Managing depression without medication

Managing depression without medication

hi everybody this is dr. Jenny burn at cognitive psychiatry of Chapel Hill and today I’m going to continue my series about lessons that I have learned from my patients over the years and today I’m going to talk a little bit about depression and specifically how some of my patients manage depression without medication so obviously I’m a psychiatrist and one of the main reasons people come to see me is for medication and when people are depressed sometimes they need medication and sometimes they don’t and one of the most important things about my job is not just deciding which medication to give them but also to help them decide if they’re going to take this medication long term or if somebody had depression and they’re feeling better should they come off the medication or should they continue and how do they make those kinds of decisions so while I’m working with people on these choices we often talk about managing depression without medications and here’s some of the things I’ve learned from my patients for some people there’s kind of a spectrum right so for some people depression is a chronic illness and it may be genetically related it may be something they were born with and no matter what they do they tend to need to be on medication so if you want to compare this to a health condition maybe compare it to high blood pressure that’s something a lot of people can relate to so there are some people in the world for whom high blood pressure is genetic and over time they are going to develop it almost no matter what they do and for those people often they need to take a blood pressure medication for the rest of their lives to prevent their blood pressure from spiking and causing problems like heart attacks or strokes so depression is kind of like that so I have some patients at one end of the spectrum who say to me you know no matter what I’ve done I’ve done therapy I’ve done lifestyle changes I’ve reduce my stress I’ve taken care of my health and I still have problems with depression those kinds of patients typically will choose to stay on medication long term the same way that somebody with high blood pressure might stay on medication long term and I will say that if you’ve had an episode of major depression every time you have another one your risk of having a future episode increases so by the time you’ve already had three or four or five episodes of depression you know there’s a very good chance you’re going to have more and medication may help to either prevent or lessen the effect of a future episode so that’s one end of the spectrum then you kind of have the other end of the spectrum where they’re patients of mine who have come in and they’re depressed maybe they’ve had a bad breakup maybe they’ve been in a abusive relationship maybe they are just struggling with choices in their life about school or jobs and they get depressed and they have a depressive episode and some of these patients would like to take medication and some would not so the patients on this end of the spectrum kind of the more mild depression or less kind of genetic there’s a lot of things they do to help manage their depression without medication so lifestyle for these patients they’ve told me things that really help them are kind of the same things for a lot of us right sleeping getting enough quality sleep taking care of their physical health is really important eating well is important reducing stress and I know we all say stress but for some people really reducing stress makes a huge difference in their life and that might be changing jobs or dealing with a relationship that’s been problematic or just simply reorganizing their lives so that there’s kind of less going on those things can be really helpful now in between the two extremes of people who really don’t want to take meditation and don’t really need to take medication to get through their depression and the opposite of stream of people who really do kind of need to be on lifelong medication there’s a whole range of people in the middle and this is where it gets tricky and in some ways this is where the decision-making is harder so what have I learned from my patients I’ve learned that there is no one solution for everybody and what is right for you at one point in time in your life may not be right for you at another point in time in your life so medications are a tool to treat depression and you have other tools that you can develop and put in your toolkit so I already mentioned some of my patients telling me about you know sleep diet exercise taking care of their general health then you can also get into some tools like mindfulness meditation yoga and I put those together not because they’re all the same but because they all kind of draw upon a reflective inner state with breathing exercises and ways to really calm down your body so I put them together because they all kind of do that in different ways those can be great tools to help with anxiety and depression and some of my patients find that that is enough maybe they’ve been on medications for a couple years and now they’re in a better place in their life and they’re ready to try to come off those medications and those lifestyle changes and meditation is enough and that keeps them feeling good you might get into some other situations so I’ve had patients one really tricky situation I’ve had with patients is when people get married or to have children and pregnancy that’s always a really big question mark for women who have had depression in the past because they wonder okay I had depression before it took some medication then I came off and I did well but now I’m pregnant and I don’t know what’s gonna happen if I get depressed a lot of women can have the blues or even postpartum depression what am I going to do that’s a tricky time period and my patients say that one thing that really helps them in those situations is having a consultation with a doctor often a psychiatrist but it could be an OBGYN with a lot of experience and depression it really helps them to prepare by having a consultation visit and to talk about their history and to talk about what they’re hoping for their pregnancy and for after their pregnancy and just to talk through these medicines and what are the pros and cons what are the risks to a baby either in utero or a newborn or baby getting breastfed having that consultation visit either before they get pregnant or during their pregnancy really helps them a lot so patients have told me that just having information and education really helps them cope with depression should it arise during a perinatal or meaning kind of before during or after pregnancy another thing I’ve learned from my patients is that monitoring is really really important so if you have had depression in the past maybe you’ve had one or two episodes of depression and you’re feeling pretty good life’s in a good place you come off your medication you’re feeling good one lesson I’ve learned is that monitoring is really the key so normally what do people do you’re feeling good you don’t go back to the doctor right of course that makes total sense but one thing that I found to be really helpful is monitoring my patients even when they’re feeling good and this is kind of counterintuitive right because if you’re feeling good why on earth would you go see dr. Berg but in reality I check in with people every three months ideally which again I know that sounds like a lot but compare it to the patient with high blood pressure so again if you’ve had high blood pressure and you’ve made lifestyle changes and your blood pressure comes down that’s great you don’t need to take medicine you don’t just forget about it right you keep checking your blood pressure and you go to the doctor and you check your blood pressure maybe you check it at home and you make sure that that kasher isn’t starting to creep up again it’s very similar with depression you keep an eye on it maybe you track your mood at home maybe you have a partner a spouse a family member a friend who helps keep an eye on your mood and tells you hey I think you seem like you’re not feeling as well is everything okay you know let’s just check in or maybe you work with a doctor that you check in with every three months that’s that’s a pretty normal interval some do a little bit longer but you don’t just forget about it just because you’re off your meds and you’re feeling good that doesn’t mean that you never have to think about it again now maybe you’ll never get depressed again and that would be awesome but you keep an eye on it because and why why do I say this is so important because if the patients come in and keep an eye on it with me or even at home then we can catch it before it gets really bad same as for blood pressure right like you want to catch that blood pressure maybe when it’s 135 over 90 instead of when it’s 180 over a hundred because the health risks of that really high blood pressure are way worse same with depression you don’t want to wait until it’s so bad that you’re not functioning to come back into the doctor you really want to catch it as it’s starting to get worse and then maybe restart that medication and you catch it and then it doesn’t really get so bad so that is a really important lesson I’ve learned from my patients and a lot of them tell me that’s not intuitive you know it doesn’t make sense to them why do you need to check in but after they’ve been through this for a while they they can see the benefit I think another may be a final thought about what I’ve learned from my patients is that the lifestyle changes and the stress reduction only work as long as you do them right so again if you make these lifestyle changes and you’re feeling better and you don’t need to take medication that’s great but if you stop doing all those good things for yourself and you have stress build-up or you’re in a bad relationship or you know that depression can come back so if you have a change in your life it’s really important to check in with yourself again with a friend a family member a doctor even a major medical change if you’ve had a new medical illness or a surgery or something it’s a good idea just to check in and say how’s my mood doing am ia noticing some things which kind of look like I might be getting depressed because that’s when you need to get in and get help so the journey of life has a lot of ups and downs and stresses and times that are better and times that are worse sometimes our ability to make lifestyle changes is better sometimes we’re not able to make those lifestyle changes for women things like pregnancy and having kids changes your body and how you have depression so life is a journey and depression is something that may travel with you and if you’ve only had it once and then you don’t have it again you’re lucky and that’s wonderful but for a lot of people it’s a journey and it can be there in the background and you need to just think about that and keep an eye on it and then medication become something in your toolkit that you can use if that depression comes back and again there’s some people on the other end of the spectrum for whom it’s you know genetic it’s part of who they are no matter what they do it’s gonna come back and those people probably do better to stay on medication and I draw the analogy with blood pressure because I think that’s something that’s easy for a lot of people to relate to and high blood pressure doesn’t have quite the same stigma as depression so I hope this has been helpful if you are having depression or you’ve had an episode in the past and you’re not sure if one is starting again or how to track it feel free to reach out to us we’re here to help and you can see our contact information below so hope today has been helpful and I’ll see you next time I

Lessons I have Learned from my Patients – Managing Depression without Medications