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My sister is introverted and melancholy. Is this depression?

The question:

My sister is a successful 26-year-old grad student. Lately she’s become more introverted, started sleeping more and become melancholy. Is this clinical depression? She’s started taking antidepressants but I’m worried that it requires more than a prescription. What do you recommend?


The answer:

You’re smart to be concerned about your sister (as unfortunately, many well-meaning friends and family will avoid addressing a loved one’s mood issues, even when they see that person possibly struggling).


Certainly withdrawal/avoidance behaviours, increased sleep and low, melancholy mood can be signs of possible clinical depression (although an accurate diagnosis always requires proper assessment by a physician or psychologist).


Since she’s started taking antidepressants, I am assuming that she has seen either a family physician or a psychiatrist who evaluated her and made a determination that medication would be helpful.


Your thought that she needs more than antidepressants is intuitive – and accurate. The majority of individuals with depression require more than just medications.


The research indicates that for mild levels of depression, the most effective treatment is self-directed “self-management” approaches (where an individual reads about effective mood management strategies and implements them on their own, or with the support of a loved one); for moderate levels of depression, self-management approaches combined with treatment by a qualified mental health professional who provides an evidence-based psychological treatment is recommended.


Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are the two types of “talk therapy”, typically delivered by a registered psychologist, which have strong empirical support for being effective for depression.


As individuals develop more severe levels of depression, the evidence suggests that the most effective treatment often requires a combination of time-limited pharmaceutical intervention as well as psychological treatment.


We know that the “depressed state” is a result of five main things:


– Life situations or stressors (certainly being in graduate school is a significant stressor)


– Thinking patterns (people tend to think more negatively about themselves, others, and feel hopeless about the future; thinking patterns are more self-critical and unfair/unrealistic)


– Behavioural patterns (people tend to withdraw, isolate, and when feeling low or depressed do less of the things they do when they are feeling well, which makes mood issues even worse)


– Physiology (changes in neurochemistry, as well as altered sleep, energy and appetite patterns)


– Emotions (which may be much broader than just depressed or low mood, and often includes significant anxiety, worry, discouragement or irritability/anger)


Medications help primarily with the physiological symptoms, whereas psychological treatments can help with the other areas.


I would encourage you to speak openly with your sister. Take a gentle and supportive approach and let her know that you just want to be there to support her in whatever way you can, given that you have noticed she is just not her usual self.


You may encourage her to see someone at the health or counseling services department at her university, as students can often receive free or low-cost services through their university.


Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail.

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