cbaReport-Nov12 - page 13

November 2012 CBA REPORT
balanced living
treatment one hour a week and take a
pill daily. For many people the key to full
recovery is a daily self-management plan
) , which includes physical
exercise (moving the body gets the mind
moving), sleep management (is there
any better medicine than restful sleep?),
planned activities that improve your
mood and add to your sense of accom-
plishment, and practicing achieving a
state of restful alertness or relaxation or
mindfulness for 20 minutes twice a day.
Symptom monitoring.
guided by regular symptom monitoring
is much more efficient than treatment
that skips this step. The PHQ 9 (
and the Beck Depression Inventory are
just two of many available depression
monitoring measures. Regular moni-
toring also teaches us to focus on the
symptoms that are improving and those
that are resisting improvement, allowing
us to tailor treatment efforts to the target
symptoms, such as insomnia or suicidal
thoughts or cripplingly low self-esteem.
Relapse prevention.
Effective treat-
ment for depression should improve
symptoms substantially in one to three
months. But for many people with a
history of multiple episodes or high
risks for recurrence, recovering from an
episode is just the first big hurdle. It is
possible to prevent further episodes, or
markedly reduce the risk, if you work
with a careful relapse prevention plan
that includes daily self-management
plans, monitoring, methods for identi-
fying a recurrence and plans for early
treatment intensification.
Not everyone has to do all of these,
but think about them when you’re
negotiating a plan for managing your
recovery. These strategies could save you
time, money and precious hope. When
you find what works for you, pass the
word on.
Wulsin is professor of psychiatry and family medicine
at the University of Cincinnati. He is the program
director for the Family Medicine Psychiatry Residency
Program and director of the Cincinnati VAMedical
Center’s Primary Care Mental Health Integration
Trust Account Guidance
Lawyers’ Trust Accounts: A Handbook on the Rules Governing
the Duties of Lawyers to Account for Client Funds
Single copy: $15; Five or more: $12 each
(plus tax, shipping and handling)
Thanks to the Cincinnati Bar Foundation.
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