Support for Depression – How to Get More

Support for DepressionMany of the people I see feel that it’s very hard to get support for their depression. They may find it hard to talk about the subject altogether or they may have had some experiences that suggests that “people just don’t want to know.”

This morning I saw several people with depression and bipolar and what struck me was that my sense of enthusiasm for helping these different people, who are all dealing with more or less similar problems, did not correlate very well with how depressed they were.

One woman who has been wrestling with depression for many years has had a significant worsening in her mood associated with suicidal thoughts this past week. After our session, during which I don’t think I came up with any particularly brilliant idea for how to solve her problem, she turned as she was leaving my office and said “thank you for your help.”

After the session, not only was I smiling, but I found myself thinking that I needed to spend some more time coming up with better answers for her.

Another woman who has also been wrestling with depression for many years and recently has seen a modest improvement in her mood, although it is certainly far from where either of us would like her to be, ended our session by saying how frustrated she was that we still hadn’t found a solution.

I’m not trying to suggest that expressing frustration to your psychiatrist is not entirely appropriate, it is. But what occurred to me this morning was how this difference in working with a psychiatrist might play itself out in other ways in the lives of these two women.

Then I happened across an article on exactly the subject in the Bipolar Magazine. It is called “advice for the support team.”

“Sometimes managing your bipolar disorder can feel so overwhelming, it’s easy to forget that the people who love you are living with bipolar, too. They get stressed. They may feel angry or hurt by your words or actions. They want to help, but don’t know how.”

“Sometimes meaning well isn’t enough: People in your support team need education and simple, concrete guidelines. That’s what columnist Stephen Propst gives inWhat Helps and What Hurts.” So make it a point to sit down together and review his ideas.

For example: “Remember to acknowledge any effort your loved one makes to deal with his or her situation.””

People wrestling with depression deserve compassion and love, but so do those who were trying to support loved ones with depression.

Thank you can be a real gift, and can help you build a strong support system.

Skill Building for Psychosis

skill buildingOne of the very hard things about many psychiatric disorders, including bipolar disorder and schizophrenia, is that they often begin at a time that is critical to the development of many skills and abilities needed for successful adult life.

Many years ago we visited a wonderful program in Atlanta developed for young people with schizophrenia called STARS. The program was intended to be a comprehensive treatment approach that helped people with schizophrenia live fulfilling adult lives. It had remarkable rates of success.

One of the many creative things about the approach that the STARS program took, was that it tried to address practical social skills as well as skills related more directly to managing the symptoms of schizophrenia.

Perhaps the most popular educational component involved having young college volunteers come in and coach the patients on dating skills. After all, many of them missed out entirely on this experience because they were so symptomatic. And if you miss out on dating skills in high school and college, you end up at a serious disadvantage for the rest of your life.

We ran across this article, which summarizes a comprehensive review of the literature on the importance of skill building for all treatment programs and we were reminded of our visit to STARS, and of the importance of providing comprehensive help to people with serious psychiatric disorders…

Skill building—which involves strategies for helping adults with serious mental illness manage their illness, develop daily-living skills, and succeed in recovery—should be a foundation for rehabilitation services covered by comprehensive insurance benefit plans. That’s the finding from the study, “Skill Building: Assessing the Evidence,” published in Psychiatric Services in Advance.

Researchers from multiple institutions searched meta-analyses, research reviews, and individual studies from 1995 through March 2013. In this review, they examined four key components of skill building: social skills training (including life skills training), social cognitive training, cognitive remediation, and cognitive-behavioral therapies that target skills for coping with psychotic processes. The researchers chose from three levels of evidence (high, moderate, and low) on the basis of benchmarks for the number of studies and quality of their methodology.

More than 100 randomized controlled trials and quasi-experimental studies support rating the level of evidence as high. Study outcomes indicated strong effectiveness for social skills training, social cognitive training, and cognitive remediation, especially if these interventions are delivered through integrated care approaches. Results are somewhat mixed for life skills training (when studied alone) and cognitive-behavioral approaches.

“The current body of research has established the value of skill-building approaches,” the researchers said. “Although further research will help clarify their effects on some outcomes, research is not needed to support the decision to include skill-building approaches as covered services, particularly for individuals with schizophrenia and other psychotic disorders.”