Major Depressive Disorder - Recurrent episode

Management and Resources

At home

When an individual is depressed, it is extremely difficult to make changes to behavior. In fact, getting out of bed might feel daunting. Even so, small tweaks in a daily routine can accelerate recovery. Behavioral changes, when added to medications and therapy, can be a powerful combination. Some ideas for positive behavioral changes are as follows:

Resolving to accomplish one thing each day. These should be simple actions: For example, to get up and get dressed. To get outside and take a walk around the block one time is even better. The goal simply needs to be doable; something that can be achieved within a day, not something more elusive like training for a half marathon or acing an assignment. When a person completes the chosen activity, they can tell themselves they did well, and work to silence any negative thoughts that say otherwise.
Doing one kind thing for someone else. This can be as small as a text message to say “I’m thinking of you,” or kind words over phone or email to a family member or friend. Some people feel better when they volunteer occasionally in their community. This helps focus thoughts away from oneself and, at the same time, help others in need.
Resolving to express gratitude for one thing at the end of the day. If the weather is bad, such as a snowstorm or a torrential downpour, it can help to try and find something about it that can be appreciated. For example, one may find the scene beautiful or be glad that it was not necessary to drive in the weather. Finding gratitude, and specifically, writing down those thoughts promotes feelings of wellbeing. Ideally this would be part of an end-of-the-day routine.
While many are aware of the vast, proven benefits of diet and exercise, taking these steps can be particularly difficult during a depressive episode. However, everyone's body needs movement, sunshine, and non-processed foods (especially vegetables). An individual should start small: eating one vegetable or fruit per day; walking one lap around the block. Tiny changes, over time, can make a real difference.

Weight gain and antidepressants

A common complaint about antidepressants is that they cause roughly 25% of individuals to gain weight, typically after six or more months of use. The mechanism by which this happens is unclear: For some individuals, antidepressants cause increased appetite or cravings for carbohydrates. For others, the medication changes their metabolism. Other studies find that simply improving one’s mood is associated with weight gain. Regardless of its cause, there a couple ways to combat medication-related weight gain.

While improving one’s diet and increasing daily exercise is particularly difficult while depressed, it is one of the best ways to manage weight gain related to medications. Individuals can try to make small changes, but they must remember to give themselves grace if this is too difficult to do during an episode of depression.

Some individuals decide that the weight gain is intolerable, and they might try a different antidepressant medication. For some, switching to another medication within the SSRI group is enough to improve their symptoms. For others, they might try switching to a different class of medication, such as a DNRI, which do not typically cause weight gain.

At work

Depression tends to affect all parts of one’s life, including life at work. It can lead to tardiness, missing details, and lower productivity. In some cases, work scenarios can contribute to one’s depression. Unsupportive work cultures, or demanding environments can contribute to burnout, which can amplify the symptoms of depression. When depressed, it is important to remember that getting treatment might make work feel more manageable. In the meantime, here are some examples of ways to move forward:

Many organizations have started to offer an employee assistance program or partner with an organization that offers mental health services. Individuals should check with human resources at their workplace to see whether such resources exist and whether the individual is eligible.
Giving oneself grace: while depressed, simply keeping in mind that one might need to take a break every so often, or perhaps a day off in order to maintain spirits. While taking breaks can seem disruptive, this strategy may be effective in protecting wellbeing and providing perspective.
One should never feel that they must tell anyone at work about having depression, and at the same time, it does not need to be a secret. The amount an individual shares is his or her choice, though some people find it useful to share that they are having a rough patch with a colleague or supervisor. Well trained managers understand that individuals experiencing depression might need a modification in their work responsibilities for a period of time.
Finding support: Having a friend, preferably at work, can lend many benefits. Getting the support of friends, family, and even online support groups can be a powerful way to listen to others and share one's stories in a confidential and dignified way.
If in an unsupportive work environment, where continued productivity is inconsistent with protecting one's mental health, think about whether a job change in the future is right. But, as a general rule, individuals should not make life-changing decisions while in the midst of a depressive episode. This applies to work and personal relationships. For this reason, it is ideal for individuals to discuss work modifications with an employer while also getting treatment. As an individual improves, it is more likely that one’s mind is clearing, and that a judgement about work is solid.

At school

Since depression affects all parts of one’s life, school is no exception. It can lead to tardiness, missing details, and absences at times. School administration typically offers student counseling services. Given the abundance of stress related to exams, and school performance, it is common for students to feel overwhelmed, depressed, and in need of support. Individuals can reach out to a dean of student services for information.

One should never feel that they must tell anyone at school about having depression, but at the same time it is not necessary to be a secret. The amount an individual shares is a personal choice, though some people find it useful to share that they are having a rough patch with a professor or TA. Teachers often understand that individuals experiencing depression might need a modification in their coursework for a period of time.

In relationships

Depression can have an impact on relationships in many ways. When an individual’s partner or friend does not have depression, it can be difficult for the partner to understand what the person is going through. One’s partner may expect the individual to be able to “snap out of it,” which can add to feelings of loneliness or sadness.

Even so, when an individual opens up about the experience of depression, it can help bridge the gap in understanding -- although, sharing struggles is not always easy. People with depression may be worried or feel like they are burdening others with their sadness or complaints, but this may not be the case. Sometimes being open during these struggles can fortify relationships.

The symptoms of depression may also bring challenges to a relationship. If someone is depressed, they may be less likely to want to plan activities together or socialize with others. They may want to sleep more and eat less. It is important to recognize that one partner may make these choices because of their depression and not because they are choosing to withdraw from the other partner. It is critical that both parties in the relationship focus on treatment, and to remember that this lack of interest is temporary. In many cases, the right combination of therapy and medication restores the person suffering from depression.

Couples counseling can be a fantastic tool for improving a relationship quality when one or more partners struggles with depression. It can help both parties empathize with the other, and to find ways to best support one another. For some people, having depression, and also taking antidepressants can impact their sex lives. An individual may experience low libido, erectile dysfunction, etc... but there is hope: The first step to addressing this issue is to acknowledge it, but sharing this type of sensitive information with a partner or provider is not always easy.

A couple steps one might try to improve libido include:

Trying a new routine with one’s partner such as exercising before sex, or incorporating new types of stimulation into the routine.
It is possible that when depression improves, libido will also improve: Research has shown that depression can cause these effects with or without taking an antidepressant.
A provider may adjust an individual’s dose of medication to find a level which balances effectiveness with libido.
Some of the commonly known medications for erectile dysfunction (Viagra, Cialis, etc..) can be helpful to antidepressant induced sexual dysfunction in men.
If the examples above do not work, a different type of medication that has fewer sexual side effects might be the next step.

Depression can cause impaired self esteem, which can also challenge relationships. An individual may find themselves needing reassurance or outside validation during episodes of depression. One should always keep in mind that periods of depression will require tenderness in relationships.

Organizations

National Institute of Mental Health

American Psychological Association

Centers for Disease Control and Prevention (CDC)