Tips for Coping With Depression or Depressive Episodes

Depression and depressive episodes afflict people of all ages and ethnicities. A depressive episode consists of a combination of signs and symptoms of depression lasting for two weeks or longer that negatively affect a person's overall functioning. People with depression experience at least one major depressive episode, and in addition do not have an underlying medical condition such as bipolar disease or hypothyroidism. Common symptoms of a depressive episode are depressed mood, decreased interest in normal activities, either insomnia or hypersomnia, and feelings of worthlessness. These symptoms were clearly evident in an otherwise healthy elderly gentleman patient of mine who complained only of insomnia. Very quickly it became clear the real problem was depression, and insomnia was only a symptom of his depression. Thankfully, the depression was found to be treatable with the nonpharmacologic strategies below, and his insomnia was cured.

When a depressive episode is confirmed, steps must be immediately taken to prevent suicide and if necessary start pharmaceutical therapy. Although most people with a major depressive episode will not commit suicide, some do. Pharmaceutical therapy combined with counseling and emotional support are implemented immediately, and in extreme cases, involuntary commitment to a mental health facility is necessary. I'll never forget the teenager I took care of in the emergency room with a self-inflicted and ultimately fatal gun shot wound to his head. If only we had gotten to him earlier it might have been prevented.

It is important to recognize that depression can be caused by an underlying physical or mental health disease. Some underlying problems that can mimic depression include thyroid disorders, new onset diabetes, dementia, and heart disease. One recent patient of mine had chronic feelings of fatigue, poor mood, and weight gain. A simple blood test identified hypothyroidism, and after treatment, her poor mood resolved, and once again she was her normal happy, energetic self.

For mild to moderate depression, where there is no risk of suicide, nonpharmacologic therapy can be particularly effective. Cognitive therapy has been most studied, and appears to be helpful in both treating depression and preventing recurrences. This is my major method of counseling used when seeing patients in the clinic. For example, one elderly female patient was having family problems, causing a depressive episode. Cognitive therapy involved changing some of her false self-beliefs about personal motivations, resulting in a paradigm shift which ultimately cured her depression.

Self treatment usually is helpful. One effective technique I've personally recommended for years is similar to the one by Drs. Paul Meier and Frank Minirth. This program involves regular meditation, being social with supportive people, and showing gratitude. Actively work to solve any personal problems. Finally, eat a healthy diet, exercise, and get enough sleep. These self-treatments, along with pharmaceutical therapy for more severe cases, often dramatically improves depressive episodes.

Depression usually is mild but can be serious, so suicide prevention is the first step, always. Proper diagnosis and treatment by a health care professional is essential. Make sure the depression is not due to an underlying physical cause or mental health condition. Finally, recognize that self-treatment at home frequently works and almost always helps. Meditation, active problem solving, giving gratitude, and a healthy lifestyle will greatly improve most mild to moderate depressive episodes.

REFERENCES

National Institutes of Health. Depression. [accessed 12/12/2012]