Written for Internet Mental Health
- 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.
- 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 cure depression.
- 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.