Is Your Major Depression Treatment Plan Working?

Track your progress with a journal of your clinical depression symptoms.

As you start to overcome major depression (also known as clinical depression, major depressive disorder, or MDD), you can boost your success by being an active member of your own treatment team. Once you’ve worked with your doctor and/or a psychotherapist to put a depression treatment plan in place, the next step is to watch for signs that you’re feeling better. Overcoming depression may take some time, but keeping regular tabs on your progress will help your depression-treatment team fine-tune the right mix of antidepressant medication and psychotherapy for you.

Keep a Depression Symptoms Journal

Day-to-day variations in your depression symptoms can be misleading, so it may be more helpful to assess your progress at the end of each week instead of daily. To keep track of subtle changes in your symptoms, use a depression symptoms journal for at least the first month of treatment. Write in it daily.

Use this checklist to assess your progress around the same time each week:

___I feel more rested in the morning.
___I’m interested at work and able to concentrate.
___My energy level seems to be improving.
___Feelings of lethargy or restlessness were less noticeable.
___I tried to eat regularly and healthfully most days of the week.
___I took my antidepressant medication daily (if applicable).
___I exercised at least 3 times this week.
___Feelings of loss, sadness, guilt, or worthlessness were not distracting.
___I engaged in an activity with friends or family.
___Overall, this week was better than last week.

If you’re taking an antidepressant, take note of the following potential side effects and contact your doctor or therapist right away if you have them:

  • Feelings of worthlessness or thoughts of self-harm
  • Worsening depression
  • Changes in your sexual interest

Modifying Your Depression Treatment Plan

Research shows that a combination of antidepressant medication plus psychotherapy offers the best chance for lasting relief from major depression, says Gerry Neely, MA, LMFT, who works with clients in her Seattle practice. For people who feel a stigma about taking medication, Neely adds, “finding the right medication can serve as a short-term bridge to feeling better and being able to fully engage with life.”

If you don’t see improvement right away, don’t give up hope. Research funded by the National Institutes of Mental Health (NIMH) shows that switching antidepressants or adding a medication to your depression treatment plan can help. If your symptoms persist, your doctor will review your current plan and your overall health to be sure nothing was missed. Your psychotherapist can try a variety of techniques to find the right match.

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Exercise and Major Depression

Learn how exercise and physical activity can change your brain chemistry and support your major depression treatment plan.

Exercise is prescribed for a wide variety of health conditions — from heart disease to diabetes. Science shows being active can improve your physical and mental health, and make positive changes in your brain chemistry. But if you’re battling major depression, the thought of working out may seem unthinkable. Here’s some information about the benefits of exercise that may change your mind.

Exercise and Nerve Growth    Early brain chemistry research found that mice living in an exercise-friendly environment stopped acting depressed after a stressful social experience — while mice who didn’t exercise stayed depressed. Scientists attribute the mice’s recovery to the growth of new brain nerves caused by exercise.  This and other research has led scientists to understand how brain nerve growth works in humans, too. Adults affect their brain chemistry through experiences — such as physical activities — and how they respond to them. The proteins largely responsible for the brain’s ability to adapt and change are called neurotrophins. Antidepressants affect neurotrophins in the brain — and so does exercise.

Benefits of Exercise Therapy for Depression In addition to stimulating new nerve growth and improving your ability to think, remember, and learn, exercise boosts serotonin, dopamine, norepinephrine, and endorphins in your brain. These neurotransmitters help you calm down and focus. In studies, exercise therapy has also shown an antidepressant effect.

One Duke University researcher, James Blumenthal, PhD, has been studying exercise and MDD for over a decade. “Based on the best available evidence to date,” Dr. Blumenthal believes that “exercise may be generally comparable to medication in the treatment of MDD.” Similar studies continue to find at least modest clinical benefit for exercise and better mental health. But don’t self-treat your depression symptoms or try to get through your recovery with exercise alone. Talk to your doctor about treatment and self-care options — including exercise — that are right for you.

Adding Exercise to Your Treatment Plan Once you start exercising, you’re likely to notice some changes in your symptoms right away. “Simply moving more and sitting less will make a difference in how you feel,” says exercise physiologist and dietitian Amy Ogle, MS, RD. “And if you typically exercise alone, consider working out with a group or partner because the social connection helps lessen depressive symptoms.”

Shoot for at least 2 1/2 hours of exercise in a week. Strength training counts toward that time, too. Just remember to check with your doctor first, especially if you have another medical condition.

“Sticking to a plan and following your progress,” Ms. Ogle adds, “will renew your sense of self-mastery and control.”  You can progress to the following routine:

  • 5-10 min warm-up, gently moving upper and lower body in full range of motion
  • 30 min aerobic exercise, such as walking, light jogging, swimming, biking or a group exercise class. You should be able to talk, but not comfortably sing.
  • 5 min cool-down and stretching

Herbal Remedies and Dietary Supplements

Some people find herbal remedies and dietary supplements useful in relieving the symptoms of depression. Herbs and supplements commonly used for this purpose include:

  • amino acids and their precursors
  • DHEA
  • folate or folic acid
  • SAMe
  • St. John’s wort (Hypericum perforatum)

Scientific evidence supports the effectiveness of at least one herbal remedy (St. John’s wort) and two dietary supplements (DHEA and SAMe) for reduction of depressive symptoms. However, herbal remedies and dietary supplements do not help all people and in some cases, the effectiveness of these treatments has not been completely established.

How Your Doctor Will Diagnose Major Depression

An accurate diagnosis is the first step toward recovering from clinical depression.

Unlike health conditions marked by clear physical signs, major depression (also called clinical depression, major depressive disorder, or MDD) can be hard to diagnose. One reason is that the symptoms of major depression can look a lot like other health conditions — especially other types of depression or grief. Another reason is that many of the most important major depression symptoms have to do with how you feel emotionally, so a solid diagnosis depends on you sharing symptoms information clearly and openly with your doctor.

To diagnose major depression, your doctor will ask you several questions to help rule out other health conditions and pinpoint the type of depression you have. Your doctor may also conduct other medical and psychological tests to better understand what’s causing you to feel depressed. Here’s what to expect from a depression screening:

  • Questions about your symptoms. To be diagnosed with major depression, you must have certain symptoms for at least two weeks. Your symptoms must also be severe enough to interfere with normal activities, work, and your ability to take care of yourself. To make a major depression diagnosis, your doctor will ask you about your feelings, thoughts, and behavior.
  • A physical exam. A physical exam won’t tell your doctor whether you have major depression, but it will help your doctor assess your overall health and rule out obvious illnesses and injuries that may be related to your depression. A physical exam is likely to include a check of your height, weight, temperature, blood pressure, heart rate, breathing, and abdomen.
  • Blood tests. Some health conditions, such as hypothyroidism (a slow thyroid) or kidney disease, can cause symptoms of depression, so your doctor may also want to do a blood test to check your hormones or complete blood cell count.

Many people don’t realize they have major depression, so some doctors include depression screening as a part of a regular office visit. Answering these two questions honestly if your doctor asks them can help you get the diagnosis and treatment you need:

  • In the past month, have you felt down, depressed, or hopeless?
  • In the past month, have you felt little interest or pleasure in doing things?

A “yes” response means you may need further depression screening.

Living with Major Depression

Major depression can take a toll on your life. Learn about your symptoms and your treatment options.

7 Ways Major Depression Impacts Your Life

Major depression (also known as clinical depression, depressive disorder, or MDD) doesn’t just affect you. It impacts your friends and family, and anyone close to you. It follows you to work and school. “Depression affects a person across the board,” says Rob Doyle, MD, clinical instructor in psychiatry at Harvard Medical School and staff member at Massachusetts General Hospital. Left untreated, it’s an equal-opportunity destroyer, he adds. Until you recover from major depression, be aware of how it affects your life.

Alcohol and Substance Abuse

Substance abuse is common among people with depression, says William Marchand, MD, assistant professor of psychiatry at the University of Utah and author of Depression and Bipolar Disorder: Your Guide to Recovery (Bull Publishing Co.). People with depression may self-medicate to feel better. Sometimes addiction is the main disorder, and depression follows. “Drinking or taking illegal drugs may have a short-term effect of feeling better, but there is good evidence that it worsens depression,” Marchand says. A drink or two a day doesn’t mean you’re an alcoholic, but your doctor should assess this. To help you recover, your doctor needs to know if you need treatment for substance abuse, depression, or both. It’s important to tell your doctor if you drink or use drugs.

Problems at Work or School

Depression can cause sleep problems, making it hard to fall and stay asleep. If you don’t get enough ZZZs, you’ll think unclearly and feel sluggish the next day. Major depression causes lost productivity at work. “If you’ve got a boss keeping an eye on things in this tight economy, the first to be let go will be those perceived not to be pulling their weight,” Doyle says. If you arrive late or take too long on tasks, coworkers may notice. “They don’t know you’re functioning on 3 hours of sleep,” Doyle says. Resentments may form, affecting work relationships, and you could be pegged as lazy or disorganized. To make matters worse, “you may not even know you’re depressed and buy into the idea that you’re lazy,” Doyle says.

Depression and Loneliness

If you have major depression, the things you used to enjoy aren’t enjoyable anymore. Say you’re a huge Red Sox fan and the team is on a losing streak. Someone not suffering from depression will get over it, especially after a few wins. “But a depressed person doesn’t care either way,” Doyle says. “If you offered them free tickets, they’d say, ‘No, give them to someone else.'” There’s a general loss of interest in life. “The depressed person is just going through the motions, not engaged,” Doyle says. “They’d rather sit at home and isolate themselves in their room.”

Thoughts of Self-Harm

A person with depression may feel like there’s a dark cloud hanging over his or her head. “It can become quite painful,” Doyle says. Friends and family may become impatient, especially if it’s the kind of depression with a genetic component that gets triggered even when life is good and things are going your way. You may start to think life is too difficult or have thoughts of harming yourself. Discuss with your doctor a plan for what you will do if these thoughts occur. If you think you might hurt yourself, call the 24-hour National Suicide Prevention Lifeline at 800-273-8255, go to the emergency room, call your healthcare provider, or call a designated family member.

Family Problems

“Depression almost always changes a person’s thinking,” Marchand says. It changes the way you act at home. You feel negative about yourself, and see the entire world through a negative lens. On top of this, work issues can lead to family problems, especially if there is job loss. Often, family members of people with depression don’t understand what’s going on. Statements such as, “What’s wrong with you?” or “Snap out of it!” only increase feelings of worthlessness and sadness. Learning about depression can help stave off comments like these. To promote understanding and support, it may be helpful for a family member or friend to go with you to some of your doctor’s appointments and therapy sessions.

Relationship Problems

When major depression sets in, your spouse or partner may wonder what he or she did wrong. “There’s a real set-up for misunderstandings and arguments,” Marchand says. Loss of sex drive can be frustrating for your spouse, adding fuel to the idea that you aren’t attracted to or don’t care about them anymore. Your partner may even blame his or herself for your behavior. Relationship problems only lead to more depression, and it becomes a vicious cycle. This is a good reason for your spouse to have an understanding of major depression and symptoms of depression, and to go with you to occasional doctor’s appointments or therapy sessions.

Depression and Anxiety

“Anxiety disorder is common with depression,” Marchand says. If you have it, it’s important to establish that upfront, since some antidepressants can initially worsen anxiety. Treatment for anxiety and major depression may include medications, psychotherapy, or both. For people with less severe symptoms, medication isn’t always necessary. Talking through feelings of sadness and anxiety with a skilled therapist is sometimes enough to alleviate the condition. “The brain changes in response to our experience,” Marchand says. A new experience changes your brain function. In this way, psychotherapy can help you find constructive ways of coping with the stress that brought on the depression or anxiety, and help you feel more like yourself again.

Top Ways to Get Your Energy Back — Now

February 21, 2010 12:00 AM by Mehmet C. Oz, MD, and Michael F. Roizen, MD

You’re grumpy at the groundhog (who needed extra weeks of winter?) and a little short with your spouse, and you have been spending more time with the mac-and-cheese casserole than the treadmill. Winter can do that. But it doesn’t have to. Use these strategies to cuff the classic energy thieves that are still hanging around this time of year, and get your mojo back before spring hits:

Energy thief #1: Short, dark days.
What happens: Short days can cause seasonal affective disorder (SAD) — neurochemical changes in your brain due to lack of sunlight. This results in depression in up to 6% of Americans (the further north you go, the more likely you are to be a SAD sufferer). From late fall until spring, people with SAD become depressed, sleep too much, withdraw from friends, and battle low energy and relentless carb cravings.
Turn it around: Light therapy — sitting in front of a special box that shines ultra bright lights — has long been considered to be the best way to combat SAD. But a new University of Vermont study reveals that cognitive-behavioral therapy (CBT) may be even better. CBT is a type of psychotherapy that helps people outsmart depression by teaching them to change their negative ways of thinking. In fact, in this study, CBT alone was able to stomp out SAD with a success rate of 81% (compared with 49% for CBT plus light therapy and 32% for light therapy alone). Why wouldn’t more therapies be better? Researchers surmise that trying to balance two therapies was just too confusing, but CBT alone allowed people to focus on the coping skills they needed to banish their winter blues.

Energy thief #2: You can’t get enough comfort.
What happens: When the mercury heads south, we crave calories, carbs (they help our brains make the calming neurotransmitter serotonin), and fat. In fact, a 2006 University of Massachusetts Medical School study found that once the days become shorter, we pack away an average of 86 extra calories a day and weigh more than at any other time of year. We also snarf down more total and artery-clogging saturated fat.
Turn it around: Just cozy up to good-for-you carbs and healthy omega-3 and omega-9 fats that will satisfy your biology and your brain without packing on a gratuitous layer of blubber.

Trade meatloaf and pot roast for hearty whole grains like whole-wheat pasta and brown rice, or try polenta, a veggie burger, or salmon. Or warm up with a satisfying bean-based vegetable chili or Tuscan white bean soup. Since beans and whole grains are digested slowly, they’ll keep you full longer, so you’ll eat less overall. And if it seems like there are slim pickings in the produce department, now is actually the prime time to load up on nutrient-packed starches, including sweet potatoes and winter squash (roast or bake them with a drizzle of olive oil). Finish your feast with seasonal winter fruit (think apples, pears, oranges, grapefruit, and tangerines, or even frozen berries) topped with a sprinkle of heart-healthy walnuts or almonds and you’ll get all the carbs and fats your body craves — but you’ll do it the healthy way.

Energy thief #3: You stay in. On the couch.
What happens: Your workout plan bites the dust. We log less exercise in winter than any other time of year, with a paltry 45% of Americans and 36% of Canadians keeping active. Pretty ironic, since exercise can lift you out of the winter doldrums by boosting energy, improving mood, and helping you sleep better.
Turn it around: Start with your schedule. Make regular exercise appointments on your calendar the same way you’d ink in any other non-negotiable activity. But give yourself a bit of a break: Don’t think exercise needs to be a hard-core trip to the gym. Taking the dog for an extra-long walk or doing crunches and lifting weights in front of the TV count, too. Still uninspired? Try the 10-minute rule. Make a deal with yourself to get moving for at least 10 minutes. Chances are, once you start, you’ll feel so much better that you’ll keep going.

Self-Help Strategies to help you along in Cope With Major Depression

Build on other depression treatments with small steps to feel better every day.

In addition to the scientifically supported treatments for major depression — antidepressants, psychotherapy, or a combination of the two — there are other steps you can take to help lift your mood and support your recovery. Although clinical depression can rob you of energy, motivation, and the desire to do things that you once enjoyed, remember that inactivity can make depression worse. Staying active will distract you from negative thoughts, and it’s one of the best things you can do to cope with major depressive disorder (MDD).

The National Institute of Mental Health (NIMH) recommends these self-help strategies to ease the burden on yourself while you’re depressed:

  • Don’t wait to seek treatment for major depression. The earlier you start treatment, the better (and faster) your recovery will be.
  • Set realistic goals. Treating major depression isn’t a quick fix, and improvement can be subtle. For example, you may start sleeping better or eating better before your mood brightens.
  • Stay active. Whether it’s exercise, cooking, going to the movies, or dinner with friends, return to activities you once enjoyed. As your treatment starts to take effect, you’ll find yourself enjoying your favorite activities again.
  • Be around other people. Isolating yourself from others worsens major depression, but spending time with family and friends helps boost your mood so you can stick with your treatment program.
  • Don’t let everyday activities overwhelm you. Divide major tasks into smaller chunks, set priorities, and do what you can.
  • Don’t accept roles with a great deal of responsibility, which can be overwhelming when you’re depressed.
  • Recognize negative thinking as a symptom of clinical depression. Try to reframe negative thoughts in a positive light.
  • Don’t engage in self-blame while experiencing depressed mood.
  • Postpone major life decisions until you get relief from depressive symptoms. Don’t change jobs, relocate, enter into or end a primary relationship, or make major financial choices when you’re in the grip of major depression.
  • Each day, make it a point to identify one positive reason to make it through the day.