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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Depression often gets worse if you are not treated. Depression can make it hard to work or to get along with others. It may also affect the way you eat and sleep, which may lead to illness. You may hurt yourself or others if you are not treated. Antidepressant medicine may increase thoughts of hurting or killing yourself after you begin using it. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Care settings:

• Inpatient Unit: This is the place where you will stay while in the hospital. It has bedrooms and a living area. Sometimes the doors of this unit are locked.
  
  
• Partial Care Program: This is when you come to the unit every day during the day or evening. After you are treated each day, you then go home. You may need a partial care program just after you've been treated in the hospital. This program may also keep you from needing to go into the hospital.
  
  
• Intensive Outpatient Program: This is when you come to the hospital or clinic for one to three hours of treatment. This program is usually two to five times a week for a short period of time.
  
  
• Outpatient Program: This is when you meet with your therapist once a week or less. Appointments are one hour long or shorter. You could meet one-to-one with your therapist, you might meet with your therapist in a group. You may have few or many scheduled appointments over time.

Caregivers:

• Psychiatrist: This is a medical doctor who works in the area of mental health. The psychiatrist is in charge of ordering your medicine. You may work closely with this doctor and another caregiver.
  
  
• Therapist: This is a caregiver that works closely with you while you are being treated. This person may be a doctor, psychologist, nurse, mental health counselor, or social worker.
  
  
• Psychiatric assessment: Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. How you answer these questions can help caregivers decide on treatment. To help during treatment, caregivers will ask you about such things as how you feel about it and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.

Medicines:

You may have one or more of the following medicines during your stay. Caregivers may decide to also give you other medicines.

• Antidepressants: This medicine is given to decrease or stop the symptoms of depression. Sometimes this medicine may take awhile to 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.
  
  
• Anti-Anxiety Medicine: This medicine may be given if your depression makes you feel nervous. It may make you feel drowsy.
  
  
• Mood Stabilizer: This medicine is given to control mood changes. It may also help your antidepressant work better.
  
  
• Sedative-hypnotics: This medicine may be given if you are having trouble sleeping. It may make you feel drowsy.
  
  
• Neuroleptic: If you have very bad agitation (restlessness) this medicine may be used.
  
  
• Psychostimulant: This medicine may be given if your depression makes you feel tired all the time.

Patient rights:

• Release of Information Form: This is a legal paper that lets caregivers share information with those listed on this form. You will need to sign this form before any information will be released to persons outside the hospital.
  
  
• Right to Privacy: Information that you share with your caregivers will be kept private among hospital caregivers. They will not share information with others without your permission.

Personal:

• Clothes: You may wear your own clothes while you are in the hospital.
  
  
• Meals: You will eat your meals on the unit or in the cafeteria with other patients.
  
  
• Personal Belongings: When you are admitted to the unit, caregivers will search your belongings. Any belongings brought to you during your stay will also be searched. This search is done to keep you and the staff safe.

Safety:

• 72-Hour Hold: This is when you are put in the hospital for 72 hours without your permission. The police or a caregiver may decide to put you in the hospital. This may only be done if others are concerned that you may hurt yourself or someone else. It may also be done if caregivers or police do not think you can safely care for yourself.
  
  
• Quiet Room: This is an empty room used for patients who need to have time out in a safe place. You may be put here if caregivers are concerned you may hurt yourself or others.
  
  
• Restraints: There are two types of restraints that may be used while you are in the hospital. They will only be used if caregivers feel you are in danger of hurting yourself or others. Physical restraints may be put on your wrists or ankles and tied to something else. These are usually cloth or leather bands. Other things will always be tried before using physical restraints, such as going into a quiet room or seclusion. Caregivers may use "chemical" restraints which is medicine used to help you calm down and relax. Restraints should never be used to punish you.
  
  
• Seclusion: This is when you need to be locked in a safe room because you are out of control. The door is locked because you might want to leave the room. Caregivers will closely watch you while you are in seclusion. You may come out of seclusion when caregivers feel you will not hurt yourself or others.
  
  
• Sharps: You will not be allowed to keep any sharp items with you. Sharp items may include scissors, nail files, razors, or glass. Ask a caregiver if you need to use one of these items.
  
  
• Time Out: This is time spent away from other people. This is usually needed when you are not able to control your behavior. You may be put in time out if your behavior is affecting others. Time out may be in your room or another room.

Types of therapeutic sessions:

Your caregiver may suggest several different types of talk therapy, in addition to medicine. Your caregiver will decide how best to treat your major depression. You may have one or more of the following therapies and treatments for major depression:

• 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.
  
  
• 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.
  
  
• 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.
  
  
• Hypnosis teaches you to change your level of awareness. This means that caregivers teach you to focus your attention so you can move away from upsetting feelings. You make yourself open to suggestions, like feeling happy and having more energy. Hypnosis can give long-lasting relief from depression without changing your normal activities. After practice, you can learn to do hypnosis when you are by yourself. You may feel better because you are actively doing something to get better.
  
  
• Biofeedback teaches your body to respond in a different way to stress. Teaching your body to relax can help you feel more in control. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. You can learn to do this without a machine.
  
  
• Relaxation is a way to focus your attention on something other than your feelings. For instance, good smells may change your mood and help you relax. For example, taking a bath with special oils. Candles, massage oils, and scented bubble baths are ways that smells can be used.
  
  
• Light Therapy may be used if your depression gets worse during certain seasons (fall or winter). It also may be used if you live in a place that gets little sunshine. You will sit in front of a box that gives off a safe light. You may need to do this daily for several months.
  
  
• Electroconvulsive Therapy is also called "ECT". It may be used for patients with life threatening depression who have not been helped with medicine or therapy. Before having an ECT treatment, you may get medicine to help you relax. During the treatment, a small amount of electric shock is sent through the brain. After ECT, you may have trouble remembering things for a short time.

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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 (Inpatient Care)