Depression
Help! I’m Feeling Depressed!
Managing Depression
Depression is characterized by a set of behaviors and thoughts that can include: feeling sad, having low energy, or feeling “keyed up,” poor concentration and decision-making, loss of interest in enjoyable activities, sleeping too much or too little, eating too much or too little, and thoughts of self-harm. Depression can run in families. It can come on suddenly with a painful experience, or it slowly worsen. Depression can also be accompanied by anxiety problems, like panic attacks and constant worry. Research shows that the best treatment for depression is to use a combination of a medication and behavioral approaches. The behavioral methods focus on changing your daily habits to help improve your mood and prevent future episodes of depression. Like anxiety, it takes a very deliberate and aggressive stance to recognize what you can control and to do something about it. It can also be difficult to have selected behaviors ready to do when you feel out of control or sad.
Here Are Some Ways to Start:
Education - There are many ideas about where depression comes from, what maintains it, and how to treat it. By far the most important tactic to overcome depression is to learn about it. Understanding that what you are experiencing is extremely common and the symptoms present to so many people the same way. Being able to recognize what your mind and body are doing is the initial step to conquering this. There are dozens of resources and some very encouraging research. However, you have to commit some time to do your homework.
Suggested Reading: “The Mindfulness and Acceptance Workbook for Depression” by Strosahl and Robinson. “The Depression Cure” by Stephen Iltardi
What Else Should I Know?
Biology - Your brain and body are one thing, not two. How you treat your body will affect your mood and thinking.
Eat three meals every day. Start your day by eating something, and make sure to include a protein with every meal. Avoid eating snacks after dinner.
Eating fewer refined carbohydrates (white rice, white bread), fewer ‘pre-packaged’ or ‘fast’ foods.
Caffeine is a tricky thing, as it can give you the energy to work and get up in the morning but can also disrupt your sleep schedule
Nicotine can make anxiety worse and affect your sleep.
Alcohol can also be a problematic addition. While it may reduce anxiety and lift your mood in the short term, it leads to worsening mood and anxiety/panic later. Alcohol can damage the quality of yours leep and make the morning much worse. It is strongly advised that you speak with your physician if you are drinking more than 14 drinks per week for men, or 10 drinks per week for women.
Sunlight - the sun provides both bright light (to set our sleep) and allows our body to make VItamin D. Getting exposure to bright light will help you to stay awake during the days, and it can improve your mood as well. Just don’t forget the sunscreen!
Exercise - After discussing with your physician whether there are medical limitations on your exertion, it can be a helpful tool. Exercise for mental health purposes should be viewed differently from attempts to get in shape or to lose weight. There is a growing body of evidence of the power of moderate to strenuous physical exercise to improve depression and anxiety symptoms. Depression is often associated with low energy and a lack of motivation, the first few workouts can be hard. Exercise should be thought of as your daily medicine. It should be something that you can do for 15-30 minutes at an aggressive pace. You should be working hard, and pushing yourself to the point where you couldn’t sing a song smoothly. Research shows that moderate to strenuous exercise releases the same transmitter (i.e., Serotonin) that most antidepressants target and has been shown to reduce anxiety and depression. Exercise makes our bodies stronger both physically as well as mentally to the effects of stress.
Suggested Reading: “Exercise for Mood and Anxiety” by Michael Otto
Sleep - Nearly everyone going through a difficult time has problems with getting the amount and quality of sleep needed to properly function. Sleep has been proved to be tied to our mental status and performance during the day. An adult should get between 7-8 hours a night of sleep. There are a number of common ways to improve sleep. It can be very helpful for your doctor if you record the the time you get to bed, your best guess at the time you fell asleep, the time you woke for the day and any times awake during the night, as well as napping done during the day. These numbers can be rough estimates and should be recorded in the morning. Take a look at the sleep hygiene page for more information
Thinking - During a depressive episode, our own thoughts can be our own worst enemy. Attempts to stop or control our thoughts do not work and often make them worse. The best way to deal with them involves recognizing when your non-productive thinking is making the situation worse and choosing to do something different.
Social Interactions - one typical response to depression is to want to be alone and pull away. Despite low motivation and a desire to “think” or “not be bothered,” choosing to do the opposite can be helpful. Anxiety and depression can lead people to be inwardly focused as they try to solve the problems they are facing. This can lead to isolation and worsening of symptoms. Those who CHOOSE to focus on others experience less mood and anxiety symptoms. The feeling of being able to help others aids in the sense of control in our world. That can be investing more energy in your family, volunteering your time at a retirement community or animal shelter, helping a friend during a difficult time, etc. This can be anything that leads you to actively help the world around you.
This time with others needs some planning and social time should not be reviewing everything in your head and having a long therapy session. Try for at least two social activities per week!
Being productive and engaged is also important. Often when you feel depressed or anxious, it’s easy to feel your life is out of control. Making lists, and establishing a healthy active routine can be useful to force structure into your life. Downtime and not knowing what to do with yourself (bedtime, sitting in traffic, watching uninteresting TV) can make these feelings worse. Productive tasks such as cleaning out and organizing your space (home, car, workplace) can be great way to change your comfort and perspective on life. Scratching items off of a to-do list can be a terrific way to apply a sense of control and accomplishment, and can be a healthy outlet for anxious energy.
Journaling - Writing down your thoughts can be a great tool to help you sort through a mind and body that is under stress. Just naming the emotions you are feeling is a simple way to start (“right now I am feeling…”). It can be the crisis “friend” when we feel overwhelmed with emotion, to get it out on paper. A journal can help you organize your day and what needs to be the focus. It can also be a good way to more objectively look at your progress: it’s easy to feel that every day is the worst day of your life when you’re struggling with depression, but when you write down your mood and review it periodically you may be able to see small progressions in your mood.
Calming Tools - Anxiety can commonly go hand in hand with depression, and it can be useful to read about that as well. We know that there are some proven methods to calm the body. Exercise is certainly a natural one that works, as is using breathing techniques and meditation/guided imagery/mindfulness.
Breathing Techniques
There are many different techniques to control your breathing that can be helpful. A common one is called “4-7-8.” It takes just a tiny bit of practice and can be used in any situation with no one being aware that you are doing the exercise. The technique starts with exhaling through the mouth all of your air. Slowly take a breath in through the nose while counting in your head to 4, then holding that breath to the count of 7, then releasing the breath through the mouth to the count of 8. Completing several cycles of 4-7-8 at a time can quickly calm the body and refocus thinking. If you experience lightheadedness or difficulty, the numbers can be changed to make it easier (for example: 4 in, hold for 4, exhale for 4).
Where Can I Find More Help?
For many people following these behavioral changes are enough to improve their anxiety symptoms. Some need more help from a mental health professional. The people who stick to their healthy routine will get more out of therapy with stronger and faster results. You can also find a therapist on Psychology Today. That website will let you find counselors, therapists, and psychologists by searching and filtering through zip code, insurances that they accept, male vs. female counselors, and other information. Remember that unless you feel comfortable with the person you’re talking to, it will be difficult to get anything out of the experience.
Self-Guided CBT for Depression including homework to discuss with your primary care provider or other healthcare professional can be found here
You’ll notice that medication isn’t on this list. It IS an important part of treating depression, and your doctor can help you with this and with many more things. Make an appointment and talk with your doctor to try to get more help!