1. Suffering in silence. Depression typically doesn’t go away on its own, and left untreatedit can worsen and progress to a point where a person can become disabled and potentially suicidal. Seeking help is key to getting out of Severe Depression, Mischoulon says. “The motto in my psychiatric residency program was ‘don’t worry alone.’ If you are depressed, tell someone about it rather than suffering in silence.” Patients can start by telling a friend or relative, or their primary care physician. “This could represent your first step toward getting the help that you need,” he says.

2. Self-medicating. There are numerous over-the-counter products that claim to treat various psychiatric and emotional symptoms, Mischoulon says. “Many people will try these rather than seeing a practitioner. While some of these therapies have evidence to support efficacy, they have to be used with the same care as prescription medications, and preferably under the supervision of a clinician.” He adds that “self-medication” includes using alcohol or recreational drugs to alleviate Severe Depression symptoms. Also a bad idea. “While these may induce a temporary feeling of well-being, over the long term they tend to worsen depressive disorders as well as present a risk of addiction,” he says.

3. Staying wedded to a treatment that is not working. “Sometimes a patient will be intent on relying on alternative treatments, like exercise or yoga, which is fine if the practice brings substantial or decisive relief,” Kramer says. But, “if a given treatment is not working, it will make sense to switch, often to a standard, well-tested approach, like psychotherapy or medication.” Patients may be reluctant to try these, perhaps on idealistic or ideological grounds, he says. That’s a mistake, he explains, because “depressive episodes are harmful to mind, brain and body, and longer episodes are more destructive. We want them to remit.”

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