Addressing depression
DR. KAUFFMAN: Medication also can play a useful role for some patients.
DR. PALMER: Patients who meet criteria for major depression—in particular if they’re having suicidal thoughts—absolutely need psychotropics. Mr. R, my case patient, benefited greatly from CBT and medication. We also worked on financial planning and handling financial conflicts with his wife and children. He is exercising, doing volunteer work, and staying connected with friends and family. He is hoping to find a job in the next few months.
DR. REDIGER: For a person who’s going though a stressful period, I try to keep medication time-limited. We talk about treating symptoms, but it’s important to look at what’s causing the patient’s problems and address it.
DR. PALMER: During this recession, a lot of people are going to be down but not clinically depressed. If the depression is mild to moderate, I sometimes recommend exercise instead of medication (such as when a patient is refusing medication or has had serious side effects from medications). I recommend exercise for all my outpatients—even if they’re taking psychotropics—because exercise has been shown to be as effective as antidepressants for moderate depression.7,8
DR. REDIGER: We’ve also been encouraging people who’ve lost jobs to volunteer in the community. Having a reason to get out of the house takes the mind off one’s worries.
DR. KAUFFMAN: The “3 good things in life” exercise studied by psychologist Martin E.P. Seligman, PhD, has been shown in a 6-month, randomized, placebo-controlled study to increase happiness and decrease depressive symptoms.9 In this exercise, you look back at the end of each day and write down 3 things that went well, their causes, and an explanation for each good thing. Ask yourself, “When was I at my best today? What happened today that I feel grateful for? What did I do to make that good thing happen?”
DR. REDIGER: Remind people to talk to their children about the recession, too. If they have to move to a different home or to a different school, let their children know things are going on and how to think about that. This can help kids understand how to deal with their anxiety.
Related resources
- Getting through tough economic times. A SAMHSA guide. Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services. www.samhsa.gov/economy.
- Seligman MEP. Authentic happiness: using the new positive psychology to realize your potential for lasting fulfillment. New York, NY: Simon & Schuster; 2002.
- Positive Psychology Center. University of Pennsylvania, Philadelphia. www.ppc.sas.upenn.edu.
Drug brand names
- Escitalopram • Lexapro
- Fluoxetine • Prozac
- Lorazepam • Ativan
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Acknowledgment
This article was researched and written by Current Psychiatry Editor Alice V. Luddington, ELS, and Senior Associate Editor Erica Vonderheid.