Shane, 31 years old chartered accountant, was referred by his physician to a psychiatrist.
Shane told the psychiatrist that he felt sad and fearful. He said that he had lost his confidence and had negative thoughts about himself and his future. He also reported poor concentration and a marked loss of energy. All these symptoms were much worse in the morning. These difficulties had been going on for 3 months and were gradually worsening. Shane reported that ten years back his sister had suffered severe depression after the delivery of her first child, but had recovered well with treatment and had done well following that.
After evaluation, the Psychiatrist diagnosed Shane as a case of Depression. Antidepressants were started and Shane was also referred to a Clinical Psychologist who started Cognitive Behaviour Therapy (CBT).
On a follow up visit, Shane asked his psychiatrist – Doctor, what can I do from my side to get out and stay out of depression?
The doctor told him that generally there are three sets of factors that need to be considered
General factors – General steps that are relevant for everybody – for example, exercise, regular routine, nutrition, social support, stress management and nurturing one’s hobbies.
Causative factors – These are factors that may have contributed to the onset of the depression. Addressing these factors may be relevant. For example, if marital discord, medical conditions or substance abuse is a relevant causative factor in a specific individual, that needs to be managed.
Perpetuating factors – These are factors are contributing to the persistence of depression. These may be same as the causative factors, but not necessarily so. For example, brooding and spending too much time in bed are common perpetuating factors. These perpetuating factors also need to be identified and managed.
These three factors are different for each case of depression and therefore the treatment effort has to be tailored for each individual. These factors are also in focus during the psychotherapy or CBT sessions.
They then went on to discuss the general factors – things any patient can do to get out of depression.
Exercise – Exercise pushes up endorphins and other reward related ‘feel good’ brain chemicals. Exercise stimulates the growth of new brain cells and connections. There is no need for extreme exercise. Walking for half an hour a day can make a difference.
Regular sleep routine – Sleeping and getting up in time, getting adequate sleep – 7 to 9 hours a day is important. Excessive sleeping or lying down in bed, sleeping at odd hours, keeping late hours can all add to the depressive symptoms. Lying down in bed also increases brooding.
Eating well – A balanced diet is important. Stopping to eat due to a lack of appetite or eating too much to feel good (“comfort eating”) are both common in depression. This can affect one’s physical health – which in turn can worsen depressive symptoms.
Social Support – People with depression frequently isolate themselves. This tends to worsen the depression. People with depression need to be particularly careful to establish, maintain and enhance their social support system.
Healthy ways of managing stress – Firstly, unhealthy ways of managing stress need to be avoided – for example, drinking excessively or acting out. Second healthier mechanisms need to be developed – for example – sports, yoga, meditation or voluntary work.
Nurturing hobbies – Depression usually leads to a loss of hobbies - activities that one did with interest and joy. Hobbies need to be reactivated and nurtured if one has an episode of depression.
Shane then discussed the various factors that were relevant in his own case with the Psychiatrist. He diligently started working on the suggestions given by the doctor. This went a long way in helping him get out of and stay out of Depression.
Please note that the information in this case study should not be considered as medical advice for an individual’s condition. If anyone shows or feel symptoms of a possible medical condition, we strongly encourage you to seek advice from your primary physician or a mental health professional for an evaluation as soon as possible.
The names been changed to protect the privacy of individuals.