Managing depressive symptoms

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Negative mood is often a trigger for relapse, and therefore addressing depressive symptoms is also an important part of relapse prevention [557]. The techniques outlined in Table 37 may help AOD workers to manage clients with depressive symptoms.

A number of simple strategies based on CBT are also useful in managing clients with these symptoms, including [310, 386]:

  • Cognitive restructuring.
  • Pleasure and mastery events scheduling.
  • Goal setting.
  • Problem solving.

These techniques are discussed in greater detail in Appendix T.

It is important to note that many depressive symptoms (and many anxiety symptoms) will subside after a period of abstinence and stabilisation [35, 290, 299]. It is useful to explain to clients that it is quite normal to feel depressed (or anxious) when entering treatment but that these feelings usually improve over a period of weeks. During and after this time, constant monitoring of symptoms will allow the worker to determine if the client requires further treatment for these symptoms. If the client has a history of depressive episodes in circumstances when he/she is not intoxicated or withdrawing, he/she may have an independent depressive disorder. For these clients, it is unlikely that their depressive symptoms will resolve completely with abstinence – indeed their symptoms may even increase. In such cases, clients should be assessed for a depressive disorder and the treatment options described in this chapter should be considered.

Table 37: Dos and don’ts of managing a client with symptoms of depression

DO:

  • Encourage and emphasise successes and positive steps (even just coming in for treatment).
  • Take everything they say seriously.
  • Maintain eye contact and sit in a relaxed position – positive body language will help you and the client feel more comfortable.
  • Use open-ended questions such as ‘So tell me about...?’ which require more than a ‘yes’ or ‘no’answer. This is often a good way to start a conversation.
  • Constantly monitor suicidal thoughts and talk about these thoughts openly and calmly.
  • Encourage the client to express his/her feelings.
  • Be available, supportive and empathetic.
  • Offer realistic hope (i.e., that treatment is available and effective).
  • Provide contact details of counselling services and offer to make referrals if required (manydepressed people struggle to do this alone).
  • Encourage participation in healthy, pleasurable and achievement-based activities (e.g., exercise, hobbies, work).

DON'T:

  • Make unrealistic statements or give unrealistic hope, like ‘everything will be fine’.
  • Invalidate the client’s feelings.
  • Be harsh, angry, or judgemental. Remain calm and patient.
  • Act shocked by what the client may reveal.

Adapted from Scott et al. [558] and Clancy and Terry [296].