Home-based depression management includes antidepressants as prescribed by a physician, usually SSRIs or SNRIs, therapy sessions specifically Cognitive Behavioural Therapy (CBT), daily exercise, proper sleeping schedule, eating habits and regular check-ins with a nurse or caretaker.

For people wondering if depression can be cured at home, online healthcare tools, telepsychiatry and peer group support can help alongside formal appointments with a psychiatrist.

The most common reason why home-based treatment fails is medical delinquency. According to research done by the National Library of Medicine, about 50% of all failed depression treatments are due to patients stopping their medication before the completion of the course.

This is due to the side effects, cost of the medicine and the treatment, or an early improvement in symptoms, which ends with the premature stopping of medication. Therefore, periodic visits are important and not optional.

When does hospitalisation become necessary?

Immediate escalation in symptoms and certain clinical signals demand immediate psychiatric care. Hospitalisation is strongly advised in cases of emergency, such as active self-directed harm or depressive stupor, according to the German National Practice Guidelines for MDD, which have standards comparable to most Western psychiatric systems. This should be carefully considered when the person is suicidal, the current treatment has failed multiple times, or the risk of chronicity is high. 

Research published in the OASIS-D study, wherein 3795 adults were consecutively hospitalised for MDD, confirms that the direct costs of depression are predominantly driven by inpatient treatment. It reflects that psychiatric care is immensely research-intensive. 

Depressed patients have a higher hospitalisation rate, about twice that of non-depressed patients, within the first few weeks of home care. The first two weeks are the narrow window in which early warning signs should be detected and acted upon. Patients typically spend 3-10 days in the hospital for acute stabilisation. However, when the situation is complex, it may take up to 40 days. 

What Are Partial Hospitalisation Programs (PHPs)? A Middle Ground Between Home Care and Hospitalisation for Depression Patients

Not every situation can have a clear ‘home-based’ or ‘hospital-based’ treatment. This is where partial hospitalisation comes into the picture. Arterial Hospitalisation programs or PHP, and Intensive Outpatient Programs or IOP are effective middle ground options. 

In PHP, the treatment includes 5-6 hours of psychiatric treatment per day in the form of individual therapy, group therapy, occupational management or medication management. This allows the patients to be at their homes by evening. This type of structured treatment plan helps to balance both family bonds and familiar environments while also providing a near-inpatient level of clinical support.

In IOP, the treatment is less intensive than in PHP. It is usually for 3-4 days per week for about 3-4 hours only. This type of treatment plan is ideal for patients who want to step down from inpatient care and switch to structured therapy over standard therapy. 

Both these models dramatically try to expand their options available to patients who are too unwell for outpatient treatment, but neither so acute for inpatient treatment.

Depression Treatment in India and Other Middle-Income Countries

The treatment rates in lower-income countries for depression are at 16.8% as compared to 48.3 percent in high-income countries. 38% people never actually get the mental health treatment they need, and in certain countries, about 90 per cent of people dealing with mental health problems go entirely untreated.

Coming to India, psychiatric bed availability remains severely limited for common people. About 3 in one lakh people actually get an inpatient depression treatment as compared to a global average of roughly 13 per one lakh. Mental health in India is surrounded by social stigma. Along with this family barrier, where families try to hide depression or attribute it to spiritual causes, delaying specialised help by months, if not years. 

Many people try depression treatment at home with the help of online information and without a formal consultation. In such an environment, inpatient treatment becomes difficult, and community-based at-home care becomes a more viable option. To bridge the gap in society, digital health platforms and telepsychiatry services are booming in India and other middle-income countries.

Relapse prevention and long-term management

Recovery from depression is often mistaken when the symptoms improve, but in reality, it is actually shifting to a phase when one is focused on maintaining stability and preventing a relapse. This stage is often overlooked, although it plays a critical role in determining whether a person remains well or experiences recurring episodes.

Continuity of treatment is one of the most important principles in long-term management of depression. Clinical physicians prescribe to continue with the therapy or with the prescribed medication; people can find it weird or unnecessary, but it is very important. Because a reduction in symptoms cannot be taken as a complete treatment, and stopping the treatment immediately increases the risk of relapse.

Another aspect of prevention is identifying the individual triggers, as depression is rarely caused by a singular factor; instead, it is caused by a multitude of factors. It develops through a combination of mental, biological and social changes.

Common triggers include chronic stress, changes in life, academic or work pressure, difficulties in relationships, and social isolation. It is important to recognise these factors and patterns to help with the issue before the symptoms escalate.

Relapse prevention plans are used in clinical practice to transform the recovery from a passive state into an active state through a monitored process.

These plans include

• Early warning signs: Sleep disturbances, loss of interest in daily activities, getting irritated quickly
• Coping strategies: Exercising, journaling, reaching out to people
• Emergency contacts: Therapists, helplines, trusted people

Social support groups are people who can be our family members, friends, trusted adults, elders or mentors. They play an essential and decisive role. A strong interpersonal connection with our social groups and peer support groups can help individuals have a better, quicker and long-term outcome. In at-home treatment plans, family members play the role of caregivers.

They help in the treatment by monitoring the patient’s behavioural patterns, encouraging them to take medicines as prescribed and providing emotional stability. But for such a scenario to be successful, it requires basic mental health literacy, as misinterpretation of any symptom or any delay can worsen the situation.

Functional recovery is when the person can resume their normal daily activities and is able to adhere to their personal, work or academic commitments. In addition to the recovery of symptoms, functional recovery is just as important as it includes going back to school, work, rebuilding relationships, and, most importantly, regaining a sense of purpose in life. Without this, a person will feel empty, lifeless and aimless. Absence of it can still be termed as clinically improved, yet still struggling with the quality of life, thus creating a risk of relapse.

There are various digital tools available which are relevant in this phase. These tools provide services like mood tracking, teleconsultations, online peer support and guided therapy platforms. These services are low-cost and in some cases free of cost, continuous and available at our fingertips.

This is particularly helpful in regions where in-person care is unavailable or limited. While these digital tools cannot be a substitute for in-person care and professional intervention, they can still be meaningful in the treatment process in maintaining consistency. 

In a Nutshell

Lastly, everyone needs to understand depression, those who are suffering from it and those who are not. Depression can be chronic yet manageable for certain people, and the recurrence of it is not the failure of the treatment process; instead, it is just an indicator that the person needs an adjustment in the treatment plan and more support and care.

With care, quick intervention and a supportive social circle, people dealing with depression can maintain long-term stability and reduce the impact of depression and its symptoms in future phases of life. 

Depression treatment at home starts with educating members, emotional care and understanding. In conclusion, successfully managing depression is not only about full recovery from it, but it is also about building resilience against its relapse.

Frequently Asked Questions Answered