Recovering from Depression
Everyone feels down and sad at times, but chronic depression, or what is called clinical, bipolar or major depression is different. Long -standing, reoccurring or deep depression is a serious illness. It takes the joy out of life and drains us of energy, hope, and drive, making it difficult even to do what we want to do to feel better. It’s not quick or easy to overcome, but it is possible.
If you have been chronically depressed you already know it’s not something that can be cured through sheer through willpower. You’ve undoubtedly tried that and grown tired of hearing people who don’t understand tell you to “Just cheer up.” But there are tools to help you manage your depression successfully even if it is severe, stubborn, recurring and persistent.
Below is a brief overview of depression and seven steps one can take toward recovery by using the tools counseling can provide. If your depression is mild in nature or related to a transient difficult circumstance or setback, you might find you using this material on your own to be helpful. If your depression is more severe, long lasting, or recurring and you can’t find your way out, counseling offers support and tools that are proven to help take steps you want to take but struggle to carry out on your own.
In some cases you may also want to talk with your medical doctor, if you have not already, about whether medication would be helpful in combination with counseling. Many studies show medication in combination with counseling using a CBT method is the most reliable and effective approach to treating depression.
If you or a loved one is suffering from serious depression, you can use these steps to consider where you or they are along the road to recovery and which tools might be most useful at this time.
Seven Steps to Recovery
1. Understand your situation
I have been surprised that clients who are referred to me with chronic depression after hospitalization or have been in treatment elsewhere previously report that no one has told
them much about depression, what it is, it’s common symptoms, how it’s treated or what has been found to be most helpful. This surprises me because knowledge is power. The more we know and understand about an illness the better to know what we’re dealing with. Here is some basic background.
What is chronic depression?
The National Institutes of Mental Health (NIMH) tell us that depressive illness is a condition in the brain that is related to imbalanced in the connection of the chemical interactions brain cells use to communicate internally. This imbalance is most likely is caused by one or more of a combination of genetic, biological, environmental, and psychological factors. Some types of depression tend to run in families. However, depression can also occur in people without a family history of depression. Trauma, loss of a loved one, a difficult relationship, or any highly stressful unnatural situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.
So we can think of depression like we would other chronic illnesses such as diabetes, heart disease, or arthritis that must be treated and managed. You did not choose it. It is not a weakness in your character or a negative reflection of you as a person.
Like with other chronic illnesses there are common symptoms of depression but people with depressive illnesses don’t all experience the same type, severity, frequency, or duration of symptoms.
Common signs and symptoms include:
- Persistent sad, anxious, or “empty” feelings
- Feelings of hopelessness or pessimism
- Negative thinking that lowers self-esteem
- Feelings of guilt, worthlessness, or helplessness
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details, and making decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
Depression is sometimes linked to physical symptoms too. These include:
- Fatigue and decreased energy
- Insomnia, especially early-morning waking
- Excessive sleep
- Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
Depression may also other health problems feel worse, particularly chronic pain. Key brain chemicals influence both mood and pain. According to NIMH findings treating depression has been shown to improve co-existing illnesses. Children and teens can suffer from depression too, although it is easy to over look their symptoms as typical “moodiness.” If you believe you or a love one is suffering from chronic depression, ask for a short confidential free screening survey.
2. Rename and reframe.
Once you consciously acknowledge that the painful depressing feelings and thoughts you’re having are symptoms caused by biological imbalances in your brain that are firing off “false messages” so to speak, you can recognize them for what they are. Each time you notice symptoms of depression, “label” them as symptoms. Consciously tell yourself, “This is not me – this is my depression.” “This is the depression speaking, not me.” You are not choosing to have these thoughts and feelings. You can’t just “snap out of them” anymore than someone can “snap out” of the horrid the cough that comes with bronchitis. Consciously “labeling,” or renaming, these symptoms and then reframing them as an illness does not make them stop occurring, but it takes the onus and judgment off yourself, just the way we routinely do with other illnesses. It puts what you are going through in the right context so you can begin the steps of healing.
3. Give yourself a break.
To overcome depression you need to start taking care of yourself, just as you would with any other illness. That will mean setting realistic limits on what you’re able to do, changing your thinking patterns, following a healthy lifestyle, managing your moods and stress, connecting with others, adopting healthy habits, and scheduling enjoyable activities into your day. But, WAIT! As my clients say, “What are you talking about? If I could do all those things I wouldn’t be depressed, would I?” That is so right! Like any other illness you have to start the healing process from where you are. If you were recovering from surgery, for example, you would want to start exercising eventually, but you wouldn’t jump out of bed and start exercising immediately. And of course you’d want to schedule enjoyable activities when you felt up to it again, but not while recuperating.
So give yourself a break now. You too are recovering from an illness. Think of the various positive changes you want to make as goals to aim toward as you recover, not yet another set of demands to put on yourself when you’re not ready. Start taking care of yourself by giving yourself a break from the expectation to be doing things you can’t do right now. Be accepting and gentle toward yourself. As with any illness, you’re not feeling so good; you don’t have a lot of energy; everything may feel like a chore and the future may look dull. But you did not choose to feel this way, so you need to begin treating yourself kindly with as much care as you can just like you would with a loved one who is ill.
4. Stick to the possible
Clearly recovering from depression requires a lot of action. But taking action when you’re depressed is hard. In fact, just thinking about the things you should do to feel better, like taking a shower, going for a walk or spending time with friends, can seem overwhelming.
This is the Catch-22 of depression recovery. The things that help the most are the things that feel the most difficult to do because you are depressed. But there’s a difference between difficult and impossible. The ideas below include a variety of opportunities to find what is possible. You can take such steps at whatever pace you need. The best motto is, “You can only do what you can do, and that is enough, so do that.”
Start by focusing on something small you might like to do. Too often when we’re depressed a list of things that need doing starts piling up. But usually these things are not especially appealing, i.e. cleaning the house, doing the dishes, paying the bills, returning phone calls, going to a meeting. In other words, they are a list of life’s “should’s.” Don’t try to start with these should’s. Give yourself a break and focus on doing something small that’s appealing to you, something you might enjoy, i.e. walking outside, having a cup of cocoa in your favorite chair, watching a good movie.
Doing Little Pleasant Things
||Putter around in your workshop
Play with a pet
Write in a journal
Listen to music you like
Do something spontaneous
Whatever comes to mind
Order in your favorite take out
You may not have much energy or interest but you probably have enough to find a few, or at least one, small personal interest to build from. You don’t need to expect that doing this will lead to your wanting to do lots of other things right away. Trying to push yourself to do too only brings you down again. The idea is to do something, not too much. Just enjoy doing that one or a few things, taking one day, one thing, at a time. Then reward yourself for each accomplishment no matter how small it might seem.
To find something you want to do follow your G/G attractions as a tool for where to start.
If you don’t push too hard, small steps will lead up to a desire for more, because each pleasant activity is like feeding yourself a nutritious meal; it brings you a little more energy. You’ll find the energy you put into working on recovery will bring more energy in return.
5. Ask for help
As you’re reading along you may be thinking, “Give myself a break! How can I do that? I have people, family, pets, a boss, depending on me. Well, of course, you are right again. But because you are ill you really might need their help in addition to the assistance of a counselor and doctor.
First you need those in your life to understand that you are not well. If you had suffered a heart-attack or were recovering from surgery, folks would naturally know you need help. But because your illness is brain-related, it is not visible so some folks have a harder time understanding. Invite them to visit this web page or suggest that they explore other sites on depression such as the slide show on WebMD, the Mayo Clinic site on depression or the NIMH site. If you wish they might also speak with your MD and your counselor better understand what you’re dealing with.
Once they understand the reality and seriousness of your illness and can see that you are getting treatment and following prescribed protocols such as these and your doctor’s advice they can help you with “must do’s” you can no longer take on. You can ask your family and friends for help with children, housework and pets. You might even need to ask your employer for temporary leave from your job. If you don’t have a support system, your church or community services may be available to help you.
If you are working you may need to ask for a reduced schedule or a leave of absence. If you cannot work you may already be on disability or your counselor or doctor can help you apply for disability so that you will have funds to give yourself time to heal.
Getting the support you need plays a big role in lifting the fog of depression and keeping it away. You deserve and need to take this step for yourself and you don’t need to feel embarrassed or guilty, just as you would not if you had undergone major surgery.
6. Learn to manage thoughts and moods
Depression thinking puts a negative spin on everything, including the way you see yourself, your circumstances and your expectations for the future. Other people may be telling you to “just cheer up.” But if you’re depressed you already know you can’t “just snap out of it” by wishful thinking or having happy, positive thoughts. As you’ve undoubtedly already discovered, trying to escape feelings of negativity by “thinking positive” doesn’t work. Instead with depression we need to recognize that the negative thoughts and feelings you’re having are symptoms, like sneezing and coughing are symptoms of bronchitis. They need a dose of treatment, just like other symptom do.
Here are some treatments you can try. There is no need to think you can apply them immediately or that your depression will lift immediately when you do, but again, think of these mental tools as goals to work toward on your own or in your counseling sessions.
- Shift your focus of attention away from yourself. Depression is very “me” oriented. Search for something outside yourself to do or think about. This can be something as simple as noticing the sun coming through the window or the sound of your cat purring. Or you might turn to something a little more active like remembering it’s time to feed your dog, wondering what the weather is outside and going out to discover first hand, , or thinking about how a friend is doing today and calling to find out.
- Talk to yourself mentally the way you would talk to a loved one who is ill. “Self-talk” is one of the most powerful anti-depression tools. But yourself self-talk may actually be triggering your depression or making it worse. So pay attention to what you’re saying or thinking to yourself in your mind. Ask if what you’re saying helpful to you. How does it feel to hear these thoughts? Is it what you’d say to a loved on who feels the way you do? If not, it is the depression talking and stop being so mean and hard on yourself. Talk to yourself the way you’d talk to a loved one whose feelings and self-esteem you care about dearly.
- Allow yourself to be less than perfect. Many depressed people are perfectionists, holding themselves to impossibly high standard and then beating themselves up when they fail to meet them. No one can be perfect. Such expectations contribute to
depression and provide an on-going source of stress. Remember, right now you’re not well yet. You’re healing. Would you expect a loved who is ill to perform everything up to par and beyond? Give yourself the same break you’d give those you love to do what you can realistically do and not more.
- Talk and socialize with positive people. One reason we feel “drained” when depressed is because we tend to isolate ourselves when we feel depressed. So we aren’t getting “fed” by the energy that comes from interacting with others in engaging activities.
Unfortunately sometimes the well-meaning people we would naturally reach out make us feel worse instead of better. This may happen even when with close friends or relatives. A parent may chide you for not doing more or getting better faster. Friends may tell you what to do and get frustrated when you don’t take their advice, or they point out that other’s problems are worse than yours. A spouse may be critical to the point it seems like you’re never good enough.
These folks probably have no idea they are making matters worse for you. They probably think they’re helping. But if you generally feel worse after talking with a particular person, you need take a break from that person for a while. It’s OK to tell them that now isn’t a good time to visit.
Look instead to find positive people and activities that leave you feeling better. You don’t need to put on a happy face, act upbeat, or be the life of the party. Just be there, say “hi” and participate to the degree you are comfortable. Even if you’re not interacting much, you’ll be surprised at how nourishing being in presence of upbeat or inspiring activities can be.
- Take note of your negative thoughts. When we’re depressed negative thoughts often play like a continuous loop tape recorder in our mind. We may not even notice them
but they are eating away at us. There is usually a thought that accompanies our moods, both positive and negative. So, start paying attention to the depressive thoughts that run through your head and the impact they have on your feelings. They are, as we’vediscussed they are not you, they are symptoms of depression talking.. So:
Notice – Rename – Reframe – Refocus
Doing this is not just a matter of “thinking positive thoughts.” It’s a matter of noticing that you are having a symptom of an illness and renaming it for what it is. That reframes what’s going on with you and allows you to consciously choose to focus your attention on something else, something that enhances your life.
You might want to jot your thoughts down in a notebook and notice what triggers particular negative thought symptoms and what feelings they lead to. When you’re in a better mood you can look over this litany of mental and emotional symptoms and reframe objectively. Is the negativity truly warranted? Is there another more useful way to view these triggers? For example, let’s say someone snaps at you and you automatically assume that they don’t like you; maybe that person is just having a bad day. Here’s some other commonly reported of symptoms of depression thinking:
|All-or-nothing thinking||Looking at things at black-or-white, either/or with no middle ground (“If I’m not perfect, I’m a total failure.”)|
|Overgeneralization||Always or never thinking. Generalizing from a single experience that something will hold true forever or never come to pass. (“I never get what I want.” “I always mess us.”)|
|The mental filter||Overlooking positive events to focus on the negative. (Noticing the
one thing that went wrong, rather than all the things that went right.)
|Diminishing the positive||Coming up with reasons why positive events don’t count (“She said she had a good time, but I think she was just being nice.”)|
|Jumping to conclusions||Making negative interpretations based on no evidence as if you could read minds (“He thinks I’m pathetic.”) or tell fortunes (“I’ll be stuck in this dead end job forever.”)|
|Emotional reasoning||Believing that your thoughts and feeling are an absolute refection of reality (“I feel like such a loser. I really am no good!”)|
|‘Shoulds’ and ‘should-nots’||Holding yourself to a strict list of rules for how you should and shouldn’t be or act and beating yourself up if you don’t live up to your rules.|
|Labeling||Defining yourself with a label based on mistakes and perceived shortcomings (“I’m a failure; an idiot; a loser.”)|
Also see Avoiding Common Errors that Defeat Us.
Monitor your moods. Just as with your thoughts, notice your moods. Is there a pattern? A cycle? Are there particular times, events, circumstances, thoughts or physical changes that accompany a shift your mood? What body sensations accompany your feelings of depression? The earlier you can notice the particular internal and external signs of an oncoming depression the easier it is to make choices to think, feel and act in ways that will lessen or circumvent a depressive episode.
7. Make lifestyle changes
Once you have given yourself a break to engage in small pleasant things, the time will come when you’ll begin to have to a little more energy and want to make other changes in your life. It might be sooner or later than you think but as you begin using the tools you learn in counseling patiently and consistently you’ll find there are certain simple lifestyle changes that will make a huge dent in your depression.
Gradually begin doing as many of the following things as soon as you have both the desire and the energy to do without pressuring yourself or making matters worse. You’ll be surprised to find that if you gear up to do one or more of these things your mood with will lift.
- Go outdoors in a natural environment and interact with nature, i.e. back yard, front porch, a nearby park or garden. Be sure to expose yourself to a little sunlight too. Lack of sunlight can make depression worse. (Ask for a sample of a Healing Nature Activity)
- Get eight hours of sleep. Sleep problems often accompany depression. Whether you’re sleeping too little or too much, your mood suffers. Establish a better sleep schedule by adopting healthy sleep habits. (Ask for our Sleep Hygiene Report).
- Drink plenty of pure fresh water. Depression is a common result of a dehydrated brain. It may sound overly simple, but it isn’t. Our bodies are 75 percent water and our brain tissue is 85 percent water. Dehydration leads to a multitude of serious illnesses and degnenerative conditions. Don’t make the mistake of confusing liquids like coffee, tea, soda-pop. commercially-produced juices, and beer, with pure water.
- Remove as much stress from your life as you can. Not only does stress prolong and worsen depression, but it can also trigger it. Identify the things in your life that stress you the most and make a plan to avoid them or minimize their impact, i.e. unsupportive relationships, taking on too much, or health problems, broken or complex equipment.
- Replace junk food you crave with tasty, healthy and nutritious foods. (Ask for our Report on Natural Remedies for Depression).
- Get support from willing others to help with things you find hard to undertake.
- Avoid the urge to isolate yourself, get out several times a week to non-threatening activities where you can interact with people.
- Get moving every day. Choose some exercise or physical activity you enjoy. To get the most benefit, aim for 30 minutes a day. But you can start small. Short 10-minute bursts of activity can have a positive effect on your mood. Here are a few easy ways to get moving:
- Take the stairs rather than the elevator
- Park your car in the farthest spot in the lot
- Take your dog for a walk
- Pair up with an exercise partner
- Walk while you’re talking on the phone
- Turn to your pets. Pets can bring joy and companionship into your life and help you feel less isolated. Caring for a pet can also get you outside of yourself and give you a sense of being needed—both are powerful antidotes to depression. Studies show that pet owners are less likely to suffer from depression or get overwhelmed by stress. (See the research data on Pet Assisted Therapy)
- Carve out time for time to rest and relax.Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation. Ask about the One-Minute Meditation and the Mindfulness program.
- Give yourself time to be well. Feeling better takes time but you can get there if you give yourself time to make positive changes at a reasonable pace
You’ll find that sometimes these changes can be combined, making them easier and simpler. For example, if you would enjoy going to the gym or a yoga class, you will be interacting with others, having time for yourself, and get moving, all at one time.
A hard copy of this guide is available to clients upon request.
© Sarah Anne Edwards, LCSW, PhD, 2012, 2013
All rights protected except with written permission