Self-Management of Depression

By Dr. David Kreindler

Self-management is “a process of taking increased responsibility for one’s health through learning about the … illness and developing the skills to recognize and control symptoms” when ill.2 Self-management in chronic disease has been described as a four-step process:

  1. Recognize that a change has occurred.
  2. Evaluate the change as linked to underlying illness.
  3. Try something to fix the change, and then
  4. Evaluate if the fix is successful6.

For example, in congestive heart failure, ankle swelling and shortness of breath may be identified as related to worsening heart functioning; taking some nitroglycerin and elevating your feet may result in improvement.

While a lot is known about the self-management of chronic medical conditions – for example, diabetes or congestive heart failure – less is known about the self-management of mental illness. We know that self-management programmes are well received by participants and they can lead to clinical benefits and cost benefits2. Interventions that promote taking medication as prescribed, teaching self-management skills, and assisting with early recognition of depressive episodes all improve outcomes in depression3,4.

In depression, self-management can include a variety of elements that are generally healthy things to do such as:

  • Putting (or maintaining) some structure in your life.
  • Trying to get good sleep.
  • Looking after your physical health.
  • Taking medications as prescribed.
  • Avoiding street drugs.
  • Keeping stress to reasonable levels.

Examples of other self-management strategies more specific to depression include7,

  • Learning about depression.
  • Educating others about it (including family, friends, and people at work or school).
  • Staying active / exercising regularly.
  • Setting goals.
  • Using family, friends, support groups, or other forms of support.
  • Using tools such as CBT strategies, mindfulness, relaxation, meditation, or distraction.

Symptom diaries can be particularly helpful. Not only do they assist with accurately tracking how you’ve felt over time, but they are also thought to be helpful5 with:

  • Identifying any environmental and psychological triggers.
  • Tracking how you respond to treatment.
  • Learning what characteristics are typical of your depression.
  • Appreciating what illness-related problems should be priorities for treatment.
  • Identifying depressive relapses as early as possible so you take action sooner rather than later.

Furthermore, self-managing your illness means becoming more actively engaged, which in turn is associated with better outcomes1.

The Sunnybrook Health Sciences Centre’s Department of Psychiatry and the Centre for Mobile Computing in Mental Health are currently recruiting for a study to assess whether a symptom diary ‘app’ on a cell phone can be helpful with self-management of depression. If you are interested in learning more about the study, please contact us at appstudy@sunnybrook.ca or visit http://sunnybrook.ca/research/content/?page=telemetry-major-depressive-disorder.

References

1. Baldassano CF. Assessment tools for screening and monitoring bipolar disorder. Bipolar Disord 2005;7 Suppl 1:8-15.

2. Jones S, Deville M, Mayes D, Lobban F. Self-management in bipolar disorder: The story so far. Journal of Mental Health 2011 Dec;20(6):583-92.

3. Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, et al. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 1996 Oct;53(10):924-32.

4. Katon W, Von Korff M, Lin E, Simon G, Walker E, Unutzer J, et al. Stepped collaborative care for primary care patients with persistent symptoms of  depression: a randomized trial. Arch Gen Psychiatry 1999 Dec;56(12):1109-15.

5. Piasecki TM, Hufford MR, Solhan M, Trull TJ. Assessing clients in their natural environments with electronic diaries: rationale, benefits, limitations, and barriers. Psychol Assess 2007 Mar;19(1):25-43.

6. Riegel B, Carlson B, Glaser D. Development and testing of a clinical tool measuring self-management of heart failure. Heart Lung 2000 Jan-2000 Feb;29(1):4-15.

7. van Grieken RA, Kirkenier AC, Koeter MW, Nabitz UW, Schene AH. Patients’ perspective on self-management in the recovery from depression. Health Expect 2013 Aug.

Dr. David KreindlerDr. Kreindler is the Head of Youth Psychiatry at Sunnybrook Health Sciences Centre, an Assistant Professor of Psychiatry at the University of Toronto, and leads Sunnybrook’s Centre for Mobile Computing in Mental Health.  He specializes in adolescent mood and anxiety disorders, and has a particular research interest in understanding how moods come to be.

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