Lesson 2

How to Cope with Depression

At some time in your life, you will be impacted by depression, whether it is your own, or the depression of someone else close to you.[1] In any given year, approximately 18.8 million American adults (9.5% of the population) are coping with depression,[2], 1 in 5 New Zealanders are impacted,[3], 20 percent of Australians are affected,[4], and 1 in 4 Britons experience a mental health problem (with depression being a major source).[5] Depression is serious – the World Health Organization considers that by 2020, depression will be the second leading contributor to the global burden of disease behind heart disease, with it already affecting about 121 million people worldwide.[6]
Feeling down or blue is a natural part of life when people let us down, things go wrong, or we lose people we love or the dreams we've valued. It's normal to feel sad when faced with setbacks, as we come to terms with what the setback means for us and struggle to find our way back to feeling normal again. This sadness becomes a problem when it fails to pass and we fail to bounce back. If the sadness stretches over weeks, is occurring frequently, and interferes with your ability to get on with life, interact with people, and to enjoy your life, then it's likely that you're experiencing some form of depression and it's vital to speak with your doctor quickly. Provided you're able to access information, and that you've got a good support network around you, even severe depression is a highly treatable condition.[7]

Steps
Seek help
Identify depression as a possible challenge you're facing and seek professional help. If you haven't already sought help for your depression, it's vital that you do so and don't try to go this alone. If you're unsure what's wrong with you and some of the things you read here resonate with your own situation, seek advice from your doctor. Signs of depression include (you might experience some or a range of these):[8][9]
An inability to function normally in everyday life, including lethargy, fatigue, and inability to get excited about things you used to love doing, finding that doing things takes a lot of your energy
Persistent sadness, including fits of crying either uncontrollably or set off easily, feelings of anxiety or emptiness
Feeling blue, sad, down all of the time over a period of at least two weeks
Feeling worthless, self-blaming
Sleeping a lot more or less than usual, insomnia or excessive sleep
Unusual weight gain or loss, overeating or appetite loss
Finding thinking or concentrating difficult, "foggy" thinking, inability to make clear decisions, forgetfulness
Pessimism – feeling a sense that life is hopeless, pointless, futile, and meaningless; may even lead to a feeling of numbness
Body pains, cramps, digestive problems, headaches, and other aches unable to ease with treatment (for some people)
Irritable a great deal of the time, restless
Suicidal thoughts, thoughts about dying; sometimes attempts at suicide.
Ask your doctor to 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, and in some cases, medical conditions can mimic depression.[10] 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,[11] although it's unclear whether lower levels of B vitamins (especially B12) cause or are caused by depression.[12] 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.[13][14]
Medications – the side effects of some medications include depression. Read the warnings and talk with your doctor about any concerns you might have.
Alcohol, drug, or other addictions.[15]
Genetic links to depression.[16]
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.[17] These diseases may precede, cause or be a consequence of the diseases.[18]
Depression is more common among women than men, including post-partum depression (the "baby blues"), premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).[19][20]
Begin your healing
Start your 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. Even when you make up your mind to get well, there will be times that your determination is challenged by self-questioning and despair. And yet, 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 – although depression sticks to us much as does a dog, our thoughts about depression can be trained, much as we train a dog: patience, persistence, and habituation can turn around depression.[21] Moreover, in naming it, you set it apart from you – it's a condition, not a definition of who you are. You can talk about "My black dog is making me feel irritable today" instead of saying "I'm always an irritable no-hoper".[22]
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 the odds of depression; even celebrities are revealing their battles with depression. Read their stories. And take heart; they managed it, so can you, only you have the benefit of their experiences to draw from too!
Be gentle on yourself. Life isn't a race or a competition, even though it sometimes seems this way in our marketing hyped consumerist lifestyles. The reality is that you matter, you have great value as who you are 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. Additionally, accepting that the journey to wellness is one of baby steps will free you up from potentially devastating high expectations.
List the things that are bothering you outside of your depression.[23] For example, unpaid bills, mortgage, rotten career, disrespectful children, poorly maintained house, lack of vacations, tough job, etc. 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, get a new job, go back to university, ask family to help fix house, see a counselor with kids, plan a vacation, talk to boss, etc.
Work with your doctor. 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.
Follow all the instructions relevant to your medication, including food and medicinal restrictions, dosage levels, and withdrawal requirements.[24]
If you don't want to take anti-depressants, raise this preference with your doctor. Do your research beforehand to discuss the options because you will need to convince your doctor that you have the ability to actively work on your depressive thinking patterns and your lack of resilience without the aid of medication. While doing this can take some convincing (have a list of questions for the doctor), it is your right to express your preferred approach to treatment.[25] It is important, however, to realize that battling depression without the aid of medication is challenging and can take longer; you may want to consider increasing the frequency of sessions with a cognitive therapy specialist.
Research about depression. Learn what you can about depression. You don't have to, and indeed should not, rely only on what the medical professionals tell you about the illness. 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 to see if they work for your situation.
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 (children do get depression[26]). Or, look at online auctions or book sites for affordable books about depression.
Visit trusted online resources targeted at your population. 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;[27] in New Zealand, check out the New Zealand Government's Depression site;[28] in Canada, check out the Government's site on Depression;[29] in the USA, check out the CDC[30] or the NIMH[31]. These are simply a small selection; there are many 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, and seems to be well suited to people who always turn to research as a way of answering anything they're experiencing in life.
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've got the bigger picture and facts about depression.
Keep 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. It can be cathartic to let out all of your thinking, to form it in words on a page. And it is better than unleashing a torrent of pain or incomprehensibility on another person in your life, or worrying that you've told anyone too much negative stuff. A diary becomes your collaborator in the struggle against your depression and can provide you with great evidence of what improves your mood as well as what brings it down.[32] It also allows you to begin afresh every day, with the last day's and week's writing behind you as you continue to push forward. Find a decent journal to write in, a book or notebook that makes you feel like writing in it, and keep it somewhere safe. Write in it whenever you feel like, although trying to add to it at least daily can be a really soothing ritual until you start feeling stronger again.
Body care
Take care of your body. Your body needs to be well-nourished, well-rested, and cherished. If you've been neglecting it or pushing it too far, you will pay a price and part of that will result in lowered resiliency and openness to depressive thoughts. The following things matter a great deal when trying to cope with depression:
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 commonplace complaint during depression, and even too much sleep can leave depressed persons feeling tired.[33] 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, keeping your room at a suitable temperature, etc.[34] Read How to fall asleep for more help. It won't be easy breaking a disturbed sleep cycle and many things can restore the insomnia or wakeful nights, so it's important to be vigilant about keeping to a routine, as well as very forgiving of yourself when you can't sleep.
Exercise. A recent study showed exercise to be as effective as Zoloft (a selective serotonin reuptake inhibitor or SSRI) in treating depression.[35] Exercise releases a natural anti-depressant chemical in your brain, and gets you out of your bed or chair and into doing something active. Start small - a simple walk to the local store, around the block, or to your garden gate might be the way to begin. Gradually work up to a regular walk, run, cycle, etc. routine that fits with your needs and enjoyment. It should be enjoyable and comfortable, not rigorous and defeating. Possibly tagging along with a friend to a group exercise session might motivate you, or attending something that permits you to express extreme emotions, such as kickboxing or running.
Eat healthily. Reduce your intake of sugar, high fructose corn syrup, fast foods, and processed foods. Eat more fruit, 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.
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.[36]
Support and healthy relationships
Find support among family and friends
Maintain a good support network. Support from people who love and care about you is an important part of the healing process. Tell people you trust that you're depressed; do it in a way that makes it clear that they're not responsible for you or a cause of your depression but that you'd really appreciate their understanding and sympathy. If it is hard for you to let on that you're depressed, remember that depression is now recognized and taken seriously by the medical profession everywhere and that it is not something to be ashamed of. It is far harder for people to help you if you're secretive and do inexplicably strange things; knowing will help people to make allowances and support you as best they can.
Find a good doctor or therapist to work with, or someone you can trust to share your feelings with as you learn to cope.
Realize that some people will find this confrontational or upsetting if they're also feeling down, and others may be dismissive. You'll need to reach a decision yourself as to whether it's worth persevering explaining things further with them, or whether it's just best to stay away from them until you're more resilient.
Be willing to be honest about your irritability and reclusive behavior with those you trust. They need to know it's not them but that you need space or time out every now and then.
Be around people who are good for you. Directly related to having a good support network is being around people who buoy you and don't drag you down. 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.
Remembering that misery loves company, it can be incredibly hard to keep away from 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 one another's fears that the rest of the world is terrible.
In particular, avoid toxic personalities. People who are entrenched in negativity, or who have difficult personalities or personality disorders are the very people your psyche cannot tolerate right now. Steer clear of them and if they zoom in on you, be polite and retreat as quickly as you can with excuses about needing to be somewhere, or having something to do right now.
Changing your behavior
Find things you enjoy doing
Keep occupied. Being busy is a way to prevent negative thoughts from going around your head repeatedly. For depressed persons, often the first step is the hardest, so making yourself do things can make a huge difference to your day and get you started.
Do 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 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.[37]
Do happy 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, for a meal or walk with friends, do a puzzle, visit a neighbor, sit in the sun, have a massage, write a poem, go window-shopping, sing, take a short swim, etc.
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. And gradually build up to more enjoyable experiences.
Help others. This can be a good way of moving through your depression once it's under better control, and is often an ideal technique to use when your healing seems to have temporarily "plateaued". In helping other people going through hardships, you will be able to channel some of your sadness and inability to cope into ensuring that other people can cope. This removes the concentration from you to 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 that you might not even be ready to be helping others just yet. It doesn't mean you won't be able to do this but it does mean take care of your own self first. Also be careful not to get into a situation where you feel that your self-esteem is continuing to be eroded – don't volunteer in stressful situations until you're ready for them; seek the "back room" work first.
Changing your negative thinking patterns
Negative thoughts breed... more negative thoughts
Understand the importance of overcoming negative thinking. This is a vital aspect of working through depression and requires more than a small place in an article but is presented here briefly to help guide your future exploration in ways to change your negative thinking patterns. Depressed persons tend to have what Aaron Beck termed an "Information processing bias", referring to the tendency to self-select the distorted and negative viewpoints of everything, entrenching the depression even further.
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 relearning patterns of thinking that support your self-esteem and increase your self confidence. While it is best to read up in this area and to speak with someone qualified to help guide you through the ways to change your thinking, some things to keep in mind include:
Acknowledge that although you feel bad right now, this feeling will pass in time (weeks, months). This can be a very difficult step but it's vital because it helps you to start banishing thoughts of hopelessness.[38]
List all of your good points. When you're depressed, it's easy to understate the positive things about yourself. Turn this around and start learning how to accept yourself 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. And 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 and also that you cannot be perfect and to 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.[39] Small decisions include making a decision to get out of bed, to call friends, to clean up the kitchen, to get help for your depression. You do have choices – act on them and once you have, they become achievements.
Learn how to replace faulty 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? Am I ignoring all the positives? Am I seeing everything as all or nothing rather than seeing the gray areas in between? Am I taking on the blame for everything that seems to go wrong? Am I overgeneralizing about things? Am I making something worse than it really is?[40] 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.
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.
Look for the good. Without being a Pollyanna, 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, for example, "my house", "my spouse", "my pets", "my children", "my garden". Over time it should grow as your dark glasses are removed and you start to experience the more joyful side of life again.
Replace unhappy thoughts with memories of happier times. You are in control of what you're thinking about: make the choice to prefer the positive, happier memories over the unhappy thoughts.
Other possibilities
Art therapy is one possible recovery aid
Try alternative therapies or remedies. Investigate the potential of alternative therapies such as homeopathy 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. Choose music that improves your mood; if you must listen to sad music, at least graduate to more upbeat music after a few songs or tunes.
Art therapy might help you.[41] 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.[42] Even if you don't own a pet, try to get access to someone else's on a regular basis and spend time together.
The way forward
Look forward to the future and know that you're amazing
Find your own pathways to emotional wholeness. There are many possible ways to cope with depression and there is a lot of information available to help you. But more important than anything you read or hear, is the ability to look deep inside yourself and to find what really works for you. This is why it's helpful to keep a diary of your recovery process, to help you to identify the best approaches and to build on those.
Accept that depression may return. Once touched 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 well. Be smarter next time though; by recognizing the growing warning signs that it's returning to your life, take constructive actions to deal with it earlier on and you may even nip it in the bud. At the best, aim to minimize its impact and duration.
Talk with other people who are experiencing depression. When you've passed through depression, you can help others to work through it too, and to reassure them that what they're experiencing is real, and is worthy of treatment, and that there is light at the end of the tunnel.
Video
Tips
For many people, having something to believe in makes an enormous difference to their emotional and spiritual well-being.[43] Turning to your existing faith, a new one, or finding a cause you believe in, might be a pathway to finding your way out of the darkness and into renewed purpose. If you believe in a religious faith, you may find solace in praying, meditating, or reading holy texts. Consult a local religious leader in your community with any questions. If you're not religious, try reading a book of philosophy or a self-help book.
Have beautiful surroundings. You define what is beautiful but remove the things from your life that upset you, or bring you down. It might be as simple as removing clutter or as complex as redecorating, all depending on your budget of course! Brighten up a dark room or let in more fresh air. Let some of the outside world bathe your inside life.
Make your sleeping room as dark and quiet as possible. Any noise or light disturbances will often be enough to awaken or prevent sleep for a depressed person.
Keep your alarm clock by your bed but away from you. This will make you get up enough to check the time. Use the very act of rising physically to check the clock as a reason to get up completely and proceed to the bathroom.
If you find therapy a little strange, try seeing the therapist as a non-judgmental great aunt or uncle on whom you can unload all of your feelings without getting back any "shoulds" or "pull yourself together" commentary! It does you good to offload the thoughts to another person, and if you can't find that person among your circle of friends or within your family, a therapist is a sound and confidential substitute. If you're prone to overthinking or analyzing everything, don't try to read too much into therapy other than accepting it helps to talk things through. Allow it to be a simple experience rather than complicating it.
Reduce your stress levels. Stress both nourishes and harbors depression, exacerbating any tendencies to react in a depressed way to life's problems, and providing ongoing fuel for sustaining depressed thinking. Learning to deal with stress constructively in the future increases your chances of preventing depression and remaining resilient in the face of pressures.
Talk to people who have been where you are and come through. Their experiences can help convince you that there is an end to the depressive state.
If the counselor you're seeing isn't helping, don't be afraid to try a different one. It can take a while to find someone that is suited to your particular needs. Look for someone who specializes in your problem area, whether it be eating disorder, addiction, relationship problems, etc. There is always someone out there who can help you but it might take looking around.
Sometimes not connecting with your therapist can be a good thing; it might actually be that your therapist is telling you things you don't want to hear, or it could be that the therapist projects things about yourself you don't much like. Take this as an incredible opportunity to either listen, or learn how to love those parts of you you're less kind with. Don't always eschew the hard work involved in facing your deeper self.
Avoid comparing yourself to other people. Compare yourself to you at your lowest point in the past and think about what's better now. Pat yourself on the back for it. If you think you're at your lowest point ever, then imagine one small thing (the tiniest thing you can think of) that you know you can make better. And then move on from there.
Change your life. Often times depression results from a deep-rooted desire to be in a different situation than you are right now. If you don't like living with your parents well into your 20s, move out of your house. If you don't like your city, move to a different one. If you don't like your job, find a new one. Allowing uncomfortable, unsuitable, or untenable situations to control you is a way of living life in an unhappy fog. Take the initiative to change what isn't working; it will be hard but staying in a rut is even harder.
Warnings
When finding a person to help you with depression, always ask to see their qualifications and understand the differences between the different types of therapists. If one type of therapy doesn't suit you, do not despair. You may need to change either the therapist or the type of therapy; keep trying until something clicks for you. Even the searching and changing of therapists is a form of making decisions and keeping active, so it is a good exercise for you; do not see it as a dead end or another hopeless situation you've ended up in!
Don't go it alone. Depression is hard enough when cocooned with your own thoughts. Let in people you can trust; you'll probably be surprised to learn that some people who are close to you have already been where you are and can help to pull you through. A lot of people try to hide their depression and negative emotions from others, including family and friends, in an attempt to ignore what is happening to them, or because they don't want to be a burden/hassle to anybody. If this is you, then remember that there are people out there who love and care about you, people who have been trained to help you, and people who are in the same situation as you. Although depression does an excellent job of making you feel unworthy of care and completely alone, it's all untrue. Don't ever try to cover up feeling this way, because it instantly makes it a whole lot worse. Depression can be helped so much just by knowing that the people around you are trying to help you and will always be there. In addition, support from the medical and therapy professions is essential, even if only at the start of your recovery from depression.
Leaving depression to work its terrors in the hopes that time will heal it all is the worst possible thing to do. The longer you leave getting help, the worse the depression will become and the harder it will be to self-help. Most, if not all types of depression will simply intensify over time, taking over your life. If you realize you may be or are definitely suffering from depression, get help immediately - by talking to someone or seeing a professional. Remember it's never too late to get help, either - if you've been battling depression for a year, it doesn't mean nobody will listen when you speak up.
Depression can often lead to self harm and suicide. Although both of these may seem like the only possible options when you're at rock bottom, remember all the positive outlets and choices - talking to people, getting support, seeking professional help. Don't become another statistic in today's society - help yourself fight it, by getting help. At the very least, think of all the others you will hurt by leaving them behind.
See your doctor or health professional for appropriate diagnosis, treatment, and medical advice.