Coping with Depression

Learn how I beat Depression

We have seen that sadness, hopelessness, loss, low self-regard, loneliness, guilt, and shame are complex conditions or processes. The causes are complex and so are the solutions. It is hard to pull yourself out of a sinkhole of misery, sometimes impossible. When you feel most like doing nothing, you need to DO SOMETHING! When the future looks most bleak, you need to face it with some hope. When hating yourself, you need to accept what you have been and work on being better. So you may need help–therapy, medicine, family counseling, and/or religious faith. But, eventually, no matter which “cure” you take, you will have to help yourself; there is no effortless, magical cure.

No one should be ashamed of being depressed. But we are. As Kathy Cronkite (1994) points out, people who openly discuss going to Betty Ford’s Clinic for alcohol abuse will carefully conceal their depression. About 1 in every 10 of us will be seriously depressed sometime in our lives. Baby boomers are having even more episodes of depression, perhaps because the high hopes of the 1960’s were crushed by the economic troubles of the 1970’s and beyond. Remember, there is serious depression which is beyond ordinary sadness; in this condition you may have no appetite, no pleasure, no energy, no hope. And, there is being “down” or in a bad mood for a few days; it may involve crying, social withdrawal, being irritable, having no ambition, being pessimistic, etc. These two conditions are probably two different things. Both should be treated but the really severe major depression must be taken very seriously; 15% kill themselves, many more attempt it. Depression is not your fault; you are not a terrible or hopeless person. Unfortunately, 70% of people suffering depression never seek treatment. Please be among the 30% who go for help and stay with it. Depression is one of the most treatable emotional problems–psychotherapy can help you, drugs can, and you can.

Note If your depression is serious (disabling or suicidal), seek professional help immediately. If you are in therapy or a group, be sure to tell the therapist how much you are hurting. If not in therapy, call a therapist or your mental health center. Do not delay by trying to treat yourself or by hoping you’ll get better. Serious depression and manic-depression seem to have genetic, hormonal, and/or chemical aspects that are activated by stress and upsetting life events and thoughts. Thus, when the depression is serious, you always need to be evaluated by an MD, who will decide if you need medication.

If your depression is primarily chemical, psychological coping techniques are useful but not sufficient. Likewise, if your depression has psychological causes, drugs may be useful but not sufficient. There is usually no way to tell if your depression is chemical or psychological, so consider both.

If you’ve read parts of the chapter relevant to you, you probably already have some ideas about how and why you have responded with sadness. Therefore, certain self-help methods in this section will seem more appropriate for you to use. Fine, try two or three and see if they work. If not, try something else. In general, gaining some optimism about getting better, having an easy going disposition, and utilizing family support, along with selected self-help methods, will lead to a better recovery from depression.

The methods for coping with depression are arranged by levels in this section. Quickly read or skim the entire list of methods before you select a few to use. This is a preview:

  1. Behavior–increase pleasant activities, avoid upsetting situations, get more rest and exercise, use thought stopping and reduce your worries, atone for wrong-doings, seek support, and use other behavioral changes,
  2. Emotions–desensitize your sadness to specific situations and memories, vent your anger and sadness, try elation or relaxation training, etc.,
  3. Skills–learn social skills, decision-making, and self-control to reduce helplessness,
  4. Cognition–acquire more optimistic perceptions and attributions, challenge your depressing irrational ideas, seek a positive self-concept, become more accepting and tolerant, select good values and live them, and
  5. Unconscious factors–read about depression, learn to recognize repressed feelings and urges that may cause guilt, explore your sources of shame (perhaps even going back to childhood).

The Use of Anti-depressants

Anti-depressants have been a major part of the pharmacological era in psychiatry. In the last twenty years, psychiatric practice has changed in major ways, namely, the shift from talking to giving pills. Many factors have contributed to this treatment revolution: (1) the development of safer drugs with fewer side effects, especially the SSRI anti-depressants. These medications may not reduce depression better than older drugs but they are less likely to kill you when an over-dose is taken. (2) The pharmaceutical companies have advertised intensely, turning consumers into drug advocates and permitting drug sales representatives to target primary care physicians rather than the much more rare psychiatrists. Moreover, (3) HMOs have realized their profit-margins can be greatly increased when the drugs are dispensed by a family physician requiring only brief and occasional follow-up visits rather than by expensive psychiatrists. The distribution of drugs got much easier: just tell your regular doctor that you have been feeling down or tired and have had some crying spells, and you immediately get a prescription for anti-depressants paid for without question by your health insurance. Millions have started taking anti-depressants and while they may have shifted from one brand to another, many have been satisfied. Nevertheless, it is generally recognized that anti-depressants take about 30 days to work and about 30% of depressed patients get little benefit from anti-depressants.

During the last two decades, the stigma against taking psychiatric drugs seems to have been considerably overcome but the stigma against “seeing a shrink” (psychological or psychiatrist) is still strong. Moreover, while Cognitive-Behavioral therapy has developed during this period, it hasn’t had a breakthrough in terms of highly publicized effective techniques or in terms of cheap or easy treatment. In other words, anti-depressant drugs haven’t had a lot of competition. Also, most people do not realize how little training and experience primary care doctors, in general, have in dealing with serious psychological disorders, including depression. Yet, as you know, if you have read the rest of this chapter, depression is a very complex and potentially dangerous disorder. It isn’t something to be diagnosed in a few minutes. Since anti-depressants take 30 days before having full impact, a significantly depressed person needs frequent and careful monitoring immediately and during the first several weeks. The treating physician needs to get a detailed mental health history (mental problems or illness often accompany depression) and he or she should strongly encourage the patient to also get psychotherapy as well as drugs. Depression is not an easily treated disorder. The doctor/therapist should be expected to maintain long-term contacts with their depressed patients, at least every week for a few months and maybe much longer. Depression frequently comes back.

Ideally, a health care service for depression would have enough coordinated psychiatric and psychological specialists to carefully diagnose each case of depression, assessing the possible psychological, personal, circumstantial, interpersonal and physiological or genetic causes of the disorder. As a part of this evaluation there should be a careful assessment of the risk of self-injury (see earlier sections of this chapter). This initial evaluation is not a trivial frill; it is crucial. This process should usually involve psychological testing and a detailed history as well as medical tests. The general practitioner is not this kind of specialist. (Light cases of depression could, I suppose, be handled more casually—but how can anyone identify a light case just by talking to a person for a few minutes?)

Another serious problem is that the general public has NOT understood or paid close attention to the research about the frequency of suicide and the obvious connection between depression and suicide. For instance, we often don’t like to think about suicide as being an integral part of depression. Suicide is the eighth leading cause of death in the US. It is the third leading cause in 15 to 24-year-olds and the fourth most common cause of death between ages 10 and 14. This is serious—60% of high school students have had thoughts about killing themselves, 9% have tried. At every age, especially in old age, depression must not be dismissed and taken lightly. The “just take these pills and call me in three months” is not acceptable treatment.

Not only has the risk of suicide underlying depression been taken too lightly, the generally positive public opinion about the effectiveness and safety of anti-depressants seems to have a major disconnect with the scientific evidence. There have been many, many studies. Of course, some of the studies have shown anti-depressants to be effective, sometimes. These drugs, however, are big sellers–among the best-selling medicines in the world, with such names as Prozac, Serzone, Wellbutrin, Zoloft, Remeron, Celexa, Effexor, Lovox, Paxil, and others—all similar in chemical composition. The total sales world-wide are about 20 billion dollars per year. In 2002 alone about 11 million prescriptions were written just for children and teens in the US. Let’s think about why is it difficult to honestly know the effectiveness of anti-depressants (or any other treatment).

People come to see doctors and therapists because they are feeling badly, often their discomfort has gotten gradually worse, and they are seeking help at the height of their depression. If so, the chances are (for a variety of reasons) that the problem will later get better rather than staying awful or getting worse. This amelioration process is observed so often when scientists re-assess unusually high or extreme conditions; this going back towards normal (for you) is called “regression to the mean.” So, you see a doctor with a bad cold, an aching back, a tension headache, etc., and soon in the natural course of things you begin to feel better (closer to average for you).

There is another process that also makes it hard to evaluate the effectiveness of a treatment method—the suggestion or placebo effect. It is well known that a sugar pill can help many people feel better (if the doctor suggests it is very effective medicine and will take care of the problem in a couple of days or weeks). If such a suggestion is made or just implied when actual medication is given, then the placebo effect and the drug effects combine together and both may be working. To prove the effectiveness of a drug (or any treatment) the amount of improvement shown to be due to the drug alone has to be significantly greater than the placebo effect by itself. Note: according to testimony given in the fall of 2004 to the Congressional Energy and Commerce Committee, about half of all studies of anti-depressants have not shown in adults that the SSRI drugs are significantly more effective than a placebo alone. Even worse, insignificant results were found in two thirds of the studies in which children were given anti-depressants and compared to children given a placebo. This is not well understood by the general public. Please note that these research findings certainly do not prove that anti-depressants are entirely ineffective (in fact, half the studies may suggest anti-depressants yield some benefits), but these results cast considerable doubt on the effectiveness of the drugs. Psychiatrists know the effectiveness of anti-depressants is limited; they commonly point out that anti-depressants do not help about 1/3 of their depressed patients.

In addition to these difficulties interpreting the results of research, more recently there is a new and very disturbing possible problem with using anti-depressants, especially with children and teens. Over several years, there have been occasional clinical reports of suicide and violence associated with taking anti-depressants. For instance, it was reported that Eric Harris, one of the suicidal shooters in Columbine High School, had been taking an anti-depressant (Luvox). Parents have described the sudden, out-of control suicide of a college student after taking a regular dose of anti-depressants (http://www.nypost.com/news/nationalnews/30505.htm). Britain prohibited prescribing anti-depressants to children and teenagers in late 2003 (a year before the US considered such action). Even more alarming, Shankar Vedantam of the Washington Post reported on September 10, 2004, that testimony was given at a congressional meeting that two internal FDA analyses showed that anti-depressants, given to children and teens, were associated with increased suicidal thoughts, actual self-harm, and hostile behavior. How much of an increase? FDA recently estimated that these drugs might double the risk of suicide in children. This sounds very risky but if the risk of suicide without drugs is 1% and with drugs 2%, there the anti-depressant doubles the risk. But if the 1% higher risk of suicide is associated with taking an anti-depressant that reduces depression in 60% of patients (compared to 35% who improve taking only a placebo), then you would probably take the drug if you are miserable. Bigger and better controlled recent research has yielded results about like that example (The Journal of the American Medical Association study of Prozac also confirmed an increased tendency towards suicidal thoughts and action). So, taking a drug that slightly increases the very low suicide rate, which sounds terrible, could be a very reasonable thing to do. We need a lot more information.

The suicide prediction problem is an increasingly important part of the decision to use anti-depressants or not. Also, the patient and his/her parents, if a child or teen, should be involved in the tough decision-making about the use of drugs, the kind of psychotherapy needed, the precautions to take, how to measure progress, etc. It isn’t just a question of what approach offers the most hope for improvement but also what methods have helped and not helped in the past, how desperate the situation is, the patient’s level of motivation, etc. If I am feeling terribly miserable, I’d be willing to take more chances with a risky drug…just the same as when risky surgery is an option.

Please remember I am not a physician. I have no expertise concerning drugs. My review is just a summary of the relevant available about anti-depressant research which suddenly seems very important. The data and my comments should in no way be interpreted as opposing the use of anti-depressants. There surely are circumstances in which it is a very good judgment to give anti-depressants to children and teens. This new information about anti-depressants with children just makes it critical that case studies and treatment plans are done at the highest level of professional competence.

I strongly recommend each depressed patient (and his/her parents, if the patient is a minor), with the help of his/her physician (the prescription writer), explore the pros and cons of taking anti-depressants. It is not a simple decision. If the prescribing physician is not a psychiatrist or a psychotherapist, then a therapist (Psychologist or Social Worker) should permanently join the team. At this time (fall of 2004), only about 15% to 20% of children and teens being treated for depression are prescribed anti-depressants. If research continues to find suicide risks are associated with anti-depressants, surely a number of changes are likely to be made in the treatment of depression. Probably many family doctors will avoid prescribing drugs having a strong warning label. Certainly, since therapists know more about the potential for suicide, they will increase the safe-guards used against the risk of suicide.

We will need to know the rate of suicide in certain types of patients in specific circumstances depending on whether they are taking anti-depressants or not. Science needs to map the high risk points for depressed patients on and off medication. Certain dangerous times have been known for many years, like when released from a hospital, but we need to know more. For instance, Wessely, Kerwin & Kaye (2004) found that the most dangerous times for adults and children taking anti-depressants were in the first nine days of treatment (a four-fold increase in non-fatal suicide behavior). The risk is also three-fold higher during days 10 to 29. What if they were not taking anti-depressants? We don’t know. Other high risk times for children and adults are when anti-depressants are started at a high level or when suddenly stopped. Start anti-depressants at a low dose and gradually increase. Reduce doses gradually. It is important that the doctor, the patient, and others around him/her know the high risk times so everyone can be especially vigilant, looking for extreme restlessness or agitation (can’t sleep), violent outbursts, psychotic behavior, talk about suicide and so on. Close supervision is really important–usually there are warning signs that people dismiss. If you think you see a warning sign, consult with others, including school counselor, close friends, and others who might know more. The patient and family members or others who are with the depressed patient should have the therapist’s cell phone #.

A recent study at the University of Colorado by Valuck, Libby, Giese & Sills (2004) illustrates the crucial need for more research into the risks of self-harm for adolescents taking antidepressants. These researchers followed 24,000 depressed adolescents for six years. The risk of a suicide attempt, in their sample, was not greater for young people given antidepressants than for those not getting antidepressants. Of possible additional significance, the adolescents given antidepressants for at least 180 days made fewer suicide attempts than adolescents taking the drug for less than 55 days. Standing alone, these results are difficult to integrate with the above studies: Do different outcome measures (suicide attempts, near-lethal acts, and suicide rates) yield different results? What factors correlate with being prescribed antidepressants? Why did some subjects take medication much longer than others? The authors suggest that the quality of health insurance may influence what medication one gets, who administers the antidepressant, who gets antidepressants alone, who gets only psychotherapy, and who gets both? Many, many studies are needed to answer these vital questions.

In summary, moderate or serious depression carries with it a threat of self-injury. This risk requires special precautions. Taking anti-depressants must be considered carefully because the drugs may slightly increase the risk of agitation and suicide in some young people while the drug may effectively relieve depression in other people. The prescribing doctor, the collaborating psychotherapist, the patient, and the parents of a child or teen should be involved in making the treatment plans. The prescriber and/or the psychotherapist must see the patient frequently, probably weekly or more for an hour, especially during high risk or high stress or high agitation times. The FDA’s concern is now high enough that all anti-depressants must display a warning label about the increase risk of suicide if used with children or teens. For unexplained reasons, the news reports describe the manufacturers as being more eager to have a blunt, rather scary label placed on their medications than was the FDA.

COPING WITH DEPRESSION

A review by levels of the useful Psychological Methods

Self-observation

Although depression frequently seems (to the depressed person) to come from nowhere, i.e. isn’t related to daily events, that isn’t true in most cases. The Lewinsohn research has clearly shown that positive events or activities lead to positive moods; negative events to depression (Grosscup & Lewinsohn, 1980). The depressed person must become aware that this is true in his/her life too. So rate your mood on a 1 to 10 scale (see chapter 2) and keep a log or a diary every day of positive events and activities. It is likely that your mood will reflect what is happening in your life.

As we have seen, depressed people tend to focus on negative events and overlook positive ones. They don’t know they are doing this. So, it is important that they “give careful recording a try and see what happens.” Look for and record all pleasant events and activities, even small, trivial, seemingly unimportant pleasant events. It is vital that you learn, again, to see the beauty, feel the warmth, and smell the roses. Don’t forget ordinary things: a cup of coffee, a walk, seeing a bird, reading a book, helping someone, watching kids go to school, watching the news, reading an advice column, going shopping, listening to music, making yourself attractive, visiting a neighbor, completing a chore, calling a friend, daydreaming, playing with children, expressing an opinion, getting a long kiss, getting or giving a compliment, etc., etc. Record in your diary (3 or 4 times each day, otherwise you’ll forget them) a brief description of these pleasant events.

After about a week, plot your daily mood rating and number of pleasant events for that same day on the same graph (see chapter 2). See if your mood doesn’t go up and down according to how many pleasant events occurred that day. If so, this is a powerful argument to increase the number of pleasant events in your life and to appreciate the nice things that happen.

This is a simplified version of a “behavioral analysis” (method #9 in chapter 11) in which one would look for the antecedents and consequences of good and bad moods. The objective is to find cause and effect relationships that can be used to increase happiness and reduce sadness. I would recommend a behavioral analysis because it explores the causes of the depression as well as the sources of satisfaction.

Look to the future

Like procrastinators, when we become depressed we tend to focus on the past or to see primarily the immediate consequences, not the long-term results of what we are doing now. We hurt, so we focus on immediate relief, disregarding activities that might be stressful but very important to our future, like getting training for a new career. To increase your awareness of the effects of your activities, do one “outcome analysis ” each day of some activity, i.e. estimate the short and long-term, both positive and negative, outcomes. Examples:

Activity Effect or Outcome
Immediate Delayed
Watch soaps on TV +Distracting. Fun.
+I can tell others about show.
-May upset me. -Shows won’t be remembered
-I wasted valuable time.
Take a hard class +Interesting.
+Meet people.
+Get ideas for current job.
+Career advancement.
+Adds hours toward a degree.
-Stressful.
-Takes time & money.
-May be unemployed so class wouldn’t help.

The objectives are (a) to encourage realistic, long-range planning, (b) to see the lasting consequences–or the wastefulness–of certain daily activities, and (c) to make some important but uncomfortable activities more tolerable today because they pay off tomorrow. This is important for all of us to do, but it is even more important and difficult for a pessimistic person with low self-esteem to do.

One small step at a time

Earlier we learned that global thinking (or end goal wishing), e.g. “I need to get better grades,” overlooks the necessary details of how to get there. Also, unrealistic, perfectionistic expectations, e.g. “I’ll get all A’s,” may lead to disappointment and self-criticism. Thus, it is important to learn to have a plan, to set realistic goals and sub-goals, and to have some success experiences. It is important to be satisfied with small gains. So, decide on some practical, possible, important self-help project–dieting, increased socializing, more detailed and prompt record keeping at work, learning to play tennis, spending more time alone with spouse, or whatever. Then, for each project goal, set several clear, explicit, attainable sub-goals (small steps), perhaps things you could do every day or every few hours (see goal setting in chapter 2). Schedule the time, give it priority, and be sure you are successful. Record your progress in a diary, along with the positive outcomes.

Self-evaluation

When discouraged, we feel at fault when things go wrong and “just lucky” when things go well. Rehm has an exercise to help you realize your contribution to success and reduce your responsibility for failure:

  • Think of an important recent event and describe it.
  • In what ways were other people, chance, luck (good or bad), or fate responsible for this event?
  • In what ways were you (your efforts, skills, abilities, experience, appearance, etc. or lack thereof) responsible for this event?
  • What percentage of the responsibility for this event was attributable to you? _____%

Do this for several events, including both positive and negative ones. You have almost always worked for positive events and against depressing events. So, if you do not think you are truly responsible for more than 50% of the pleasant events, reconsider your explanation of those events and see if you aren’t causing more positive things than you thought. Factually based confidence in your self-control is a powerful antidote to pessimism and helplessness (remember depressed people underestimate their problem-solving ability).

Usually others or circumstances or just bad luck cause unpleasant events (the exception to this general rule is when our passive-dependency is the cause). So, if you see yourself as responsible for negative events–over 50% of the time–go back and see if others and chance aren’t more responsible. If your passivity is the problem, see chapter 8. Ideally, you will come to believe (accurately) that your general, stable abilities and traits, e.g. intelligence, personality, organizational, and communication skills, etc., cause good things to happen and uncontrollable, temporary external factors that you are not responsible for produce the downers. (You are correct if you are thinking this fits better in level IV. See #29 below.)

Self-reinforcement

Self-depreciating people feel that giving themselves overt self-rewards–going out for dinner–is being selfish, and they think giving themselves covert self-rewards–“I really handled that well”–is shameful bragging. These attitudes become barriers to using some of the most powerful self-control tools, such as self-reinforcement and self-praise (see method #16 in chapter 11). Rehm recommended making a list of assets–true positive traits. Read it frequently and add accomplishments to it. Make another list of possible rewards, as in method #16 in chapter 11, and use them in self-help projects. Depressed people need more good things in their lives.

Get active. Actually, research has shown that we do fewer fun things when we feel low, but simply doing more pleasant activities is no guaranteed cure-all (Biglan & Dow, 1981). Yet, actions do change feelings. Increase your activity level, get out of bed (or your chair or house), find interesting, fun things to do but, more importantly, undertake profitable, beneficial activities that solve problems, improve your situation or future, and replace sad thoughts. Start with easier tasks, work up to harder ones. Reward your progress.

Several therapists recommend that every major activity on your daily schedule be rated for “mastery” (how well you did it) and for “pleasure.” From these rating we can learn a lot, e.g. that we are getting more pleasure than we thought out of life, that we can do many things pretty well, that many activities are satisfying even though we aren’t very good at them, and so on. You may have to push yourself to be active. A book by McGrath (1994), stressing converting depression’s dissatisfactions into motivation to self-improve, could also prod you into constructive action. Examples: feeling like a victim may lead to correcting the situation, anguish about aging may encourage exercising, a poor evaluation may inspire us to learn more, etc. Deep depression makes it very hard to get active (in those cases medication may be needed).

Exercise promises long-lasting results. In just the last couple of years, there have been a couple of interesting studies showing that an aerobic exercise program–stationary cycling or treadmill–for 30 minutes 3 times a week reduced major depression as much or more than medication (Zoloft). After 16 weeks, the remission rate was 60% for both groups, but at follow up after another 6 months the exercise group had a higher recovery rate (than the drug group) and they were less likely to relapse (8% vs. 38% in the Zoloft group). The subjects in this study were middle-aged or older (Babyak, et al, 2000). Be sure to check with your doctor first, but exercise would be good for you in many ways, not just with depression. Seriously consider this. Even more recently, other studies report that daily exercise reduces depression by 1/3 or 1/2 within 10 days, that is faster than most people respond to anti-depressive medications.

The data keeps coming in. Please pay attention to this. Another well done study (Trivedi, M. , January, 2005, American Journal of Preventive Medicine) shows that exercise alone three or five times a week for 30 minutes reduces depression by about 50%. That is as good as taking antidepressants or as good as getting Cognitive-Behavioral psychotherapy. The study observed mild to moderately depressed 20 to 45-year-olds.

Avoid unpleasant, depressing situations. Take a vacation, get complete rest and lots of sleep (just for a week or two–not for months). Our interpersonal situation powerfully influences our happiness and depression. Barnett and Gotlib (1988) found that introversion, loneliness, dependency, and marital problems often precede the onset of depression. Avoid losses and these conditions if you can (of course, it can be a joy to lose a lousy marriage).

Change your environment. Try to change your depressing environments –working conditions, family interactions, stressful relationships and so on. Our mood reflects our surroundings.

Reduce negative thoughts. Reduce the negative thoughts that characterize depressed people: self-criticism (“I’m really messing up”), pessimistic expectations (“It won’t get any better”), low self-esteem (“I’m a failure”), and hopelessness (“There’s nothing I can do”). How do you stop or limit these depressing thoughts, memories, or fantasies? Try using thought-stopping, paradoxical intention (massed practice) or punishment (chapter 4). Or restrict unwanted sad thoughts to specific times or places, e.g. a “depression” chair; then reduce the time spent in the chair (see McLean, 1976). Or reward stopping negative thoughts; replace them with pleasant fantasies (Tharp, Watson & Kaya, 1974).

Have more positive thoughts. Make an effort to have a lot more positive thoughts: satisfaction with life (“Living is a wonderful experience”), self praise (“I am thoughtful–my friends like that”), optimism (“Things will get better”), self-confidence (“I can handle this situation”), and respect from others (“They think I should be the boss”). Even if you don’t feel like saying these things every hour, say them anyway. They will become part of your thinking.
Ask others to model for you how they control depressing thoughts and guilt producing ideas. What self-instructions do they use to “get out of a bad mood?” Practice talking to yourself out loud, then silently. See method #2 in chapters 4 and 11.

Become aware of any payoffs for depression or self-putdowns. Reduce these reinforcements: don’t complain or display sadness, ask others to ignore your sadness (but interact with you more during good times). Remember excessive talking about your depression may sometimes make you more depressed (don’t use this as an excuse for not seeking help).

Act happier. Practice smiling more, speaking in a less whiny voice, standing up straight with chest out, dressing up more and expressing compliments, feeling self-satisfaction, and acting as though the future will be better. Acting happier can change our mood.

Become a better self-helper. Become a better self-helper as you work on a variety of personal problems (Rehm, 1981). Learning to master a life–your life–is not easy. Read self-help books. Use the steps in my chapter 2 to make some self-improvements. Prove to yourself that you can change your environment, your behavior, your mood, and so on. Recognize your increased ability…but know your limitations. Both knowledge of useful psychology and self-confidence are important. Feeling in control of life is an important part of enjoying life.

Atonement. Figure out a way to make up to others or to society for the things you have done wrong (see discussion of guilt above).

Develop marital contracts. Develop marital contracts that provide each partner with a reward for changing in ways requested by the mate. See method #16 in chapter 11.

Seek support. Self-Help or Support Groups, Marriage Enrichment Programs, Parents Without Partners, Integrity Groups, Singles Groups, Emotions Anonymous, The Compassionate Friends (for bereaved parents), Neurotics Anonymous, Recovery, Inc., Theos Foundation (for widows), Widowed Persons, encounter groups, group therapy, church groups, or local groups of people in similar circumstances. Use the phone book and/or Mental Health Center to find the appropriate group for you (see discussion in chapter 5).

Learn how I beat Depression

50 Comments

  1. Yes But
    Posted April 1, 2009 at 4:35 pm | Permalink

    You’ve provided a long list of things to do to fix depression, which apparently work based on studies. Yet classic symptoms of depression include apathy, a lack of motivation or feeling negative about the future. How are we going to motivate depressed people to do these things? Sounds like a lot of effort, especially if this sort of change also involves un-learning lifelong bad habits…

  2. robert clarke
    Posted May 13, 2009 at 9:06 am | Permalink

    hi i find your information very useful
    as i myself have sufferered from depression and have tried various forms of recovery
    but find it dtill returns

  3. Helen New
    Posted June 12, 2009 at 9:56 am | Permalink

    its hard to feel possitive when you’ve just got out of divorce and have lost everything – home, job, family, financial security (divorce isnt cheap!). Trying to build a new life when the world seems against you is nigh-on impossible. Every day its hard not to top yourself. . . and your expected to be bright and happy when your world is black and lost . . . hmm. . . :-) . . will that do!

  4. minijaxter
    Posted June 16, 2009 at 1:02 pm | Permalink

    yes but-

    thats the whole point of the article is to change lifelong bad habits. thats one way to beat depression. they are advocating a bunch of different steps. since depression is a mental illness it cant really be cured with a shot in the arm. its also a behaviourial issue. think of it like when you break your leg – you go through six weeks of wearing a cast and then 6 months of physical therapy to get the leg strong again.
    depression is similar – the antidepressants and psychiatry get you started and then you have to go through therapy to get over the apathy and make yourself stronger.
    its not a quick fix. there is no quick fix for depression.

  5. Salim
    Posted July 30, 2009 at 5:37 am | Permalink

    Sometimes it’s difficult to truly identify that a individual is suffering from depression, when he also suffers from other related symptoms.

    Not knowing which symptom is primary, secondary and so forth. Or whether more than one symptom can indeed be both primary, this can remain a mystery for some of those who suffer from such health disorders.

    thank you

  6. Nora Dempsey
    Posted August 27, 2009 at 8:27 pm | Permalink

    My partner is suffering from depression and a bright, intelligent man has become a nightmare at times. How can I help him to see sense and get this thing treated? I know he is a proud man afraid of stigma, but I say to him that if he had a broken arm, he would get it mended, this is no different. Any suggestions anyone how I can my man back on the track towards a brighter future?

  7. carol
    Posted September 2, 2009 at 11:26 pm | Permalink

    i have had depression for many years , on and off , my biggest part, is not liking myself, i have been threw abuse, battered house wife , and a lot more , i have lovely children who i love very much, and a fantastic partner now , who loves me , but when does all the pain from the past end , all i want to do now is start to like myself, so i can move on to the future, can anybody help me , cause tablets don t . . . .

  8. admin
    Posted September 3, 2009 at 6:55 am | Permalink

    You need to speak with someone !! Preferably a doctor or therapist

  9. Daniel
    Posted September 5, 2009 at 1:59 am | Permalink

    its hard to apply these if you have extreme..i mean extreme irritability, depressive thoughts and such…

    right now im just pushing with exercise and john st wort…
    im wondering if this is a major depressive symptom…

    ultra low mood…or am i bipolar? i haven’t had any normal mood for a long time…just very low wish i had a high at least

  10. hubert
    Posted September 17, 2009 at 11:26 am | Permalink

    Thank you very much for your useful information. An depressed person should basically understand that depression is curable. Sometimes, it may take a long time. The essential thing is that he/she should aware of possible steps that can make the person feel better and try to adopt those. I have been suffering in depression for past 2 years. But now relatively feel better than of two years back. I have been taking anti-depressant. Really, I am felling a new and good experience in every morning in the mind set. In fact, the suffering has gradually changing me to behave as a useful human being to the society. In the sense, I have understood now that the fact, nothing is worth better than health. I am 100 per cent hopeful that I will overcome depression completely very soon and will be a complete person.

  11. admin
    Posted September 17, 2009 at 11:50 am | Permalink

    Well , no one said it was going to be easy, people need help from a strong support network like family, friends and people in the medical community..

  12. j
    Posted October 22, 2009 at 8:56 am | Permalink

    i have always been a strong person always been able to get my self in the frame of mind to cope. yes i av felt low for no reason and felt tat black cloud lurking. i suffered a touch of depression for 3 weeks where if i could have anyting including millions, would nt make me happy, then i stopped smoking and took champix this as canged my life i am not the bubbly person i was before, i cannot this time talk myself out of this awful black feeling of dread. noting can make me happy and i am in catch 22 if i start smoking again will this make me happy or am i doomed with this forever. what have these tablets done to my receptors. i am a proffessional in this field so it just goes to show we do not have all te answers when it comes to ourselves. lol to all x

  13. carol shearn
    Posted October 22, 2009 at 10:49 pm | Permalink

    i have tried so hard to beat this , but i cant . i have found my perfect partner , how is he suppose to love me , when i dont even like myself , i don t want to lose him , some one help me please .

  14. Joe bloggos
    Posted October 31, 2009 at 11:02 pm | Permalink

    it was nice reading the text. It reminded me how happy I felt after giving a busker some change. Its not a big thing to do but there was a mutual appreciation of the gesture. This I have done unconsciously never relalising that it may have been a call for help from within for me to take care of myself and address my depression.
    Carol you should know that finding the perfect person can be a trigger for depression for me that trigger was getting the perfect job. Its no fun when you get there.

  15. yasmin
    Posted November 23, 2009 at 6:50 pm | Permalink

    i think i have depression, my confidence has been shot to pieces , my future seems like im going to be alone. i hate myself most of the time. id rather go to bed and sleep. I am trying too pull myself together i do exercise and eat heathly – wot more can i do???????

  16. ccat
    Posted January 13, 2010 at 11:07 am | Permalink

    I suffer from depression and have just came out a negative relationship and am feeling really bad cant seem to get the energy to put things into practice, have took anti depressants in the past but the feeling of going on them again makes me feel worse any advice

  17. Yasmine
    Posted January 19, 2010 at 3:13 pm | Permalink

    i jus really want to say this site is really helpful i was confused and scared about what i am going through and not accepting i was depressed as i am only 18 but i think reading this i agree with the doctor. My GP put me on anti depressent tablets and 1 day something really small happened that normally wouldnt bother no1 but i thought it was the end of the world i thought i was worthless and couldnt go on or deal with ANYTHING no more and took all my anti depressent tablets, Luckerly my mum realized and made me go hospital were i stayed for 2days. I feel i need help now realizing what i was going to do scares me alot. i WANT TO SAY THANK YOU!

  18. sam
    Posted March 7, 2010 at 12:29 pm | Permalink

    i’m 21 years old and everything in my life seems to be too much for me i had a drug addiction a few years ago that i’m over but i think its left me with some mental problems but i’m scared to face these issues with help from anyone because i dont want to let anyone down like my girlfriend and my little girl. i’ve been trying to cope for such a long time but i fear its left me with a more serious problem dont know if i can go on anymore

  19. sarah
    Posted March 24, 2010 at 11:25 pm | Permalink

    i have suffered from depression for some years now,i find life very hard most of the time, hard work when you put a brave face on for your family. as you don’t want to dissapoint them or let them down or worry them.im a 44yr old woman who is a very sad person who so wants to b happy. what is happy tho?????

  20. admin
    Posted March 25, 2010 at 8:04 am | Permalink

    being happy in my eyes is being content with what you have and the way your life is going :)

  21. shirley
    Posted May 10, 2010 at 7:50 pm | Permalink

    i have suffered deppesion for years, the reason for it is life feels worthless no matter what i do in my life i get kicked down, life from when i was born has been a struggle, i just keep wondering what i have to do in this world to get to the next, its such a horrible feeling. i dont have any family apart from my kids who are 11 and 13 so no family help

  22. shirley
    Posted May 10, 2010 at 8:08 pm | Permalink

    the first time i attemped suicide i was 14 i am now 43 i have ms, and no family well my kids 11 and 13 but its not like i can speak to them about it. i feel as though i’m waiting to die, i have no get up and go, i cant find a suitable job and dont know what direction to go in and with these feelings its making me worse, no hope! cause thats what i’ve been clinging on to since i was 14 but having kids i would never do that to them, that would scar a kid

  23. andy
    Posted May 11, 2010 at 11:59 am | Permalink

    hey, i’m a teen in sixth form college and I am dealing with depression. I feel that everyone is constantly judging me, and it is making me hate myself more and more each day, the tiniest thing will upset me, and also, i hate to admit, i have contemplated suicide many times, including once in the school building. i really need some help because i cannot speak to anyone. i tried a councillor but that didn’t help, and i told my friends how i was feeling but they made no effort to help me whatsoever. please help

  24. Tazz
    Posted July 2, 2010 at 1:58 pm | Permalink

    I need help with coping with serisous chronic depression. i cant take pills as im easily addicted and tend to over dose.i used to harm and cannot go back to that as the scars are starting to look really bad and taking longer to fade.it’s really hard holding on to this thing calle life, i dont even feel human tbh…what can i do?

  25. les.woodward
    Posted July 28, 2010 at 1:32 pm | Permalink

    I don’t know whether depression is curable or not, or do we just cope until the “black dog” bites us again? I have had depression on and off for around 10 years. Two years ago I came off the tablets thinking I was “cured”. At the moment I am finding it very difficult to cope. I have an appointment with the GP tomorrow and have mixed feelings. If I go back on the tablets have I failed? Will there ever be a time when the blck dog doesn’t spring up and bite me? I feel guilty coz I am upsetting my wife who I love dearly? I feel weak, childish, and worthless and a burden on everyone.

  26. migrocom
    Posted August 14, 2010 at 7:12 am | Permalink

    I am almost ina crisis,I am supposed to b providing support but it seems at a point where I also nid help.my broda is ovbiously depressed but being a lawyer has refused to c a doctor for fear of sigma.my wifes case seem even worse as she is unconsolably depressed and negative.she shows most of d symtoms explained but blames every oda person in dworld including me & refuse to b positive abt most things.

  27. Sabah
    Posted August 16, 2010 at 2:15 pm | Permalink

    hello karl,
    i just wanted to say that your story touched me, i am so pleased that you are now better. i too suffered from manic depression and anxiety, it was a tough ride as i thought i was going mental and didnt know what the illness was, i am greatfull to god for giving me some of my old self back, i am still trying and i will never give up to be my old self again. Thank you for the lovely story, it has given me so much hope. May god bless you and your family.

  28. Linda
    Posted August 19, 2010 at 2:28 pm | Permalink

    I’ve been suffering from depression since March this year and this is the first time I’ve read other peoples struggles with depression. I can relate to the things people have said and especially what you said Andy. I have thoughts of suicide and when im feeling that way i really want to take my life. but when I get through that terrible feeling (for me concentrating on my breathing and watching a little grasshopper helped :-) I realise I dont want to take my life. I’ve learned today that these feelings are a normal cry for help which is a sign that im struggling to cope with my situation at the moment. People who are suicidal dont want to die they just need help. I saw your words Andy “please help” I really hope you got the help you were needing. Maybe sharing your thoughts on here with people who understand helped. I’ve heard a saying, “when your walking through hell, keep walking” you will advetually come out the other side. im going to keep walking by using self development books, exercise, eating healthy and have ordered some fish oil which I learnt about on this website. PS one last important thing is to smile :-) Ive read it helps too.

  29. anonymous
    Posted August 27, 2010 at 11:27 pm | Permalink

    i am 16 years old, and people think i’m ok because that’s what i tell them, but i’m not. i have a lot of stressful stuff going on at the moment, with my family and a lot has happened in my past which has left huge holes in my life. i have friends and family, but i’m too scared to tell them how i’m really feeling, i feel guilty putitng that sort of worry on them. i told my boyfriend about how upset i get, but didn’t go into too much detail, about how i’ve selfharmed before and sometimes i get in the state of mind where i just feel like giving up completely. i’m fed up of trying to stop people from leaving my life, i just want someone to want to stop me from leaving for a change. i cry so much when i’m alone, so i try and avoid that because it makes me weak. i try and spend as much time with company to stop me from thinking horrible things, i just wanna be the girl i am when i’m with my friends,boyfriend – happy, but as soon as i get the smallest downfall i feel liek everything around me just crashes. i also have this weird thing where i develope stupid ocd things, like touching everything with my right hand last, if i don’t something tells me i’m going to lose something important and everytime i take the risk and not do it, it just plays on my mind, i just wnat to know if this is me being a stupid teenage girl, or if this is something that needs to be treated. i read in this article that depression can be generic or something? and i know my mum, nan and uncle suffered badly with it, and my aunty has bipolar. i just want some adivce please, because this just doesn’t seem to ever go away?

  30. les.woodward
    Posted September 1, 2010 at 7:25 pm | Permalink

    I dont think you are being a silly teenage girl. In fact I think yhe opposite that you are clued up and intelligent enough to realise that you need help and support. My advice is to do the right thing and get that help and advice. Go and see your GP and arrange counselling. Self help is ok if you know wht you are doing first instance is getting proffesional help and support.

    Good luck

  31. Linda
    Posted September 2, 2010 at 10:36 am | Permalink

    Hello Les,
    You saw the doctor about a month ago, I just wondered how are you coping now? and what things help you?

  32. Miss Andrea Tina
    Posted September 9, 2010 at 9:48 am | Permalink

    I 31 years old,have a lovely son of 12 years.I feel Tired constantly,weak and worry constantly about Things!I Have a lovely partner and have moved to a new abode but find it hard as its not private and find it hard to confront people sometimes,like to hide away!My family have drifted and Havent got a loyal friend I can confide in!I dont like The area I live in,feel alone!I have just given up my job as a support worker,working with disabled people as was making me more depressed!I am loosing my fight,strength,motivation!I have Tryed medication,makes me even more Tired cant focus!Im getting worse please help docters will just put me on medication!does anyone know of a more natural approach That can get me Through This!

  33. Linda
    Posted September 9, 2010 at 4:41 pm | Permalink

    Hello Andrea,
    I understand how your feeling. worrying about things can zap our energy and make us even more tired. when I worry about things I find that they rarely happen? you have a lot of positives in your life. quiting your job that you were unhappy in was a brave thing to do! and shows you do have the strength you need to make changes. being intouch with your feelings is important, you sound unhappy where your living, sounds like you need time out to nurture yourself this will give you the strength you need right now. your only 31. chat with your lovely partner and think of as many solutions you can together. Think of one thing you would love to do and do it. when things get hard, tell yourself, “I will get through this” I wish you well Andrea :-)

  34. Linda
    Posted September 9, 2010 at 4:59 pm | Permalink

    I do advise for you to see your doctor to tell them how your feeling. You need as much support as possible around you right now.

  35. Marysa
    Posted October 12, 2010 at 8:50 pm | Permalink

    I have suffered from depression as long as I can remember and my problem is that I find a guy and then I expect him to rescue me and turn around my life. It isn’t fair on the person and it just ends in fights anguish and more misery. I know I do it cos I don’t think I can improve my life on my own, but I am trying now as I can’t take the neediness that comes with relying on someone else.

    I am joining a gym in an effort to naturally improve my mood.

    Can anyone relate to relying on someone else to get you out of a rut? I know I need to learn to be more independant, but I don’t know how?

  36. Miss T Yates
    Posted October 15, 2010 at 12:42 pm | Permalink

    I have been taking antidepressants since my suicide attempt last October i did not even know i was suffering from depression – how does my doctor know i am – the tablets dont make me feel any different! At this minute in time i feel so up tight but i dont know why – is it me my brain missing or lacking in something?? just dont understand just trying to plod on and keep things together one day i might just find me the person i should be the real me hey!!!!!!!!!!!!!!!!!

  37. admin
    Posted October 15, 2010 at 1:07 pm | Permalink

    Just recently I have made a connection ( only with a few people) with bowel problems ie , fungi , bacteria and parasites and depression… this is a good starting point http://h-pylori-symptoms.com/h-pylori-symptoms/ have a good look around this site and see if anything falls into place for you.

    cheers Karl

  38. SJ
    Posted January 25, 2011 at 3:45 pm | Permalink

    A well thought out site. Thanks. I just wondered if anyone reading these pages suffered from emotional numbness and, if so, what are their experiences ? I was diagnosed with clinical depression 3 years ago but think I’ve probably suffered from it all my life. My mood is now stable after 18 months on Reboxetine and, more recently, a beta-blocker but I just don’t seem to be able to FEEL anything – good or bad. Nothing seems to get through and I feel emotionally detached from my wife and family.

    Is this common with depression ? Any tips ?

    Keep up the good work.

    SJ

  39. admin
    Posted January 25, 2011 at 3:51 pm | Permalink

    Hi SJ

    Thanks for posting a comment , yes I had this with one of my meds, olanzapine … I think thats how you spell it , couldnt laugh couldnt cry !! just right down the middle …..

    Cheers Karl

  40. SJ
    Posted January 25, 2011 at 4:47 pm | Permalink

    Thanks Karl. That does pretty much describes how I feel too. May I ask if the symptoms lifted ?

    Any thoughts on the debate about whether depression is ever ‘cured’ or just goes into remission ?

    SJ

  41. admin
    Posted January 25, 2011 at 5:11 pm | Permalink

    The symptoms only seem to lift when I stopped that particular med… I do think depression is totally curable for 99% of people but its a HUGE debate to open with so many contributing factors… for me personally ( see homepage) cutting out gluten and dairy , made a huge difference, having a good work – life balance again made a huge improvement, sorting out my gut flora made a huge difference, good bit of reading “potatoes not prozac” I now see medication as a “first emergency point” after that, the nhs should be giving out advice on lifestyle and diet , since you opened the question lets say we took 1000 adults suffering from depression, what would we find, possibly 10-15 who have lost someone , maybe another 200 so unhappy at work , maybe another 200 unhappy at home , maybe some really worried about other people etc etc etc , so say we disregard the people who have lost someone and take the rest and put them into a stress-worry free enviroment where they felt loved and valued , then we radically changed their diet got the doing excersise and just gave them a real sence of purpose … how many do you think we would “cure” its a very interesting debate to open…. totally a non starter, but it would be interesting to see how things would turn out !!

  42. admin
    Posted January 25, 2011 at 5:54 pm | Permalink

    Just reading down a few of the comments above proves my point , life stresses , poor diet contribute soooo much to the word depression… adrenal stress can make you feel highly uptight and depressed ….

  43. Anonymous
    Posted January 31, 2011 at 6:32 pm | Permalink

    My partner has been struggling with depression now for almost three years,
    Initially I didn’t fully understand and I thought that I could help by being positive and keeping him busy, yet that didn’t help it only made him worse,
    I realise now that the only person who can help is himself, yet without sounding like a spoilt selfish little girl I am really struggling with his behaviours! I have watched him fade away into a shell of a person, he has no confidence yet comes across as a strong willed person in front of people,
    He has lost all interest in any kind of social activities, and is so cold when it comes to being intimate, he has an attitude of he doesn’t need or want anybody around him, when the going gets tough and then says he no longer wants to be with me! He is pushing me away, what can I do to help him overcome this or should I just leave? I feel as though I can’t leave and I don’t want to because i love him so much, but am I making the situation worse? Every other day he creates and argument and I just feel deflated and heartbroken all of the time! It’s so hard as a partner/ family member to watch somebody you love go through depression, you are helpless and constantly feel like a catylist to the mood changes!
    I found it really inspirational reading your stories of overcoming depression yet he states often that he will not get through this and now I am also starting to doubt whether he will either!
    What can I do?
    He has Been on medication now for the whole of his diagnosis which hasnt helped, he has also Been through a stint if therapy which also has made no difference, I’m so scared that he will take his own life!
    Please help xxx

  44. admin
    Posted January 31, 2011 at 7:31 pm | Permalink

    I really feel for you !! But I really dont have the answer… part of me thinks some people are just “born” that way out , some people just love the attention, some people have the hormone- chemical imbalance, their are just so many contributing factors in peoples lives that you cant just put a “one size” fits all , I personally find talking helps me alot , its a great release !

  45. Anonymous
    Posted January 31, 2011 at 10:26 pm | Permalink

    Thankyou for your reply, if we could find an answer i suppose it wouldn’t be an issue would it?
    It’s hard tho because I want to support him, I always thought that
    Mayb a depression support group would be useful so he can talk to people in the same boat, do you know of any? Xxx

  46. anon
    Posted February 14, 2011 at 12:56 am | Permalink

    hi

    Im 34 and have had depression since I was 10 yo. I was on tablets when i tried to commit suicide due to feeling worthless and i couldnt cope with the mental cruelty at that time. I stopped taking the tablets for years and just struggled through each day, living, working and not much else. I lost everything with having this, family wise! For the past year ive been depressed even more due to bereavement and its not been any easier. I have had to call it a day for the self help side of things and go back on the tablets and get help medically. I havent started therapy yet but im hoping with everything i have left that it works. I cant go on like this and i dont want to lose my new partner over it.
    Thanks for listening!

  47. sarah
    Posted February 15, 2011 at 12:15 pm | Permalink

    I think this is brill, I am only 22 years old and suffer from panic attacks, Agraphobia and depresion.
    what I have read sums everything up for me. It is not easy having depresion but changeing things such as your diet does rearly help! I keep a log of the food I eat every day and how I feel and what I have acheved I try not to focus on negatives any more as much as it is hard life is getting easyer, I see a councler who rearly helps. i try not to think WHAT IF any more I just go with the flow. Anyone who is suffering from depresion there is one think that makes me feel rearly good when i am down :) smile it rearly works then have a little laugh because your smileing and feel happy. i wish you all good luck x :)

  48. anonimous
    Posted February 18, 2011 at 12:17 am | Permalink

    it is very hard to deal with depression no matter if that si mild or not severe. it cna take a long tiem to figure out what works and what does not. Your experience was very helpful. I think digging helps with depression .The sweating is a must for someone who has depression.There is a German research regarding digging.I had that experience before the reserach. That really works well but needs to be done on regular basis till the symptoms disappear.Another thing that has helped me to beat depression was the journeywork.That is “a must” as well.Good luck everyone and do not miss your prayer and meditation. Spiritual help is essential.

  49. Frans
    Posted March 9, 2011 at 4:22 pm | Permalink

    I was diagnosed with depression at 41. We have just came back from a year working in Ireland. My family have rejected me and my wife with our decission of leaving our country. I was disinherrited from my father and we had to face all kinds of verbal abuse.
    Now three years later, I stopped Welbrutin, joined the gym and am trying to solve my problem. I cannot stop the eltroxin and that isa pitty as it makes the weightloss so much more complicated.
    All the best all ofyou

  50. Claire
    Posted December 13, 2011 at 5:08 pm | Permalink

    Having recently had a unexpected set back, I have found this website and others suffering with depression helpful. I don’t have the answers but believe in yourself, accept help, find someone to talk too and give in to therapy and medication. It takes a lot of strength, determination and focus. This may happen again to me and you but surround yourself with good things and loving people. It took 14 months to face up to the stigma of mental help but I’m not going to give in to it. I wish you all the help you need and what works for you can ease some of the dark days.

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