While the recidivism rate for major depression is uncomfortably high (50 percent according to recent estimates), this does not mean that someone who has already experienced depression is doomed to relapse at some point. Some people may just be especially vulnerable to depression (due to genetics, other mental health problems, or an abusive relationship, etc.), but they can still learn to move on with their lives without experiencing new episodes.
Even though the risk of relapse will never completely go away, anyone worrying about slipping back into their old self-destructive patterns of thinking and behaving should consider the following:
First of all, the very act of surviving depression the first time around often means being much stronger as a result. In writing about his own battle with depression, author William Styron described it as being “mysterious in its coming, mysterious in its going, the affliction runs its course, and one finds peace.” Resilience, which is usually defined as the ability to recover quickly from adversity, is a quality that is often found in trauma survivors. But it can also be seen in people who have faced depression and bounced back from it. Knowing that depression can be overcome is an essential part of surviving when the dark times return.
Treatment programs such as CBT and IPT involve the teaching of basic coping skills that can be used to deal with new depressive episodes as they arise. This includes learning to control negative ruminations, maintaining a positive mind-set, and resolving interpersonal problems before they become toxic. Continue practicing these skills even after the treatment ends so that they can be used whenever the need arises.
But these skills aren’t simply for dealing with depression. We all encounter major life problems that can seem hopeless at times. Skills such as muscle relaxation, stress management, and cognitive restructuring can boost our general ability to cope with these new crises as they occur.
People who have successfully completed treatment for depression already have a support network in place that they can use if they find themselves relapsing. This can include mental health professionals, family physician, local support groups, and family members who have been supportive in the past. Don’t be afraid to use these resources as needed.
Perhaps most importantly of all, do your best to maintain a hopeful outlook. That may seem impossible at times, especially if you’re dealing with a traumatic loss or facing a life crisis, but always remember that “this too shall pass.”
While the risk of further depression will never go away completely, it is still possible to deal with it as it comes and enjoy life to the fullest. We will explore this a little further in Question 50.
49. How effective are awareness campaigns in helping people who are depressed?
Perhaps more than ever before, we are seeing numerous awareness campaigns aimed at educating people about depression and suicide. For example, the National Alliance on Mental Illness (NAMI) sponsors the National Anxiety and Depression Week as part of Mental Health Month each May as well as Suicide Prevention Awareness Month each September. Along with hosting awareness events nationwide to help combat the stigma surrounding depression and suicide, NAMI and participating groups also provide online resources allowing vulnerable people to learn more about treatment options and to contact therapists in their area. Among the different awareness events organized by NAMI are the annual 5K NAMIWalks held each May for fundraising and to promote public participation as well as the CureStigma campaign held at different times of the year.
Similar awareness campaigns occur each year in numerous other countries as well. In the United Kingdom, for example, there have been popular programs such as You in Mind, the Defeat Depression, and Changing Minds campaigns to help fight depression, suicide, and mental illness. In Australia and New Zealand, there have been campaigns such as beyondblue; Like Minds, Like Mine; and the Community Awareness Program over the past few decades. Along with these national campaigns, there have also been international ones sponsored by the World Health Organization (WHO) as part of World Health Day. Under the WHO, new awareness campaigns have been held in many developing nations to help combat the terrible stigma surrounding depression and to encourage better mental health care.
But how effective are awareness campaigns in changing attitudes about depression and mental illness and in reducing suicide rates? While numerous research studies looking at national programs such as NAMI’s mental health campaigns suggest that they can be effective, comparing different programs is often difficult. A 2009 study examining fifteen programs in eight different countries over a twenty-year period (1987–2007) suggests that the benefits of these programs often depends on how long the programs run and what the programs are intended to accomplish.
For example, many of these programs were extremely short term (often involving only a single television program) with very little follow-up to see if they actually changed attitudes. The most effective programs tended to be much more comprehensive with nationwide coverage and an extensive media campaign that could be repeated on a yearly basis. This ensures that the message these campaigns are intended to deliver reach as many people as possible.
In general, public awareness and information programs about suicide or depression do appear to improve knowledge and awareness of mental illness in the population, at least in the short term. Campaigns can also be effective in teaching “gatekeepers” such as doctors and nurses about depression and suicide and make them better able to inform patients about treatment resources and identify people who might be at risk.
As for whether these awareness campaigns actually reduce suicide rates or encourage more people to seek treatment, the results tend to be mixed. While some programs do appear to make people in need more likely to reach out for help, it’s often difficult to tell whether they actually discourage people from attempting suicide. While some research studies show an increase in calls to suicide hotlines following media campaigns, this effect is usually temporary. As a result, public exposure campaigns seem to work best when there is repeated exposure (such as with annual campaigns) since this helps reinforce the message they are trying to get across.
While public awareness campaigns aren’t going to eliminate depression and reduce suicide on their own, they can help people overcome many of the misconceptions that can interfere with them getting help. They can also make the general public more aware of how to identify friends and family members who might be at risk and help them get treatment before it’s too late.
50. Can people who have been depressed learn to move on with their lives?
While treatment and support from health care professionals, family, and friends can play a key role in helping people with depression get better, it’s ultimately up to them to take charge of their emotional well-being and learn to move on; that means developing the kind of healthy habits that can boost resilience and coping with mood changes as they occur.
And they will occur again at some point or other. We all have “dark days” due to setbacks or disappointments that can bring back the symptoms of depression, if only temporarily. For those who have already experienced depression and who are feeling as if their symptoms are returning, here are some commonsense things you can do to help yourself as you seek treatment:
Don’t neglect your physical health. Though people who are feeling despondent often feel apathetic as well, it is essential that they take care of their physical needs as well. This means trying to get a good night’s sleep (even if you find yourself resisting this); practice good sleep hygiene. It’s also important to exercise regularly and stay as active as possible.
Make sure you eat regularly even if you lose your appetite. Take a multivitamin tablet each day to avoid nutritional problems. If you find yourself losing weight too rapidly, see your doctor immediately.
Follow all recommended treatment. If you are on medication, keep taking it as prescribed. Discontinuing medication abruptly can be extremely dangerous, even if you feel it isn’t working. Also, if you have gone through psychotherapy,
use the techniques you have learned to help get your mood under control. See your doctor if your current treatment isn’t working.
Join a support group. If you have already been in treatment, you likely already know where to go to find individual or group counseling in your community. You can also try online resources, including chat rooms or online group support such as the ones listed in the appendix.
Rely on your family and friends for help. Many depressed people who experience a relapse may be reluctant to tell family or friends what is happening because they don’t want to be a burden or they are afraid of being rejected. More likely than not, the people in your life will already be aware that something is wrong and want to help.
Keep a journal. Many people dealing with depression find that writing down what they are thinking on a daily basis can help them keep a clear head.
Be careful with your computer. Not only can regular use of social media sites such as Facebook add to your depression, but many depressed people are especially vulnerable to using online sites as a way of shutting out the real world.
Avoid making life-altering decisions. Depression has a way of distorting judgment, and more often than not, you are going to end up regretting making hasty decisions that will likely haunt you later on.
Don’t blame yourself for feeling depressed. Not only are depressed people plagued with self-doubts but their self-esteem plummets as well. Hold onto hope and accept that what you’re going through will pass eventually.
And finally, and most importantly, seek help immediately if you are feeling suicidal or have difficulty controlling thoughts of self-harm.
Continue taking care of yourself and recognize that your depression can be controlled. Even if you dread the thought of going through the whole treatment process again, the knowledge that depressive episodes pass with time can make the future seem a little brighter.
Case Studies
Case 1: David
When David’s older brother, Gary, died in a car accident, it seemed as if the world had come to an end. All his life, David had looked up to Gary and counted on him for help whenever he needed it. When he turned nineteen, David was even planning to go to the same college that Gary was attending just to have a chance to see his brother on campus from time to time.
When his parents told him the news about Gary’s death, David had refused to believe it at first. He even insisted that he could feel Gary’s presence in his room and could hear his voice at times, something that seemed to pass quickly enough though the emotional numbness he began showing made his parents worry even more about his mental state.
Though David’s parents were dealing with their own emotions following Gary’s death, they saw that David was taking it especially hard. They even offered to arrange grief counseling that the entire family could attend. Increasingly moody since Gary’s death, David snapped that he didn’t need counseling though his parents could see that he was going into a decline.
Not only was he cutting class more frequently, but he was often up at night, and his parents could hear him wandering through the house early in the morning. Whenever they tried to talk to him about this, however, he would just lash out at them. According to his friends, David was much more aggressive at school and was on the verge of being suspended if his behavior failed to improve.
David’s parents became even more alarmed when his mother discovered that he had begun cutting himself though he had been careful not to require a visit to the hospital (so far). He also began sneaking alcohol from the liquor cabinet that his parents kept for visitors, and his mother became alarmed by the empty bottles in David’s room. When they confronted him about his drinking, he just lashed out at them over invading his privacy.
Finally, following an incident at school where he punched a fellow student, David was suspended, and his parents decided to take matters into their own hands. After consulting with a counselor recommended by their family doctor, they arranged for him to start attending a grief support group being held at a local community center. While David refused at first, his parents ordered him to attend as a condition of continuing to live under their roof. Though they were unhappy to have to get tough with their son, they knew how much he needed to talk to someone about what he was going through.
Before the group began, however, David received a phone call from Laura, one of the groups’ facilitators, who helped explain what the group was all about and what would be expected of him. The group was aimed at young people who were the same age as David, all of whom were dealing with grief and loss. While David had been afraid that he would be expected to “spill his guts” to total strangers, Laura made it clear to him that he wouldn’t be made to do anything that made him uncomfortable and that it was perfectly fine just to sit and listen for a while. Based on what Laura told him, David decided to give the group a try.
Though David was reluctant to speak at first, he became more comfortable after hearing each group member share his or her story, Since all of them had dealt with a similar loss, David decided to open up about losing his brother. Over the next few weeks, he began to form a bond with the other group members since he felt they knew what he was feeling. He also admitted to feeling alienated from his parents and his friends who kept saying the wrong thing or otherwise making it clear that they didn’t really understand what he was going through.
Just as importantly, David was able to provide support for other group members and show them that they were not alone. This helped him recognize that grief was a perfectly normal reaction to sudden loss and provided him with practical tips on how to handle the changes resulting from Gary’s death as well as learn how to move on with his own life.
While he still misses his brother and likely always will, David has managed to pull back from his depression and is managing his school and home life a little better. He continues to attend the group and has even helped facilitate a few meetings. So far, so good.
Analysis
Though dealing with the loss of a parent, sibling, or close friend is something that many young people will experience at some point, this kind of bereavement can also make them much more susceptible to depression. Since not all young people are going to react to grief in quite the same way, it’s hard to anticipate how this kind of loss will affect them. While denial, anger, sadness, guilt, and anxiety are all perfectly normal reactions to grief, young people may try to keep these feeling to themselves. There are still signs that parents and teachers can watch for in children and adolescents dealing with loss, however. They include: irritability, social withdrawal, poor performance in school, sleep and appetite problems, aggressiveness, and a tendency toward emotional outbursts. There may also be guilt feelings if they feel responsible for the death by somehow having failed to stop it from happening. They may also feel anxious about the possibility of someone else in their life dying as well. Though not every community will have a group program for young people dealing with grief and loss, peer counseling still can be a valuable resource. By learning how to mourn effectively as well as learning how to cope with feelings of depression stemming from grief, young people can move on with their lives as well as become more resilient with time.
Case 2: Alexa
Fifteen-year-old Alexa has been arguing more frequently with her mother over the past nine months. Alexa had always been a moody child (especially following her parents’ divorce) though never to the point of needing counseling. But her mother has become more worried about the changes she is seeing in her daughter and the growing changes in her mood. On one occasion, the argument became so severe that Alexa left the house and stayed away for twelve hours. When her mother asked where she had been, Alexa flatly refused to say. Along with her anger issues, Alexa also seems to have a problem with her self-image and insists that she is unattractive no matter what she wears. Not only is her negative mood affecting her relationship with her mother but she has also alienated the few friends she once had, and her teachers are reporting problems in school,
including cutting classes and failing to hand in assignments. When her mother tried to get Alexa to attend counseling with her, she stated that everything was hopeless and nothing would ever get better in the future.
Alexa’s mother became even more alarmed when she realized that her daughter was cutting herself. Though the scars were mostly confined to Alexa’s wrists (which she kept concealed with long-sleeved shirts and sweaters), her mother soon realized that the self-cutting was becoming much more frequent and often deep enough to require a trip to the emergency room for stitches. Realizing that Alexa was too depressed to ask for help on her own, the mother began attending a support group for parents of children with emotional problems and, while there, began learning of the different programs available in their area that might help her daughter.
Finally, when the self-cutting became more severe, the mother had no choice but to give Alexa an ultimatum: either attend counseling or be sent to an inpatient program due to her suicidal behavior. Though Alexa was furious with her mother who she felt was betraying her, she finally agreed to attend one-to-one counseling at a local clinic. She also agreed to begin taking antidepressant medication (which her mother carefully monitored to ensure that Alexa was actually swallowing the pills).
Treatment was rocky from the start since Alexa had been forced to attend rather than being allowed to choose for herself. Because she was so antagonistic, the counselor made the decision to see her individually rather than put her in the regular group program.
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