The role of self-management in the treatment of depression

Blog Post by Albert Yeung, M.D., ScD; Greg Feldman, Ph.D., Maurizio Fava, M.D.

While the exact etiology of unipolar depression continues to be unclear, most clinicians and researchers consider that it is caused by a mixture of genetic predisposition, psychological factors like negative thoughts and unrealistic expectations, and sociological factors like marital problems, tension at work, or difficulties with interpersonal relationships.  Intuitively, treatment of depression should involve a multi-dimensional approach to help patients achieve an improved quality of life. 

Conventional treatments of depression are antidepressant medications and some forms of psychotherapy like the cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).  Increasingly, research findings have informed us of the benefits as well as the limitations of these treatments.  A significant percent of patients who receive antidepressant medications do not adhere to the treatment; many suffer from medication side effects or show inadequate or partial response. Many patients who show initial response to medications experience relapse of their depression.  Although psychotherapies like CBT and IPT have been shown to produce lasting improvements in symptoms for many patients, not all patients who try these treatment experience these benefits.   Furthermore, patients may have difficulty finding a therapist in their area who practices empirically-supported psychotherapy. When such therapists are available, patients may find a long waitlist for an initial appointment.

These may be some of the reasons why many patients in recent years have started to ask, “Is there anything more I can do to control my depression?”   This may also be part of the evolving trend in which many patients do not want to be passive recipients of medical treatment.  Rather, they want to be partners in both the medical decision making process and the treatment of their illness.  The partnership between clinicians and patients is particularly relevant for an illness like depression as a person’s thinking style, behavior, and ability to regulate his/her emotions are likely to impact treatment outcomes.

In our new book on Self-Management of Depression: A Manual for Mental Health and Primary Care Professionals”,  we discuss effective self-management measures for depression that are supported by scientific evidence and informed by successful approaches to manage other chronic medical illnesses.   For example, many clinicians advise depressed patients to exercise.  This book presents the evidence for exercise as a treatment for depression, the type and dosage of exercises shown to be useful, and whether exercise can be used to prevent future relapse of depression.  In addition, we present strategies for helping patients overcome motivational barriers to regular exercise. We provide a similarly detailed discussion of the efficacy of other self-management approaches including psychoeducational resources, peer support groups, mind-body interventions such as relaxation response and mindfulness meditation, and computerized self-administered CBT programs. We also provide practical suggestions for clinicians incorporating self-management into a treatment plan as well as downloadable, reproducible handouts that can be given to patients to support them in applying self-management.  Clinicians who read this book will be equipped with a broad knowledge base and specific strategies to advise their depressed patients and empower them to become active partners in the management of their depression symptoms

Albert Yeung, M.D., ScD; Greg Feldman, Ph.D., Maurizio Fava, M.D are the co-authors of Self-Management of Depression: A Manual for Mental Health and Primary Care Professionals

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