treatment

Depression: Management and Treatment Options

 
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What help is there for me?

If you’re struggling with depression, there are options out there for you to get through this. Below we take a closer look.

 

There are many different management and treatment options for depression. Try to remember that overcoming depression will take time, and you’ll need to stay strong through some of the tougher days. Still, overcoming depression is possible!

Check out the Depression: Causes, Symptoms and Types article for more information about depression.

Management and treatment options

Types of depression that are linked to biological factors (melancholic depression and psychotic melancholia) are more likely to need medical treatments like antidepressants, and are less likely to be resolved with counseling alone. Non-melancholic depression may be treated equally effectively with medical treatments or with psychological treatment.

Psychological treatment

Psychological treatment provides either an alternative to medication or works alongside medication, and is usually provided by a mental health professional, like a psychiatrist, psychologist or counselor.

Psychiatrists are physicians who are also trained as mental health professionals. Psychiatrists have special training in mental illnesses, including depression, schizophrenia and suicidal behavior. Psychiatrists are the only mental health professionals who can prescribe medications.

Clinical psychologists, counseling psychologists, and professional counselors are also trained to be able to help people with depression.

In some cases, psychiatrists, psychologists and counselors work together to help someone who is depressed. The psychiatrist manages the medical part of treatment, with the other mental health professional (psychologist or counselor) providing the psychological treatment.

There are a number of psychological treatments or therapies used for depression, including cognitive therapy and cognitive behavior therapy. As always, talk to your doctor or therapist about the best approach for you.

Medical treatment

Medication. Medication may be helpful in managing depression. There are several different types of antidepressant medications, which are prescribed by doctors or psychiatrists. Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) are three common classes of antidepressants. They each work in different ways and have different applications. Like most medications there can be side effects. It’s best to ask about what options you have, how the medication will affect you, and how to take the medication safely.

Hospitalization. Hospitalization may be necessary if your depression is particularly severe or if you are suicidal. If you begin taking medication, you might also spend a short amount of time in the hospital so your doctors can make sure it’s working effectively and gauge your side effects. Check out the Psychiatric Hospitals and Wards article for more info.

ECT. ECT is short for Electro-Convulsive Therapy, sometimes called “shock therapy.” While under anesthetic, you receive a brief, mild electric shock, which lasts only a fraction of a second and is delivered to the brain through electrodes placed on the head. ECT has been shown to be effective in treating severe depression. Like any treatment it’s important to discuss the benefits, side-effects, and other options for ECT treatment. ECT is generally only used when no other treatment has helped to alleviate the depressive symptoms.

Things you can do for yourself

Along with seeking treatment to manage depression, there are a number of things you can do for yourself that may help when you are feeling depressed. Some of these include:

Eating well and being active. Even though you might not feel like it, exercising and eating well can help when you are feeling down. Biological factors, as well as social factors, influence how you will feel and think about things and yourself. Exercise helps stimulate hormones like endorphins, which help you feel better about yourself and your life. If you haven’t done a lot of exercise before, it might be a good idea to start doing something small a couple of days each week—for example, a 15-minute walk or two or three laps in a pool.

Share your struggle with others. Although it can seem hard, sharing how you feel and hanging out with someone you trust can help you get through the hard times, see alternative ways of solving or thinking about a problem, and help to make you a happier person. If you’re having difficulty talking about what you’re going through, you might start with sentences such as, ”Right now, I’m feeling…”; ”I think it started when…”; ”I’ve been feeling this for…”; ”My sleep has been…”; or ”Lately school/work has been…”

There’s numerous online forums, groups, pages, apps and servers where you can also get support 24/7 from peers that have been through something similar and can empathize with you.

Although it can be good to find support through others, be mindful of what content you’re subscribing to online and see regularly in your social media feed. For instance, following a bunch of blogs that put out depressing content (even though it’s relatable) won’t help you find ways to cope and manage your depression like you might by following a blog centered on positive mental health.

Get outside. Evidence shows that when you have some sort of contact with nature—like pets, plants, gardens or parks—your mood improves and you feel less stressed. Even just going for a walk in the park may help.

Write down your feelings. Writing down your feelings or keeping a journal can be a great way to understand your emotions. It can also help you think about alternative solutions to problems.

Take time out to relax. It’s a good idea to try and take a bit of each day to do something you enjoy. When you are feeling down, it may be hard to be social or motivate yourself to be active. It might help to make a list of all the things you enjoy doing and then plan to do something from this list each day.

Support groups. Along with family and friends, support groups can be a place to share experiences and inspiration with others going through similar times. Talk to your doctor for details on support groups in your area. Also, if you are a college student inquire at your campus counseling center to see what kind of support groups the center might be sponsoring.

Call a crisis line. If you’re having difficulty talking to people you know or you’d like to talk to someone outside of your situation, Lines for Life has a Suicide LifeLine that can be reached at 1-800-273-8255, as well as a YouthLine at 1-877-968-8491. They are staffed by highly trained volunteers that can offer support and assistance 24/7/365, over the phone, text or through an online chat. If you’d like more resources, check out our crisis helpline directory.

Set small goals. Sometimes people set goals that are almost unachievable and then feel even worse when they can’t reach them. Try to set goals that are attainable for you, even if it’s on a day-by-day, or hour-by-hour basis. And remember to reward yourself, too.

Reduce stress. It might be a good idea to try and reduce the level of stress you’re feeling. You might want to check out the Stress fact sheet for some ideas on how to manage stress.

Go easy on drugs and alcohol. Try not to use drugs or alcohol in an attempt to feel better. The feeling you get from drugs and alcohol is usually temporary, and the after effects often make problems worse.


Acknowledgements: This article was originally developed by youth and staff for us.ReachOut.com

Psychiatric Hospitals and Wards

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Psychiatric Hospitals

A closer look at what to expect

What happens in psychiatric hospitals and wards?

Psychiatric hospitals and wards specialize in treating people who are experiencing a variety of different mental illnesses, including depression, schizophrenia, anxiety and eating disorders.

Psychiatric hospitals and wards can be part of a larger hospital or located in a smaller building like a clinic.

Many people find spending time in a psychiatric hospital a very helpful way to:

  • Rest and reflect

  • Find out what is happening emotionally and why

  • Stabilize medications they might be taking

  • Get intensive treatment from doctors and other health professionals with specialist training, like nurses, occupational therapists, social workers and psychologists

Voluntary and involuntary admission

A voluntary admission is when a person enters a psychiatric hospital at his or her own request or at the suggestion of a doctor, parent, or guardian. This can be at a time when that person feels he or she needs some extra support. Voluntary admission can be organized by the person who is being admitted or by a doctor, parent, or guardian.

There are times when a person becomes so ill that they are at risk of hurting themselves or others and hospitalization becomes necessary even though the individual does not wish to enter a hospital. This is called an involuntary admission. This occurs when someone else has recognized that the person is imminently a danger to him or herself or others. In most states, police officers and designated mental health professionals can require a brief commitment of an individual for psychiatric evaluation. If the individual is evaluated and needs further hospitalization, a court order must be obtained.

Where are psychiatric hospitals located?

You might find it difficult to research psychiatric wards and hospitals over the Internet, but your medical doctor or psychiatrist should be able to recommend one that will suit you best.

Some are privately run, while others are within larger hospitals. Some might also have a limited number of places available, while others may only admit people at certain times of the year.

Things you might consider when choosing a psychiatric hospital is the cost, program (including any restrictions in activity and other policies), size and length of stay.

How much will it cost to stay at a psychiatric hospital?

The cost of a stay in a psychiatric hospital or ward varies widely. Some run on donations or require a very small fee, while others are privately run and expensive. You or your parents might be able to claim back some of costs through private health insurance or through federally funded health insurance programs.

How much time do people spend in psychiatric hospitals?

The length of stay depends on a variety of factors. These can include what you are being treated for, the type of treatment you need and what your doctor decides will help you best. Most stays are short-term.

It’s common that programs will run for a set period of time, and most people stay for the duration of that period. Involuntary patients may have the length of time set by a judge. After that set amount of time expires, a doctor will usually decide if further treatment is needed. Sometimes, the judges and doctors will not agree and a lawyer might need to get involved.

What happens in the psychiatric hospital?

Upon arrival at the hospital, a patient will have a consultation with a doctor.  The doctor will give an assessment of the situation a patient is in, and tell him or her a bit more about how everything works. If you’re a patient, this is a good time for to ask any questions you might have about your treatment or what you should expect. Depending on state law, you might get a second opinion from another doctor early on in your stay.

During your stay, the activities you take part in will vary depending on what your goals are. They might include:

  • Group work. This is a group discussion with other patients that is facilitated by a social worker, nurse, doctor, psychiatrist, psychologist or counselor.

  • Individual therapy. This is one-on-one counseling with a social worker, psychologist, psychiatrist or counselor.

  • Personal time. You’ll probably find that you have a lot of time to yourself during your stay. How you fill this time is up to you, but it might include interacting with other patients, doing work or studying if you feel able, or just chilling out and reflecting. Depending on the hospital and your needs, you might have your own room, or you might have to share with others. You might also be allowed to bring your own books, phone and music.

  • Visitors. Many hospitals have set visiting times so you can see family and friends. You might also be allowed to go home during weekends.

Medication

Unless it is an emergency situation, you can work with your psychiatrist on deciding whether medication should be part of your treatment.  Medication might include antidepressants, sedatives, antipsychotics and occasionally electric shock treatment for very severe mental illnesses. Just because a person is on more or less medication than you doesn’t mean that you are any better or worse than they are.

What to do if you’re unhappy with treatment

If you’re unhappy or unsatisfied with any part of your treatment, it’s important that you talk about it with your doctor or psychiatrist. They may not realize you’re unhappy unless you say something. You might then discuss ways to adjust your treatment so you’re getting the best possible outcome. If you continue to be unhappy with your treatment, you have the right to ask for a second opinion.

Dealing with fears about going home

You might look forward to going home, or you might feel scared or nervous at the thought of leaving the hospital. You might be scared that things will go back to the way they were, that you’ll be alone, or that you won’t be able to cope with the added pressures of home, like chores, work and school. The first few days at home can be tough. If you’re having a rough time, it’s important to make use of the supportive people you have around you. Try to identify people that you can talk to or call when you are having a hard time, like friends, family or a counselor. You might want to set this up before you leave the hospital.

It might also help to arrange activities before you leave the hospital so you have something to look forward to and to make you feel less alone. It’s a good idea to investigate and list these activities before leaving the hospital so that supports are in place before returning home, making the transition a little easier and less overwhelming. Hospital staff or a community mental health team member can assist you in doing this.

You or your doctor might also arrange for you to attend an Intensive Outpatient Program (IOP) as a way to transition from hospital to home. IOPs meet three to five days per week, for three to eight hours at a time. Like a hospital, you do a variety of work, including group and individual meetings, art therapy or recreational activities. Unlike a hospital, you go home at the end of the day. An IOP might also be an option if you aren't able to find a hospital that can help you, or if you want a treatment option that is in-between outpatient therapy and inpatient hospital stay.  

 

Acknowledgements: This article was originally developed by youth and staff for us.ReachOut.com


Mental Health Professionals

Who can help me through my mental health issues?

What do they do? Who’s the best fit for me? Below we take a closer look.

How can mental health professionals help you feel better?

Counselors, therapists, psychologists, and psychiatrists are all different kinds of trained mental health professionals. These professionals will work with you to identify your strengths and the things that cause you distress, and can help you find solutions and make changes. Here are some of the differences between these types of mental health professionals.

Counselors

Counselors often work in schools, at community health centers, on university or college campuses, and family planning clinics. Some may also work privately, having an office alone or with a group of other professionals. Counselors usually have a master's degree or higher, have completed many supervised training hours, and are licensed by the state they practice in. They are usually called Licensed Professional Counselor, or LPC, although some states have different licensing rules and so counselors may have slightly different initials after their names, like LPCC or LCPC. You can get more information on Counselors from the American Counseling Association.  

Another kind of counselor is a drug and alcohol counselor or a residential treatment counselor. These professionals usually have bachelor's degrees and are not necessarily licensed by the state. State standards for credentialing drug and alcohol counselors vary from state to state.

Therapists

Therapists, or psychotherapists, often work in private practices, alone or with a group of other professionals. Some work in hospitals, schools, or in community mental health clinics as well. Therapists have a master's degree or higher, have completed many supervised training hours, and are usually licensed as Marriage and Family Therapists (MFT) or a Licensed Clinical Social Worker (LCSW). You can find out more from the American Association of Marriage and Family Therapists and the National Association of Social Workers.

Psychologists

Psychologists have doctorates in psychology (PhDs or PsyDs), have completed many supervised training hours, and are licensed by the state. Both clinical psychologists and counseling psychologists are trained to diagnose and treat a wide variety of mental health problems, but typically, clinical psychologists work with people who have more severe problems (such as phobias, bipolar disorder, and schizophrenia), while counseling psychologists work with people suffering from less severe disorders (including depression, anxiety, everyday stresses, and relationship and family difficulties). Psychologists can work in agencies, hospitals, clinics, or private practice offices. The American Psychological Association has more information on licensed psychologists.

School psychologists are another type of psychologist; they usually work in a K-12 school setting. Generally they focus on learning and behavior problems, diagnose learning difficulties, and work with teachers and family members to suggest ways to improve classroom climate and parenting skills. Get more information from the National Association of School Psychologists.

Psychiatrists

Psychiatrists are medical doctors who can prescribe psychiatric medications. They are licensed as doctors but also have special training in mental health issues. Psychiatrists treat conditions such as depression, severe anxiety, schizophrenia and bipolar disorder. Psychiatrists have medical training, and as such, they can prescribe medication if they think it will help you. If your medical doctor thinks that it would be helpful for you to see a psychiatrist, he or she can refer you to one.

Your psychiatrist will listen to you, and talk to you about your emotions and how your emotions may be affecting your behavior. Most psychiatrists are happy to assist young people in this way. If you think your psychiatrist is not listening or hearing your concerns, or if you’re uncomfortable seeing a particular psychiatrist, you can go back to your doctor and ask to see a different one. If you are feeling anxious about a first appointment, you can take a friend or family member to the appointment with you. Sometimes a psychiatrist teams with a psychologist or other mental health professional, with the psychiatrist handling the medication aspect of treatment and the other mental health professional providing the counseling or therapy.

Other people you can talk to

If you’re struggling and need someone to talk to, check out our Crisis Helpline directory to find a resource near you or nationwide. You can call Lines for Life’s Suicide LifeLine at 1-800-273-8255 or Your Life Your Voice at 1-800-448-3000, run by Boys Town for everyone. There are also several apps you could use that connect you to peers going through similar things, as well as licensed professionals waiting to help you.

What mental health professional is right for me?

When you are looking for a mental health professional, it is important to look for someone who is licensed or credentialed in some way, so you are protected by ethical and legal rules governing all health professionals. What kind of license they hold is usually less important than if they’re a good fit in terms of training, specialty, personality, and availability.

If you need to find someone who works at a sliding scale clinic or accepts your insurance, then that is a more important factor for you than which license they hold. Similarly, you want to look for someone with training and experience in your particular area of concern, because the most skilled eating disorder therapist might not know the first thing about bipolar disorder. Just as importantly, you want to find someone who you feel comfortable with, someone you trust. All of that is usually more important than what initials someone has after his or her name!

It’s normal to use your first session with a prospective therapist (of some kind) to ask them questions to get to know if they’re the best fit for you. For ideas of what questions you should ask, try some of these. One resource you can use to maximize your search for a mental health professional is through Psychology Today’s Find a Therapist tool. You can search by location, insurance, religious affiliations, specific mental health issues, the gender of the therapist, and more. Theravive is an international resource that can help you find a therapist local to you, also. It’s important that you can trust your therapist, otherwise you won’t be getting the help you deserve to aid in your treatment.

Different approaches to counseling

Not all mental health professionals are the same—each has his or her own personality, theoretical orientation or approach to counseling and general style. For more information on some common types of therapy, check out the Counseling and Therapy article.  Finding someone to suit you is important. It’s helpful to remember that this can take time, and the first counselor or therapist you see might not be the right one for you. Try not to give up. If you don’t feel comfortable with the first counselor you see, or if you think the person isn’t listening to you, it’s OK to find a different counselor.

Taking medication

Sometimes just talking to someone will help. Other times, you might need medication to feel better. If a psychiatrist suggests you take medication, make sure you understand the effects of the drug and what some of the potential side effects might be. Some people find it useful to get a second opinion about taking medications. A second opinion may help you decide if using medication is something you want to do. It is important that you receive the information you need to make this decision.

Making an appointment

Psychiatrists work in both agency or hospital settings as well as private practice. Regardless of the setting, you will usually have to make an appointment. If they are busy, you may have to wait a while before your first appointment. If things feel really desperate, tell them it’s urgent, and they may be able to fit you in.

Asking about your privacy

It’s a good idea to talk to the psychiatrist you see about keeping your information private. This is generally something that your psychiatrist will bring up in your first session, but if they don’t, it’s OK for you to ask. In most situations, unless you ask the psychiatrist to share information, your psychiatrist will keep what you tell him or her confidential. If you would tell your psychiatrist something that suggests you are in serious danger to yourself or another person the psychiatrist would be ethically bound to share that information so that you or the other person could be safe. Psychiatrists are also required by law to report instances of abuse and there may be circumstances where they would be compelled to testify in a court case. The parameters for when a mental health professional can be required to testify vary by state.

Paying for treatment

If you’re insured, your insurance provider might require you to see a psychiatrist within a specified network, and you might have to pay for part of your visit. This payment is called a co-pay, and usually costs between $20 and $40 or a percentage of the costs (e.g. insurance will cover 80% and you will pay 20%). Your insurance might also only cover specific treatments. If you don’t have insurance, you might have to pay for your treatment out-of-pocket, which can be costly.

Every insurance carrier is different, and you might want to ask your psychiatrist about payment before you make an appointment. Some community agencies may offer a sliding scale which means you pay according to your income and what you can afford. If you are in school, you can check to see if there is a school counselor who can talk to about your struggles.

 

Acknowledgement: This article was partially developed by youth and staff for us.ReachOut.com