Featured Painting Title: Blue Woman
By Alexis Apfelbaum
"Experienced depression while living in the Blue Mountains, SW. Blue Woman shows the outside appearance of beauty and serenity while inside is the unseen pain of depression. She is floating and not whole; unable to connect with others or the world. Yet in her hand is a tool of release through the act of art and expression."
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Interventions for depressive disorders
Professionals who can help
A variety of health professionals can provide help to a person with depression. They are:
• GPs
• Psychologists
• Counsellors
• Psychiatrists
• Allied health professionals such as occupational therapists, social workers and mental health nurses.
Only in the most severe cases of depression, or where there is a danger a person might harm themselves, is a depressed person admitted to a hospital. Most people with depression can be effectively treated in the community.
Treatments available for depressive disorders
Most people recover from depression and lead satisfying and productive lives. The following treatments are available for depression.
Psychological therapies
There is good evidence for the following psychological therapies in the treatment of depression:
• Cognitive behaviour therapy is based on the idea that how we think affects the way we feel. When people get depressed they think negatively about most ago. There may be thoughts about how hopeless the person's situation is and how helpless the person feels, with a negative view of themselves, the world and the future. Cognitive behaviour therapy helps the person recognise such unhelpful thoughts and change them to more realistic ones. It also helps people to change depressive behaviours by scheduling regular activities and engaging in pleasurable activities. It can include components such as stress management, relaxation techniques and sleep management.
• Interpersonal psychotherapy helps people to resolve conflict with other people, deal with grief or changes in their relationships, and develop better relationships.
• Behaviour therapy (also called behavioural activation) is often part of cognitive behaviour therapy. It focuses on increasing a person's level of activity and pleasure in their life.
• Marital therapy can help where there are relationship problems along with depression. It focuses on helping a person who is depressed by improving their relationship with their partner.
• Problem solving therapy involves meeting with a therapist to clearly identify problems, think of different solutions for each problem, choose the best solution, develop and carry out a plan, and then see if this solves the problem.
Research shows that there is an even better outcome when psychological therapy is given in combination with antidepressant medication.
Medical treatment
The following medical treatments are known d be effective:
• Antidepressant medications have been found effective with adults who have moderate to severe depression.
• Electroconvulsive therapy can be effective for people with severe depression that has not responded to other treatment. However, it has also been known to cause some negative side effects, such as memory loss.
• Antipsychotic medications are used to treat people with bipolar disorder. They are also sometimes used to treat people with major depression, in combination with antidepressants, where other treatments have not worked.
Lifestyle and complementary therapies
The following have some scientific evidence for effectiveness in helping with depression:
• Exercise including both aerobic (eg jogging, brisk walking) and anaerobic (eg weight training).
• SAMe (S-Adenosy|methionine) which is a compound made in the body and available as a supplement in health food stores.
• Self-help books which are based on cognitive behaviour therapy. These are most useful when used under the guidance of a health professional.
• Computerised therapy which is self-help treatment delivered over the internet or on a computer. These are most useful when used under the guidance of a health professional.
• Light therapy which involves bright light exposure to the eyes, often in the morning. This is most useful for seasonal affective disorder, when used under the guidance of a health professional.
• Increasing pleasant activities because depressed people engage in pleasant activities less often than other people. They also find fewer activities pleasant. Depressed people can increase the frequency of pleasant activities as a form of self-help, but is most useful when done under the guidance of a health professional.
As well as looking at scientific evidence of what treatments and supports work for depression, it is also important to look at what people who have experienced depression find to be helpful. A large internet survey of people who had received treatment for a depressive disorder asked them to rate the effectiveness of any treatment they had had. The treatments they rated as most effective were: some antidepressant medications, cognitive behaviour therapy, interpersonal psychotherapy, other types of psychotherapy and exercise.
Importance of early intervention for depression
Early intervention is very important. People who wait a long time before getting treatment for depression tend to have a worse outcome. Once a person has had an episode of depression they become more prone to subsequent episodes. They fall into depression more easily with each subsequent episode. For this reason, some people go on to have repeated episodes throughout their life. To prevent this pattern occurring, it is important to intervene early with a first episode of depression to make sure it is treated quickly and effectively.
Crises associated with depression
Two main crises that may be associated with depression are:
• The person has suicidal thoughts and behaviours
• The person is engaging in non-suicidal self-injury
Suicidal thoughts and behaviours
Suicide is a significant risk for people with depression. Of Australians aged 16-85 who have had a depressive disorder in the past 12 months, approximately 4% attempt suicide.
A person may feel so overwhelmed and helpless that the future appears hopeless. The person may think suicide is the only way out. Sometimes a person becomes suicidal very quickly, perhaps in response to a trigger (such as a relationship breakup or arrest), and act on their thoughts quickly and impulsively. The risk is increased if they have also been using alcohol or other drugs.
However, not every person who is depressed is at risk for suicide and nor is everyone who is at risk of suicide necessarily depressed.
Non-suicidal self-injury
Non-suicidal self-injury is also a significant risk for people with depression. People who engage in self-injury report more intense experience of emotional distress. They may also struggle to express these emotions. For these people, self-injury may alleviate their distress temporarily.
Adults who engage in self-injury typically started doing so during adolescence, and it may have become a very difficult habit to break.