Support groups for spouses of depression

SAMHSA’s National Helpline | SAMHSA

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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

Suggested Resources
What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.
It's Not Your Fault (NACoA) (PDF | 12 KB)
Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.
Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.
For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Recovery and Recovery Support | SAMHSA

Recovery and Resilience

Resilience refers to an individual’s ability to cope with change and adversity. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges but also to be better prepared for the next stressful situation. Psychological resilience, the ability to cope with adversity and to adapt to stressful life events, varies widely from person to person and depends on environmental as well as personal factors. It refers to positive adaptation, or the ability to maintain mental and physical health despite participating in stressful situations. Resilience is playing up those protective factors so they can outweigh the risk factors. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery.

Because recovery is a highly individualized process, recovery services and supports must be age appropriate and offered over the life course and flexible enough to ensure cultural relevancy. What may work for adults in recovery may be very different for youth or older adults in recovery. For example, the promotion of resiliency in young people, and the nature of social supports, peer mentors, and recovery coaching for adolescents and transitional age youth are different than recovery support services for adults and older adults.

Recovery and Relationships

The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. They provide essential support to their family member’s journey of recovery and similarly experience the moments of positive healing as well as the difficult challenges. Families of people in recovery may experience adversities in their social, occupational, and financial lives, as well as in their overall quality of family life.

These experiences can lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery.

Peer support assists individuals to engage or stay connected to the recovery process through a shared understanding, respect, and mutual empowerment. Peer support extends beyond the reach of clinical treatment into the everyday environment providing non-clinical, strengths-based support. This relationship can help lay the foundation for SAMHSA’s four dimensions of recovery.

Recovery Support

SAMHSA advanced recovery support systems to promote partnering with people in recovery from mental and substance use disorders and their family members to guide the behavioral health system and promote individual, program, and system-level approaches that foster health and resilience; increase housing to support recovery; reduce barriers to employment, education, and other life goals; and secure necessary social supports in their chosen community.

Recovery support is provided in various settings. Recovery support services help people enter into and navigate systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.

Recovery support services include culturally and linguistically appropriate services that assist individuals and families working toward recovery from mental and/or substance use problems. They incorporate a full range of social, legal, and other services (PDF | 409 KB). that facilitate recovery, wellness, and linkage to and coordination among service providers, and other supports shown to improve quality of life for people (and their families) in and seeking recovery.

Recovery support services may be provided before, during, or after clinical treatment, or may be provided to individuals who are not in treatment but seek support services.

These services, provided by professionals and peers, are delivered through a variety of community and faith-based groups, treatment providers, schools, and other specialized services. The broad range of service delivery options ensures the life experiences of all people are valued and represented.

For example, in the United States there are 34 recovery high schools that help reduce the risk in high school environments for youth with substance use disorders. These schools typically have high retention rates and low rates of students returning to substance use.

Additionally, SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) advances effective recovery supports and services for people with mental or substance use disorders and their families.

Find more Publications and Resources on Recovery and Recovery Support.

Depression

Russian Academy of Medical Sciences
SCIENTIFIC CENTER FOR MENTAL HEALTH

DEPRESSION (from hope to certainty).
(INFORMATION FOR PATIENTS AND THEIR FAMILIES)

nine0003

MOSCOW
2008

Oleichik I. V. - Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

© 2008, Oleichik I.V.
© 2008, NTsPZ RAMS

The vast experience accumulated by mankind and reflected in many literary works convincingly shows that sadness (sadness, spleen) has always gone side by side with people, being one of the natural human emotions. None of us is immune from failures, illness, breakups, loss of loved ones, financial collapse. Each person can face something inevitable and inevitable, when it seems that life loses its meaning, and despair becomes boundless. However, normally, sadness, sadness and melancholy, as natural reactions to traumatic events, weaken over time and the person's condition returns to normal without special treatment. The situation is different with depressions, which are mental disorders that differ from natural physiological reactions in greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment. nine0003 A depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only an individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. And this applies to all countries, regardless of their level of social development. Every year, at least 200 million people in the world fall ill with depression. Perhaps these figures are even higher, since most victims of depression do not seek help because they are not aware of the painfulness of their condition. Scientists have calculated that almost one in five people who have reached adulthood will experience at least one episode of depression during their lifetime. nine0003 In the most general sense, a depressive state is one of the possible forms of a person's response to the impact of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic disease, traumatic brain injury, changes in the hormonal background, which is especially important for the female body, regular certain medications, such as hormones, blood pressure medications, alcohol or other drug abuse. In other cases, depressive states develop as a manifestation of such mental illnesses, in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc.). If, based on the description of depressive symptoms set out later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to control yourself”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is a disease like rheumatism, arthritis or hypertension, it responds well to treatment, resulting in almost always a full recovery. You should not blame yourself for the occurrence of depression, it does not indicate either your fault, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely diverse. nine0018

Manifestations of depression

Manifestations of depression can be very different. Depressive states can be manifested by a violation of almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscle retardation, lasting at least 2 weeks. Depressed mood during depression can manifest itself as mild sadness, sadness, and boundless despair. Often it is accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain behind the sternum, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant "companion" of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to violent excitement, riot. Anxiety and bad mood arise at the mere thought of the need to make some kind of decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself on the physical (bodily) level in the form of belching, intestinal cramps, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc.
The picture of depression is complemented by the disappearance of desires, interests, a pessimistic assessment of everything around, ideas of one's own low value and self-blame. Deficiency of vital impulses is manifested in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between different options, human activity is sharply hampered. Depressed people are well aware of this: they complain that insignificant everyday tasks, small issues that used to be solved almost automatically, take on the significance of complex, painful, insoluble problems. At the same time, a person feels that he began to think, act and speak slowly, notes the suppression of instincts (including food and sexual instincts), the suppression or loss of the instinct of self-preservation and the lack of the ability to enjoy life up to complete indifference to what used to be liked evoked positive emotions. nine0003 People suffering from depression often feel "stupid", "mentally retarded", "feeble-minded". Thinking in depression becomes viscous, painful, requires special efforts, one mental image is hardly forced out by the next. The sick person is oppressed by the feeling of his own intellectual insolvency, professional collapse. Depressed patients can hardly describe their painful experiences to the doctor. Only after getting out of depression, many of them say that the mood at that moment was lowered, thinking was slow, all undertakings (including treatment) seemed in vain, and the years lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this because of the almost complete absence of thoughts in their heads, “para-lich of thinking”. With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have "Alzheimer's disease", "schizophrenia", "senile dementia", which is not true. Especially often these complaints are found in depressions that develop in adolescence. nine0003 Typical story
Aleksey, 18 years old, 1st year student of a technical university, describes his condition during depression as follows:
“From childhood, I was fond of technology and modeling, I could read special literature for hours, won school and regional olympiads in mathematics and physics. After graduating from school, my dream came true - I brilliantly passed the exams to a prestigious university. Then it seemed to me that the whole world was at my feet, I flew with happiness "as if on wings." In September, I happily began to study. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming increasingly difficult for me to absorb what I read, I did not remember the simplest text, I could not solve problems that I used to “click like nuts”. Trying to achieve success through many hours of brainstorming or drinking a few cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I was "finally and irreversibly stupid." At night I sobbed, wrapped in a blanket and thought about how best to commit suicide. Luckily, I met a senior in the library and shared my problems with him. My new acquaintance said that he experienced something similar and advised me to contact the psychiatrist of the student clinic. After the examination, I was diagnosed with juvenile depression and sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates. nine0018

Depression can also be accompanied by real setbacks: for example, a decrease in academic performance, the quality of work, family conflicts, sexual disorders and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result there is a false sense of the irreparability of what happened, "the collapse of all hopes."
Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which happens either without clear external causes, or under the influence of traumatic situations, unpleasant news. It is during these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, loss of work and a sharp change in lifestyle, as well as relatives commit suicide. nine0003 Typical story
Eugene E., 35 years old, leading manager of the company.
Almost all my life, my career went “on the ascending”, the goals set were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all the time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the country. He often lacked sleep, stayed late at work, took home assignments, and was deeply worried about the affairs of the company. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, more and more often he suffered a “fiasco” in intimate life. Thoughts appeared that life was lived in vain, that it is a "chain of tragic mistakes" that led to a dead end. He began to believe that the choice of work, friends, family was wrong, for which now "retribution has come." Analyzing the past years for a long time, he found more and more evidence and examples of his "duplicity, hypocrisy, insincerity, etc. " I realized that the only way to solve all problems is to voluntarily leave this life. At the same time, he believed that by this act he would free the family from the “burden”, “loser”, “loser”. I decided, having locked myself in the garage, to get poisoned by the exhaust gases of the car. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an "accident". The thought of leaving life did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After a shot in the mouth, in a serious condition, he was taken to the Research Institute. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relations, he himself believed that treatment by psychiatrists was completely useless, because. his situation is hopeless and no medicines will help here, but will only "stupefy" his psyche. However, after two weeks of taking a modern antidepressant, the patient's point of view changed. Everything began to look not so bleak and hopeless, interest in work and life in general returned, I began to feel more cheerful, more energetic, interest in intimate life appeared. He took work to the clinic, called up colleagues. After two months of treatment, he fully returned to his usual life. With bewilderment, he recalled his thoughts about insolvency, the collapse of life, suicide. He took the drug prophylactically for about six months, then, on the recommendation of a doctor, he gradually reduced the dose and stopped taking it. Over the next two years, the condition remained stable, career growth continued, another child was born. nine0018

Depression is also characterized by sleep disturbances, occurring in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of a sense of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression.
If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems, to admit to "weaknesses". Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka heals”). In addition, often patients suffering from depression, in order to "shake themselves up", "throw into all serious", engage in casual sex, are fond of gambling or extreme sports, leave to serve on a contract in "hot spots", lead an idle lifestyle with constant attendance at entertainment events. Surrounding people, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, parasitism. Meanwhile, this behavior is a kind of “cry for help”, an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions. nine0003 Depressive conditions can occur in shallow forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by:
- ideas of guilt, sometimes reaching the degree of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Mankind will die, that they are “moral monsters” from birth, supposedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth.They find in their past numerous "confirmations" of the above, believe that the doctor and other patients are aware of these transgressions and express contempt and indignation with their facial expressions and gestures, but in words “they hide, deny the obvious.” Both the patients themselves and their relatives must remember this in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, potent drugs and poisonous close household fluids, close windows or shutters, do not let the patient go anywhere alone. If these ideas become persistent and cannot be dissuaded, it is urgent to seek advice from a psychiatrist. neurological institution or call a psychiatrist at home. nine0003 - mood swings during the day: in typical cases, the patient, waking up, immediately feels longing. Sometimes, even before full awakening, through a dream he experiences a painful premonition of a heavy coming morning. In the evening, the state of health improves somewhat.
- the patient may experience a feeling of unmotivated hostility towards relatives, friends, constant internal discontent and irritation, which makes him unbearable for the family.
- in a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive ones, come to the fore. arising against the will, ideas about the misfortunes and troubles of family members. nine0018

Typical story
Dmitry Petrovich, 58 years old, teacher.
“After minor troubles at work, I began to feel incomprehensible anxiety and agitation. Unpleasant thoughts came into my head that I did something wrong at work, because of which I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not let go: as soon as the daughter or wife lingered for at least half an hour, terrible pictures of traffic accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up broken and felt sleepy all day. I took Valerian, Corvalol, but it practically did not help. At work, they hinted whether I should take a vacation. Friends advised me to consult a neuropathologist, but he did not find his pathology and sent me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely recovered.” nine0018

- in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly report pain, internal discomfort. Some complain of headaches, pains in the stomach, joints, lower back, others - of disorders in the intestines: constipation, indigestion, irritation of the colon, others pay attention to a decrease in sexual desire and potency. In women, menstruation often becomes painful and irregular. Approximately 50% of depressed people at the doctor's office complain of such physical ailments, without mentioning the depressed mood or state of mind underlying the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort. nine0003 - some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, in the limbs, behind the sternum, in the abdomen and in any other parts of the body, he may be haunted by anxious fears, he may suffer from insomnia or, on the contrary, too much sleep. nine0003 - Patients may experience disturbances in the cardiovascular system, skin itching or lack of appetite. All of these are manifestations of depression.
- the pathological sensations that patients experience during such depressions are quite real, painful, but they are the result of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depressions exceeds the number of explicit ones many times over.
- with such depression, patients, as a rule, also have a changed attitude towards food: they can go without food for a long time and not feel hungry, and sitting down at the table, eat only 1-2 spoons - they have neither strength nor desire for more . nine0003 - a sign of depression can serve as a weight loss of more than 5 kg. within a month. In some people, especially women, the appetite for depression, on the contrary, increases, sometimes reaching the level of excruciating hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased craving for sweets or attempts to distract oneself from painful thoughts by frequent eating.
Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, when the symptoms described above appear, it is necessary to seek help from a psychiatrist who will prescribe and monitor antidepressant treatment. nine0018

TREATMENT OF DEPRESSIVE DISORDERS

To date, it can be argued that the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression. nine0003 The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a violation of the mechanism of biochemical transmission of nerve impulses in the brain regions responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure the coordination of the work of all these functional divisions, the brain sends special "commands" to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical mediators (neurotransmitters), which, after transmitting a signal, partially return to the original neuron. This process is called neurotransmitter reuptake. Thanks to him, the number of mediators in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. Numerous studies have shown that mediators of various structures, in particular, norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has the main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, therefore serotonin is called sometimes a "good mood" regulator. A decrease in the number of mediators in the synaptic cleft causes symptoms of depression, while an increase, on the contrary, prevents their appearance. The ability of some drugs in one way or another to increase the concentration of mediators in the synaptic cleft allows them to be used as antidepressants. nine0003 Now antidepressants are used in Russia, which can be conditionally divided into 4 generations according to the time of creation.
The first antidepressants to find wide clinical use were tricyclic drugs: amitriptyline and imipramine. They have a fairly powerful effect on most depressive states by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which drastically reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effect on receptor structures. Acting in addition to the serotonin and norepinephrine system and other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, palpitations, fluctuations in blood pressure, confusion, tremor, sexual dysfunction. functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant action. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, physicians are less likely to prescribe these drugs to patients on an outpatient basis. nine0003 The situation was somewhat improved by the introduction into practice of drugs of the second generation - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have antidepressant activity comparable to them, but unlike their predecessors, they are safer, since they cause unwanted side effects much less often. In addition to the antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild balanced antidepressant effect. In general, these drugs are able to cure mild to moderate depression, but are ineffective in patients with severe depression. nine0003 To date, antidepressants of the 3rd generation, such as fluoxetine (Prozac), fluvoxamine (Fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (Cipralex) and some other drugs that selectively (selectively) affect the serotonin metabolism system, have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into a group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level panic disorders, so-called social phobias, various obsessive-compulsive disorders and chronic pain symptoms. These drugs have gained popularity due to the possibility of a once-daily intake, concomitant anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have low toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive states, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, is not proven. nine0003 Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - IV generation drugs that selectively block the reuptake of both serotonin and noradrenaline, without affecting other mediators. system and with minor side effects. Currently, 3 drugs meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which at the same time showed that these drugs are well tolerated. nine0003 It should be noted that antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc.) can be effective in mild depressive states, but there are no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture, should be recognized as unfounded.
For extremely severe depressions that do not improve despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by the commission of doctors and the consent of the patient. nine0003 An important additional role in antidepressant therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that can, when taken systematically, prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. With their systematic intake in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, requiring no hospitalization and not significantly affecting the ability to work. nine0003 Antipsychotics play a significant role in the treatment of certain forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining more and more recognition among doctors: seroquel, solian, zeldox, rispolept, abilify, serdolect and others.
In drug therapy of depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding doses and regimens for taking medications. The patient's faith in the possibility of recovery, the absence of prejudice against the "harm" caused by psychotropic drugs, the systematic observance of the prescriptions prescribed by the doctor largely contribute to the achievement of therapeutic success. nine0003 Drug treatment of depression takes time. You should not expect a complete cure already in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its appointment, should be carried out only by a doctor. Cancellation is usually made no earlier than 6 months from the normalization of the mental state. Even after the complete disappearance of all symptoms of depression, do not rush to stop taking the drug yourself, as there is a risk of an exacerbation of the disease. Therefore, doctors recommend continuing to take the antidepressant for a certain period of time. A common mistake is the premature withdrawal of drugs soon after a significant improvement in the condition or due to "forgetfulness". To avoid this, try to include the drug in the list of daily urgent matters - for example, store it in the bathroom and take it after hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period of absence from home. Breaking therapy is fraught with serious troubles. nine0003 Conducted along with drug treatment, psychotherapy of patients with depressive states implies various systems of influence, including individual conversations, family and group therapy, etc. An important element of social rehabilitation is participation in the work of mutual support groups for patients who have experienced depression. This allows other patients to feel help in understanding their problems, to realize that they are not alone in their misfortune, to see the possibilities of personal participation in rehabilitation activities and in social life. nine0018

Depression after adoption. What to do if this happened to you?

Translated by L. Lavrov

Site material

RainbowKids.Com

Garriet McCarthy is an adoptive mother of three boys from Russia, a member of the East European Adoption Association and other associations of adoptive parents. She is familiar with the problems of international adoption, one of them is depression after adoption.

The international adoption community is going through a crisis of very serious proportions. It can endanger the health and well-being of many families with adopted children. It's about depression after adoption. According to a study by the Eastern European Adoption Association, this phenomenon affects 65% of adoptive mothers. Despite this, adoption agencies, social workers, and most medical professionals do not notice or recognize him. nine0018

Postpartum depression has long been considered an expected part of normal pregnancy and childbirth; medical professionals and society openly discuss and understand this phenomenon. According to various estimates, from 50 to 80% of mothers experience postpartum depression in its mildest form. Of these, approximately 10% experience a more severe form of postpartum depression that lasts longer and has more symptoms. The cause of both of these phenomena is seen in hormonal changes and disorders. Families, doctors and caregivers are prepared for these symptoms and support mothers without question during this usually short period. nine0018

Public and medical attitudes towards postpartum depression are fundamentally different from the silence and closeness surrounding the increasingly widespread problem of post-adoption depression. The term was coined by June Bond in her article in the spring issue of Roots & Wings magazine in 1995. Those of us who enter the international adoption community, especially foster parents of children from orphanages, face additional challenges when adopting newborns. babies who were not brought up in a family. Usually the age of these children is from the age when they learn to walk to school age. Their background and language problems are an additional factor that influences the possibility of adoptive mothers developing depression syndrome after adoption. nine0018

For the last seven years I have been closely involved with the international adoption community. I am an adoptive mother of three older boys from Russia, a member of the East European Adoption Fellowship, and the founder and co-chair of International Adoption in Families in Piedmont.

Throughout my work experience, post-adoption depression has been a constant and pressing issue. In the fall of 1999, with the help of the East European Adoption Association, which posted a questionnaire on the website, I conducted a study to test how common post-adoption depression was. The results were alarming. Our questionnaire was available to mailing recipients from the list of adoptive parents for children from Russia and the list for education and training of parents; the total number of mailing list recipients exceeds 3,100 people. Those who had not experienced post-adoption depression were particularly encouraged to participate in the survey. Of the 145 parents who responded, over 65% said they experienced depression after adoption. And only 8 people reported that social workers or adoption agencies warned them that such a syndrome even exists. 61% of all respondents confirmed that such training would be useful. nine0018

Why is post-adoption depression so common among adoptive parents? There are many concrete and understandable reasons. Most adoptive parents have spent literally years before adopting a child. Their unfulfilled hopes, dreams, and long waits can create unrealistic ideas about exactly how things will be when they become foster parents. And they are not ready for the disappointment they experience when reality contradicts their ideas about the child. Adoptive parents may feel guilty because of their feelings of ambivalence, dislike or irritation towards the adopted child. The belief that there will be instant attachment or "love at first sight" is often unrealistic. Love for a child is in many ways similar to love for a future life partner: initial infatuation and euphoria give way to a long and often difficult process of getting used to the daily presence of another person. According to many families that are part of the East European Adoption Fellowship, it often takes two to six months for a real feeling of affection to form. Without training and support, new adoptive mothers, experiencing depression, try to “bear it” without seeking any help. Many mothers worry that if they tell the adoption agency or social worker (whom they have been convincing for months or years of their excellent parenting qualities) that they are experiencing difficulties, then these same agencies and social workers will consider them to be bad parents and in the worst case scenario. events will take their adopted child away from them. As a consequence, the difficult situation worsens even more due to the lack of understanding and support. Adoptive parents are often completely deprived of the primary assistance from the family that mothers who have given birth on their own receive. In many cases, after going through years of disappointment due to infertility, family members do not understand why the adoptive mother does not feel completely happy and content now that she finally has what she has been wanting for so long. Rather than disappoint or confuse their family members, many adoptive mothers simply suffer in silence, feeling shame and guilt, feeling imperfect and selfish. nine0018

Our survey did not specify the gender of the respondents, but we assume that most of the questionnaires were completed by women. An unexplored but very important issue is post-adoption depression in fathers. Stress plays a major role in this issue, which we consider equally important. It is the adoptive fathers who have to go to work earlier, and they have an additional difficulty: to combine work and raising children.

While all of these problems affect all adoptive parents, our international community faces additional challenges that make the situation even more difficult. Almost never do we adopt newborns. Among other things, we experience the loss of a child's life history and lost opportunities to form attachments. We see our children for a very short time before an adoption, and we often find unpleasant surprises about our children's past after the adoption has taken place. Older children are already mature individuals, some of them easily fit into our family, while others become a daily sharp reminder of our differences. We adopt children who have experienced an unimaginable amount of loss. We adopt children who have experienced the consequences of being raised outside the family, in an orphanage and completely neglected. Often we adopt children with hidden problems in learning, emotional, neurological sphere, with health problems. Often adopted children are attached only to one of the parents, then the other gets upset and disappointed. Add to all this the stress of moving to another country, the time difference, the difficulty of communicating with our older children and hosts, lack of sleep and culture shock. This situation creates all the prerequisites for frustration, feelings of helplessness and anxiety, which is an excellent set for the onset of depression. nine0018

When I analyzed the data on the duration of depression after the adoption of , a very disturbing picture emerged. While mild postpartum depression lasts a very short time (less than two weeks), 77% of those surveyed who experienced depression after adoption suffered from its manifestations from two months to more than a year, of which 45% - six months or more. 85% of those who had depression reported that it affected their health in one way or another (significant weight loss/gain followed by sleep disturbances and headaches). 70% felt that the post-adoption depression syndrome interfered with the smooth entry of adopted children into the family and building relationships. Clearly, post-adoption depression is an important, multi-faceted issue that needs to be recognized, better understood, and certainly needs to be counseled and supported by all members of the adoption community! nine0018

How to survive the bad weather

Knowing that you are more likely to experience depression after adoption can help you prepare for it if you are among those who experience it. The preparation may include discussion with the initial caregiver as well as with your child's future pediatrician. Make sure your agency is aware of the post-adoption depression syndrome and that they are aware of the growth and prevalence of this problem. They should be ready to support you if you need help. nine0018

If you have had depression before, you are at greater risk. Make sure your psychologist is available to help if you need support in the form of medication or advice. Warn family members and spouse and tell them about it. Explain that you may need moral support just like families with newborns.

In their book on parenting, Dr. Bill and Martha Serz give some great advice for families dealing with postpartum depression that can also be applied to families with post-adoption depression. When you finally arrive home from traveling with a foster child (or children), make sure you have enough time to settle in. Skip hosting for a few weeks and don't feel guilty about doing so. An exception might be a family member or close friend who can help around the house and provide support so that the new small family has time to learn about each other and start building relationships. Before you travel, check with your employer about adoption benefits and the maternity leave policy. Take advantage of the maximum time allowed before you go to work. Make sure you get enough sleep and exercise. Fresh air and a walk can do wonders for helping with mild depression. Take your child for a walk - this is one of the best and simple joys of life, which will bring pleasure to both you and the child, and will positively affect the establishment of relationships. If you are alone or your husband cannot look after the child while you are on vacation, arrange for a nanny who will come when you sleep, go on business or just take care of yourself. nine0018

A new role as a parent often means a deterioration in other tasks. Don't let yourself feel guilty about not doing your housework perfectly or not feeling the urge to cook your usual delicious meals. Postpone most of the things until you get comfortable. If you foresee that leaving things for a while will make you very anxious, find someone who can replace you in housework and household chores. Stock up on good frozen food to make meal prep easier. nine0018

If you are married, one of the most important changes that comes in your life with the arrival of a child is a change in your relationship with your spouse. Be prepared for this change and, to reduce the negative impact, set aside special time that you will spend together without a foster child. This is a key condition for successful parenting, important for both of you and for the child. Your strong, secure relationship with each other is one of the greatest gifts you can give your adopted child. If you managed to create a strong and happy family before adoption, spare no effort to unite and save it. nine0018

Preparing for depression after adoption is the key to enduring it and reducing its duration. Accept that adoption carries some risk. Be prepared for the surprises, disappointments, and difficulties with an adopted child as part of an international adoption. Rejoice if none of this happens! Attend as many parenting classes as possible before the foster child comes to you. Prepare to be the parent-therapist. The emergence of kindred feelings and affection is a slow process. Learn to be patient and make time for one-on-one time with your child to strengthen the relationship and attachment. Your journey as an adopter does not end the day you bring your child home. In fact, this day is only the beginning. Get ready for the emotional ups and downs you had before adoption to continue for at least another year. If you have adopted a child with serious disabilities, be prepared that this period will last two years! Ask for help. Be honest with your caseworker and adoption agency. If you have problems, let them know! You may be pleasantly surprised by their willingness to help, but if they don't know you're having a hard time, they won't be able to help. Join a support group. Thousands of people are ready to help and support. Make time for yourself, your spouse, and your own children. Reduce social and workload for as long as possible. Reach out to family and friends for support. Accept your limitations and don't be afraid to make mistakes. We learn from mistakes. If the post-adoption situation is particularly difficult, remember to tell yourself every day that tomorrow will be better, because maybe it will. nine0018

Most importantly, remember that your feelings are a normal reaction to stress, that you are not alone, and that you will be helped through this difficult phase after adoption.

Signs of depression

Criteria for diagnosis (from the Diagnostic and Statistical Manual of Mental Disorders)

Having five or more signs in two weeks:

✓ Daily depressed mood for most of the day (feelings of sadness, emptiness or tearfulness) or feeling exceptionally irritable. nine0018

✓ Markedly reduced interest or pleasure in all or almost all activities.

✓ Significant weight loss or gain, increased or decreased appetite.

✓ Almost daily insomnia or increased sleepiness.

✓ Almost daily psychomotor activity or slowness of action noticeable to others (restlessness or slowness).

✓ Almost daily fatigue or loss of energy.

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