportive friend, it may prove very helpful
for this individual to share the appointment time. This friend can then
be aware of the nature of the course of the disease and offer support
based on accurate information.
- The psychiatrist should be willing to listen to the
description of side-effects. Even though these will gradually lessen,
they are very real to the depressed person. Smiling encouragement about
what the future will bring may be in sharp contrast to what the depressed
person is feeling.
- The psychiatrist should monitor the symptoms of depression
at each meeting. If these symptoms are becoming less, the patient should
be told and given encouragement.
- Depressed persons frequently go off the antidepressants
after three or four weeks. By patient and relentless effort, the psychiatrist
should get the patient to resume medication.
- If the patient goes off the medication and if the
depression is worsening (especially with regard to suicidal thoughts),
the psychiatrist should make hospitalization a necessity. The mere mention
of this may suffice to encourage the depressed person to resume medication
and have the freedom of being treated as an outpatient.
- As the antidepressants begin to take effect after
three or four weeks, the psychiatrist should be encouraging and hopeful.
Since the depressed person heals very slowly and there are many ups and
downs, the psychiatrist should also ask the patient about the bad times.
These remain very real and should not be overlooked. The friends of the
depressed person are impatient and expect a full and hasty recovery. The
depressed person needs someone to listen about the bad times.
- Once the medication is taking effect, the psychiatrist
can move into psychotherapy. The depressed person may still be very fearful,
panic stricken, or anxious. Help with this behavior can now be given.
The depressed person knows how irrational these feelings are and may be
embarrassed to speak of them. Again these symptoms should be seen as part
of the disease and hope for recovery given.
- The psychiatrist should be available until the depressed
person seems fully recovered and then available with more widely spaced
visits. Always the patient should be made aware that depression can be
healed. Depressed persons need to learn that they can recover a sense
of dignity and worth. Most importantly, they must come to believe that
they will be able to cope with life and be creative once again.
Internet Mental Health (www.mentalhealth.com)
copyright © 1995-2011 by Phillip W. Long, M.D.