Caregivers of depressed adults

Help for Parents and caregivers of Depressed Teens

Caregivers of depressed adults

What’s CBT

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Many therapists today suggest CBT as a therapy for patients suffering from mental health disorders.  If you’re loved one is undergoing talk therapy sessions and the therapist is using CBT you’ll want to understand how it works. Here’s a brief overview of how it works.

What’s CBT? (stands for Cognitive behavior therapy)

If you’ve ever listened to Dr. Laura Schlessinger on Sirius radio you’ll hear her recommend CBT to many people.  It’s one of the most effective and popular treatments for learning new behaviors.

CBT, as it’s most commonly known, stands for Cognitive Behavior Therapy. And the nature of the method is as it’s named. It involves reprogramming thought and behavior patterns you’ve learned overtime, that have helped prevent you from dealing with fears, or pain, and allow you to ensure your survival.

CBT acknowledges that what you think about a external situation influences your emotional experience. And, what you think and believe is also related to what you’ve learned.

For example, a person that almost drowned as kid may see a body of water and think “I need to stay far away from the water”. They will feel fear and the action they will take will be to avoid  the water. Whereas, a person who spent summers at the beach, took swimming lessons and never had an accident, may see the same body of water and think, “wow, I’d love to hop in there right now.” They will feel happy when they see water and will take an action like going for a swim.

When your behavior does not serve what you would like to do – for example, the adult that had the swim accident is embarrassed of their inability to swim on a vacation with friends – it becomes a distressing problem. The good news, is this thought – emotion – behavior pattern can be disrupted and changed through CBT.

CBT as a diagram looks like this:

What's CBT? (stands for Cognitive behavior therapy)

The diagram above presents a triangle to show how thoughts, behaviors and emotion are connected and continue to reinforce one another overtime.

CBT acknowledges that individuals learn automatic behaviors that become difficult to control through rational thought. It appears as if they act spontaneously to situations, without any reasoning. That’s because the past has conditioned them to react automatically.

 

Why CBT is effective and how it’s different from other therapies

 

CBT targets the problem in behavior, which makes it a problem-focused type of treatment. It teaches you new actions that stop you from taking unwanted actions you have taught yourself to take. It replaces them with healthy behaviors that lead to more favorable outcomes. Therefore, it is more “action-oriented” than earlier therapies and leads to fast results.

 

Earlier therapy techniques (which are still in practice today) focus on understanding the past to learn why you have a tendency to behave a certain way. This introspection can be helpful, though it does not address present issues.  It looks directly at the problems the individual is suffering from and treats them. The goal is not to diagnose, but to fix.

Six phases of CBT treatment:

  1. Assessment
  2. Reconceptualization;
  3. Skills training;
  4. Application of skills
  5. Maintenance;
  6. Post-treatment and follow-up.

A typical CBT program consists of in-person sessions with a therapist.  A minimum of six to 10 sessions with one to three weeks in between. There are often homework assignments to do that help you learn and use various skills.

 

Antidepressants: Should your loved one take them?

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Read this article to understand the struggles that coming with considering taking antidepressant medications. Share it with your loved one. It may help them decide what to do.

Hair loss. Fatigue. Increased thoughts of suicide. Tremors. Weight gain. These are some of the side effects you’ll read on pamphlets that come with antidepressants. It likely won’t make you feel good about taking them.Antidepressants: Should you take them?

There are many proponents for antidepressants.  And there are some who believe that you can live with herbal supplements. Some depression sufferers succeed in overcoming the disorder without them. Then there are people who need to take antidepressants to live their life.

The truth is: Everyone is different.  Every case of depression is different. So, finding what works for you takes a lot of discovery, a lot of trial, and eventually the more you try the more you get close to finding out what works.

And that may mean, going through months of trying medications that don’t work and make you feel worse. It’s sadly part of the process. Until there is a research breakthrough that improves treatment for depression, this is the reality about the tools we have to deal with it.

Antidepressants: Should you take them?

It’s your choice. But consider these facts:

Taking antidepressants is your choice. Though, sometimes you need to make this choice even if you don’t want to.  If you are not improving on natural remedies and by taking what is considered “healthy actions” (see articles on health minimums) then you should probably opt to try an antidepressant.

Here are some points to consider:

  1. You may only need them temporarily.If you go on an antidepressant you can always choose to go off. Even later in life, if you feel well, are under a doctor’s care, once you get stable in other areas, you can try to go without them.
  2. Never mess with what the doctor prescribes.  Antidepressants target your brain and go off them suddenly, even if you are not finding them helpful, can make you worse.
  3. They might be the only thing that helps you. You’ll know this if you are taking all the healthy actions and your mood isn’t improving.
  4. One in 10 Americans take antidepressants. This means, that a lot of people find them useful and effective. It’s a large number so on the flip side, it’s been suggested by experts in the medical community that we are treated versus curing the issue.
  5. When you have a cold you take cold medicine. Depression is the same. The issues arise in your brain, the difference is you can’t see depression.
  6. Your brain could be missing a chemical it requires to function properly. So you are not putting something synthetic, you are giving your body what it requires.
  7. Antidepressant medications can be expensive. They’ll need to be factored into your budget. Depending on your treatment plan and insurance options you’ll likely spend anywhere from $0 – $350 per month.

Antidepressants explained

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Finding the right antidepressant medication requires a trial and error approach. Currently, there exists no test to accurately measure symptoms. Your loved one’s doctor doesn’t really know what to prescribe them. They select one from a list, prescribe it to and monitor them over 4-12 weeks (this is how long it takes to see benefits and qualify a medication) to see if what they’ve chosen works. If not, they try another medication. This process continues until they find what works.

How doctors prescribe antidepressants:

There are approximately 22 antidepressant medications on the market that have been approved by the American Federal Drug Association (FDA). They fall under four categories, labeled for the brain chemical they target. (each variety is explained below)  In order to choose an appropriate medication for your loved one, the doctor may consider these factors:

  • Their situation. Each case of depression is different, which means so are the symptoms. Their doctor will like assess their situation and choose an antidepressant that is likely not amplify a negative issue you are dealing with. For example, if they are severely overweight or have an eating disorder a doctor will try and prescribe a medication that does not have a side effects of weight gain because that will only make the situation worse.
  • Their lifestyle. Antidepressants have side effects that can unobstrusive but annoying (ie. dry mouth, low sex drive). A doctor may ask them some lifestyle questions to help him discover what a good medication would be. For example, for a man trying to have a baby with his wife, taking a low sex drive medication may not be helpful. 
  • Their current physiology. The doctor will evaluate their current physiology, this includes taking into account other health conditions they may have.  If they are pregnant or breast feeding, there are some antidepressants they should not take.
  • Their genetics. If they have a family members that takes antidepressants their doctor may prescribe the same treatment. Often genes play a role in how a patient reacts to a medication. If it work for a family member with a similar genetic predisposition then it may be effective for them.
  • Their financial capabilities. If they do not have medical coverage antidepressants can cost up to $350/month.  Some antidepressants are cheaper than others.
  • Their other medications. Are they  taking other supplements and/or medications? This will be considered as some medications work negatively together.

 

How do anti-depressants work?:

The basic premise of an antidepressant is that once you take it the drug passes through your body via your blood and into your brain.  There, it targets a specific brain chemical (or chemicals) that control your mood.

If you read the word “inhibitor reuptake” what that means is that the drugs stops a process where the chemical does not re-enter the brain cell, which it would normally do.  That means, less of the chemical remains in the nerve cell.

The brain chemicals that are targeted by these drugs are called: Dopamine, Serotonin, and Norepinephrine

Selective serotonin re-uptake inhibitors (SSRIs)

These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants.

Common SSRIs by drug name include: Prozac, Selfemra, Paxil, Pexeva, Zoloft, Celexa, Lexapro

Serotonin and norepinephrine re-uptake inhibitors (SNRIs)

Common SNRIs by drug name include: Cymbalta, Effexor XR, Pristiq, Khedezl, Fetzima

Norepinephrine and dopamine re-uptake inhibitors (NDRIs)

One of the few antidepressants not frequently associated with sexual side effects.

Common NDRIs by drug name include: Wellbutrin, Aplenzin, Forfivo XL.

Tricyclics

Not many doctors prescribe tricyclics these days, though they are still effective for many people. They are often used after other drugs haven’t work. They’ve been replaced because they tend to have more side effects.

Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood.

Norpramin, Tofranil, Pamelor, Vivactil, Trimipramine, Surmontil

MAOIs Using an MAOI requires a strict diet because of dangerous food interactions. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs

Atypical antidepressants

Oleptro, Remeron, Brintellix, Viibryd

Why your loved one needs a second opinion

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Here is one of the most valuable pieces of information when it comes to mental health diagnosis for your loved one: Make sure they get a second opinion.why you should always get a second opinion

Or a third. Or forth. Really. Have them get as many as they can. The more they get, the more expert evidence they can collect as to what is the real issue.  

As a patient or someone who is helping someone with depression it’s important to always remain aware.

Don’t believe what their family doctor says because they have the “almighty powers” that come with the allowance to put the letters M.D. after their name. While they are more knowledgeable than you on the topic of medicine, they are still human.

And humans make mistakes. Even doctors. They have bad days and can miss important aspects of your diagnosis.

They also have different life experiences, which may make give them different ideas about your diagnosis. A doctor who just treated a patient with the rare condition, may consider that as possible condition for you. While a doctor who learned about it once in med school, won’t even think about it.

Why you should always get a second opinion

The problem with mental health diagnosis and perception:

If you break your leg your doctor will take an x ray, show you the evidence, and put your leg in a cast. That’s not like mental health diagnosis. The evidence medical professionals have to go on is a set of behaviors that can’t be represented physically. Their evaluations are based on symptoms that you tell them you have, and personal accounts. Sometimes the accounts involve your family members and friends but those stories have different people with different experience different life and different perceptions.

Some doctors will be smart enough to take that into account. Some won’t. It can be a problem. So, what you need to do is be aware of the humans frame stories. This includes yourself.

Consider how you’ve been relating to or thinking about your loved one’s conditions? Is what you think of them getting in the way of how you see them and related to them?

 

How doctors diagnose depression

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The most common diagnostic tool used by doctors to help them decide if a patient with symptoms of depression is actually suffering from the full on illness (and not just a passing state of feeling sad that’s caused by a life event) is a questionnaire.

How do doctors diagnose depression? Here are the common tests they use:How do doctors diagnose depression?

Currently the most common ones are:

  1. Hamilton Depression Rating Scale (HAMD)
  2. Montgomery-Asberg Depression Rating Scale (MADRS)
  3. Beck Depression Inventory
  4. Patient Health Questionnaire (PHQ-9)

Your doctor will likely used one of these tests to assess you. Questions are similar in nature for each.  They ask you about symptoms your experiencing – such as: Sleep disturbances, issues with fatigue, suicidal thoughts, feeling uninspired or hopeless, loss of motivation, loss of pleasure.  They will also ask you questions to help them understand the severity of your symptoms.

Here are some examples of the types of questions you may be asked:

  • Have you lost interest in activities you used to find pleasurable?
  • Ae you experiencing changes in appetite such as eating too much or not feeling like you want to eat?
  • Are you having difficulty concentrating?
  • Having you been experiencing thoughts of suicide, death, or wanting to die?

In most cases, if you have felt hopeless for a least two weeks or more and it’s so bad it’s affecting your life – you’re having trouble going to work, socializing, enjoying activities you once thought were pleasurable etc. – these are high indications you have depression.

The diagnostic criteria for depression appears in a medical text for mental illness called the DSM-IV.  (Read the diagnostic criteria here).

Your doctor will also likely run some basic biological tests to rule out other potential issues that cause depression. The most common ones are the:

  1. Physical exam. Your doctor will likely examine your body to ensure there is nothing notable wrong with your physiology that could be causing depression symptoms.
  2. Blood tests : A blood sample may be taken and a complete blood count (CBC) will be performed. This helps the doctor find out if you have any hormonal issues or a vitamin deficiency.

How doctors “fix depression”: Antidepressants

If your doctor rules out all other medical issues that could be causing your depressed mood and suggests a diagnosis of major depression they’ll likely treat you by prescribing an antidepressant medication. Doctors are trained to fix medical problems and this is how they do cure depression. It’s the only tool available to them, aside from referring you to a different type of specialist.

You need to be aware that the problem with this route is that they may skip identifying other potential causes for your depression. They will treat the symptoms without curing them. So, you need to investigate therapeutic forms of treatment that teach you how to proactively deal with negative and uncomfortable emotions.

What you need to understand about antidepressant medications:

Finding the right antidepressant for you is like finding the perfect wedding dress. You have to “try on” many to find what works for you.  This is because the current diagnostic criteria that doctors use is based on asking you a line of questions, ruling out other illnesses with basic physical tests, and then making an educated assumption.

They don’t do a brain scan to see what’s really going on and here’s why:

  1. It would put too much pressure on the medical system to do these tests for the number of people who end up in their office with symptoms of depression. There are too many people that treating everyone would cause a dramatic back up. This would lead to longer treatment wait times, and possibly more deaths.  So, prescribing an antidepressant is the fastest way to treat depression.
  2. Even if they could see what brain regions were affected it still wouldn’t tell them anything about how the condition was caused and thus what treatment to use. So, brain scans would help to identify the problem but hast nothing to do with treating it. Therefore, it’s a lot of fuss for no reason.

So, they test you on a medication for 4-6 weeks and if it doesn’t work, they try something else.  If you get worse, well, the sad truth is, sometimes that’s part of the process.

As you can see, this is hardly an effective treatment. But for now, it’s all doctors have. A questionnaire, some basic tests and a lot of trial and error with antidepressants.

But, don’t blame the doctor, it’s the system that’s flawed. We don’t know enough. And because we don’t know our treatment options are unfortunately somewhat limited right now. That is why it’s important to do what you can to help speed up your recovery process.