Part Three: What to Do about Depression

Hopefully, you’ve read the first two parts of this series and understand the medical realities of Depression, how common Depression is, and what factors increase your risk.  Before we look at what works in dealing with Depression, here is some information about what people most often do when they’re depressed.

How to Make Depression Worse

People who don’t understand Depression tend to respond to it in predictable, ineffective ways; it seems that our gut instincts about how to handle it generally miss the mark, and in fact, generally make it feel worse and/or last longer.  So here then, is a list of the things you are most likely to do to self-treat Depression, explanations for why they don’t work, and suggestions for what to do instead.

Keep pushing yourself, as if nothing is wrong.  This is a good way to cause your already-compromised system to break down even further.  Imagine deciding to run a marathon on a badly injured knee.  You wouldn’t be able to complete the marathon, and you’d make your knee a lot worse in the process.  Same thing goes for increasing the load on your nervous system when it’s already struggling.  Much like the gimpy knee, you need to scale back the demands you make on your nervous system until it has recovered enough to resume full duty.  The key in any given moment is to do the most that you can comfortably do without over-taxing your system at all; your capacity will gradually return as the Depression remits.  If you ignore this guideline, you will likely cause your Depression to be more severe and/or longer-lasting.

Frequently berate yourself for not coping better.  Critical, judging self-talk never improved anyone’s performance, and certainly won’t lighten an episode of Depression.  Unfortunately, a characteristic of Depression is the presence of such thoughts.  It is most helpful to remind yourself that the thoughts are a symptom of the Depression, and leave them at that, without taking them to heart.  Then, gently redirect yourself back to coping as well as you can in the moment, and give yourself credit for doing so in difficult conditions. 

Eat junky food and stop exercising.  These are both tempting in the throes of Depression, because it just feels like too much effort to do anything.  However, low-quality food will affect your body in ways that will actually worsen the Depression.  By allowing physical activity to stop, you miss the nervous system chemical boost that such activity provides; exercise is actually one of the most effective strategies for managing Depression that there is.  So, even though you feel drained and apathetic, muster whatever energy you can to get decent food and move around at least a little, every day (but not to the point of over-exertion). 

Let your living space get cluttered up.  This is another one that is easy to slip into when depressed, due to lack of energy and interest.  However, the more your space gets cluttered, the more depressing and stressful the space itself becomes, thus hindering your eventual recovery.  Try to keep things up however well you can, knowing it will hasten your recovery to keep your living space relatively healthy and welcoming.

Allow your sleep schedule to become very haphazard.  Sleep changes are a frequent symptom of Depression.  If you suffer insomnia, you may take to staying in bed lots of extra hours or napping whenever you can in an effort to cobble together enough bits and pieces of sleep to get by.  Conversely, you may want to sleep excessively, and do so for hours more per day than is usual for you.  Either change disrupts the normal rhythm of your sleep, which will reduce its quality and restorative function.  Whether your sleep is insufficient or excessive, it is important to maintain a consistent time that you get up each morning; this will provide an anchor point for maintaining the rhythm of your sleep.  Beyond that, time in bed (regardless of insomnia or over-sleeping) should be limited to that required for a healthy amount of sleep.  Increasing time in bed actually aggravates insomnia by training your system to get better at sporadic, shallow sleep.  It aggravates over-sleeping by increasing sluggishness and therefore the further desire to sleep excessively.

Stay home as much as possible.  The low energy of Depression makes isolation and stillness very tempting, but the more you do this, the more likely you will worsen and/or lengthen your Depression.  It is best to make a point of getting yourself out of the house every day, even if only briefly, and to try to maintain as many of your normal activities as you can (without over-tiring yourself), to keep as much positive energy flowing into your system as possible, and to maintain the broader, healthier perspective that contact with the outside world helps to preserve.  A good way to approach decisions about what to do is to ask yourself not what you feel like doing (since you’re depressed, you probably don’t feel like doing much of anything), but what decision is likely to make you stronger for having done it.  Always go with what makes you stronger.

Watch a lot of TV.  This goes with the low-energy tendency to just sit and zone out.  If watching TV resulted in you feeling more refreshed and energized, it would be fine, but the result is usually just lost, numb time spent watching programming that doesn’t matter.  TV actually stimulates brainwave activity that keeps you stuck in Depression.  If you must be still, try doing something that adds life energy, like listening to meaningful music, appreciating the companionship of your pets, or sitting in front of a sunny window.  In even the lowest energy times, you will find that choices like these feel much better than mindless hours spent watching junk TV.

Avoid your friends and loved ones.  This tends to be done out of a combination of low energy, and depressive distorted thinking that tells you nobody really wants to be with you anyway.  It sometimes happens that time with friends is actually quite tiring because of the energy required to behave socially.  If this is the case, then based on the rule of doing whatever makes you stronger, it can occasionally be healthier to stay on your own temporarily to rest.  Most of the time however, it creates more energy and healing to be with your support system than without it, so if in doubt, try joining in.  You can always choose differently next time if it seems more healing to do so.

Use alcohol to numb the pain.  Depression can feel so painful that you may be willing to try nearly anything to help yourself feel better; alcohol may look like an attractive option because it's easy to get, and does produce a different feeling, at least temporarily.  This is a self-defeating strategy, however, because alcohol is a nervous system depressant, which means that it is actually worsening your Depression in the long-term, regardless of how it might make you feel for a few hours right now.  Alcohol is also toxic, and therefore further stresses your already-compromised system.  Your best strategy by far is to concentrate on the healthiest choices for your body that you can make (see below) -- alcohol does not make this list.

Managing Depression on Your Own

The first line of defense for preventing Depression is the same as the first line of treatment if you find yourself in mild-to-moderate Depression: Take particularly good care of yourself, living with the highest quality you can create.  The less you feel like doing this, the more important it is to do it anyway.  What this means:

Choose the highest quality nutrition you can afford, and eat in accordance with your body’s needs (breakfast daily; protein throughout the day; emphasis on natural, whole foods; minimal use of processed foods; lots of water; daily multi-vitamin).

Maintain whatever routine of exercise you can, as exercise is a powerful tool for restoring the proper chemical functioning that your nervous system needs.  Do as much as you comfortably can without over-tiring yourself.  If you’re just too fatigued for anything energetic, at least go for a leisurely walk, or do some gentle stretching exercises.  Physical movement is marvelous medicine, as long as it is paced to your needs.

Continue to participate in recreation and hobbies, even if your heart really isn’t in it.  You need to keep positive energy flowing in your life, even if you don’t feel the benefit of it sometimes.  It’s part of building yourself a bridge back to feeling the way you want to.

Spend time with supportive others as much as possible.  You may need to push yourself to get started, but will generally find that you feel better once you’re involved. 

Make all choices based on what is likely to make you stronger.  For example, if the choice is to either stay inside napping or go out for a walk around your neighborhood, the walk will almost always leave you feeling better than the nap would.  Make your best guess as to what will strengthen you, and then do it no matter how little you feel like it. 

When Self-Care is Not Enough 

The next line of defense may be psychotherapy, medication, or both.  What gets recommended first depends largely on where you go to ask for help.  Your family physician will most often suggest the use of an anti-depressant medication, because medication is the tool your physician has available to help you.  Psychotherapy may or may not be suggested at this time.  If you go to a therapist for help, you will certainly hear therapy recommended as your treatment, with the possible addition of medication depending on the intensity of your symptoms.  The truth is that some people benefit nicely from medication alone, some benefit nicely from therapy alone, and some get their best results from a combination of the two.  What works best for you will be up to you and your care providers to decide.

Psychotherapy helps by providing support and education, along with clarifying problem issues, identifying potential solutions, and correcting the distorted thinking that frequently worsens Depression.  You will also be advised about self-care strategies, as described above.

Anti-depressant medication, contrary to common misunderstanding, is not an “upper” – it does not artificially elevate mood as some recreational drugs do.  Rather, it directly addresses the Depression at the level of nervous system chemistry, ideally restoring that system to proper chemical balance and functioning.  It takes these medications several weeks to work, and it is advisable to stay on such medication for six months after your symptoms remit, to assure you don’t quickly relapse upon discontinuing the treatment.  While many people are helped with the first drug that’s tried, it sometimes takes a few trials to find the best medication dosage or combination, which can take a frustrating amount of time.  Many people get relief from their symptoms with no troubling side effects at all, but side effects are common, and can range from merely annoying, to being bothersome enough to necessitate a change in the treatment plan.  Most people will not need long-term use of these medications, but if you are prone to recurrent, severe episodes of Depression, you might decide that staying on medication is the best choice for you. 

Medication can be administered by your family physician, and this is often sufficient.  Your family physician manages this kind of medication in addition to many other forms of medical care for a wide variety of conditions, and therefore does not have the highly specialized knowledge of these medications that you will find with psychiatrists.  Psychiatrists and staff under their supervision are particularly helpful if you have a medically complicated situation, or your Depression has not responded to the treatment regimens tried by your family physician.  You might be referred to a psychiatrist by either your family physician or a psychotherapist, or you may choose treatment by a psychiatrist on your own if your insurance allows for self-referral.  As with all healthcare providers, your best bet is to see a psychiatrist whom you have heard recommended by someone you trust.

For the most severe, treatment-resistant forms of Depression, ECT (electroconvulsive therapy) remains an important treatment option.  It gets a bad rap from movie depictions of the barbaric-looking procedures of years past, but is in fact, now a highly-refined, gentle process.  There are some issues such as memory loss, and it doesn’t work for everyone, but for Depression that cannot be helped any other way and which has made life feel unbearable, it can literally be a life saver.  If you have tried everything else and have not found relief, don’t give up – ECT is well worth trying.

For more information, consult with your doctor for good educational resources, or feel free to contact me.  Whatever you do, don’t give up.  Depression can feel absolutely devastating, yet is one of the most treatable mental conditions we tend to get.  There is help for you.

Copyright © 2006, Elizabeth Babcock, LCSW.  All rights reserved.


Related articles:

Self-Help for Intense Anxiety

Sleep Well -- Self-Help for Insomnia

Dealing with Unwanted Feelings and Bad Days: Book Excerpt

Taking Care of Yourself When You Least Feel Like It: Book Excerpt

Rebuilding Your Strength after a Setback: The 95% Rule

When is It Time to Consider Psychotherapy?


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