How to break depression?

How to cope with a depressive episode

Tackling depression as soon as symptoms develop can help people recover more quickly. Even those who have experienced depression for a long time might find that making changes to the way they think and behave improves their mood.

The following tips may help people deal with a depressive episode:

1. Track triggers and symptoms

Keeping track of moods and symptoms might help a person understand what triggers a depressive episode. Spotting the signs of depression early on may help them avoid a full-blown depressive episode.

Use a diary to log important events, changes to daily routines, and moods. Rate moods on a scale of 1 to 10 to help identify which events or activities cause specific responses. See a doctor if symptoms persist for 14 days or more.

2. Stay calm

Identifying the onset of a depressive episode can be scary. Feeling panicked or anxious is an understandable reaction to the initial symptoms of depression. However, these reactions may contribute to low mood and worsen other symptoms, such as loss of appetite and disrupted sleep.

Instead, focus on staying calm. Remember that depression is treatable and the feelings will not last forever.

Anyone who has experienced depressive episodes before should remind themselves that they can overcome these feelings again. They should focus on their strengths and on what they have learned from previous depressive episodes.

Self-help techniques, such as meditation, mindfulness, and breathing exercises can help a person learn to look at problems in a different way and promote a sense of calmness. Self-help books and phone and online counseling courses are available.

3. Understand and accept depression

Learning more about depression can help people deal with the condition. Depression is a widespread and genuine mental health disorder. It is not a sign of weakness or a personal shortcoming.

Accepting that a depressive episode may occur from time to time might help people deal with it when it does. Remember, it is possible to manage symptoms with treatments, such as lifestyle changes, medication, and therapy.

4. Separate yourself from the depression

A condition does not define a person; they are not their illness. When depression symptoms begin, some people find it helpful to repeat: “I am not depression, I just have depression.”

A person should remind themselves of all the other aspects of themselves. They may also be a parent, sibling, friend, spouse, neighbor, and colleague. Each person has their own strengths, abilities, and positive qualities that make them who they are.

5. Recognize the importance of self-care

Self-care is essential for good physical and mental health. Self-care activities are any actions that help people look after their wellbeing.

Self-care means taking time to relax, recharge, and connect with the self and others. It also means saying no to others when overwhelmed and taking space to calm and soothe oneself.

Basic self-care activities include eating a healthful diet, engaging in creative activities, and taking a soothing bath. But any action that enhances mental, emotional, and physical health can be considered a self-care activity.

6. Breathe deeply and relax the muscles

Share on PinterestInhaling and exhaling slowly has psychological benefits.

Deep breathing techniques are an effective way to calm anxiety and soothe the body’s stress response. Slowly inhaling and exhaling has physical and psychological benefits, especially when done on a daily basis.

Anyone can practice deep breathing, whether in the car, at work, or in the grocery store. Plenty of smartphone apps offer guided deep breathing activities, and many are free to download.

Progressive muscle relaxation is another helpful tool for those experiencing depression and anxiety. It involves tensing and relaxing the muscles in the body to reduce stress. Again, many smartphone apps offer guided progressive muscle relaxation exercises.

We have reviewed some meditation apps that can help with depression and anxiety.

7. Challenge negative thoughts

Cognitive behavioral therapy (CBT) is an effective therapy for those with depression and other mood disorders. CBT proposes that a person’s thoughts, rather than their life situations, affect their mood.

CBT involves changing negative thoughts into more balanced ones to alter feelings and behaviors. A qualified therapist can offer CBT sessions, but it is also possible to challenge negative thoughts without seeing a therapist.

Firstly, notice how often negative thoughts arise and what these thoughts say. These may include “I am not good enough,” or “I am a failure.” Then, challenge those thoughts and replace them with more positive statements, such as “I did my best” and “I am enough.”

8. Practice mindfulness

Take some time every day to be mindful and appreciate the present moment. This may mean noticing the warmth of sunlight on the skin when walking to work, or the taste and texture of a crisp, sweet apple at lunchtime.

Mindfulness allows people to fully experience the moment they are in, not worrying about the future or dwelling on the past.

Research suggests that regular periods of mindfulness can reduce symptoms of depression and improve the negative responses that some people with chronic or recurrent depression have to low mood.

9. Make a bedtime routine

Sleep can have a huge impact on mood and mental health. A lack of sleep can contribute to symptoms of depression, and depression can interfere with sleep. To combat these effects, try to go to bed and get up at the same time each day, even at weekends.

Establish a nightly routine. Start winding down from 8 pm. Sip chamomile tea, read a book, or take a warm bath. Avoid screen time and caffeine. It may also be helpful to write in a journal before bed, especially for those whose racing thoughts keep them up.

10. Exercise

Exercise is extremely beneficial for people with depression. It releases chemicals called endorphins that improve mood. An analysis of 25 studies on exercise and depression reports that exercise has a “large and significant effect” on symptoms of depression.

11. Avoid alcohol

Alcohol is a depressant, and alcohol use can trigger episodes of depression or make existing episodes worse. Alcohol can also interact with some medications for depression and anxiety.

12. Record the positives

Often, depressive episodes can leave people focusing on the negatives and discounting the positives. To counteract this, keep a positivity journal or gratitude journal. This type of journal helps to build self-esteem.

Before bed, write down three good things from the day. Positives include regular meditation, going for a walk, eating a healthful meal, and so much more.

10 Things I Do Every Day to Beat Depression

From the moment my eyes open in the morning until the second that I pull my sleep mask over my face as I go to sleep, I am engaged in battle: I must protect myself with armor against ongoing negative intrusive thoughts that flood into my brain, while sending my prefrontal cortex — the home of logical thought — the green light to make decisions and to take charge of my brain’s limbic system (the emotional hub). That is, before the amygdala (fear center) spazzes out. I spend more time and energy chasing and maintaining good health than I do in any other aspect of my life — my marriage, family, work — because I know that everything meaningful and good around me depends on a stable base. I hope that one day I won’t have to fight so hard for my sanity; however, until then, here is a list of things I do everyday to beat depression.

1. Swim.

I start the day in the pool. I show up before I can even think about what I’m doing diving into ten feet of cold water loaded with chlorine with a bunch of other nutjobs. Tom Cruise believes that all a depressed person needs to do to get rid of the blues is to strap on a pair of running shoes. I think a few other steps are needed, however, exercise is the most powerful weapon I use every day to whack the demons. If I go more than three days without working out, my thoughts turn very dark and I can’t stop crying. All aerobic workouts release endorphins, while helping to block stress hormones and produce serotonin, our favorite neurotransmitter that can relieve depression. However, swimming is particularly effective at shrinking panic and sadness because of the combination of stroke mechanics, breathing, and repetitiveness. It’s basically a form of whole-body, moving meditation.

Volumes of research point to the benefits of exercise for mood, like the study led by James A. Blumenthal, PhD, a professor of medical psychology at Duke University in Durham, N.C., which discovered that, among the 202 depressed people randomly assigned to various treatments, three sessions of vigorous aerobic exercise were approximately as effective at treating depression as daily doses of Zoloft, when the treatment effects were measured after four months.

2. Record my “joys.”

A very wise person once told me to try to let go of the big thoughts (“Why do I suffer from depression?” “When will I feel better?” “Will I ever feel good again?”) and concentrate instead on the little joys that happen throughout my day, to allow those unsuspecting moments of delight carry me over the ones fraught with anxiety and sadness. So each day I record in my mood journal a list of joys: a long swim with friends, my daughter’s little hand in mine as we crossed a street, my son’s proud expression after making a three-point basket, seven hours of sleep, a warm dinner. This exercise forces me to be open to little joys, to collect them, and to have more appreciation for what is right in front of me. Psychologists like Sonja Lyubomirsky, PhD, at the University of California Riverside say that keeping a gratitude journal (or a list of joys) can increase your energy, and relieve pain and fatigue.

3. List my accomplishments.

I started to do this when I was too depressed to work. As someone who had always attached her self-esteem to career achievements, I felt completely worthless when I couldn’t produce a single piece of writing. I read books by positive psychologists and happiness experts like Dan Baker, PhD, director of the Life Enhancement Program at Canyon Ranch, who said to start with small accomplishments, and build strength and confidence from there. So my list would include things like: ate a full breakfast, took a shower, picked up the kids from school, called my mom, got groceries, wrote my husband a loving email, read a chapter of a book. Today I make sure to record all my efforts toward good health: I list how many laps I swam, how many minutes I meditated, if I helped someone with his depression, or if I made a difficult food choice (ate a boring spinach salad at lunch when everyone was eating tasty calzones). I will record work feats (i.e., wrote a blog), but I make sure to balance out my list with the kinds of small but important accomplishments that I often dismiss (helped my son with his school project, talked to a friend about anxiety, had tea with my husband instead of rushing to work).

4. Laugh.

Charlie Chaplin once said, “To truly laugh, you must be able to take your pain and play with it.” I suppose that’s why some of the funniest people out there — Stephen Colbert, Art Buchwald, Robin Williams, Ben Stiller — have journeyed through periods of torment. There is an unspoken message hidden within a giggle that says this: “I promise, you’ll get through this.” In fact, New York City’s Big Apple Circus has used humor to console sick children since 1986, when they started sending teams of clowns into hospital rooms with “rubber chicken soup” and other fun surprises.

Studies indicate that human beings can heal (at least partially) from a host of different illnesses if they learn how to laugh. For example, in 2006 researchers led by Lee Berk, DrPH, and Stanley A. Tan, MD, PhD, at Loma Linda University in Loma Linda, Calif., found that two hormones — beta-endorphins (which alleviate depression) and human growth hormone (HGH, which helps with immunity) — increased by 27 percent and 87 percent, respectively, when volunteers anticipated watching a humorous video. Simply anticipating laughter boosted health-protecting hormones and chemicals.

5. Meditate.

I’ve read more than 100 articles on how meditation can help relieve depression and anxiety. Research has shown that formal practices of meditation can halve the risk of future clinical depression in people who have already been depressed several times, its effects comparable to antidepressant medications. I swear it’s been the feature story of every health Web site at least once a week for the last five years. That’s how long I’ve been trying to do it. Unsuccessfully. Until I enrolled in a mindfulness-based stress reduction (MBSR) program at the local hospital. I have two more weeks to go before I graduate from meditation school and am far from wearing one of those radiant smiles that grace the faces of Tibetan monks; however, I have been able to follow through on my commitment of 20 minutes of meditation a day. Meditation, alone, doesn’t take away all of my symptoms of depression as some studies suggest it can, but I think it’s lengthening the time span between negative intrusive thoughts, or at least making my brain a less healthy environment for them to thrive.

6. Take DHA and vitamins.

Okay, this is coming from someone who gets vitamin catalogs sent to her house, but I believe that a brain armed with all the right nutrients is going minimize your struggle with depression by at least 50 percent. I start with 2,000 milligrams of DHA. That’s a motherload. But consider this: One quarter of the brain is DHA. Renowned neurologist David Perlmutter, MD, names three reasons why you need extra DHA in his bestselling book “Grain Brain”:

DHA is an important building block for the membranes surrounding brain cells, particularly the synapses, which lie at the heart of efficient brain function. Second, DHA is an important regulator of inflammation. It naturally reduces the activity of the COX-2 enzyme, which turns on the production of damaging inflammatory chemicals… DHA helps orchestrate the production, connectivity, and viability of brain cells while at the same time enhancing function.

I also take liquid vitamin D and vitamin B12 (because they are more easily absorbed that way), as well as iron, vitamin K2, vitamin C, calcium, and magnesium. Vitamin D and B-Complex vitamins are especially important for optimal mental health.

7. Drink a power smoothie.

They say breakfast is the most important meal of the day, so I start off with a smoothie of kale, chard, spinach, or collard greens mixed with pineapple or strawberries. Then I add a potent probiotic, a powdery mix containing bacteria (yep, you read that right) that helps keep the intestines healthy and supports digestion. Why? Because your brain is only as healthy as your gut. In fact, the nervous system of your intestines is so complex, including an estimated 500 million neurons, that neuroscientists often refer to the gut as the second brain. The nerve cells in our gut manufacture 80 to 90 percent of our body’s serotonin, the neurotransmitter we need to stay sane. That’s more than our brain makes. The gut is in constant communication with the brain, sending it information that most definitely affects your mood, even as the messages never come to consciousness. If you are a person who has struggled with stomach and digestion issues like I have, you might be surprised to learn that some depression and anxiety symptoms can be relieved by tending to the gut and feeding it organisms that keep it happy.

8. Avoid sugar and grains.

Bestsellers “Grain Brain” by Dr. Perlmutter and “Wheat Belly” by preventative cardiologist William Davis, MD, should be required reading for anyone prone to depression and anxiety. Both authors explain that the cornerstone of all degenerative conditions — including depression, anxiety, and bipolar disorder — is inflammation, and the most prominent stimulators of inflammation in our diet are gluten and sugar. We get into trouble because we can’t feel the inflammation in our brain like we can in other parts of the body, so we rarely link a kind of food we eat with our mood. Perlmutter points out that study after study demonstrates that people who suffer from mood disorders also tend to be gluten sensitive and vice versa: Depression is found in as many as 52 percent of gluten-sensitive individuals. This was the case with me. I got tested two months ago. He also explains how we now have documented evidence proving the relationship between hemoglobin A1C (which is a measure of our average blood sugar) and the future risk of depression. Studies have shown that a diet that is low in carbohydrates and high in fat can improve symptoms of depression and schizophrenia.

9. Use my sun lamp.

This is by far the easiest thing I do on the list. Each morning I turn on the sun lamp on my desk. An hour later, I turn it off. It’s relatively small for producing full-spectrum fluorescent light at an intensity of 10,000 lux. If I have spent a few hours outside, or if I know I will be, I don’t bother. However, for most of the fall and winter months — and for the dark rainy days during the spring and the summer — my sunbox helps me regulate my circadian rhythm, the body’s internal biological clock that governs certain brain wave activity and hormone production. The fluctuation of natural light can cause mood-related chemicals to shift, causing depression in sensitive folks like myself. So if nature isn’t giving me what I need, I give it to myself.

10. Pray.

Lots of folks lump meditation and prayer together. I think they are very different. Meditation, for me, is a mental-health exercise of being aware of my breath and staying in the present moment as much as possible. Prayer is my chat session with God. I start by saying my three favorite prayers: “The Prayer of Saint Francis,” “The Serenity Prayer,” and “The Third Step Prayer.” All of them basically say this: “Big Guy, I’m putting you in charge today because, just like yesterday, my brain feels like Chuck E. Cheese on Kids Eat Free Night. I’m hoping you can use my struggle and my pain for some greater cause, and, if not, please don’t let me know that. Help me to see with eyes of faith, hope, and love, and to always err on the side of compassion.” Then I read a scripture passage, as well as a piece from a spiritual author, like Henri Nouwen. If I still have time, or if I’m especially anxious, I will pray the rosary over and over again, until I can catch my breath.

How to lift depression quickly and safely

Joe Griffin and Ivan Tyrrell explain how and why the human givens approach can help therapists shift depression in just a few sessions — or less.

DEPRESSION kills people — in every country in the world suicide rates are increasing. At all age levels depression rates in the population are rising quickly. Although not a biological illness, it appears to be ‘contagious’. Moreover, people’s understanding of it is confusingly coloured by myths: it is caused by a chemical imbalance in the brain; it is anger turned inward; it takes a long time to come out of; it stems from childhood events that have to be explored before progress can be made, etc.

It has now clearly been shown that neither non-directive counselling nor cognitive behavioural therapy is more effective as a treatment for depression than a few short visits to a GP over a twelve month period., Extensive research shows that psychodynamic therapy deepens depression and makes it last longer. And, now that antidepressants are being shown to be an unsafe treatment, the need for health workers, counsellors and psychotherapists to understand depression and be trained in treating it effectively has never been greater.

The rapid increase in the incidence of depression revealed by epidemiological studies is one of the reasons we know that depression is not a genetic disease. A large body of evidence, published over the last three decades, shows that most depression is learned, brought about by the way we interact with our environment. It is not caused as a result of the specific events we experience — the majority of people exposed to adverse life events do not develop depression — but by the way we respond to them. Further support for this view comes from evidence that depression responds well to certain kinds of therapy or counselling, — that which is active, time limited, focused on current problems and aimed at symptom resolution, not personality change.

The human givens approach

The human givens approach to counselling works with what we are all born with — our genetic endowment — namely the physical and emotional needs programmed into us by evolution, which seek their fulfilment through our interaction with the environment, and the innate resources provided to help us meet those needs. When emotional needs are not met or when our resources are used incorrectly, we suffer considerable mental distress — most commonly anxiety and/or depression. Therapy based on the human givens looks for what is missing in people’s lives and works towards enabling needs to be met.

The resources which are available to help us do this include the ability to build rapport, empathise and connect with others. Imagination is a resource: one that can allow us to focus our attention away from our emotions in order to solve problems more objectively. We have a conscious, rational mind that can question, analyse and develop the ability to ‘know’ — understand the world unconsciously through metaphorical pattern matching.

Central to all these abilities and functions, and in many ways perhaps paramount, is the dreaming brain which preserves the integrity of our genetic inheritance every night. The role of dreaming is key to a full understanding of depression, and why practical therapies help.

Depressed by dreams

We all dream for about two hours a night, even though we often don’t recall having done so when we wake up the next morning. There is evidence to show that the function of dreaming, which occurs predominantly during REM sleep, is the metaphorical acting out (not the resolving) of unexpressed, emotionally arousing preoccupations, so that the arousal can be discharged and the brain freed up to deal with the concerns of the following day. The process of discharging, and thus completing, patterns of arousal in this way preserves the integrity of our core personality.

In depression, however, this process goes dramatically wrong. Instead of having about 25 per cent (REM) sleep and 75 per cent slow wave sleep (which boosts energy levels in the brain), these proportions become inverted, with the depressed person having far too much REM sleep and too little slow wave sleep. The prolonged negative self examination and introspection which tends to characterise depressed people creates higher than average arousal levels and greater need for discharge during dreams. The first period of REM sleep occurs much earlier in depressed people, because the pressure for discharge is so great. The first REM sleep period is also more prolonged and shows an especially high rate of discharge. However, so much discharge activity not only reduces the arousal levels in the brain but also depresses and exhausts it, leaving the dreamer likely to lack motivation the following morning. Indeed, very many depressed people say they wake up from sleep feeling exhausted.

In experiments in the sleep laboratory, if depressed people are woken every time they go into REM sleep, their depression lifts. Antidepressants also reduce REM sleep, and this is thought to be why they can help to lift depression. Only those patients whose REM sleep goes back to normal stay out of depression. (However, there are ways to bring this about without using drugs, as we will shortly show.)

The black and white emotional brain

By spending too long on worrying and emotionally arousing rumination (a simple saliva or blood sample from a depressed person will show elevated levels of the stress hormone cortisol), depressed people are misusing the tool of imagination. Unfortunately, all this emotionally arousing introspection not only leads to excessive dream sleep, it also prevents people seeing their life situations objectively. High emotional arousal inhibits the higher cortex, the rational part of the brain, and blocks rational thought.,

To the emotional brain, everything is either black or white, good or bad, right or wrong, safe or dangerous. This is because high arousal locks us into a trance state, a confined viewpoint. It is only the higher cortex that can inject the shades of grey and see the bigger picture.

People who are not habitual black and white thinkers can snap out of this emotional trance state fairly quickly. But those who have a tendency towards endlessly analysing the negative aspects of their lives, catastrophising every little setback and conjuring up more, are more likely to stay locked in their depressive trance. It has been shown that those who take events most personally (blaming themselves for everything that goes wrong), have a highly pervasive view of how negative an event will be (losing a job or a lover means that their whole life is ruined) and also consider its impact permanent (there will never be another job or lover) are the most likely to suffer from depression.

With a clearer picture of what depression is and what causes it, we can set about lifting it more rapidly.

How to lift depression

The main task in any counselling for depression, which is very commonly accompanied by anxiety, is to lower emotional arousal and help patients stop their negative introspection as quickly as possible. This can be done by drawing on the human givens in realistic, practical ways.

We routinely find that, using a variety of appropriate approaches that are attuned to the human givens, we can make, in one session, much faster progress, even with severe depression, than if we slavishly follow one particular model of therapy.

The approach has been demonstrated publicly and filmed for training purposes many times (also see “I went away with so many ideas”).

Therapists working from the human givens will integrate behavioural, cognitive and interpersonal approaches with relaxation and visualisation techniques, to motivate people to widen their life view, raise their self esteem and solve problems. We can work alongside patients giving practical guidance for breaking problems down into manageable chunks (focusing outwards on resolution rather than inwards on nonproductive worrying). We can use humour to jerk them out of their black and white thinking; we can reframe their negative comments in a novel, positive way; we can inform, set tasks, get patients to exercise, engage again in fun activities or involve themselves in helping others (again, to direct their attention outwards), rouse their curiosity, and so on.

Above all, we use their imagination in guided imagery to help them vividly see themselves making the changes they need to make in order to overcome their difficulties. This works on the time honoured principle that the human brain tries to bring about what it focuses on. Only then can we be sure of getting commitment from a patient to take the action they need to take to bring themselves out of their exhausted state.

Speedy results

This organic mind/body approach can bring about the remission of depression in a fraction of the time taken by cognitive or behavioural or interpersonal therapy. In our experience, when patients know that their negative ruminations are causing their poor nights’ sleep and their exhausted days, they are quickly motivated to work to break the cycle of depression.

Psychologists Joe Griffin and Ivan Tyrrell are experienced psychotherapists and co-founders of the human givens approach to therapy.

> Read the related case study of how one session of human givens therapy was enough to transform the life of a depressed single mother called Sarah

This article first appeared in the “Human Givens Journal” Volume 9 – No. 1: 2002

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The no-drug approach to mild depression

Looking for a boost or alternative to antidepressant medicines? Here are four therapies that may help relieve your symptoms.

Published: February, 2019


Image: © RgStudio/Getty Images

Many men suffer bouts of mild or moderate depression as they age. Health issues and the loss of a spouse, family member, or friend are common triggers that can lead to persistent sadness and loss of enjoyment.

While antidepressants like selective serotonin reuptake inhibitors (SSRIs) can be helpful to relieve and control symptoms, they are not always the right choice.

“Many older men don’t want to be dependent on antidepressants, or are sensitive to their common side effects, such as dry mouth, dizziness, sleepiness, and weight gain,” says Dr. Darshan Mehta, medical director of the Benson-Henry Institute for Mind Body Medicine at Harvard-affiliated Massachusetts General Hospital.

Fortunately, there are nondrug options available to help treat and manage mild depression. “These are also ideal as a preventive measure for people who have yet to experience depression, but may have a family history of the disease and are at high risk, as well as those who have had past episodes and want to avoid future ones or be better prepared if they occur,” says Dr. Mehta.

Always consult with your doctor if you experience symptoms of depression. Depending on the severity of your condition, medication may be appropriate, at least in the short term. Otherwise, you may be able to manage and even prevent episodes of depression with these four nondrug strategies.

Exercise

There is strong evidence that any kind of regular exercise is one of the best antidepressants. “It not only helps keep your current mental state from getting worse, but it can prevent mild depression from becoming more severe depression,” says Dr. Mehta. Exercise helps to lower symptoms of anxiety, improve sleep quality, and boost energy levels.

Exercise combats depression by enhancing endorphins — natural chemicals that create a sense of euphoria. Some research has suggested aerobic exercise can have an especially strong antidepressant effect.

A meta-analysis published online Oct. 18, 2018, by Depression and Anxiety found that people with major depression who engaged in an average of 45 minutes of moderate-intensity aerobic exercise three days a week for at least two months experienced a greater antidepressant effect compared with those who did minimal exercise.

Still, any type of exercise or level of intensity is helpful, according to Dr. Mehta. “Focus on doing whatever gives you enjoyment, as regular movement is key,” he says. “When you look at societies around the world that have the lowest levels of depression and highest quality of life, they don’t go to gyms, but instead incorporate a lot of movement during their days.” Your exercise could be as simple as a daily walk, attending to your garden, or working on house projects.

Nutrition

When it comes to nutrition and depression, Dr. Mehta suggests focusing on what not to eat. “Research on what nutrients can help protect against depression symptoms is ongoing, but curbing refined sugar found in sweets, soft drinks, and processed foods may be especially beneficial,” he says.

A study published online July 27, 2017, by Scientific Reports that examined the diets of 8,000 men found that those who consumed 67 grams or more of sugar per day — equal to about three candy bars — were 23% more likely to be diagnosed with depression compared with men who ate 40 grams or less.

The connection? The brain depends on an even supply of glucose, and too much sugar can trigger extreme emotional highs followed by extreme lows. “When you are depressed, you want to feel good, which is why you crave feel-good sweets and not kale, but this can make your symptoms worse,” says Dr. Mehta. A solution is to always have healthy snacks on hand when sugar cravings hit. So instead of sweets, you can have a piece of fruit or a handful of nuts. “This can help break your sugar dependency and not fuel your depression,” he says.

Gratitude

Expressing gratitude has been shown to have a positive emotional effect on people with depression. A study in the March 2016 NeuroImage found that writing down what you appreciate in your life can increase activity in the medial prefrontal cortex, the brain region often associated with depression.

You might be grateful for something as simple as encountering all green lights as you drive, or somebody holding the door for you as you enter the building. Begin a journal where you record examples of what inspires your gratitude, and reflect on those entries for a mood boost when you feel low. You don’t have to write every day — some research has found that even just once a week is helpful.

Also, don’t just list people and things for which you’re grateful, but try to provide details about why you are grateful and how they improve your life.

Social connection

The evidence is clear that social isolation increases a person’s risk of depression and can make symptoms more severe and longer-lasting. Of course, when you are depressed, socializing is even more difficult. One solution is to join a group devoted to something for which you have a strong passion.

“For instance, volunteering for a favorite cause can keep you connected with others on a regular basis, plus you have the extra motivation to engage because of your personal interest,” says Dr. Mehta. Another way is to join a team that plays a sport you like, such as golf, bowling, or tennis.

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Breaking the Cycle of Depression

When I was a psychology student, I learned about a phenomenon called “state-dependent learning,” based on the idea that our brains associate certain memories with specific environments, sensory experiences (smells, tastes, sounds, etc.), and internal experiences (emotions, thoughts, images, etc.). For example, if you study in a blue room, you’re likely to recall the studied material better if you take the test in a blue room or with something blue nearby. If music is playing when you fall in love, hearing that music again will take you back to those memories. The brain works by association, and certain associations bring up other associations.

This extends to emotions as well. If you’re happy, you’ll more easily recall happy memories. Thus it follows that if you’re depressed, it’ll probably be more difficult for you to recall happier memories. So, when you’re feeling helpless and resourceless, it’s harder to get in touch with resources.

And what happens when a depressed person seeks help from a mental health professional? Most of us therapists tend to ask our clients to talk in detail about their depression. Now, of course, that’s part of our task: to assess the level and history of depression. But an inadvertent side effect can be a deepening of the depressive experience as we bring it to the foreground. Indeed, a recent study shows that extensive discussions of problems, encouragement of ‘‘problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect lead to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time.

To counter this effect, I like to use a method that I call “marbling.” My father owned several meat-packing plants, and early on I learned that marbling refers to the fat streaks embedded in the leaner meat in a cut of steak. It gives the steak more flavor. In a similar way, but with less cholesterol, in therapy I suggest marbling discussions and evocation of non-depressed times and experiences in with discussion of depressed times and experiences. This way, we don’t just evoke and deepen the depression, and we avoid losing contact with the depressed person by listening to her and being careful not to invalidate or minimize her suffering. By going back and forth between investigations of depressed and non-depressed experiences and times, the person who’s been depressed is reminded of resources and different experiences, and often begins to feel better during the conversation.

One of the first ways I suggest implementing marbling is to discover, with the depressed person, a map of her depressed times, thoughts, actions, and experiences, as well as a map of her non-depressed times, thoughts, actions, and experiences. This is like asking the person to join you as a co-anthropologist of her life so that she can help you not only learn about the contours and geography of her suffering, but also about her competence and better moments.

Let me give you an example. While traveling to do a workshop in another city, I was asked to do a consultation with a woman, Cindy, who was spinning her wheels in therapy. Cindy would get stuck in severe depressions regularly and would basically stop functioning, quit her job, and become dependent on her therapist, whom she’d call many nights during the week in the depths of despondency and desperate for help.

I began my conversation with Cindy by asking what had brought her to therapy. She said she’d be fine, feeling confident and competent, and then she’d get depressed, losing her sense of confidence and sleeping until noon. I asked Cindy to compare and contrast her more confident and competent times with her depressed times, and the following picture began to emerge.

During her depressed times, Cindy:

  • Stayed in bed until noon
  • Got up, but stayed in her night clothes
  • Sat in her living room
  • Ate breakfast cereals all day
  • Did nothing
  • Talked only to her therapist and one male friend (who was also depressed)
  • If working and beginning to feel depressed, went to lunch alone
  • Thought about how she was getting worse and how she might have to move in with her father and stepmother if she couldn’t care for herself, or even be committed to a psychiatric institution if they couldn’t care for her or got tired of her
  • Took her shower and got dressed in the evening

During her confident and competent times, Cindy:

  • Got up, showered, and dressed before 9 a.m.
  • Went to work or met a friend for breakfast
  • Did art or played music
  • Spent time with her girlfriends
  • Met a girlfriend for lunch if she was still working
  • Gave herself credit for small or big accomplishments in the recent past (e.g., getting a paper and looking for a job, finishing an art project)

As we talked about this, Cindy began smiling at times, even while discussing her depressive experience. I told her that I wanted to learn the Cindy way of doing a “good depression,” and this phrase seemed to tickle her. She also got a kick out of my naming her depressive experiences “Depresso-land,” and contrasting it with “Confidence/Competent-land.”

We often talk about “depression” as if it were a uniform experience, but although many depressed experiences share common features, they always occur in specific and particular ways for the person in front of us. The non-depressed features are also very particular and specific. But we’re so often focused on the suffering of depressed clients that we neglect to investigate and discover other experiences that don’t fit with their depression. I’m interested in discovering and detailing non-depressed experiences, actions, thoughts, and experiences. That way, I learn about the person’s abilities, competence, and good feelings as well as get a sense of her suffering.

This blog is excerpted from “Out of the Tunnel.” Check out the full issue on Depression Unmasked. Or read more FREE content on Depression/Anxiety.

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Topic: Anxiety/Depression

Tags: antidepressant | antidepressants | Anxiety | Bill O’Hanlon | clinical depression | coping with depression | curing depression | depressed | Depression & Grief | free depression resources | Milton Erickson

How To Break Free From the Anxiety/Depression Cycle

You may be confused as to whether you first experienced depression or anxiety, but now you have a diagnosis that includes both. That can feel overwhelming and that you must have something terribly wrong with you. That isn’t necessarily the case and I am going to explain why. I am actually going to take it a step further and say that it actually indicates that your brain is working just right. It is a basic chemical process that can be easily understood without a degree in neuroscience.

You may remember being very anxious over a long period of time, maybe you even possess an anxious temperament from birth. You may have experienced a trauma that overloaded your brain with stress chemicals. Perhaps you have had long term bouts of anxiety or panic attacks. If this is the case it is likely that stress chemicals such as cortisol have been working overtime in your brain.

Short term, these chemicals are good and necessary. Long term they wear you down. They also begin to crowd out or eat up the good chemicals such as dopamine and serotonin that are associated with calmness and a non-depressed state. You cannot function well with just the stress chemicals running amok up there. After a while, with the time period being different for each individual, the brain finally says, “I can’t do this anymore” and begins to draw back its resources. What it is doing is trying to slow you down a bit in order to replenish the good chemicals needed for healthy functioning. You are overstimulated at this point.

You don’t feel like going out anymore, you don’t feel like talking to people, you have no energy and you just want to lay around. You may crave carbohydrates and be putting on weight. Your brain has put you in “down mode” to protect you and build itself back up. You can’t do that in an overstimulated state. At this point it is actually doing you a favor and it is working just as it should. It is not a disorder when this happens. It is your body telling you something is out of balance. It is not something to be ashamed of. In fact, give yourself a pat on the back for having a good brain.

You may have found that you have repeated this cycle many times during your life. Anxious-Depressed, Anxious-Depressed. The key to eliminating this cycle is to learn a middle ground. If you don’t, you go straight from depressed back up to anxious and the whole thing starts over. If you haven’t learned to moderate your anxious or panicky thoughts you find yourself right back where you started, burning yourself out with the stress chemicals. These chemicals are designed to be used in emergencies, not on a daily basis.

You may find that when you were younger the depressed periods didn’t last as long as they do now. You may find that they come more frequently. You may have exhausted your system to the point it needs additional rest. I can’t think of any system or machine that doesn’t eventually give way under too much duress. That is why it is critical to unlearn any dysfunctional thought patterns that may be keeping you in a stressed out state for no reason. All of our emotions and feelings start with our thoughts, and these thoughts all have a physical counterpart or reaction in the body.

For example, if I have out my crystal ball and see a disaster of some sort in the future, I am going to think something scary, its going to scare me and my body is going to produce the chemicals and reactions that go along with fear. If I do this several times a day I am really overworking the fear factor in my brain. The best part is, none of it is for sure, it is just based on something I think might happen or could happen.

If during the “depressed” period I tell myself that I am disordered for life, mentally ill or not in control of my life, I am going to bring about worse feelings of sadness to add to the ones already there. Be kind to yourself and just understand you need some down time.

There is a saying, “My life has been filled with terrible misfortunes; most of which never happened”. How true for those of us who are the worrywarts. The “what if’s” come into play here also, plaguing us with all the possible horrific scenarios.

In the “old days” you might have been sent to a rest home or some such place to recover. If it were financially feasible you could go to a spa setting or resort for a few months to tune out. This is not a reality for most of us, but there are some things you can do.

  1. Rest. You are overloaded. Cut back on anything you can for a few weeks.
  2. Meditate and learn mindfulness. You are the type that needs it most. No, its not silly.
  3. Examine your thoughts and the way you handle anxiety and stress. You are not doing a great job if you have found yourself in this pattern. It is time to learn.
  4. Check your environments for daily stressors such as clutter. This includes your car and workspace. Clutter is a form of overstimulation.
  5. Give your schedule a reality check. Does your weekly regime call for more than what is realistic to keep yourself in a good state? Think of when you feel irritable during your week, at that point you have probably overloaded yourself.
  6. Check your thoughts, don’t be hard on yourself about this. Feeling poorly about yourself keeps you down.
  7. Learn to self soothe while you are in anxious mode to prevent future relapses.
  8. Do natural things that increase serotonin such as seek novelty and eat complex, healthy carbs.
  9. Exercise a little but not a lot. The point is to reduce stress on the system, taking on a a strenuous new exercise regime does not accomplish that. If you are already working out a lot you might want to cut back a bit. Thirty minutes to an hour a day would be plenty.

I have developed a free worksheet to help you get started eliminating the dysfunctional thoughts that can keep you in this cycle, visit me at Psychskills.com and get the freebie “How to Break Free from 12 Dysfunctional Thought Patterns … and a handy chart to help you track your progress”

Psychology That Makes Sense!

How To Break Free From the Anxiety/Depression Cycle

9 Best Ways to Support Someone with Depression

If your loved one is struggling with depression, you may feel confused, frustrated and distraught yourself. Maybe you feel like you’re walking on eggshells because you’re afraid of upsetting them even more. Maybe you’re at such a loss that you’ve adopted the silent approach. Or maybe you keep giving your loved one advice, which they just aren’t taking.

Depression is an insidious, isolating disorder, which can sabotage relationships. And this can make not knowing how to help all the more confusing.

But your support is significant. And you can learn the various ways to best support your loved one. Below, Deborah Serani, PsyD, a psychologist who’s struggled with depression herself, shares nine valuable strategies.

1. Be there.

According to Serani, the best thing you can do for someone with depression is to be there. “When I was struggling with my own depression, the most healing moments came when someone I loved simply sat with me while I cried, or wordlessly held my hand, or spoke warmly to me with statements like ‘You’re so important to me.’ ‘Tell me what I can do to help you.’ ‘We’re going to find a way to help you to feel better.’”

2. Try a small gesture.

If you’re uncomfortable with emotional expression, you can show support in other ways, said Serani, who’s also author of the excellent book Living with Depression.

She suggested everything from sending a card or a text to cooking a meal to leaving a voicemail. “These gestures provide a loving connection they’re also a beacon of light that helps guide your loved one when the darkness lifts.”

3. Don’t judge or criticize.

What you say can have a powerful impact on your loved one. According to Serani, avoid saying statements such as: “You just need to see things as half full, not half empty” or “I think this is really all just in your head. If you got up out of bed and moved around, you’d see things better.”

These words imply “that your loved one has a choice in how they feel – and has chosen, by free will, to be depressed,” Serani said. They’re not only insensitive but can isolate your loved one even more, she added.

4. Avoid the tough-love approach.

Many individuals think that being tough on their loved one will undo their depression or inspire positive behavioral changes, Serani said. For instance, some people might intentionally be impatient with their loved one, push their boundaries, use silence, be callous or even give an ultimatum (e.g., “You better snap out of it or I’m going to leave”), Serani said. But consider that this is as useless, hurtful and harmful as ignoring, pushing away or not helping someone who has cancer.

5. Don’t minimize their pain.

Statements such as“You’re just too thin-skinned” or “Why do you let every little thing bother you?” shame a person with depression, Serani said. It invalidates what they’re experiencing and completely glosses over the fact that they’re struggling with a difficult disorder – not some weakness or personality flaw.

6. Avoid offering advice.

It probably seems natural to share advice with your loved one. Whenever someone we care about is having a tough time, we yearn to fix their heartache.

But Serani cautioned that “While it may be true that the depressed person needs guidance, saying that will make them feel insulted or even more inadequate and detach further.”

What helps instead, Serani said, is to ask, “What can we do to help you feel better?” This gives your love one the opportunity to ask for help. “When a person asks for help they are more inclined to be guided and take direction without feeling insulted,” she said.

7. Avoid making comparisons.

Unless you’ve experienced a depressive episode yourself, saying that you know how a person with depression feels is not helpful, Serani said. While your intention is probably to help your loved one feel less alone in their despair, this can cut short your conversation and minimize their experience.

8. Learn as much as you can about depression.

You can avoid the above missteps and misunderstandings simply by educating yourself about depression. Once you can understand depression’s symptoms, course and consequences, you can better support your loved one, Serani said.

For instance, some people assume that if a person with depression has a good day, they’re cured. According to Serani, “Depression is not a static illness. There is an ebb and flow to symptoms that many non-depressed people misunderstand.” As she explained, an adult who’s feeling hopeless may still laugh at a joke, and a child who’s in despair may still attend class, get good grades and even seem cheerful.

“The truth is that depressive symptoms are lingering elsewhere, hidden or not easy to see, so it’s important to know that depression has a far and often imperceptible range,” Serani said.

9. Be patient.

Serani believes that patience is a pivotal part of supporting your loved one. “When you’re patient with your loved one, you’re letting them know that it doesn’t matter how long this is going to take, or how involved the treatments are going to be, or the difficulties that accompany the passage from symptom onset to recovery, because you will be there,” she said.

And this patience has a powerful result. “With such patience, comes hope,” she said. And when you have depression, hope can be hard to come by.

Sometimes supporting someone with depression may feel like you’re walking a tight rope. What do I say? What do I not say? What do I do? What do I not do?

But remember that just by being there and asking how you can help can be an incredible gift.

9 Best Ways to Support Someone with Depression

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