Depression
Feeling down or blue is a natural part of life. People let us down, things go wrong, we lose people we love or the dreams we’ve valued. When feeling down stretches over weeks or months, is occurring frequently and interfering with your ability to interact with people and enjoy your life, it is likely that you’re experiencing some form of depression. Provided that you’re able to access information and have a good doctor and support network around you, even severe depression is a highly treatable condition.
PART 1 : Diagnosing and Treating Depression
1.1 Look for the signs of depression.
If you haven’t already sought help for your depression, it’s vital that you do so and don’t try to go through this alone. There are many common symptoms associated with depression. If you identify with one or more of those listed below, seek advice from your doctor. Signs of depression include:
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- An inability to function normally in everyday life.
- Inability to enjoy activities you once loved, such as reading, playing video games, drawing, etc.
- Lethargy, fatigue, and the feeling that doing things takes a lot of your energy.
- Persistent sadness, including fits of crying either uncontrollably or being set off easily, feelings of anxiety or emptiness.
- Feeling blue, sad, and down over a period of at least two weeks.
- Feelings of worthlessness, self-blame and a lack of self esteem.
- Sleeping a large more or less than usual, or experiencing insomnia.
- Unusual weight gain or loss, overeating or appetite loss.
- Finding thinking or concentrating difficult, “foggy” thinking, inability to make clear decisions or forgetfulness.
- Pessimism, or feeling a sense that life is hopeless, pointless and futile. This may even lead to a feeling of numbness.
- Body pains, cramps, digestive problems, headaches, and other aches that don’t go away with medication or treatment.
- Being irritable or restless a great deal of the time.
- Suicidal thoughts, thoughts about dying, or attempts at suicide.
- An inability to function normally in everyday life.
- Inability to enjoy activities you once loved, such as reading, playing video games, drawing, etc.
- Lethargy, fatigue, and the feeling that doing things takes a lot of your energy.
- Persistent sadness, including fits of crying either uncontrollably or being set off easily, feelings of anxiety or emptiness.
- Feeling blue, sad, and down over a period of at least two weeks.
- Feelings of worthlessness, self-blame and a lack of self esteem.
- Sleeping a large more or less than usual, or experiencing insomnia.
- Unusual weight gain or loss, overeating or appetite loss.
- Finding thinking or concentrating difficult, “foggy” thinking, inability to make clear decisions or forgetfulness.
- Pessimism, or feeling a sense that life is hopeless, pointless and futile. This may even lead to a feeling of numbness.
- Body pains, cramps, digestive problems, headaches, and other aches that don’t go away with medication or treatment.
- Being irritable or restless a great deal of the time.
- Suicidal thoughts, thoughts about dying, or attempts at suicide.
1.2 Have your doctor explore possible medical causes behind your depression.
Some depression results from, or is a side effect of, medical conditions or treatment for other medical conditions. In some cases, medical conditions can mimic depression.[4] It’s important for your doctor to identify any physical causes for depression that require specific treatments or to eliminate other reasons for your condition. Common medical conditions that might trigger depression include:
- Vitamin or mineral deficiencies, especially for people on restrictive diets. B vitamins are associated with depression, although it’s unclear whether lower levels of B vitamins (especially B12) cause or are caused by depression. In addition, much new research has come to light on Vitamin D being a powerful mental health regulator. Either way, if you know your vitamin and mineral input isn’t optimal, fixing it is an important first step.
- Thyroid problems, hormonal imbalances (including pre-menstrual), or disease.
- The side effects of some medications include depression. Read the warning labels and talk with your doctor about any concerns you might have.
- Co-existing illnesses. Depression often accompanies anxiety disorders (for example, post-traumatic distress disorder, OCD, social phobia, etc.), alcohol and substance abuse, heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson’s disease.These diseases may precede, cause, or be a consequence of depression.
Medical conditions that are specific to women, including postpartum depression (the “baby blues”), premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)
1.3 Research depression to get a full understanding.
Learn what you can about depression. Supplementing your knowledge about your condition will enable you to overcome it. Knowledge is an important way to reassure yourself that depression is real, that it is a concern to be treated with seriousness, and that there are many ways to defeat it. A wider understanding of depression will help to allay some of your fears and worries. It will also give you many tools to try for yourself.
Visit your local library and borrow books about depression, anxiety, and happiness. Look in the psychology, self-help, therapy, and medical sections. For youth, ask about books specifically written for teenagers and children. You can also look at online auctions or book sites for affordable books about depression.
Visit trusted online resources that have articles and other resources the help you understand more about depression. Government and national institutes set up for mental health treatment are reliable sources of information. For example, in Australia, check out the Beyond Blue National Depression Initiative;[12] in New Zealand, check out the New Zealand Government’s Depression site;[13] in Canada, check out the Government’s site on Depression;[14] in the USA, check out the CDC[15] or the NIMH[16]. There are many other good resources available online. Just be sure to verify their trustworthiness.
Helping recovery from depression through reading is referred to as “bibliotherapy.” If you’re motivated enough to take this path of recovery, it can be very beneficial. This method seems to be well-suited to people who always turn to research as a way of answering anything they’re experiencing in life.[17]
Use your deeper knowledge to educate others around you as to what you’re going through. It can help to fend off awkward or unsympathetic comments if you can share the bigger picture and facts about depression
1.4 Try talk therapy.
One of the most helpful solutions for your depression is meeting with a mental health therapist for psychotherapy. There are a range of psychotherapy treatment options, and each therapist will have his/her own unique style. You will have the best chance of being successful in therapy if you feel comfortable with your therapist. Consult with a number of providers before you select one to work with. Three of the most effective evidence-based therapeutic approaches for depression include:
Cognitive behavioral therapy involves the therapist and the patient working together to point out, challenge, and change negative thought patterns. It has been proven to be just as or more effective as an acute treatment (treatment for severe, but not chronic, depression) than antidepressant medications, and even offers those who receive it protection against relapse.[19]
Dialectical behavior therapy, a form of CBT, targets unhealthy or disruptive behaviors and teaches the skills necessary to become more adaptive to stressful situations in the future. This form of therapy is useful for treatment-resistant depression.[20].
Interpersonal psychotherapy is a time-limited empirically-researched treatment for mood disorders that focuses on how the symptoms of depression affect an individual’s interpersonal relationships. Interpersonal therapy is most effective with mild to moderate forms of depression
1.5 Consider taking prescription medication.
Many doctors will prescribe medication. Ask questions about the medication you’re taking, including duration and side effects. Be sure to report back to your doctor on anything you notice doesn’t feel right or if you’re experiencing side effects. You may need to have a change of dosage or switch to a different medication.
If you don’t want to take anti-depressants, make this clear to your doctor. Do your research beforehand to discuss alternative options because you will need to convince your doctor that you have the ability to actively work on your depressive thinking patterns without the aid of medication.[24]
If you don’t wish to take prescription medication, you may want to look into alternatives to antidepressants. St John’s wort is a popular non-prescription herbal remedy for mild depression that contains the active ingredient Hypericum perforatum. St John’s wort should not be taken with other antidepressant medication, because it may lead to serotonin syndrome.[25] Some effects of serotonin syndrome include shivering, confusion, seizures, and/or high fever. It can be fatal if left untreated; if you think you may be experiencing serotonin syndrome, call your doctor or visit a hospital immediately.
1.6 Try alternative therapies or remedies.
Investigate the potential of alternative therapies such as art therapy and acupuncture. In conjunction with other healing choices you’ve made, these can sometimes help restore your emotional balance. It’s important to find a respected practitioner in any alternative therapy, and don’t be surprised if you meet resistance from some medical practitioners to any reliance on alternative therapies.
Music is a form of self-help therapy that is known to change mood.[27] Choose music that improves your mood. If you must listen to sad music, switch to more upbeat music after a few songs.
Art therapy is another common alternative practice for depression.[28] Draw, paint, or create designs that unleash your feelings on a canvas or paper. There are qualified art therapists who can assist you if needed.
Pet therapy can help. Pets prevent a sense of isolation, they don’t judge, and studies have proven that they induce a feeling of well-being in people who are depressed.[29] Even if you don’t own a pet, try to get access to someone else’s on a regular basis and spend time with them.
PART 2: Making Lifestyle Changes
2.1 Sleep well.
Sleep is essential to a healthy, balanced body. Lack of sleep can aggravate negative thinking and easily becomes a vicious cycle whereby your negative thoughts keep you awake and disable your ability to get enough sleep. Waking unrefreshed and feeling tired is a common complaint during depression, and even too much sleep can leave depressed persons feeling tired.[30]
Breaking this cycle requires enforcing a strict sleep routine of the same bedtime and waking time every day, avoiding caffeine and alcohol, not exercising three hours prior to bed, removing anything distracting from your bedroom, and keeping your room at a suitable temperature.
Read how to fall asleep for more help. It won’t be easy breaking a disturbed sleep cycle and many things can cause you to relapse back into insomnia or wakeful nights, so it’s important to be vigilant about keeping to a routine, as well as forgiving yourself when you can’t sleep
2.2 Exercise.
A recent study showed exercise to be as effective as Zoloft (a selective serotonin reuptake inhibitor or SSRI) in treating depression.[31] Exercise releases a natural anti-depressant chemical in your brain and gets you into doing something active. Start small with a simple walk to the local store or around the block, or to your garden gate might be the way to begin. Gradually work up to a routine that fits with your needs and enjoyment.
Look for friends or group exercise sessions since having a partner will keep you more motivated. You can also look for activities that will allow you to release some of the pent-up emotions that may be built up, such as kickboxing.
Playing sports is a great way to get regular exercise, stay occupied, focus on self-improvement and meet new people. Some studies have found that people who participate in sports have somewhat fewer symptoms of depression.[32] Choose a sport that is exhausting to quiet the chatter in your mind and leave you feeling wrung out—just don’t overdo it. Join a team or class in your area and commit to showing up to as many of these meetings as possible, even if you may not feel like going some days.
2.3 Eat healthy.
Reduce your intake of sugar, high fructose corn syrup, fast foods, and processed foods. Eat more fruits, vegetables and whole foods. Drink plenty of water and do some research on foods that are said to improve your state of mind and well-being. Improving your diet can be a positive project to keep you constructively occupied and focused when you’re working through your depression. Plus, many healthy foods are effective at improving mood.[33]
2.4 Restore any neglected grooming.
It’s can be easy to let yourself go when depressed and to pay no attention to appearance and clothing. Reintroducing daily attention to grooming can help improve your mood and give you a sense of well-being. Get a new haircut or new clothes as part of cheering yourself up. And concentrate on the parts that you do love about yourself instead of fretting over what you don’t like.
2.5 Maintain a good support network.
Support from people who love and care about you is an important part of the healing process.[35] Tell people you trust that you’re depressed and would appreciate their understanding and sympathy. It is far harder for people to help you if you’re secretive and do things that seem inexplicably strange. Knowing will help people to make allowances and support you as best they can.
Be willing to be honest about your irritability and reclusive behavior with those you trust. They need to know it’s not personal, but that you need space or time out every now and then.
2.6 Be around positive people.
Talk with friends, family and colleagues who make you feel good and who are good to be around. Spend time with people who see the world in a positive way and ask them to share their visions, ideas, and approaches to life with you. Most positive people will be more than happy to reveal the things that help them keep upbeat and happy about their lives. Learn from them.
Remember that misery loves company. It can be incredibly hard to keep away from negative people as down and out as you’re feeling, but do your best to avoid them. You won’t be doing either of you a favor by confirming each other’s fears that the rest of the world is terrible.
PART 3: Changing Your Behavior.
3.1 Keep occupied.
Being busy is a way to prevent negative thoughts from going around your head repeatedly. For depressed persons, the first step is often the hardest, so making yourself do things can be a huge difference in your day and getting you started.[37]
Engage in a hobby you enjoy or think you’ll enjoy. Immerse yourself in it. It doesn’t have to be expensive or difficult. As long as it’s interesting it will serve the purpose.
Care for pets. The routine involved in pets needing to be fed, groomed, and played with can be very satisfying for a depressed person. This is especially so because pets don’t provide a sense of judgment, but only return love and acceptance.
Introduce structure into your everyday life. Make a schedule of what to do every day, no matter how mundane, and gradually expand this as you start to feel better. It doesn’t matter whether you work or not. A schedule can put some direction back into a day that might otherwise feel empty or aimless.
3.2 Do fun things and treat yourself.
Feeling down feeds on itself and it soon becomes a catch-22 when you convince yourself that you don’t deserve to enjoy anything. The antidote is to do things that you used to enjoy or that are fun for people around you — “one fun thing a day to keep the blues at bay.”
As with everything else, do this gradually. One fun thing a day, such as watching a beloved comedy or reading a funny book can give you a sense of fun for a while.
Schedule positive events into your life. Go out to dinner, the movies, or for a walk with friends.
Take it slowly. If you used to enjoy gardening, plant a single plant. If you used to enjoy a long walk, take a short one. Gradually build up to more enjoyable experiences.
3.3 Start a journal of your journey through your depression.
Document your feelings somewhere personal and completely private. This will be the place where you let out your darkest thoughts — no holds barred — because you don’t need to worry that anyone will judge you for them. A diary can become your collaborator in the struggle against your depression because it eventually provides you with great evidence of what improves your mood as well as what brings it down.[39] Try to write in it daily if possible
3.4 Help others.
This can be a good way of moving through your depression once it’s better under control, and is often an ideal technique to use when your healing seems to have temporarily plateaued. Helping other people going through hardships removes your concentration from yourself and onto others, which can be good if you’re prone to too much introspection.
Don’t overdo volunteering. If you become involved in charity or volunteer work and you feel exhausted or used up, that’s a sign you’re overdoing it or may not even be ready to help others just yet. It doesn’t mean you won’t be able to do this, but it does mean take care of yourself first.
PART 4: Changing Your Negative Thinking Patterns
4.1 Think of it as a journey to wellness.
Depression can feel endless when the lethargy takes over and everything seems too hard. For this very reason, it’s important to view getting well as a journey of gradual steps, rather than something with an instant cure. There will be times that your determination is challenged by self-questioning and despair, but this is precisely when you must do your best to avoid being “depressed about being depressed!” Here are good ways to start:
Name your beast. Winston Churchill called his depression his “black dog.” By turning it into a pet, he made a difficult situation into a controllable one. In naming it, you make it a condition and not a definition of who you are. You can say something like “My black dog is making me feel irritable today,” instead of saying “I’m always an irritable no-hoper.”[41]
Find a role model. Think you’re alone in being depressed? Go to the library and pull out five biographies. It’s highly likely that at least one of those high-achievers suffered from depression. Do a little research online to find famous people who have overcome depression. Read about the many celebrities who are revealing their battles with depression. Read their stories. Take heart in the fact that there are others who have overcome depression, and now you have the benefit of their experiences to draw from too!
Be gentle with yourself. Life isn’t a race or a competition. The reality is that you matter, you have great value as a person, and making things harder for yourself is akin to beating yourself up. Avoid obsessing about your depression or creating a shrine to it to hide behind when things all seem to hard. The feedback loop of hopelessness and despair created by being angry with yourself for being depressed will deepen your despair. Go back to naming your beast and setting it apart from who you are. Accept that the journey to wellness is a matter of baby steps.
List the things that are bothering you outside of your depression.[42] It could be unpaid bills, a lack of vacations, or a tough job. In another column, write down some practical things that you think you can do to deal with the things that are bothering you. For example, find ways to pay these bills, plan a vacation, and figure out how to get a new job.
4.2Understand the importance of overcoming negative thinking.
This is a vital aspect of working through depression. Depressed persons tend to have what Aaron Beck refers to as an “Information processing bias.” This refers to the tendency to self-select the distorted and negative viewpoints of everything, entrenching the depression even further.
4.3 Change your thinking.
As part of progressing, recognizing and defeating negative thinking patterns is a very important aspect to concentrate on. Cognitive behavioral therapy, psychotherapy, or other forms of psychological therapy are helpful when you’re unlearning negative thinking and establishing patterns of thinking that support your self-esteem and increase your self confidence. While it is best to read up in this area and speak with someone qualified to help guide you through the ways to change your thinking, there are some important things to keep in mind.
Acknowledge the feeling will pass. This can be a very difficult step, but it’s vital because it helps you to start banishing thoughts of hopelessness.[43]
List all of your good points. When you’re depressed, it’s easy to understate the positive things about yourself. Turn this around by listing everything that is good about you. Include achievements from the past and hopes for the future, however few or random they may seem. If you can’t write this list, have a trusted friend or family member start one for you. This is a list to keep building upon as you work through your depression. Self-acceptance is a vital part of recovering from depression because you acknowledge that there are good things about yourself, but also that you have challenges to overcome. This will help you stop judging yourself more harshly than anyone else.
Make decisions, however small, and act on them. Again, while this is very difficult to do during depression, it is a vital element in facing the sense of helplessness that tends to overwhelm depressed persons.[44] Small decisions like getting out of bed, calling friends, or cleaning up the kitchen all add up. Once you act on them, they become achievements.
Learn how to replace faulty or negative thinking by focusing on it. Ask questions such as: Am I assuming the worst? Am I condemning myself because something bad has happened? Am I focused on my weaknesses rather than my strengths? [45] It is helpful to arrange the negative thought in one column and a rationalization in another column, so that you can confront and undo the negative thinking. In one column you may write the thought: “I’m a failure,” and in the other you challenge that thought with: “I made a mistake. I’ve made mistakes in the past and things have turned out okay. I’ve also had many triumphs.”
Learn assertiveness techniques once you’ve challenged the harder aspects of your negative thinking processes. Assertive techniques will allow you to find a pathway to standing up for yourself without giving in to feelings of anger, fear, or powerlessness. Knowing how to assert yourself is an important part of not falling back into depressive patterns in the future.
4.4 Look for the good.
Sit back and try to find the good in your life. Whatever it is, it is something worth finding. Return to this list regularly and continue to update it. In your initial recovery, it might have one or two things such as “my house” or “my spouse.” Over time, it should grow as you start to experience the more joyful side of life again. Replace unhappy thoughts with memories of happier times. You are always in control of what you’re thinking about. Make the choice to prefer the positive, happier memories over the unhappy thoughts
4.5 Change the way you talk.
Alter the language you use to help yourself look at things more positively. By saying “at least…,” this turns a negative into a positive. Other examples include rather than regretting something and feeling a failure, ask yourself, “What have I learned from this?”
4.6 Accept that depression may return.
Once you’re affected by depression, your vulnerability to it can mean it has a higher chance of returning in your life if you don’t manage its causes.[46] Recognize the warning signs and take constructive actions to deal with it earlier on before it starts. Aim to minimize its impact and duration.
If you believe your depression is returning, speak with your doctor, psychiatrist, psychologist or therapist right away to begin treatment.