Major Depression

WHAT YOU SHOULD KNOW:

Major depression is a type of mood disorder that makes you feel uncontrollably sad. You may be depressed if you feel sad for at least two weeks. Depression is a mood (an emotion or a feeling) that affects your behavior (how you act). Your moods also affect how you feel about yourself and life in general. Major depression is a true medical condition, just like diabetes and high blood pressure. Caregivers will talk with you about the many ways to treat depression. Medicine is often used to treat depression along with other therapies. Caregivers will teach you how to manage your depression. Caregivers can teach you how to handle problems better, and how to cope with stress.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of what medicines you take and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicines. Talk with your caregiver before taking any other medicines.
  
  
• If you are taking medicine that makes you drowsy, do not drive or use heavy equipment. Talk with your caregiver before drinking liquids that contain alcohol.
  
  
• Taking vitamins is very important because many people do not eat a healthy diet. Check with your caregiver before you start taking vitamins to make sure they are the best ones for you. Always tell your caregivers if you are taking any herbs, such as St John's Wort or other food supplements.

Caregivers may first treat you with the following medicines:

• Antidepressants: This medicine is given to decrease or stop the symptoms of depression. Sometimes it may take awhile to work. Do not stop taking this medicine unless your caregiver tells you to. Caregivers may try a different antidepressant if one type does not work. You may need to take antidepressants for up to 1 year. If you have had more than two past episodes of major depression, you may need to use antidepressants longer. Antidepressant medicine may increase thoughts of hurting or killing yourself after you begin using it.
  
  
• Sedative-hypnotics: This medicine may be given to help you sleep better at night. It is usually given for a short time. Sometimes this medicine may make you feel drowsy the next day.
  
  
• Anti-Anxiety Medicine: This medicine may be given if your depression makes you feel nervous. It may make you feel drowsy.

Later, your caregiver may treat you with the following medicines:

• Mood Stabilizer: This medicine is given to control mood changes. It may also make your antidepressant work better. Sometimes you may have to get blood tests while taking this medicine.
  
  
• Neuroleptic: This medicine is usually given to decrease the symptoms of psychosis (seeing, hearing, or having thoughts of things that are not real). It also decreases very bad agitation (restlessness). Sometimes it may be given to help antidepressants work better.
  
  
• Psychostimulant: This medicine may be given if your depression makes you feel tired all the time.
  
  
• Thyroid Medicine: This medicine may be added to your antidepressant to help it work better.

Medicine monitoring:

Each time you meet with your caregivers, they will ask you about how you are feeling. Caregivers will watch how you respond to your medicines. Tell caregivers about side effects or problems you may be having with your medicine. Sometimes the kind and amount of medicine may have to be changed. The goal is for you to feel better with the least amount of side effects. Sometimes your medicine may take awhile to work. You and your caregiver will talk about how long you need the medicine. Once you are taking medicine for depression, you may need to give a blood sample. This sample is used to check how much medicine is in your blood. Caregivers use the results of this test to decide how much medicine is right for you.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Where can I go for support?

Accepting that you have depression is hard. People who know you may feel angry, sad, or frightened. These feelings are normal. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to live with a person who has depression. You may also want to join a support group. This is a group of people who also have depression. Ask your caregiver for the names and numbers of support groups in your town. Ask your health care provider if they know about books that you can read. Reading about your illness might help you better understand it. Contact the following for more information:

• National Alliance for Research on Schizophrenia and Depression
  60 Cutter Mill Road, Suite 404
  Great Neck , NY 11021
  Phone: 1- 800 - 829-8289
  Web Address: www.narsad.org
  

• National Alliance for the Mentally Ill
  Colonial Place Three, 2107 Wilson Blvd, Suite 300
  Arlington , VA 22201
  Phone: 1- 703 - 524-7600
  Phone: 1- 800 - 950-6264
  Web Address: http://www.nami.org
  

• Depression and Bipolar Support Alliance (DBSA)
  730 N. Franklin Street, Suite 501
  Chicago , IL 60610-7224
  Phone: 1- 800 - 826-3632
  Web Address: http://www.dbsalliance.org
  

• National Institute of Mental Health (NIMH), Public Information & Communication Branch
  6001 Executive Boulevard, Room 8184, MSC 9663
  Bethesda , MD 20892-9663
  Phone: 1- 301 - 443-4513
  Phone: 1- 866 - 615-6464
  Web Address: http://www.nimh.nih.gov/
  

Types of therapeutic sessions:

Caregivers may give you therapy to help treat your depression. This can be done alone, or in a group with other patients. It may also be done with members of your family or your significant other. Your significant other may be your spouse (husband or wife) or a boyfriend or girlfriend. During this time, you will talk about how to cope with your illness.

Your therapy may include some of the following approaches:

• Assertiveness Training teaches you to stand up for yourself. It also teaches you how to ask for what you need, how to set limits, and how to say no.
  
  
• Behavioral Modification teaches you how to change your behavior (actions). You will look at the reasons for your behavior and the results of your actions. With behavior "mod" therapy, you learn that certain behaviors have good or bad results. These results may make you feel either good or bad about yourself. Good behavior makes most people feel good about themselves. Good behaviors are often rewarded.
  
  
• Cognitive Therapy helps to make you aware of how you see things. You may have trouble seeing the good in things around you. Then you are more likely to feel depressed, sad or angry. Cognitive therapy teaches you to recognize how you see things and helps you to see them in a more positive way.
  
  
• Exposure/Desensitization Therapy helps you to face your fears in a safe setting with caregivers there to support and help you. After you have practiced ways to decrease your fear and anxiety you are better able to handle your fears when alone. Desensitization is when caregivers help you practice facing a fear a little at a time. This is taught in a supportive and safe setting.
  
  
• Insight Oriented Therapy makes you think about things that have happened in the past. It helps you to understand your feelings and behavior now as it relates to past events.

Wellness hints:

• Eat a variety of foods including fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. Ask your caregiver if you need to be on a special diet.
  
  
• Drink six to eight (8-ounce) cups of healthy liquid each day. Follow your caregiver's advice if you must limit the amount of liquid you drink. Good liquids for most people to drink are water, juices, and milk. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda, and sports drinks and foods.
  
  
• Do not drink liquids that contain alcohol while taking medicine for depression. Alcohol can make you feel depressed or anxious (worried and upset). It can also upset your sleep cycle so you feel more tired. You should also not take any street or illegal drugs. Both alcohol and illegal drugs can affect the way your medicine works and can make depression worse.
  
  
• Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. Exercise can also makes you feel better and happier.
  
  
• It is never too late to quit smoking if you smoke. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
  
  
• Stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to control it. Learn new ways to relax (deep breathing, relaxing muscles, meditation, or biofeedback). Talk to your caregiver about things that upset you.
  
  
• Regular sleep is very important. Most people need six to eight hours of sleep each night. Tell your caregiver if you are not able to sleep, or if you are sleeping too much.

CONTACT A CAREGIVER IF:

• After starting antidepressant medicine, you feel anxious, restless, angry, or you have a panic attack.
  
  
• You have questions or concerns about your illness or medicine.
  
  
• You feel that you are becoming depressed again. The sooner you see your caregiver, the easier it is to control depression.
  
  
• You are not able to sleep well, or are sleeping more than usual.
  
  
• You cannot eat, or are eating more than usual.
  
  
• You cannot make it to your next meeting with your caregiver.

SEEK CARE IMMEDIATELY IF:

• After starting antidepressant medicine, you or a family member or friend notice sudden changes in your moods, actions, or thoughts.
  
  
• You think about killing yourself (suicide) or killing someone else (homicide).
  
  
• You have a rash, swelling or trouble breathing after taking medicine.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Major Depression (Discharge Care)