The Complete Guide to Self-Management of Depression

Depression is a complex illness, which presents in myriad ways and affects more than 350 million people worldwide. It is now accepted that genes and environmental interplay leads to depression. While there are several ways to treat depression, the most popular being antidepressants, almost 60-70% people treated with antidepressants fail to achieve a symptom-free state when first treated with these medications. Needless to say, antidepressants are not the be-all and end-all of depression treatment. In addition, about 80% of people with depression will experience a recurrence and approximately 15% will have a long-standing course. Self-management is increasingly becoming the standard of care in people with long-standing medical conditions. Self-management puts one in the driver’s seat with regards to making choices to treat depression. People with diabetes, heart disease, emphysema, asthma, and other long-standing medical conditions have successfully used self-management to live a healthy life. However, treatment of depression has lagged behind in incorporating the concept of self-management with most popular self-help books on depression focusing mostly on cognitive-behavioral approaches. Other self-help books on depression do talk about positive life style changes, but don’t elaborate on medications, psychotherapy, or other alternative approaches such as light therapy or supplements. This book, a product of thorough research with over 600 references, attempts to fill this void by consolidating evidence-based approaches for treatment of depression and presenting this information in a practical and easy-to-use format that can be incorporated into day-to-day self-management of depression.

The beginning few chapters of the book focus on identifying depression, recognizing the various presentations of depression, assessing its severity using self-assessment tools, understanding the course of depression, familiarizing oneself with the concept of self- management, introducing the cognitive model of depression, and using behavioral strategies to treat depression. The middle section of the book deals with the common symptoms of depression and the therapeutic techniques used to address these symptoms. The last few chapters discuss other approaches to treat depression such as exercise, bright light therapy, role of social support, medication treatment, and other positive life style changes. In contrast to the traditional paternalistic model of healthcare, consumer-defined wellness and recovery are now becoming the norm of healthcare delivery in mental health settings. The book ends with a discussion on the role of wellness and recovery in self-management of depression.

Some features unique to this book include:

• Strategies to manage anxiety and substance use, which commonly co-occur with depression.

• Discussion of overlap between grief and depression and strategies to deal with grief.

• Evidence-based discussion on the usefulness of medications in treating depression.

• Evidence-based discussion on alternative and complementary approaches in treating depression.

• Strategies for treatment-resistant and chronic depression, which are often overlooked in self-help books.

• Recognition and treatment of cognitive symptoms as research now suggests that these influence functional outcomes in depression.

• Discussion of internet-based psychological treatments of depression that are supported by research.

• Elaborate discussion on seeking professional help, improving communication with mental health professionals, and the concept of “measurement-based care.”

This book is not limited to one type of psychotherapeutic technique or school of thought for treating depression. It broadens the narrow perspective of self-help beyond the traditional treatment of symptoms to self-management of depression. Self-management, besides a focus on treating symptoms, also addresses life style changes, social relationships, communication, problem-solving, and also includes elements of wellness and recovery. Being trained in cognitive-behavioral therapy, interpersonal psychotherapy, motivational interviewing, and integrated dual diagnosis treatment (for co-occurring psychiatric and substance use disorders), this is my humble attempt to synthesize evidence-based approaches for depression and present them under the rubric of a self-management model. The strategies in this book are derived from the following evidence-based approaches used in treating depression:

• Cognitive-Behavioral Therapy (CBT).

• Other cognitive therapy approaches such as Rational Emotive Behavior Therapy (REBT)

• Interpersonal Psychotherapy (IPT).

• Behavioral Activation (BA).

• Problem-Solving Therapy.

• Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

• Positive Psychology interventions such as gratitude.

• Mindfulness-Based Cognitive Therapy (MBCT)

• Couple Therapy.

• Motivational Enhancement Therapy.

While the highlight of this book is to make you aware of the proven strategies that work for depression based on research, where applicable, caveats or situations when a particular strategy may not work are also discussed. This approach differs from the traditional self-help books on depression that sometimes tend to convey the “one-size-fits-all” paradigm. However, depression is a very heterogeneous condition and its treatment cannot be pigeon-holed into one or two kinds of treatment modalities. This book, in contrast, offers you a menu of options for self-management of depression.

Managing depression can sometimes be a long journey and this book will help you prepare yourself as an effective self-manager who is capable and confident of dealing with any bumps on this journey. While this book serves as a guide for self-management for depression, it is in no way a substitute for the professional opinion or treatment that you may be getting from your mental health professional.