"What is Depression?" Part One described some of the causes of depression. This article presents some of the most common and useful suggestions for coping with depression. Some of these techniques may work for you; others may not. Some may work sometimes, but not all the time. If you try to follow one of these suggestions and it doesn't work for you -- forget about it and try something else. Before you try any of these techniques, consult with your physician or mental health professional. Every person is so unique that what might sound like a helpful suggestion for one person may be detrimental to another. Only a physician or licensed mental health professional who knows you well can make a determination about whether a specific coping technique will be beneficial for you.
The following suggestions are based not only on my experience as a therapist and books on depression, but on the suggestions made by some of my clients who have struggled with depression for a long time.
The symptoms of depression fall into three categories: emotional, mental, and physical.
Emotional Symptoms
The emotional symptoms of depression include anger, withdrawal, feeling "flat," "empty" or "like a dead person."
Anger: If you can, try to express your anger in a way that does not harm you or others. Physical exercise, cleaning, gardening, carpentry, ceramics, or writing, talking, praying or drawing pictures about your anger often help to release at least some of it. Some people find it helpful to write letters to the person whom or agency which they feel is the source of their anger. If you want to try this writing technique, be prepared to write two letters. The first letter should be only for your eyes. In it, you can write whatever you feel. You can give vent to all your raw emotions of rage and frustration. The point of writing this letter is to release some of the rage. You don't have to keep the letter if you don't want to. You can simply tear it up and throw it away. If writing it has reduced your anger even a little bit, it has served its purpose.
However, if you want to write a letter to actually send to a person or agency, you need to "sleep on it" and share it with people you trust to determine if sending it will serve a useful purpose. Such a letter will take careful thought. Although it may be a strong letter, it should not contain threats of aggression. Furthermore, if you find that expressing your anger, either in writing or in other ways, only increases your anger and makes you feel out-of-control of yourself and more likely to be aggressive, then you may be one of those people who needs to hold their anger in and not express it.
Withdrawal. Depressed people tend to withdraw from others. The first step towards counteracting this trend towards withdrawing is to acknowledge its existence. You need to admit to yourself that you are withdrawing. The second step involves talking to someone about your withdrawing and feelings associated with withdrawing, feelings such as feeling "dead" inside. You need to talk to someone safe who won't criticize or reject you. Set a time limit on the amount of time you will talk about your feelings with a friend, for example, five minutes. If you keep the time short, then you need not worry about burdening the other person. Then, if you can continue to relate to that person.
If there is no one to talk to, you might consider thinking about what it means to you to be withdrawing or writing about it in a journal.
If you can (and only if you can), try to attend whatever function it is that you want to withdraw from for a limited amount of time. The "function" may be as simple as talking to your partner or someone in the family or it may be as major as a family reunion or big party. Make a deal with yourself that you will attend the function for a limited amount of time. Pick a time period that you know you can handle, not a period of time that you think you SHOULD handle. Then cut that period of time in half and make it your goal to stay at the function for that period of time. If you achieve this goal, consider yourself a success.
After you have stayed or engaged in the activity for the time you set for yourself, you may want to leave as planned or you can stay a little longer.
However, if you find you don't have the energy to relate to others, then don't beat yourself up over it. Find your safe place and enjoy being alone with no one or nothing making demands upon you. Although depression can be painful, it can also be thought of as a "time-out" for you to re-evaluate your life and priorities. [It's also a great time to work on projects of activities that require solitude -- if you have the energy or interest.] Some psychologists like to think of depression as positive in that it gives people time to center themselves. Instead of thinking, "I'm a social failure or a psychological wreck," tell yourself, "I'm recharging my batteries." Criticizing yourself for being depressed is a waste of precious energy.
Feeling "flat." If you don't mind feeling flat, don't be concerned about it. If you don't feel comfortable feeling "flat," then you can try to activate your emotions by listening to music, watching a movie or favorite television program, helping someone in need, or reading. Remember, the goal is to feel more alive, not more numb. If watching t.v. enlivens you, continue watching it However, if watching television or videos lulls you into a state of numbing, you are no longer achieving your goal of feeling more alive.
Mental Symptoms
The mental symptoms of depression include confusion, slowness of thought, memory loss, problems concentrating and other mental dysfunctions
If your brains feel like molasses, make a list of what you need to do that day. Include only important activities which must be done and rank order them. If there is a time you have to have a certain activity, like picking up children at a certain hours, write that time down next to the name of the activity.
This list can be your guide when you get confused or can't remember.
Perhaps you feel ashamed at having to make a list like this. "If I was normal' I wouldn't have to this," you might be telling yourself. Perhaps if you weren't depressed, you might not need to make a list. However, many non-depressed persons, even high achievers, make and use lists. Wealthy people hire secretaries to make and tend to their lists.
Unless you are severely depressed, keep in mind that depressive episodes come and go. Just because you need a list during a difficult time, does not mean that you will always need a list and that you will be making lists forever. This is a temporary coping device, that will help you to feel more competent and help you do what you need to do or be where you need to be, which will improve your self-esteem.
Reduce your goals. If you usually can read a three page article when you aren't depressed, your goal when depressed should be smaller. Keep the goal of reading, but shrink it. For example, make your goal one paragraph or on page. Your difficulties with concentrating and other mental difficulties may be temporary. Even if they are not and you must live with them for a long time, denigrating yourself for something you can not change and never chose for yourself is counter-productive. Putting yourself down uses up valuable energy which you need to function in life. When you're depressed, every ounce of energy counts. Don't waste it reminding and chastising yourself for having symptoms of depression. You didn't chose to have clinical depression, did you?
Physical Symptoms
Fatigue: If you're depressed, the last thing you'll want to do is move your body. Yet it may be the thing you need to do the most. Any movement helps. Simply getting out of bed and taking a shower is a start. Your physical movement will help your mental problem. The more you move, the more your brain can work. Physical movement, especially exercise, activates the mind and releases a natural anti-depressant.
If you can't exercise as much as you used to when you weren't depressed, then consider doing a fourth of what you used to do and consider yourself a success. Perhaps once you get started, you will find you have enough energy to do more. In most cases in life, motivation comes before action That is, you are motivated to do something, then you do it. If you are depressed, action precedes motivation. You have to act, then you get motivated --- maybe. Suppose you try some exercise or some other type of action in hopes of helping your depression to lift, and you find yourself not only unenergized, but more fatigued then ever. In that case stop, if you want. You tried. For now your degree of depression may not allow you to proceed. But that doesn't mean that you should stop trying. Depression is unpredictable. Maybe on Tuesday when you forced yourself to go for a walk, you had to turn around and go home because you were so tired. But perhaps on Wednesday, when you force yourself to go for a walk, the walk will achieve it's purpose of "waking you up."
Distraction. Some people find that distracting themselves, by driving reading, talking to others (not necessarily about the depression), watching tv or a movie, or helping others may help shake the fatigue. Others, however, find that watching tv or a movie, fatigues them even more. Judge the worthiness of an activity by its fruits: does the activity enliven you or deaden you? If it enlivens you, then it may be worth pursuing. If it deadens you, then you know it is not helpful in counteracting depression.
Eating. Overeating as a way to pleasure yourself and "wake yourself up" will ultimately put you to sleep. Try not to overeat -- or undereat. Either one can add to the fatigue of depression.
Pain. If you have physical pain, call a doctor or nurse. At least keep a record of the pain -- how severe it is, when and where you experience it.
Drugs and Alcohol . Like food, they can be used as a "pick me up" but in the long run they let you down. Both alcohol and drugs drain the nutrients out of your body, diminish your mental capacities, alienate important people in your life, and hence, in the long run, contribute to increased depression.
Medication
The right anti-depressant in the right dose can work wonders -- if you can tolerate the side-effects. Although there have been great strides in research on anti-depressant medications during the last few decades, sometimes even the most competent and caring doctor can not prescribe the right dose of the right medication on the first try. You will need to be in frequent contact with your psychiatrist or physician to assess your response to the medication.
Some of my clients can not tolerate some types of anti-depressants, but have found found relief in others. This involved a process of experimenting with one drug, then another, that was time-consuming, costly and frustrating. "But I'm worth it ... and I have no choice. If I can find a drug that helps me, then it's worth all the trouble," explains a client. This man was lucky. He eventually found the right combination of anti-depressant and anti-anxiety drugs that gave him energy and helped him repair his marriage and his finances. But not all people are so lucky. I've had clients who have tried ever single medication on the market, including herb remedies, to no avail. Some of these persons became ill from the medications. Others found that the medicine helped lessen their depressions, but that certain side effects of the medications were intolerable.
The side effects of medication must always be weighed against the benefits. Once again, each person is an individual. The medication which helps one person may not help another. A side-effect which is a minor nuisance to one person, may be unbearable to another.
Taking care of your depression by seeking psychiatric help can sometimes feel like a part-time job. It takes energy and effort to keep the appointments, monitor the effects of the medication, and call the doctor when there is a problem. You must keep calling your doctor if you have a negative effect from any medication.
Managing depression takes work: mental emotional, and physical work. And it takes energy -- what depressed people lack. While it is important to accept your lack of energy and depressed condition, and not beat yourself up over it, it also important to try to push yourself - just a little bit to do something to help yourself out of a state of hopeless inertia. Even if you don't feel like it or feel it's hopeless, do something that has helped you in the past or that has been recommended by your mental health or medical professionals. Depression will tell you that it's not worth the time or trouble: that nothing can help. But depression is a liar.
Taking action on your own behalf, even if it's as small as taking care of your hygiene, can be a first step towards reclaiming a sense of personal power. Ask for help in mustering the energy to "fight" your condition to "fight" your condition. At the very least, go through the motions: that is, get out of bed and get dressed, brush your teeth and bathe, eat regular meals, try to complete at least one necessary chore, and remember that depression need not be a permanent condition.
If you are on medications, realize that it is your responsibility to take the medication as prescribed, not just when you feel like it. You also need to report side-effects to your doctor and be assertive enough to tell the doctor the truth -- the whole truth -- about your reactions to the medication.
The doctor can't do it all. You have to take an active part in telling your doctor what works and what doesn't and in calling the doctor if you have questions or if you develop a medical problem or begin taking other medications.
Clients with depression offer the following suggestions in coping with depression. Since everyone is unique, the same activity or coping strategy will have a different effect on each person. Only you can judge, from your own experience, what helps to feel more alive than more dead. Some of these suggestions include the following:
Talking, walking, getting in touch with nature, helping others, eating something special that isn't harmful or against food plan, exercise, medication, listening to soothing tapes, reading or learning something, being alone, being with others, resting (or the opposite, exercise); medication, fishing, fantasizing about good times; staying with routine, gardening, driving in country.
For additional information on depression and related conditions, such as guilt, anxiety, trauma, and finding good mental health care, visit www.matsakis.com
