Living with depression

I started writing this post on 4/9/12, and at the time it was three years since the last time I’ve used antidepressants. (I was on them for five years, though my first major depressive episode was when I was fifteen and I didn’t start medication until three years later.) I feel fine most of the time, but every now and then I find myself sliding into a prodromal period where it is likely that I will relapse if I don’t do anything to stay afloat. (I can tell that I’m getting there when I find myself feeling sad a lot, feeling tired but staying up late doing nothing, and having thoughts of destructive nature.)

I’ve accepted that depression is something I’m pretty much stuck with. However, if I’m careful, most of the time I can work my way around it, so that I can avoid relapsing (up to a certain point).

I’ve heard other people with depressive disorders say it, and I agree that I can manage as long as I keep my lifestyle a certain way.

The following are some things (in no particular order) that I have found to help. Everyone’s case is different, so what works for me may not work for you, but I believe in trying different alternatives until I find one that works, and sticking to it until I find something more effective.

  • Physical activity has been shown to improve mood. For me, running “resets” my mood, whether I’m feeling sad or angry before I run. Afterward, I’m feeling pretty good and have no interest in negative thoughts. I know I need to run almost every day, to keep my mood up, but it’s something that I look forward to doing.
  • Getting adequate sleep. Sleep is always important, especially when you’re depressed. Having a regular sleep cycle is a way to make sure you get enough sleep, though I’ll admit it’s a challenge to maintain. When I’m tired I tend to stay up later but not accomplish much (because my brain is slower). I end up feeling sad more, because of the sleep deprivation, and it doesn’t help that I also feel angry at and disappointed in myself. (It’s harder to regulate emotions when sleep deprived.)
    • In order to do this, designate a time by which you want to go to bed and start getting ready before that time, depending on how long it takes. For me it takes much longer than I think it will, so I tell myself to get ready even before I think I need to. Be able to say no to anything that is not urgent, since that will only keep you up longer.
    • I haven’t actually tried the sleep deprivation treatment, though from the publications that I’ve read on it, the effects are short term and what matters is the sleep stage that is disrupted. (See this and this for more information.)
  • Learn how to manage stress. I don’t handle stress well. In fact, I find many situations stressful, including ones that most people don’t think much about. [Edit: Scientists have found that certain individuals are more susceptible to stress and depression, depending on the activity of β-catenin in their brain.] The best solution I’ve come up with is trying to minimize stress in my life. Unfortunately, some things have to be done, but there are ways to make them seem less stressful. Making clear plans, breaking tasks down into smaller parts, starting earlier (or leaving earlier when commuting), and studying/working on assignments regularly are ways to reduce last minute stress.
  • Having positive social interactions. This really makes a difference for me, because I can go for days with almost no interaction with people outside of my family. If you’re isolated like I am, small superficial interactions count. I once felt apprehensive about calling a pharmacy about my prescription, but the guy was friendly and my question was answered, so I felt good after the call, even though I knew that he was just doing his job. It’s even better to have a friend to confide in.
    • A friend once told me that when he was depressed, his therapist told him to make it his goal to have at least one positive social interaction with other people every day. This is especially important since depression makes us want to withdraw from others.
  • Avoid stimuli with negative thoughts and emotions. This includes depressing music, films, poetry, prose, artwork, etc., and depressed people who like to dwell on their depression or see beauty in their pain. (Some of you may already know my attitude toward people who seem to enjoy their depression.) I’ve realized that it’s best for me to stay away from the mental health field because exposure to emotionally unhealthy people affects me too much. It’s not that I no longer care, but that I know my limitations.
  • Identify and counter cognitive distortions. This may be the most effective of all of these strategies, since our own inaccurate beliefs and perceptions are in large part responsible for our negative thoughts and feelings. I strongly recommend reading Feeling Good: The New Mood Therapy by David Burns, MD for thorough explanations of the most common cognitive distortions and how you can identify them and come up with counter examples in your own life.
  • Even if you “don’t feel like it,” do it anyway. Unless you’re sleeping all day, when you are awake, make the effort to get up, get dressed, shower and go out (even if just for a walk) or do something. If you’re waiting for the moment when you “feel like it,” you’ll be waiting for a long time. I’ve heard many people, myself included, who think, “I can’t do it, I’m sick,” and continue to do so even after recovery. However, more often than not, after I push myself to get up and go out, I realize that I was able to, and most importantly,  I felt better afterward.
  • Be thankful. I’m NOT trying to shove the whole “you’re actually very fortunate and there are so many people much worse off than you, so you have no right to be depressed” spiel at anyone, because 1) the people who say that don’t understand how you’re feeling and 2) saying that never helps. However, gratitude has been shown to raise mood. I find it helpful to think of three things that I am thankful for, whenever I catch myself feeling sad for no obvious reason. It can be as simple as having acceptably clean air to breathe, toilet paper, something you like about yourself (or that something you don’t like about yourself isn’t worse). If after I’ve enumerated three things but I’m still feeling sad, I’ll continue until I feel better. There have been times when I went up to sixteen.

I hope you have found these helpful. Feel free to share this list with anyone whom you think can benefit from it. If you have experience with clinical depression and know of other techniques that help, please share them in the comments.

Depression Obsession: Basking in Your Misery

Some of you may have read this post on my old blog when I first published it 11/19/2010. I have made some revisions. Next week, I will post my list of activities that I have found effective for keeping my depression under control.

This post is specifically about some common unhealthy thought patterns that are a major impediment to recovery from depression. I used to embrace these fallacies myself and I recognize them in other depressed people, too. It took me eight years (without therapy) to realize these beliefs are false and counterproductive.

That said, I am not trying to discount anyone’s experience with clinical depression because I acknowledge that it’s real, and I have experienced it myself. I am only referring to unipolar depression here, since I have no firsthand experience with bipolar disorder. Everyone’s case is different, but these are based on observations from my own thoughts and experiences, including over 250 hours of service as a crisis counselor for a suicide hotline, and my observations of others. I’m not an expert, so take it or leave it.

This post is NOT about those of you who want to recover and are actually trying to, because you are taking care of yourself.

What I consider to be a “depression obsession” describes the people who come across a though they are almost proud to be clinically depressed, “messed up,” mentally ill, etc. They express a desire to get out of their living hell, to feel happy again, normal again. But some of their actions indicate they are holding on dearly to their depression.

These are the people who see “beauty in pain.” Their depression defines their life and who they are. You can usually identify the extreme ones from all the lists of hospitalizations, diagnoses (with insurance codes), and past and present medications (including doses) that they flaunt on their blog. (Perhaps their blogging behavior is different from their daily life, but posting something publicly on the Internet is indicative of a desire for someone else to see it.) They show it off, as if to say, “Look at all I’ve been through!”

I used to want to show off, too, that I was “messed up” and taking antidepressants. But I’ve learned that most people are not always accepting or understanding, especially when it comes to something as misunderstood as mental disorders. There are many people who will immediately pass judgment and think you’re crazy, unreliable, or even dangerous if they know you’re on psychotropic medication. The older I get, the more I see the importance of keeping personal issues separate from academic and professional work. (In fact, I felt quite hesitant to post this entry on my public site, but I decided to do it in hopes that some people can benefit from it.)

When I was in high school, I used to think I was special among my peers because I was clinically depressed. Later I figured out my next point, which is: Depression does not make you special. In the U.S. alone, an estimated 14.8 million adults suffer from major depressive disorder, and another 3.3 million have dysthymic disorder.1 One in eight adolescents are clinically depressed.2 How special is that? Everyone is unique (even when it comes down to the details of their problems). Why not try to cultivate your uniqueness in some other direction?

Being depressed does not mean you’re deep and meaningful–it just means you’re depressed. Yes, you tend to notice and have an appreciation for things that non-depressed people do not. You may be offended when people who have no idea about mental illnesses just don’t get it, and think that they’re shallow. But it’s still possible to be deep and introspective when you’re not depressed.

My guess is that people who have to go through some form of suffering or misfortune that they have no control over will start to come up with reasons for why the experience isn’t really so bad. (Such justification is known as cognitive dissonance.) After seeing what we’ve learned from it, we begin to see it as a privilege that only people who have suffered like us get to experience. Then the feelings of superiority may start to kick in. Those who have not been through such experiences look “simple” and oblivious in comparison. There is no doubt that there are many things that we will never truly understand unless we’ve been there ourselves, but I see such experiences as an opportunity for me to develop empathy for other people who are suffering.

Any “benefits” are not worth the cost. I used to think I was a better writer during my depressed moods. I wrote strange stories about depressed people, which impressed non-depressed people. At the time, I honestly did not want to let go of my depression because I did not want to lose my ability. Well, hanging on to it caused more harm in the long run.

Even if you can make a living from your artwork or writing, depression still results in lost productivity. You should know. I shouldn’t even have to bring out the statistic that every year $35.7 billion is lost in the U.S. due to depression significantly reducing productivity.3

There really is nothing deep, romantic, sexy, glamorous, cool, or special about being depressed. Depression also has negative affects on your physical health. Studies have found links between depression and heart disease, as well as depression and hippocampal atrophy. (The hippocampus is a brain structure that is crucial for learning and memory. Hippocampal volume has been found to be significantly reduced in depressed patients. The longer the duration of depression, the more atrophy.)

If you constantly use your depression as an excuse, and think you can’t do anything because of it, you will never get anywhere. Yes, it does affect functioning, significantly. But I’ve noticed that there are some people who have gotten so used to the excuse that they still use it even after they’ve started recovering, and it’s only going to hold them back. I made this mistake for the longest time, and I sometimes still catch myself falling for it. Yes, it’s difficult, but I keep reminding myself to face my fears. It’s the only way to grow. (This deeply ingrained habit will most likely take some—or a lot—of cognitive behavioral therapy to change.)

In writing all this, the main point that I’d like to get across is that we often do have more control over our mood disorder than we realize. For instance, I can usually sense a possible relapse, but I know there are things I can do to try to not let it get there. I can either make sure I get adequate sleep, some physical activity, time out of the house, and positive interactions with people, or I can stay up late doing nothing, continue to think negative thoughts, dwell on things that can’t be changed, withdraw from others, and stay curled up in bed all day. Even if my effort does not prevent a relapse, my attitude will help me work my way out of it earlier, before it gets real tough. I know that preventing relapse is not the same as trying to recover when you are in-a-ditch depressed, but what I am saying is that you can take active steps to make the best of your condition.

If you don’t think you can do it on your own, get a psychotherapist to help you. An effective therapist who practices cognitive-behavioral therapy will teach you how to recognize your cognitive distortions and evaluate the evidence for and against such negative automatic thoughts. The therapist can assist you in coming up with alternatives, instead of only letting you ramble on and on about your problems. This is not the same as giving advice. Having someone listen is important during times of crisis, but if you’re not in a crisis and come in week after week to talk about the same issues, but never work through them, they will remain there (until you do or die, whichever comes first). There are some problems that pills alone can’t solve. Although people who were treated with cognitive therapy and medication recovered more than people on a placebo did, those with cognitive therapy were less likely to relapse the after treatment was finished.5

I’ve heard many people say that sometimes it’s necessary to accept their depression instead of trying to fight it. I agree that acceptance is important, because acknowledging there’s a problem is the first step to dealing with it. However, I also believe there is no need to dwell on it. In fact, people who ruminate more will remain depressed for longer and with greater severity than those who do not.4 You’re a victim only as long as you think of yourself as one. I don’t like the word victim because it implies powerlessness. I remind myself: Don’t be a victim, be a survivor!

Knowing what it’s like to be clinically depressed, these words will most likely be met with resistance. Nothing could get through to me while I was under that cloud. I am NOT telling anyone to simply “snap out of it” because I know that’s not possible. My only hope is that this will lead to a change in attitude and a sense of empowerment, however slight they might be, and a start on the road to recovery.