Overcoming Depression For Dummies

by Smith, Laura L.

  VNS treatment is currently not available on the NHS and it’s expensive: costs are difficult to establish in the UK, but in the US vagus nerve stimulation costs as much as $25,000. Also, the evidence for its effectiveness is at a very early stage and the treatment is still considered experimental. Only consider this therapy if you’re experiencing seriously treatment-resistant depression.

  Magnetising depression

  Since the close of the 20th century, a body of research has emerged on a new treatment for depression known as transcranial magnetic stimulation (TMS). It involves putting an electrical coil, which produces a strong magnetic field, on the scalp. The magnetic field is aimed, at varying frequencies, at certain areas of the brain. This treatment is showing promise as an alternative to ECT (see the earlier section ‘Electrifying results’) for treating stubborn, treatment-resistant depression.

  TMS has two different approaches: one of which involves inducing a seizure (like ECT), It’s unclear which strategy works best. However, TMS’s real advantage is that it doesn’t seem to cause short- or long-term cognitive impairments. Patients also say they tolerate the procedure quite well.

  However, there isn’t enough evidence currently for recommending TMS as a replacement for ECT. Some research has been promising. For example, in 2007 the Journal of Biological Psychiatry reported a study in which people responded significantly better to TMS than to placebo (see the earlier section ‘The placebo effect’). Some other studies are less positive about TMS results.

  Perhaps in a few years, more data will be available to help your doctor determine whether this may be the best procedure for you. In the meantime, TMS must be considered rather experimental in nature.

  Searching Further

  There is a vast amount of literature on complementary therapies which include treatments for depression. We assure you, no way are you going to want to know everything anyone’s ever written or said about the subject – but here are just a few other intriguing possibilities.

  New complementary treatments, as well as new medication and refinements in psychological therapy techniques, are continually being explored for the treatment of depression. We urge you not to give up hope. We know many people who didn’t show much improvement following a range of medication and therapies, but then eventually discovered the formula that is now working for them.

  Air ionisation

  You can purchase devices that have been designed to increase the negative ion concentration in the air. Manufacturers suggest using these devices for treating SAD (refer to Chapter 2), because negative ions appear to increase serotonin levels (see Chapter 15 for more info about serotonin), which decrease in autumn and winter. And according to two controlled studies, this type of device may actually help ease the symptoms of SAD.

  Much more research is needed about these machines before we can strongly recommend them Up to now, the only type of depression they’ve been tried for is SAD. However, they have shown potential, and they may actually have little or no side effects.

  Massage

  Massage therapy, delivered by a trained therapist, involves the manipulation of the body’s soft tissues. Most people agree that a massage feels good, but can it improve depression? Two controlled studies have actually suggested that repeated massages may help treat depression. However, these studies didn’t assess the long-term outcomes of massage therapy. Again, more research is clearly needed. However, massage probably won’t hurt you, and it may have both short, and even long-term, benefits.

  Relaxation

  Various techniques exist for teaching people how to relax their muscles. We discuss several of these in detail n Overcoming Anxiety For Dummies by Elaine Iljon Foreman, Laura Smith, and Charles Elliott (Wiley).

  Around half a dozen small, controlled studies suggest that relaxation may be effective for treating depression. Once again, more research is called for – studies haven’t yet shown if relaxation training reduces depression in the long run.

  Although relaxation training as a possible treatment for depression has fallen out of fashion, the early results appeared to show some worthwhile benefits. Relaxation has very few negative side effects, and it may indeed help ease depression.

  Part VI

  Life After Depression

  In this part . . .

  Read these chapters only when you’ve largely overcome your depression. While depression frequently recurs, the good news is that you can take action to reduce the chances of that happening. And if depression should return, we give you other ideas on how to overcome it yet again. But good isn’t good enough! We want you to feel better than good. Positive Psychology offers ideas for finding true, authentic happiness. We draw on Positive Psychology for suggestions enabling you to find renewed purpose and meaning in your life.

  Chapter 17

  Reducing the Risk of Relapse

  In This Chapter

  Understanding the nature and risks of relapse

  Protecting yourself against relapse

  Managing relapse

  After successfully getting to grips with your depression, it’s very important to keep up your new found improvement. Most of this book suggests many techniques for helping you conquer your depression and maintaining your wellbeing. However, if after putting in a lot of personal effort your depression still hasn’t improved much, seek professional help. Or, if you’re worried that your improvement is slipping and that you’re in danger of falling into a relapse – keep on reading this chapter.

  Pippa took a new post as headteacher of a secondary school last year. But somehow she just hasn’t felt like her normal self for the past six months. Pippa usually tackles problems head-on, so she makes an appointment with her GP, who prescribes antidepressants (refer to Chapter 15 for information on antidepressant medications). After just six weeks of regularly taking her prescribed medication, Pippa feels back up to scratch. She has no remaining symptoms of depression. Although her doctor recommends continuing the medication for at least a further six months, Pippa chooses to ignore her doctor’s advice and stops. Pippa ‘knows’ that she’s going to be alright; after all, she hasn’t felt this good in years. Besides, she slowly tails off her medication dosage, so that she can avoid the withdrawal effects that her doctor warned her about. Five weeks later, Pippa suffers a relapse and, with her low mood worsened by disappointment, ends up feeling even more depressed than she did before she started on the medication.

  In this chapter, we discuss relapse and depression. Relapse refers to a recurrence of depression that occurs after apparently overcoming and recovering from depression. We explain how relapse occurs, give you advice on reducing the risk of relapse, and ideas for dealing with relapse, if you’re unlucky enough to be experiencing it.

  Facing Up to the Potential of Relapse

  This book talks about the reality of depression. Our approach to cognitive therapy (see Part II) recommends that you use objective, evidence-based thinking rather than delude yourself with simplistic, positive self-affirmations as a cure-all for your depression. We want you to see yourself and the world as they are, not as a fairy tale or fantasy. Denial only makes things worse. Remember the lines from the song ‘Just call me Cleopatra – I’m Queen of De Nile!’

  So when it comes to the treatment of depression, we give you the good news and the bad. The good news is that, with the wide array of both tried and tested and new therapies, and the range of medication currently available, the vast majority of people with depression can be successfully treated. By successful treatment, we mean that many of your depressive symptoms can be reduced and possibly got rid of for at least six months or more. The bad news is that the risk of relapse is distressingly high.

  Fortunately, we have more good news – you can do quite a bit to reduce the risk of relapse, and if you do suffer a relapse, you’ve got a good chance of overcoming your depression once again.

  Reaching your verdict: Relapse versus low mood

  In Chapter 3, we explain that recove
ring from depression isn’t usually a smooth process, it’s uneven, having many ups and downs. In fact, not one of us has worked with anyone who’s never experienced a setback. Everyone has a low mood, or a lousy day from time to time. So how can you tell if what you’re experiencing really is a relapse?

  When you’re experiencing a full-blown relapse, you have clear signs of one of the types of depression we discuss in detail in Chapter 2, seemingly coming from nowhere after a period of six or more depression-free months. Your symptoms may be mild, and not meet the criteria we described in Chapter 2. If so, then see this as an early warning sign – something to be taken seriously, but not an actual relapse. The suggestions we offer in the ‘Creating a Prevention Plan’ section, later in this chapter, can be helpful in dealing with these early warning signs. If you are actually experiencing a relapse, read the later ‘Reining in Relapse When It Recurs’ section later in this chapter.

  Getting the low-down on relapse rates

  So, just how high is the risk of your relapsing? Well, research shows that up to 50 per cent of people who have recovered from one episode of depression find themselves experiencing another bout within the next year or two, and if you’ve had more than two episodes, there’s an 80 per cent chance you’re going to have another. In part, your likelihood of relapse depends on whether your depression was treated with medication or psychological therapy.

  If you stop medication not long after your depression improves, then the chances of a relapse are more than 50 per cent over the next year or two. Your odds are a bit better if you received cognitive therapy on its own, with, or following antidepressant medication. Interpersonal therapy (we discuss elements of this therapy in Chapters 13 and 14) also shows some promise in reducing relapse. Your odds of reducing the risk of relapse further improve if you also have behaviour therapy, such as problem solving (go to Chapter 12 for more) or one of the newer developments of cognitive behaviour therapy called ‘Mindfulness’ (see Chapter 18).

  Combining medication with the therapies we talk about in this book is a very effective way of reducing your risk of relapse.

  Although there are many treatments available to help reduce the likelihood of relapse, your risk of relapse is much greater if you stop treatment before your symptoms of depression disappear. Don’t stop your treatment until you have six months or more of normal energy, appetite, sleep, and you’re back enjoying your interests and activities.

  Rating your risk

  As well as the reasons for relapse occurring that we outline in the previous section, one other intriguing, possible reason is emerging. New evidence suggests there’s a surprising problem that may increase the likelihood of a recurrence of your depression.

  Try doing the Relapse Quiz in Table 17-1 to get an idea of whether this particular relapse risk factor applies to you. Rate how much you agree with each statement, on a scale of 1 to 7. Use 1 if you completely disagree, 2 if you largely disagree, 3 if you disagree a little, 4 if you don’t agree or disagree, 5 if you agree a little, 6 if you generally agree, and 7 if you totally agree with the question.

  Table 17-1 Relapse Quiz

  Question

  Disagree Agree

  I’ll sacrifice my own needs in order to please other people

  1 2 3 4 5 6 7

  I feel I must have the approval of others if I’m going to be happy

  1 2 3 4 5 6 7

  I know I can control depression if it returns

  1 2 3 4 5 6 7

  There’s nothing I can do to deal with depression

  1 2 3 4 5 6 7

  When I feel sad, I’m sure that my view of life is realistic

  1 2 3 4 5 6 7

  When I’m depressed, I absolutely know that my thoughts and emotions don’t accurately reflect what’s going on

  1 2 3 4 5 6 7

  I’m the cause of my own depression

  1 2 3 4 5 6 7

  I get depressed when I make a mess of things

  1 2 3 4 5 6 7

  You score this quiz a little differently to most self-tests. You don’t add or subtract any of the scores. Rather, the more items you totally agree or completely disagree with, as indicated by a rating of 1 or 7, the higher your chance of relapse.

  We know that it sounds strange to hear that your relapse risk rises if you completely agree with items such as:

  I know I can control depression if it returns.

  When I’m depressed, I absolutely know that my thoughts and emotions don’t accurately reflect what’s going on.

  And we also know that having an increased risk of relapse sounds strange if you completely disagree with the statements:

  I feel I must have the approval of others if I’m going to be happy.

  When I feel sad, I’m sure that my view of life is realistic.

  You may be wondering why we don’t want you to totally believe that you can control your depression when it recurs. And also why, if you’re sad, don’t we want you to completely believe that you’re viewing life and events unrealistically? Well, we do, sort of, but just hang on a moment.

  In Part II, we describe how cognitive therapy can help you view yourself and the world realistically. If you’ve ever experienced a bout of serious depression, absolutely and completely controlling your depression if it recurs probably doesn’t sound all that realistic. It may be more reasonable to say that you have some confidence in your ability to manage your emotions, but not total confidence. You may even be able to say that you have quite a lot of confidence, but not complete confidence. Stating that you don’t believe you need other people’s approval to be happy may also be realistic. But isn’t it likely that you may just have some doubt?

  Idealistic, overly optimistic thinking just may set you up for relapse. In Chapter 7, we explain that viewing yourself as superior to other people can increase your risk of experiencing disappointment and depression. Similarly, unrealistic, over-optimistic thinking can do the same.

  Our Relapse Quiz isn’t a scientific test, so don’t get depressed if you score quite a few 1’s or 7’s. Research by Dr John Teasdale and colleagues suggests that it’s important to reframe any thoughts that you’re having that are fixed or extreme. Do be aware that if you’ve never suffered from depression, this quiz is unlikely to predict if you’re likely to develop depression in the future. Because you’ve never been through the darkness of depression, it’s probably more reasonable for you to have greater confidence in the views you hold about yourself and the world.

  Equipping Yourself to Prevent Relapse

  If you completely ignore the real possibility of your depression returning, relapse may very well lurk just around the corner, ready to jump out and pounce on you. But you can do a lot to minimise the danger. We’re now going to look at strategies for preventing relapse.

  Sustaining success

  When depression finally goes away, most people feel like stopping treatment. And we don’t blame them for feeling that way. All treatments for depression (including self-help) require time, energy, and at least some money.

  Given the demands made by treatment, why work harder and longer than you have to – especially when you’re feeling good again? The reason is that the risk of relapse is much higher if you stop your treatment too soon, especially when you consider the debilitating nature of depression.

  Most professionals believe in treating depression until the symptoms completely subside, not just until they’re partially resolved. Also, therapists typically recommend continuing treatment for at least a few months after being free of depression – and a return to normal energy, concentration, appetite, sleep, and enjoyment of life’s activities.

  The suggestion to continue treatment is based on the idea that adopting new skills, behaviours, and ways of thinking is the best approach. These newly acquired, fledgling skills won’t survive in the face of the inevitable adversities of life. You need to repeatedly practise the skills you acquire.

  Continue practising the strategies that first helpe
d you to ease your depression until you feel you’ve completely mastered them. Also, you may want to try something different (such as behaviour therapy or relationship therapy) and rehearse those new skills. If you haven’t yet tackled cognitive therapy, we strongly urge you to do so because cognitive therapy not only defeats depression, it also helps prevent relapse.