If you or someone you love receives a diagnosis for a depressive disorder such as major depressive disorder (MDD) or bipolar disorder (BD), it’s not easy know what type of treatment is best: should you search for outpatient treatment or inpatient treatment for depression?
The first step is the diagnosis, which will determine the appropriate level of care. The phrase level of care describes the level at which a person with a mental health disorder receives professional treatment and support. After a full biopsychosocial assessment administered by an experienced mental health professional, they’ll refer a patient – you or your loved one – to one of the following levels of care:
Outpatient treatment
- Office visits with a therapist, psychiatrist, or counselor once or twice a week
Intensive outpatient treatment (IOP)
- Outpatient treatment with a full treatment team 3-5 days a week for 2-3 hours per day
Partial hospitalization treatment (PHP)
- Outpatient treatment with a full treatment team 5 days a week for 4-6 hours per day
Residential inpatient treatment
- Inpatient treatment with a full treatment team. Patients live at the treatment center 24/7, with treatment activities scheduled throughout the day, evening, and weekends.
Inpatient hospitalization
- Inpatient treatment with doctors, nurses, and support staff in case of psychiatric emergency. This level of care is for patients in acute mental health emergencies. It’s designed to support patients until a medial team determines they’re stable and it’s safe to discharge them to one of the levels of care above.
We list these levels of care from the least immersive, which is outpatient treatment, to the most immersive, which is inpatient hospitalization. This article will focus on residential inpatient treatment, which is the most immersive level of care before emergency inpatient hospitalization.
How Do Clinicians Decide on a Level of Care?
When a clinician completes a full assessment and arrives at a diagnosis, they refer a patient for a specific level of care. Here’s the criteria they use:
- The overall intensity and duration of the depressive symptoms.
- The immediate risk or danger associated with the depressive symptoms and behaviors.
- How significantly the depressive symptoms impact the ability to participate in or complete typical daily activities.
- Previous attempts at treatment. A person with an unsuccessful attempt at outpatient treatment may receive a referral for inpatient/residential treatment.
During the assessment, they look for symptoms that correspond to an officially recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5). Here are the symptoms which, when present, indicate the presence of a depressive disorder such as MDD:
Depression: Common Symptoms
- Persistent sadness
- Frequent crying
- Persistent feelings of hopelessness
- Persistent feeling of pessimism
- Anger/irritability
- Open hostility
- Persistent feelings of guilt/worthlessness
- Withdrawal from favorite activities
- Low energy/tired every day
- Self-isolation
- Difficulty describing/taking about feelings
- Persistent boredom
- Agitation/restlessness
- Difficulty concentrating/making decisions
- Memory problems
- Changes in sleep: not sleeping or sleeping far more than usual
- Changes in eating: not eating enough or eating far more than usual
- Weight gain/weight loss
- Small maladies that don’t go away with typical treatment, i.e. headaches/stomach aches
- Suicidal ideation: thinking about, talking about, or attempting suicide*
* Never ignore talk of suicide. If someone you know is in imminent risk of harm or poses an imminent risk to themselves others, call 911 or go to the hospital. If they’re in crisis but no one is at immediate risk of harm, dial 988 for the National Mental Health Emergency Line*
Many of these symptoms occur in people every day. When they appear and fade quickly, they’re signs you’re having a bad day, or possibly a bad week. However, when any of the symptoms on the list persist every day for two weeks or more, then they may indicate the presence of a depressive disorder.
When is Inpatient Treatment for Depression the Best Choice?
Here’s how the DSM-V defines clinical depression:
“…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”
The risk factors for depression include:
- Family history of depression
- Previous diagnosis of mental health disorder
- Significant trauma, stress, or life changes
- Significant illness/disease in self or family
These risk factors increase the likelihood a person will develop a depressive disorder. Understanding the presence of absence of those can help a clinician diagnose depression and determine the appropriate level of care, which may include inpatient residential treatment. If the depressive symptoms we describe above prevent you or a loved one from participating in the following basic activities, then inpatient residential treatment for depression may be appropriate.
When we say, prevent, that’s what we mean. Symptoms that mildly impair full participation or create obstacles that are relatively easy to overcome, in most cases, require a less immersive level of care. However, if symptoms prevent full participation in the following activities, residential/inpatient care may be the best option:
Family and Home
If depressive symptoms prevent a person from completing the essential behaviors of life, such as eating, maintaining personal hygiene, and completing chores/helping around the house, then they may need time in residential treatment to get on track.
Interpersonal/Family Relationships
When depressive symptoms prevent a person from forming and engaging in healthy relationships with family, peers, or romantic interests, then time in residential treatment may be what they need. Please understand that health relationships are characterized by harmony, understanding, respect, and love. Turbulent relationships filled with conflict may have been healthy at some point and may heal and become healthy again. But if a person cannot connect with others and almost all their relationships are negatively impacted by depressive symptoms, inpatient treatment for depression may be appropriate.
Work Life/School Life
Depressive symptoms can have a profoundly disruptive impact on school and work. In some cases, they completely prevent an individual from meeting the basic requirements of school and work. Again, when we say prevent, that’s what we mean. A person with symptoms that impair participation may not need the immersion of residential care. When depressive symptoms are so severe a person cannot get out of bed and make it to work or school, they may benefit from residential treatment.
Social Activities and Hobbies
When someone with a robust social life and a set of hobbies they love – like music, sports/exercise, gaming, or others – develops a depressive disorder, and the symptoms prevent them from enjoying those activities, or participating in them at all, they may benefit from inpatient treatment for depression.
We’ll remind you here that an article like this cannot make a diagnosis or refer you to an appropriate level of care for treatment. If you recognize any of the symptoms above, they appear alongside the risk factors we mention, and they cause disruption on the scale we describe above, then we advise you to seek a full psychiatric assessment. Only a mental health professional can determine a clinical diagnosis and refer you to inpatient treatment for depression.
How Inpatient Treatment for Depression Helps
There are two major reasons inpatient treatment for depression can make a difference when a level of care life intensive outpatient or partial hospitalization might not:
- Time. When you have the time away from everything, including family, work, relationships, and the need to take care of your essentials, you can dedicate yourself to understanding your symptoms and learning how to manage them. That’s they key: your symptoms may persist, but your ability to manage them – without disruption – is what enables you to rediscover what a full and fulfilling life feels like. When depressive symptoms completely overwhelm you, time in immersive care can help you regain balance, return home, and re-engage in your life.
- People. In residential treatment, you’ll most likely meet a group of people facing similar challenges. They can help you learn and grow in treatment and recovery. You can learn from them, and they can learn from you. In addition, group therapy is often where people make substantial gains. You can practice distress tolerance skills and practice different approaches to managing symptoms all in real time with real-time feedback from people who know and understand what you’re going through.
With your counselors, therapists, and peers, you can identify the skills you need, validate your emotions and point of view, understand the relationship between your emotions and your behavior, then use this knowledge to empower yourself on your healing journey. The earlier a person with a mental health disorder gets the treatment they need – at the appropriate level of care – the better the outcome.
Gianna Melendez
Jodie Dahl, CpHT