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 AS@W...Supported Self-Management of Depression 

What is self-management of depression?

• Self-management is a way of dealing with depression in which the depressed person takes responsibility for managing the condition. The depressed person takes an active role in learning the signs and symptoms of low mood or depression, understanding the possible interventions and making decisions about the best course of action. This may be done independently or in partnership with a medical or mental health practitioner (see Supported Self-Management below).

• Self-help books, websites or groups can be part of self-management.  The goal of self-management is to foster personal empowerment and responsibility. These self-management tools should be evidence-based and designed specifically for treating depression.

• Bibliotherapy is the form of self-management in which an individual is provided with an evidence-based workbook. The individual can bring this home and work on it independently.

• Antidepressant Skills @ Work (AS@W) is a self-management workbook based on cognitive-behavioural principles that targets mood difficulties associated with the workplace and the individual’s work functioning.

 

What is Supported Self-Management of depression?

• Supported Self-Management is a way of dealing with depression in which the self-management workbook or other tool is accompanied by encouragement, information, assistance and follow-up by a health care provider. A partner, family member, friend, or peer counsellor might also fill the supporter role.

 

Is self-management effective?

• Self-management approaches have been shown to be effective for individuals with mild depression. In fact, there is more evidence supporting the use of self-management than antidepressant medication for mild depression.

• Due to the combination of limited effectiveness and risk of side effects and other adverse events, antidepressants are not recommended for the initial treatment of mild depression by some experts. Supported Self Management represents a reasonable alternative to medication for this population. This is reflected in the depression care guidelines produced by the National Institute for Clinical Excellence (a health advisory body in the United Kingdom) which recommends self-management based on CBT as the first-line approach for mild depression.

• There are a number of advantages to using depression self-management based on CBT:

• It provides evidence-based information and support for individuals with low mood or depression who may not otherwise have access to care.

• It increases the flexibility and accessibility of care since most self-management can be done at home.

• It is inexpensive when compared to talk therapies or antidepressant medications.

• It is supported by evidence as being helpful for mild depression.

• It can be used as an adjunct to pharmacological or psychological treatment.

• It encourages responsibility for one’s own health.

• It is particularly relevant to workplace issues as it typically includes the skills of goal-setting, problem-solving and adaptive patterns of thinking -- all of these skills are critical to workplace success.

 

References

National Institute for Clinical Excellence. (2004). Depression: management of depression in primary and secondary care. Accessed from http://www.nice.org.uk/CG023NICEguideline

Nelson, G. & Loomis, C. (2005). Review: self-help interventions improve anxiety and mood disorders. Evidence Based Mental Health, 8, 44.

McKendree-Smith, N.L., Floyd, M., & Scogin, F.R. (2003). Self-administered treatments for depression: a review. Journal of Clinical Psychology, 59, 275-88.

About AS@W

How was Antidepressant Skills at Work developed?

The guide was developed by British Columbia Mental Health and Addiction Services (BCMHAS), an agency of the Provincial Health Services Authority. The guide and accompanying materials have been authored by Dr. Dan Bilsker, Dr. Merv Gilbert, and Dr. Joti Samra – registered psychologists and scientist-practitioners with expertise in issues relating to workplace mental health. These psychologists are with the Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University. The guide was written on the basis of a review of the scientific literature; consultation with employers, unions, mental health providers and employee groups; and adaptation of existing self-care depression programs.

How can the manual be accessed?

The manual is available for viewing and free download at www.carmha.ca/antidepressant-skills/work/ or from www.bcmhas.ca/research. Individuals or organizations are free to print and make multiple copies of the guide, with permission from CARMHA. Print copies and audio CDs are available at a low cost from our ordering page at www.comh.ca/ordering/