When to Institutionalize for Depression

By Sheila Tombe

If you are severely, chronically depressed and cannot function at work or at home, seek professional help immediately. If you are worried about a friend or loved one, here are the chief characteristics of severe depression that might lead you to consider hospitalization. But in any case, please know that you are not alone and that help is waiting.

Symptoms

Profound, long-lasting depression is a crippling disease; like cancer or diabetes, it needs medical care to relieve the symptoms. If you or a loved one suffer three or more of the following symptoms, you might want to talk to your doctor about the possibility of hospitalization: • You can't stop crying or feeling sad • Your appetite or sleep patterns have changed • You are constantly anxious, worried or angry • You just don't care anymore • You have no energy • You feel worthless or guilty all the time • You just can't focus or decide what to do • Your former interests hold no pleasure for you any more • You want to hide from friends • You suffer aches and pains and don't know why • You just can't get up in the morning • You think about death or suicide being easier than living

These symptoms may be mild or severe; obviously, if you find you can't stop thinking about death or suicide, you should seek help immediately. Don't carry the weight of your depression alone. Professional care is available, and many who understand your pain want to help you through this dark time of your life.

Unipolar Depression

Unipolar (clinical) depression is caused by a chemical imbalance in the brain that controls the re-uptake of serotonin, norepinephrine or dopamine. Such depression may run in families and a history of alcohol or drug abuse may be present, as sufferers often try to carry on with their lives, self-medicating, thinking they can manage the depression if they just try harder to do so. Unfortunately, it doesn't work that way. Note that unipolar depression is different from bipolar depression, which needs a different medical approach to manage the periods of highs and lows.

Hospitalization

Deciding to admit yourself to a psychiatric ward in a hospital or institution can be a great relief if you cannot continue with the tasks of daily life. If you can't face going to work or even getting out of bed in the morning, it does not mean you are lazy or worthless---you might be seriously depressed. You will need to be referred by a doctor, but a quick phone call to your own doctor or an emergency helpline will ensure that you receive immediate treatment. If you are considering suicide, please call a help line instead of hurting yourself. Hospital wards for patients with depression are warm, comforting places where you can feel safe. Nurses will monitor you for your first day or two, as you will be on suicide watch; after that, you will continue treatment from the resident doctors until you feel strong and confident enough to go home.

Institutionalizing a Loved One

If you are worried about a loved one who is severely depressed, you can encourage the individual to voluntarily enter a psychiatric hospital or ward, but you cannot (in the United States or the United Kingdom) have the person committed unless he is an immediate threat to his own or someone else's health. Involuntary commitment requires a court hearing with a report submitted by a doctor, although the police in both the U.S. and the U.K. can arrest and commit someone they suspect to be an immediate danger to himself or others. The statistics in the U.K. suggest that middle-aged patients who are admitted to hospital involuntarily are more likely to commit suicide. If you are worried that someone is in immediate danger, call a suicide hotline or the police.

Inpatient Treatments

Once you are hospitalized, the doctor will start you on antidepressants or review the antidepressants you are taking and suggest increasing the dosage or trying a different combination. There are three main types of antidepressant: NDRIs (norepinephrine and dopamine reuptake inhibitors); SSRIs (selective serotonin re-uptake inhibitors); and SNRIs (serotonin and norepinephrine re-uptake inhibitors). Patients who are severely depressed may need to try two or three before finding one that works. Unfortunately, there is no way of predicting which one will work for you, or even if it will always work as effectively. Trial and error is not uncommon, but severely depressed patients generally do not care if there are side effects (such as loss of sexual appetite or weight loss), as long as the heavy cloud of depression can be lifted in the process.

In the most severe cases, if combinations of antidepressants are not working for you, your doctor may talk to you about ECT---electro-convulsive treatments. This is a last-resort treatment. Although it can be performed on an out-patient basis, you will usually need to be hospitalized for all or part of the time. ECT is a controversial form of therapy, with patients reporting memory losses and disorientation as being the most common short-term side effects.

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