Stanford Mood & Anxiety Disorders Laboratory

Q. Where should a person go for help?
If you think you might need help, see your internist or general practitioner and explain your situation. Sometimes an actual physical illness can cause depression-like symptoms so that is why it is best to see your regular physician first to be checked out. Your doctor should be able to refer you to a psychiatrist or psychologist if the severity of your depression warrants it.

Other sources of help include the members of the clergy, local suicide hotline, local hospital emergency room, local mental health center.

Q. How can family and friends help the depressed person?
The most important things anyone can do for depressed people is to help them get appropriate diagnosis and treatment. This may involve encouraging a depressed individual to stay with treatment until symptoms begin to abate (several weeks) or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the doctor. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon.

The depressed person needs diversion and company. but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or laziness or expect him or her to "snap out of it." Eventually, with treatment, most depressed people do yet better. Keep that in mind, and keep reassuring the depressed person that with time and help, he or she will feel better.

Q. What should you look for in a doctor? How can you tell if he/she really understands depression?
If you are looking for a psychopharmacologist to prescribe medications to help control your depression there are a number of things to check. If you are in psychotherapy, it is important to ask prospective doctors about their opinions on the psychotherapeutic treatment of depression. Psychopharmacologists who are hostile to psychotherapy are difficult to deal with while you are in therapy.

It is always legitimate to ask any professionals you are thinking about seeing regularly about their understanding of depression, their beliefs about the causes of depression and their philosophy of treatment. You might ask about how often the prospective doctor has worked with people who have had your particular variety of depression. If you have a rapidly cycling Bipolar depression, for example, you should seek a doctor who has much experience dealing with people who have this problem. Prior to the first visit it is important to clarify with the doctor or the secretary the fee of the initial and subsequent visits, the doctor's policy regarding missed and changed appointments, whether the doctor will accept assignment from insurance companies. If you have Medicare or Medicaid it is important to make sure that the doctor sees people with these forms of medical coverage.

Another aspect of the style of doctors is the extent to which they include their patients in the decision-making process. You might ask "How do you go about deciding which treatment is right for me?" See if you are comfortable with the method the doctor describes. Much can also be learned from how doctors respond to questions such as these. There is much difference between a doctor who welcomes such questions and answers them fully and one who is annoyed by them and answers them superficially.

	1. I do things slowly	0 1 2 3 4 5
	2. My future seems hopeless	0 1 2 3 4 5
	3. It is hard for me to concentrate on reading	0 1 2 3 4 5
	4. The pleasure and joy has gone out of my life	0 1 2 3 4 5
	5. I have difficulty making decisions	0 1 2 3 4 5
	6. I have lost interest in aspects of life that used to be important to me	0 1 2 3 4 5
	7. I feel sad, blue, and unhappy	0 1 2 3 4 5
	8. I am agitated and keep moving around	0 1 2 3 4 5
	9. I feel fatigued	0 1 2 3 4 5
	10. It takes great effort for me to do simple things	0 1 2 3 4 5
	11. I feel that I am a guilty person who deserves to be punished	0 1 2 3 4 5
	12. I feel like a failure	0 1 2 3 4 5
	13. I feel lifeless--more dead than alive	0 1 2 3 4 5
	14. My sleep has been disturbed: too little, too much, or broken sleep	0 1 2 3 4 5
	*15. I spend time thinking about how* I might kill myself**	0 1 2 3 4 5
	16. I feel trapped or caught	0 1 2 3 4 5
	17. I feel depressed even when good things happen to me	0 1 2 3 4 5
	18. Without trying to diet, I have lost, or gained, weight	0 1 2 3 4 5

Q. How can I help myself get through depression on a day-to-day basis?
On a day-to-day basis, separate from, or concurrently with therapy or medication, we all have our own methods for getting through the worst times as best we can. The following comments and ideas on what to do during depression were solicited from people in the alt.support.depression newsgroup. Sometimes these things work, sometimes they don't. Just keep trying them until you find some techniques that work for you.