My depression won’t go away

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8 Things to Consider When Your Depression’s Not Getting Better

I keep getting the same email over and over again, and my heart aches each time I read it: “I have tried everything to overcome my depression, but nothing has helped. Is there anything else I can do or will I have to live the rest of my life plagued with sadness?”

First, hear these three words: There is hope. If there wasn’t any, I would not be alive writing my blog. I am one of the worst cases out there like you are. I have spent more years of my life fantasizing about death than wanting to be alive. I get it. But now I do enjoy some really good days — where I feel better than I ever have. And those good days keep me motivated to get through the harder ones. From my own 43 years of experience fighting the demon of hopelessness and from all my conversations with folks in my online depression community, Project Beyond Blue, here are some suggestions that you might try.

1. Get a Physical

The reason that you may not be getting better despite trying 20 different combinations of medication is that your symptoms of irritability, fatigue, and apathy may not be caused by a lack of serotonin or norepinephrine in your brain, but rather by a tear in your diaphragm or a problem with your aortic valve. A few conditions that are often misdiagnosed as depression are: hypothyroidism, vitamin D deficiency, vitamin B-12 deficiency, insulin resistance or blood sugar imbalances, and anemia. (See my piece, 6 Conditions That Feel Like Depression But Aren’t). You should really get a physical and have some bloodwork done by an integrative or functional doctor; however, that can be costly, especially if you get a functional doctor who wants to run every test on you.

I asked my integrative doctor, Alan Weiss of Annapolis Integrative Medicine, to give me a list of the three or four most important blood tests a person with chronic depression should ask their primary care physician to do for them, if they can’t afford to go outside their insurance network for a consultation. He suggested:

  • Complete blood count (CBC)
  • Comprehensive metabolic profile (CMP)
  • Thyroid testing, including TSH, free T4, free T3, and thyroid antibodies
  • 25-OH vitamin D, B-12 levels

2. Check Your Thyroid

I want to return to the thyroid for a moment since this is so tricky and so critical. Every person I know who suffers from chronic depression has a thyroid issue. That is no lie or exaggeration. Every person. I was seeing an endocrinologist, someone who specializes in thyroid disease, for six years and she never tested me for an underactive thyroid. She was merely testing my TSH levels, not the full panel, which is what most primary care physicians, endocrinologists, and psychiatrists do.

Dana Trentini has a great post, The Top Five Reasons Doctors Fail to Diagnose Hypothyroidism, on her blog Hypothyroid Mom. If you are sluggish, gaining weight, have brain fog, need to lie down all the time, and are depressed, please have a FULL panel of your thyroid done. Your T3 and T4 levels are needed to detect slight problems that can wreak havoc with your mood and energy level. Now that I am taking natural medicine for that, I have much more energy.

3. Load Up on Vitamin D and Vitamin B-12

I was relieved that Dr. Weiss included blood tests to check vitamin D and vitamin B-12 levels, as well, because deficiencies in both of those vitamins can cause severe depression. They are included in my list of 10 Nutritional Deficiencies That Can Cause Depression. According to a 2009 study published in the Archives of Internal Medicine, as many as three-quarters of U.S. teens and adults are deficient in vitamin D. Last year Canadian researchers performed a systematic review and analysis of 14 studies that revealed a close association between vitamin D levels and depression. Researchers found that low levels of vitamin D corresponded to depression and increased odds for depression. In another 2009 study, more than a quarter of severely depressed older women were deficient in B-12. I take each of those vitamins in liquid form so that they absorb quickly and efficiently.

4. Adjust Your Diet

If you are annoyed at this suggestion, let me say I understand. I was annoyed for the first 40 years of my life when someone would insinuate that there was a tight connection between my diet and my distorted thinking. I thought I ate well. By most American standards, I was a health freak. However, I didn’t realize how much insulin I was throwing into my bloodstream until I stopped eating all sugar cold turkey one day, as well as processed flour, dairy, and caffeine. (Alcohol is bad news too, but I gave that up 25 years ago.) All those nut and fruit KIND bars that are supposed to be good for you, the honey in my tea, the cereal and pumpkin bread in the morning … all of them were creating a blood sugar nightmare that got me high only to make me crash … and hard. No street drugs were involved. Just a lame granola bar that I thought was sanctioned by Dr. Oz. Consider eliminating sugar and white flour from your diet for a few months. As much as I’d like to tell you that the effect was immediate, it took up to nine months before I really started to feel better, before I was free of death thoughts.

5. Get a Consultation With a Teaching Hospital

Before my husband begged me to have a consultation at Johns Hopkins Mood Disorders Center, I had been to six psychiatrists. One of my blogs, in fact, is called The Psychiatric Guide to Annapolis. Let me just say that there are a lot of people who shouldn’t be practicing medicine, like one I dubbed “Pharma King,” who received generous kickbacks from a pharmaceutical company.

The reason I trust teaching hospitals like Johns Hopkins, is that they never stop researching, and they are not afraid to use the older drugs like lithium that have proven track records but aren’t lucrative. Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins, wrote an excellent op-ed piece in the New York Times just after the death of Robin Williams called Depression Can Be Treated, But It Takes Competence. She writes:

“Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.” Go to a teaching hospital. You won’t regret it.

6. Consider Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The procedure was approved by the FDA in 2008. In September, I featured a story about Stephanie, a woman in Project Beyond Blue, who underwent 30 sessions of TMS and was transformed into a new person. She now moderates a group on Project Beyond Blue called Exploring TMS. Several other people I know have had success as well.

7. Try EMDR

My friend Priscilla Warner first turned me on to eye-movement desensitization and reprocessing (EMDR) therapy. She devotes a chapter in her bestselling memoir, Learning to Breathe, about it, and how it was instrumental in breaking down her anxiety. It is mostly used for people with some form of post-traumatic stress disorder, but it has also been used to address generalized anxiety from a dysfunctional childhood, a bad marriage, or a boss from hell.

According to the EMDR Institute, “EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.”

8. Find a Way to Lower Your Stress

I don’t mean putting a few less to-do items on your list. I’m talking about radical lifestyle changes — like changing jobs in order to work in a less toxic and stressful environment, moving into a smaller home so that you don’t have to moonlight, deciding against adopting a rescue dog or having a third child. It can be practically impossible to keep your mood resilient if you are under chronic stress because it increases the connection between the hippocampus part of your brain and the amygdala (worry central), impairs your memory retention, affects your cortisol production (making it difficult for you to handle more stress), and weakens your immune system.

There are other ways to try to lower your stress besides quitting your job, like practicing mindfulness meditation. I took the eight-week Mindfulness-Based Stress Reduction (MBSR) program at my local hospital because I read numerous studies on how mindfulness meditation can reset neural passageways and change rumination patterns. As a result of the class, I am now more aware of my thinking, and I try my best to keep coming back to the present. However, nothing beats the anesthesia from depression and the calm I experience after an intense aerobic workout. I swim and run for my sanity.

In summary, the road to my recovery has been rocky as hell. I had to throw out the old system — my belief that medication, therapy, and exercise was all I needed — that the brain lived in another solar system as my body. I now believe that you must approach the illness of depression systematically: there is nothing that you eat, say, or do in your day that doesn’t affect your mood. While that thought can be overwhelming, it also points the way to hope.

You are not a lost cause.

Join conversations like “Hypothyroidism & Depression” and “Nutrition” on “Project Beyond Blue,” a new community for persons with treatment-resistant depression.

Depression and Anxiety

Mental health problems such as depression and anxiety can accompany an illness. The following information includes information on signs, symptoms and treatment.

Symptoms of Depression

Depression is characterized by feelings of sadness, despair and discouragement. It often follows a personal loss or injury. It is not a sign of weakness nor does it represent a moral failing.

Sadness that lasts a long time and a loss of enjoyment in almost all activities are the central features of depression. Sadness is a symptom, but not the same thing as depression. Everyone is sad sometimes. The type of sadness that occurs in depression lasts all day or most of the day, every day for a long time (at least two weeks). Other symptoms include feelings of worthlessness or guilt, suicidal thoughts, loss of concentration, decreased energy, slowed thinking and movement, appetite loss and sleep problems.

It is important to remember that many of these symptoms can occur with illnesses such as brain injury or stroke or even less serious problems like a cold or flu, but may not indicate depression. Even if you have trouble sleeping, lack of appetite and problems concentrating, there is no reason to be concerned about a separate mental health condition unless you also feel sad most of the time or rarely find enjoyment in life.

What is the difference between normal grief and depression?

Some symptoms of depression as described above are normal after any kind of loss including the onset of a disability or severe illness. If you have had these symptoms for a long time it may be helpful to talk with a mental health professional. It is also helpful to talk to someone if you have other symptoms such as feeling guilty or worthless, or if sadness interferes with the ability to do important life tasks (take medication; go to therapies, work or school).

Symptoms of Anxiety

Following a major life-changing event like a disabling illness, it is normal to feel a great deal of stress. Stress can build up over time and can lead to anxiety. Anxiety can be a response to a specific situation such as learning to walk all over again; it can also be more generalized such as not wanting to leave the house after being discharged from the hospital.

The most common symptoms of anxiety are fear and worry. Anxiety can also cause restlessness, and difficulty concentrating and sleeping. Sometimes people will express anxiety by being irritable, tired or even stubborn. Anxiety can cause physical symptoms like muscle tension, shortness of breath or even feelings of panic. Nearly everyone feels anxiety when faced with a bad physical problem. Anxiety becomes a concern when these feelings are very strong and interfere with important tasks in life.

Can anxiety or depression be different depending on age?

Children and older adults often show anxiety and depression differently. Children may misbehave either at school or at home. Older adults might report vague physical problems when there is no clear medical cause.

Treatment

Both depression and anxiety can go away over time but without treatment the symptoms last longer and may return. Chronic depression or anxiety can cause low self-esteem and poor quality of life.

Anxiety and depression are usually treated with medication and/or psychotherapy (counseling) by a trained professional. Treatment is usually quite successful, so there is little reason to delay seeking help.

If feeling anxious or depressed, it is important to admit to it and get help. Even when family and friends are around for support, professional attention is best. A good first step is to discuss concerns with your regular doctor. He or she can provide advice about the best treatment and suggest a qualified therapist. There are several types of mental health professionals who can provide psychotherapy (counselors, social workers and psychologists), but any medications must be prescribed by a physician (your regular doctor or a psychiatrist). It is important to select a therapist with whom you fee comfortable and can talk honestly about your feelings. Psychotherapy can be done individually, with other family members, or in a group.

Sometimes it is best to both take medication and see a therapist. Medications can be helpful in many cases. Sometimes people are afraid of acting and thinking strangely, or becoming dependent on drugs used to treat anxiety and depression. When these medications are taken as prescribed by a doctor, bad side effects can be reduced or eliminated and there is little risk of becoming addicted to them. Remember that these medications are not the same as street drugs used to get high.

Tips for Coping with Anxiety and Depression While in the Hospital

There is no single, simple way to adjust to a disability, but there are a few tips to keep in mind.

  • Follow a routine. Aside from the regular therapy schedule, try to go to bed the same time each night, and to set aside time for relaxing and visiting (either in person or on the phone).
  • Be open with staff, family and friends regarding your needs.
  • Ask questions about any aspect of your care that is unclear.
  • Share things that worry you with others. Keeping feelings bottled up often makes being in the hospital more difficult. Sometimes people have problems admitting anything bad has happened as a way to be protected from depression and anxiety. It is healthier to admit you may not be able to do everything you used to do.
  • Acknowledge that you will be sad about this for a while until you find new things to do that you enjoy. Try not to exaggerate these losses with thoughts such as “I can’t do anything anymore;” “I’ll never be able to find anything worthwhile to do again.”

Tips for Coping with Anxiety and Depression after Leaving the Hospital

Sometimes people have prejudices about physical disability that make them feel like “second class citizens” when they become disabled themselves. Sometimes people with a disability get into the habit of letting other people do things for them and as a result they start to feel helpless. Sometimes people with a disability start to avoid situations that make them nervous (for example going out in public where others can see that they look or act differently). This makes those situations much more scary or upsetting when they can no longer be avoided.

  • Set up a routine and stay with it to work on your recovery after leaving the hospital.
  • Stay involved in life. Find enjoyable activities – either ones from before or new ones.
  • Acknowledge improvements. This decreases the risk of boredom and depression and will boost self-confidence.
  • This is a stressful time, so be open to the support of others. Healthy relationships with family, friends or others with a disability can go a long way in preventing depression and anxiety.
  • There is also evidence that a strong spiritual life can help keep you healthier and hopeful.

Special Tips for Parents

Parents may need to provide more comfort and support than usual for their children. It is not unusual for a child to regress to an earlier stage of development following a traumatic event. Children may find it hard to separate from parents, become clingy or emotionally needy during a hospital stay. Children usually show signs of greater independence by the time of discharge. Please talk to your physician if these problems do not improve.

Additional Resources

American Medical Association (1998). Essential Guide to Depression. New York: Pocket Books.

Bourne, E.J. (2000). The Anxiety and Phobia Workbook. New Harbinger Press.

Mental Health: Does therapy work? Consumer Reports. November, 1995.

Sheffield, A. (1998). How You Can Survive When They’re Depressed. New York: Harmony.

Internet resources

For adults:

  • American Psychological Association
  • National Institutes of Mental Health
  • Psychology Information Online

For children:

  • Kids Health

Does Depression Ever Go Away If Left Untreated?

By Stephanie Kirby

Updated December 03, 2019

Reviewer Wendy Boring-Bray, DBH, LPC

Living with a mental health challenge like depression can make it very difficult for you to handle normal life. And, no matter how badly you want to feel better, it isn’t something that you can just make disappear. When you have an illness like bronchitis or the flu, in general, you know you’re going to get better and about how long the illness will last. While depression doesn’t work that way, there is hope for overcoming it.

Wondering If Depression Can Go Away On Its Own? Talk To An Expert. Schedule An Appointment Online With A Counselor Today.
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Depression And Treatment

When you are depressed, it doesn’t seem like there is a lot of good news. However, the one thing that you can take relief is that depression is a very treatable condition. There are lots of options available to help you find relief from your symptoms.

The ultimate goal in treating depression is not just to alleviate the symptoms temporarily, but to secure a lasting positive outcome. This does not mean that someone who has gotten rid of depression will never feel sad again. Sadness is a normal part of a person’s emotional life. It does, however, mean that the unrelenting, hopeless state of mind caused by clinical depression will not be a regular feature of life after that.

While medication is a popular option for those suffering from depression, it should be understood that this is only an asymptomatic form of treatment, not a cure. If someone truly wishes to rid themselves of depression, talk therapy is generally the best route to wellness. Unlike simply swallowing a capsule, therapy talks work on a more personal level. Confronting the issues head-on in this way offers the best chance of beating it permanently.

Many times, a combination of multiple forms of treatment is the best treatment plan to help someone recover from depression. This could include things like focusing on self-care, counseling, and medication.

Does Depression Ever Go Away Without Treatment?

Depression is a complex illness with a variety of possible causes. Often, it is the result of an underlying physical medical condition, which, when addressed, causes the depression to fade away.

Your depression is not likely to go away if you don’t seek treatment. Depression causes people to withdraw from the very things that are likely to make them feel better. This includes things like taking care of their physical health, maintaining relationships with friends and families, and taking their mind off of themselves. When you are feeling depressed, these are not typically things that you are going to choose to do. If you are going to just wait for your depression to go away, you might want to think again.

If you are experiencing reactive depression, which is the result of a specific situation, and the situation improves, it can help your depression to gradually vanish over time. For example, if you have high levels of anxiety and feelings of depression because you had a difficult end to a relationship, within time, the feelings will start to dissipate. Eventually, you will come out of a depressive state.

However, it is unusual for serious depression to disappear without making any effort or changes at all. While the willpower of someone with serious depression is likely to be much lower than usual, the only roads to lasting relief are those that demand work to follow them. In this regard, the support of family, friends, and a therapist can be invaluable in taking the necessary steps.

Living Without Depression

The strategies below can help you overcome depression, but they are best when combined with professional help. They will know how to lead you through the steps that you need to go through to start to make progress. There’s also something helpful about talking to another person that isn’t personally connected with you.

Overcoming depression is rarely something that happens suddenly but is rather a process of gradually feeling the symptoms less and less intensely until they are no longer a burden. Unfortunately, individuals who’ve had depression in the past tend to be at more risk for future relapses, whether through their biology, temperament, or circumstances.

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The battle against depression is not something that can be conquered by a single victory. Those prone to it will have to pay attention to their state of mind even when they feel better to avoid falling back into its clutches. Developing habits like self-care, journaling, meditation, and connecting with those who support you can help you catch any relapses before they become a deep depression.

Things That You Can Try On Your Own

If you are struggling with depression and don’t want to talk to a therapist, there are some things that you can try on your own. However, if you don’t find relief, it’s in your best interest to seek professional help.

  • Journaling – Sometimes, getting your thoughts and feelings out of your head and onto paper can help you to process any painful situations that you have experienced. This can help you work through your feelings and recover from your depression.
  • Get Enough Sleep At Night – Every situation in life is harder to deal with if you are operating on a night of insufficient sleep. Your body needs rest, so try to get around eight hours of sleep each night.
  • Make Good Food Choices – When struggling with feelings of depression, it’s easy to have changes in your appetite. Typically, people struggling with depression experience a loss of appetite. However, it could also lead to overeating. Make sure you work to keep your eating in check if you are struggling and try to focus on having small amounts of food throughout the day. Try to include fruits, vegetables, and whole grains in your diet.
  • Try Meditation – Mindfulness meditation can help you reconnect with yourself and learn to cope with your feelings. It’s a way to feel what you are feeling without allowing it to control you and make you feel anxious. Meditation can also teach you how to focus on your breathing. This can help you to shift your mind from what’s causing your anxiety with exercises like breathing deeper and stretching.
  • Connect With Others – The normal response to depression is to withdrawal from family and friends. However, these are the people you need to try to spend time with when dealing with depression. This helps significantly because you are spending time with people that can help you feel “normal” again. Even if it’s only for a few minutes, it’s still very beneficial.

Wondering If Depression Can Go Away On Its Own? Talk To An Expert. Schedule An Appointment Online With A Counselor Today.

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There are times when simple changes that you make on your own, like those above, can help you to overcome depression. However, if that’s not working for you, then it’s time to get help. Working with a therapist, including online therapists like those at BetterHelp, can help you find the relief that you’re looking for. They can help you to identify where your depression is coming from, triggers that you face, and coping strategies to overcome it. You can read the reviews of our therapists below, from people experiencing similar issues.

Counselor Reviews

“I was kinda skeptical going into trying this platform, not sure if it would really help me or not and also nervous about it. Kat is a really great therapist! She is very patient and understanding. She always made sure to check in with me and how I’m doing and there to have sessions when I really needed it if something came up. She really takes her time to process what I’m going through and gives me great feedback and advice to work through things. She does an amazing job and doesn’t make you feel uncomfortable to talk about things that would be hard for you to discuss normally. You don’t feel like you’re being judged in any certain way, as some people might make you feel. Kat is always prompt to respond and schedule sessions. I really would recommend her as a therapist to anyone!”

“Karen is an amazing resource, and I’m so thankful I have her in my corner. Having been in traditional therapy previously, I have to say having someone that you can message 24/7 and talk to via phone makes it so much easier to be consistent in my therapy. She has given me great tools and insight to manage my depression.”

Moving Forward

Depression is treatable with traditional forms of medicine, as well as strategies that you can implement on your own. However, you don’t have to face this battle by yourself. BetterHelp offers the effective tools you need to move forward. Take the first step today.

13 Ideas on How to Help Depression That Just Won’t Go Away

You’ve been to the doctor, you’ve seen a therapist, you’ve spent time with people who love you. In short, you’ve done everything people say you should do when it comes to overcoming depression.

Yet no matter what you do, that depression just won’t go away.

After all that, with those feelings of hopelessness, despair, fatigue and apathy at their peak, it can be all too tempting to give up. Tempting though it may be, it doesn’t have to be this way.

Just because you’ve read all the usual advice on how to help depression and found that it hasn’t worked, that doesn’t mean that nothing will.

The truth is that just because that advice was right for some people, that doesn’t necessarily mean it’s right for you.

Today, we’ll look at some unique strategies, suggestions, tools and techniques you can use to help your depression, but first, there’s something you should know:

You can overcome this

No matter how low down you feel right now, no matter how much it feels like your depression just won’t go away, know that there are still plenty of things you can do to turn things around for the better.

Yes, things may seem hopeless right now.

Yes, even simple things like getting out of bed in a morning may require a Herculean effort that you’re not always able to muster.

But no, that doesn’t mean you have to give up.

Here, we’ll look at some practical advice on how to help depression when nothing else works, complete with simple, actionable steps, you can take right now, no matter how severe your depression may be.

1. Make the decision: Depression isn’t going to win

There’s no getting away from the fact that overcoming depression is going to take action, but one of the simplest, easiest actions you can take right now is this:

Make a decision.

A firm, concrete decision that, no matter what, depression isn’t going to win.

You deserve to be free from your depression. You deserve to be happy and enjoy life and you can be.

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If you do nothing else as a result of reading this article, make it this:

Take out a pen and a piece of paper and write down your decision. Write down your intention to get through this period of your life, and keep that piece of paper somewhere you can see it.

You may be surprised at what a difference something this small can be. In an instant, it can transform your mindset from that of somebody who is suffering with depression to somebody who is recovering from -and ready to beat- that depression.

2. Have a laugh

It’s true what they about laughter, it really is the best medicine.

Laughing releases the “happy chemical” dopamine, which moves through our body and makes us feel good.

It also releases other “feeling-positive” substances like endorphins which, among other things, relieve pain, reduce stress and can even help you sleep better, particularly useful if your depression is keeping you up all night.

With that in mind, watching funny movies or TV shows, watching standup comedy or just spending time with a friend who always makes you laugh can produce positive results.

3. Remind yourself of good times and big achievements

When you’re in the throes of severe depression it’s easy to forget that you ever felt any other way. The way you feel, it’s as if you’ve always felt this low.

If your depression is also tied into feelings of low self-worth and low self-esteem, it’s tempting to believe the lie that you’ve never done anything good or worthwhile in your life either.

You may think that, but look:

Just because you have that thought doesn’t mean you’re under any obligation to believe it.

Remind yourself of times when you were happier. When you did enjoy life, no matter how long ago that may have been.

Remind yourself of past accomplishments. Even simple things like landing a job or passing an exam can be a pretty big deal when you have low self-esteem.

Go through photographs, scrapbooks or simply your memories and remind yourself of better times. It may not be a magic cure, but it does prove powerful in flicking a switch in your brain, turning your thoughts from “I can never be happy” to “I have been happy before and if I can be that way once, I can be that way again.”

4. Create the right environment for recovery

When we go through depression, it’s easy to let even basic things like housework fall by the wayside. The result is that our environment becomes messy, dirty, chaotic and that only makes our state of mind even worse.

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So we continue to ignore the housework and thus the vicious cycle continues.

But look:

You can break that cycle, and doing so will help create the ideal environment for recovering from depression.

You don’t even have to do it all in one go.

Focus on one thing at a time, even if it’s only one corner of one room. Do what you feel you have the energy for and before you know it, you’ll have a clean, tidy, clutter-free space that’s far more conducive to overcoming your depression.

What’s more, the sense of accomplishment you get from tidying up can do wonders for your self-esteem and provide a powerful boost to your mood.

5. Cut down on sugar

When we’re deep into our depression, many of us turn to comfort foods to make us feel better; but the truth is that doing so could actually be doing more harm than good.

Sure, when we eat foods with processed sugars like candy, cookies, sugary cereals and junk food, we may get a temporary boost that makes us feel better as a small amount of dopamine is released.

Yet before long, that “sugar high” wears off and we crash down to a state of mind that’s even lower than the one we started with.

As if that wasn’t enough, much research has been done linking high sugar intake to increased levels of depression, so it’s well worth cutting down to give yourself the best possible chance of beating t his.

6. Lay off alcohol

This isn’t the only article about how to help depression which advises on changing diet, but what few others will tell you is that there’s compelling evidence as to why you should leave alcohol alone too.

A glass of wine or a beer may help you feel more relaxed or less anxious, but that’s because alcohol is actually a depressant, and it depresses that part of our brain that controls inhibition, anxiety and how we feel.

The problem is that the more we drink, the more we’re basically taking a depressant into our systems, which pushes us all the way to into feeling low, possibly even more anxious and depressed than when we started.

Nobody’s saying you need to go teetotal for life but if you’ve been battling depression for a long time, this might be a good place to start.

7. Dress to impress

Depression saps us of our energy, which can make even simple things like having a good shower and getting dressed properly seem like monumental challenges.

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When depression is linked to low self-esteem, overcoming those challenges hardly seems worth it.

But finding the energy to get ourselves together and look our best, even if we don’t necessarily feel at our best, can work miracles in transforming our mindset.

Take a long shower, shave, find your best outfit – the one that always makes you feel confident and attractive and change into it.

If wearing make-up is something you feel helps you look your best, wear it.

When you’re done. Take a look at yourself in the mirror.

This is you at your best, and when you’re at your best, you can do anything, including making the big changes that will help you overcome your depression once and for all.

8. Head outdoors

With your mood lifted -even if only slightly- by looking your best, its time to head outdoors.

Sometimes, depression and social anxiety will mean that you won’t want to go very far, especially not to somewhere with crowds of people, but that’s OK. You don’t have to go very far.

After hiding away and withdrawing (as so many of us do at the height of our depression) simply taking that first step in facing the world again will provide a huge boost to the way you feel.

That’s before we even get to the added benefits of fresh air and Vitamin D from the sunshine.

9. Dance

One of the best things any of us can do to keep depression at bay is to exercise – but let’s be honest:

When you’re in the thick of it, the last thing you feel like doing is hitting the gym or going for a run.

The good news is that dancing has the same effect, if not an even bigger one.

Your body still gets all the endorphins from moving around, plus, if you’re listening to the kind of songs that always make you dance, you’ll get an added boost from that too.

10. Do a good deed

Most tips on how to help depression are all focussed on what we can do to help ourselves but there’s a lot to be said for reaching out and helping somebody else.

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In 2013, Sonja Lyubomirsky, a psychology professor at the University of California published research which showed that carrying out acts of kindness can help us feel happier long-term.

It doesn’t have to be a huge gesture either. Donating to your local food bank or Goodwill store, paying somebody a compliment, watering a neighbours plants or volunteering to take their dog for a walk when they’re unable to do it themselves can all make a significant difference to the way you feel.

11. Keep up your usual routine

When all you want to do is hide under the covers and never come out again, even the simple things that make up our routine can seem impossible.

It’s tempting -and much easier- to ignore them but in my experience, doing so has a tendency to make things worse.

Yes, there’s a lot to be said for taking a few days off to practice self-care and implement strategies for overcoming your depression, but where possible, keep up with day-to-day tasks like paying the bills, doing the grocery shopping, stopping by for that weekly catch up with family or friends.

When we let those things pile up, those few bills we could have dealt with turn into a literal mountain of debt and bad news, which is not what we need when we’re trying to overcome depression.

Friends and family worry about us and offer us all kinds of unsolicited (albeit well-meaning) advice which only causes us more resentments.

Things that should have been easy get harder and harder to deal with the more we ignore them, so keeping up these day-to-day parts of our routine, no matter how much of a struggle it may feel at times, can actually prove incredibly effective.

12. Get creative

Write, draw, paint, pick up an instrument, build something, knit something. Working on something creative changes our thought patterns, giving us something else to focus on besides how we feel.

Plus, the sense of accomplishment we get from having made something of our own can once again prove to be a big help in changing our mood.

13. Create your depression emergency tool kit

Depression is a serious issue which for many people requires medication, therapy and professional support to deal with, but that doesn’t mean that you can’t do as much as you possibly can to alleviate the symptoms whilst getting that support.

Create a Depression Emergency Tool Kit full of things that will help you to feel good and keep it on standby for those times when nothing else seems to be working.

You might want to include an old iPod loaded with all your favourite feel-good music, blu-rays or DVDs of funny movies guaranteed to make you belly laugh, old photographs of happier memories, even a voucher to treat yourself to a trip to the cinema, a new outfit, or whatever makes you feel good.

You could even write yourself a letter, reminding yourself that this bout of depression will pass and that you have it within you to overcome it, no matter how tough things get.

Find what works for you best

The ideas and suggestions listed here aren’t meant to replace medical advice. If you’re dealing with depression, consulting a doctor or therapist can make all the difference.

Yet if you’ve tried those things and find they aren’t working, or if you simply want to give yourself the very best possible chance to turn things around, working your way through this list may mean you finally find the one thing that really works for you when it comes to making your depression go away for good.

Featured photo credit: Pexels via pexels.com

Reference

^ drinkaware: Alcohol and mental health
^ University of California: Acts of Kindness Can Make You Happier

Depression: What You Need To Know

Cognitive-Behavioral Therapy (CBT)

CBT can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.

Interpersonal Therapy (IPT)

IPT is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.

Problem-Solving Therapy (PST)

PST can improve an individual’s ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.

For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.

More information on psychotherapy is available on the NIMH website at www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

Computer and/or Internet-Based Therapies

Meredith made a cup of coffee and settled into the living room sofa, then she clicked on an icon on her laptop. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her computer screen.

Your therapist could be only a mouse click or email away. There are many therapy programs available online or on the computer (e.g., DVDs, CDs), and some research shows that Internet-based therapies may be just as helpful as face-to-face. But results can vary from program to program, and each program is different.

Many of these therapies are based on the two main types of psychotherapies—CBT and IPT. But they may be in different formats.

For example, you might learn from materials online and get support from your therapist by email. It could be a video conferencing session that progresses much like a face-to-face session. Or you may use a computer program with video, quizzes, and other features with very little contact with a therapist. Sometimes these therapies are used along with face-to-face sessions. Sometimes they are not.

There are pros to receiving therapy on the Internet or on the computer. These options could provide more access to care if you live in a rural area where providers aren’t available or if you have trouble fitting sessions into your schedule. Also, tech-savvy teens who feel uncomfortable with office visits may be more open to talking to a therapist through a computer screen.

There are also cons. For example, your health insurance may only cover therapy that is face-to-face. And although these various formats may work for a range of patients, they also may not be right for certain patients depending on a variety of factors.

If you are interested in exploring Internet or computer-based therapy, talk to your doctor or mental health provider. You may also be able to find an online mental health care provider on your own. But remember that there are many online “therapists” who may lack the proper training or who may try to take advantage of you. Speak with your provider first to see if he or she can provide a recommendation or trusted source for more information. You can also check the online provider’s credentials and ask about his or her treatment approach. Sometimes you may need to have a conversation with more than one provider to find the right one for you. If cost is an issue, be sure to also contact your health insurance provider to see what’s covered and what’s not.

Depression: Is There an App for That?

If you have a smartphone, tablet, or “phablet” (phone tablets), you may have noticed that there are many mobile applications, or apps, marketed as support for people with depression. Some of these apps aim to provide treatment and education. Other apps offer tools to help you assess yourself, manage your symptoms, and explore resources.

With a few taps on the screen, you could have information and tools to help your depression in the palm of your hand. But, just like with online health information, it is important to find an app that you can trust.

Here are a few things that are important to remember about mobile apps for depression:

  • Some apps provide reliable, science-based health information and tools. Some do not.
  • Some app developers consult doctors, researchers, and other experts to develop their app. Others do not.
  • A mobile app should not replace seeing your doctor or other health care provider.
  • Talk to your doctor before making any changes recommended by any online or mobile source.

Quick Tip: Questions to Ask Before Using a Mobile Health App:

  • Who developed the app? Is that information easy to find?
  • Who wrote and/or reviews the information?
  • Is your privacy protected? Does the app clearly state a privacy policy?
  • Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Does the FDA Regulate Mobile Apps?

Many mobile apps for depression provide information or general patient educational tools. Because these are not considered medical devices, the FDA does not regulate them.

Some mobile apps carry minimal risks to consumers or patients, but others can carry significant risks if they do not operate correctly. The FDA is focusing its oversight on mobile medical apps that:

  • Are intended to be used as an accessory to a regulated medical device—for example, an app that allows a health care professional to make a specific diagnosis by viewing a medical image from a picture archiving and communication system on a smartphone or a mobile tablet.
  • Transform a mobile platform into a regulated medical device—for example, an app that turns a smartphone into an electrocardiograph (ECG) machine to detect abnormal heart rhythms or determine if a patient is experiencing a heart attack.

Does NIMH Have an App for Depression?

NIMH does not currently offer any mobile apps, but NIMH’s website, www.nimh.nih.gov, is mobile-friendly. This means you can access the NIMH website anywhere, anytime, and on any device—from desktop computers to tablets and mobile phones.

If you see an app that claims to be created or reviewed by NIMH, please call the NIMH Information Resource Center to verify that it was developed or reviewed by us.

NIMH Information Resource Center

Telephone:

  • 1-866-615-6464 (toll-free)
  • 1-301-443-8431 (TTY)
  • 1-866-415-8051 (TTY toll-free)

Available in English and Spanish

Monday through Friday
8:30 a.m. to 5:00 p.m. Eastern Time

Electroconvulsive Therapy And Other Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. There are a lot of outdated beliefs about ECT, but here are the facts:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • ECT can be an effective treatment for depression.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short term, but sometimes they can linger. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment.

Some people believe that ECT is painful or that you can feel the electrical impulses. This is not true. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses.

Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat severe depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). In 2008, the FDA approved rTMS as a treatment for major depression for patients who have not responded to at least one antidepressant medication. In 2005, the FDA approved VNS for use in treating depression in certain circumstances—if the illness has lasted 2 years or more, if it is severe or recurrent, and if the depression has not eased after trying at least four other treatments. VNS is less commonly used, and more research is needed to test its effectiveness.

Quick Tip: Get the Latest Information

This information may have changed since the publication of this booklet, so please visit the NIMH website at www.nimh.nih.gov to explore the latest research and the FDA website at www.fda.gov for the most recently approved treatment options.

Beyond Treatment: Things You Can Do

If you have depression, you may feel exhausted, helpless, and hopeless. It may be extremely difficult to take any action to help yourself. But as you begin to recognize your depression and begin treatment, you will start to feel better. Here are other tips that may help you or a loved one during treatment:

  • Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
  • Set realistic goals for yourself.
  • Break up large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself and let others help you.
  • Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
  • Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
  • Continue to educate yourself about depression.

You are not alone.

Major depressive disorder is one of the most common mental disorders in the United States. You are not alone.

Sometimes living with depression can seem overwhelming, so build a support system for yourself. Your family and friends are a great place to start. Talk to trusted family members or friends to help them understand how you are feeling and that you are following your doctor’s recommendations to treat your depression.

In addition to your treatment, you could also join a support group. These are not psychotherapy groups, but some may find the added support helpful. At the meetings, people share experiences, feelings, information, and coping strategies for living with depression.

Remember: Always check with your doctor before taking any medical advice that you hear in your group.

You can find a support group through many professional, consumer, advocacy, and service-related organizations. On the NIMH website (www.nimh.nih.gov/outreach/partnership-program/index.shtml), there is a list of NIMH Outreach Partners. Some of these partners sponsor support groups for different mental disorders including depression. You can also find online support groups, but you need to be careful about which groups you join. Check and make sure the group is affiliated with a reputable health organization, moderated professionally, and maintains your anonymity.

If unsure where to start, talk to someone you trust who has experience in mental health—for example, a doctor, nurse, social worker, or religious counselor. Some health insurance providers may also have listings of hospitals offering support groups for depression.

Remember: Joining a support group does not replace your doctor or your treatment prescribed by your doctor. If a support group member makes a suggestion that you are interested in trying, talk to your doctor first. Do not assume what worked for the other person will work for you.

If You Think a Loved One May Have Depression

If you know someone who is depressed, it affects you too. The most important thing you can do is to help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment or to seek different treatment options if no improvement occurs after 6 to 8 weeks.

To help your friend or relative:

  • Offer emotional support, understanding, patience, and encouragement.
  • Talk to him or her, and listen carefully.
  • Never dismiss feelings, but point out realities and offer hope.
  • Never ignore comments about suicide and report them to your loved one’s therapist or doctor.
  • Invite your loved one out for walks, outings, and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon.
  • Provide assistance in getting to doctors’ appointments.
  • Remind your loved one that with time and treatment, the depression will lift.

Caring for someone with depression is not easy. Someone with depression may need constant support for a long period of time. Make sure you leave time for yourself and your own needs. If you feel you need additional support, there are support groups for caregivers too.

Helpful resources

NIMH has a variety of publications on depression available at www.nimh.nih.gov/health/publications/depression-listing.shtml. If you need additional information and support, you may find the following resources to be helpful.

Centers for Medicare and Medicaid Services (CMS)

CMS is the Federal agency responsible for administering the Medicare, Medicaid, State Children’s Health Insurance (SCHIP), and several other programs that help people pay for health care. Visit www.cms.gov for more information.

Clinical Trials and You

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. To learn more about participating in a clinical trial, please visit www.nih.gov/health/clinicaltrials/index.htm.

Depression (PDQ®)

PDQ® (Physician Data Query) is the National Cancer Institute’s comprehensive cancer database. The PDQ cancer information summaries are peer-reviewed, evidence-based summaries on topics including adult and pediatric cancer treatment, supportive and palliative care, screening, prevention, genetics, and complementary and alternative medicine. Visit www.cancer.gov (Search: Depression).

Locate Affordable Health Care in Your Area

Within the Federal Government, a bureau of the Health Resources and Services Administration provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost health care. Start your search at http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

Mental Health Treatment Program Locator

The Substance Abuse and Mental Health Services Administration is pleased to provide this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/.

National Alliance on Mental Illness (NAMI)

NAMI is the Nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. There are nearly 1,000 NAMI state organizations and NAMI affiliates across the country. Many NAMI affiliates offer an array of free support and education programs. Find your local NAMI at www.nami.org/Find-Your-Local-NAMI.

NIDA for Teens: Depression

NIDA for Teens website is a project of the National Institute on Drug Abuse (NIDA), National Institutes of Health. Created for middle and high school students and their teachers, this website provides accurate and timely information for use in and out of the classroom. Find information and discussions on depression at http://teens.drugabuse.gov/ (Search: Depression).

NIHSeniorHealth: Depression

NIHSeniorHealth (www.NIHSeniorHealth.gov) has added depression to its list of health topics of interest to older adults. This senior-friendly medical website is a joint effort of the National Institute on Aging and the National Library of Medicine, which are part of the National Institutes of Health (NIH). It is available at http://nihseniorhealth.gov/depression/.

St. John’s Wort and Depression

This fact sheet has information about St. John’s wort, a popular herb being used by the public today to treat mild depression. This publication includes information on the FDA’s role to monitor the use of this herb, how St. John’s wort works, how it is used to treat depression, and a drug interaction advisory. Read it at https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm.

Questions to Ask Your Doctor

Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at www.ahrq.gov/patients-consumers/index.html.

Reprints

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  • NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.
  • NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of such information.
  • NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and “brand” when using the publication.
  • Addition of non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services, or medical treatments or services.
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If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail at [email protected]

Citing This Publication

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. 15-3561

To get better, you need to take an active role in your treatment. You can’t be passive as a patient. You and your doctor have to work as a team.

Of course, you might not feel up to taking an active role in anything. You might have doubts that treatment will help. But push yourself. Depression can make you feel helpless. Taking charge of your treatment is one way to feel in control again.

Here are some tips.

  • Stick with it. Treatment usually won’t work right away. Antidepressants may not take effect for four to six weeks. In some cases, a medication may not work and you’ll need to try another, or possibly a combination of medicines. Therapy can take a while, too. But don’t despair. If you give them time, these treatments are very likely to help. When a depressed person gets the right medicine, at the right dose, and takes it long enough, treatment succeeds about 70% of the time. But you and your doctor may sometimes need to try quite a few treatments before landing on the right therapy for you.
  • Take your medicine as prescribed. Get into good habits. Take your medicine at the same time every day. It’s easier to remember if you do it along with another activity, like brushing your teeth, eating breakfast, or getting into bed. Get a weekly pillbox, which will make it easy to see if you’ve missed a dose.
  • Never stop taking your medicine without your doctor’s OK. If you need to stop taking a medicine for some reason, your doctor may reduce your dose gradually. If you stop suddenly, you may have side effects. Stopping medication abruptly may also cause depression to return. Don’t assume that you can stop taking your medicine when you feel better. Many people need ongoing treatment even when they’re feeling well. This can prevent them from getting depressed again. Remember, if you’re feeling well now, it might be because your medicine is working. So why stop?
  • Make lifestyle changes. There’s a lot you can do on your own to supplement your treatment. Eat healthy foods, high in fruits and vegetables and low in sugars and fats. Avoid alcohol and illicit drugs, which can cause or worsen depression and interfere with the effects of the medicines that treat depression. Make sure to get a good night’s sleep. Follow a regular daily structured routine. Don’t lie in bed during the day or allow yourself to take naps. Several studies show that physical activity can help with the symptoms of depression. Start slowly. Try taking walks around the neighborhood with a friend. Gradually, work up to exercising on most days of the week.
  • Reduce stress at home and at work. Ask for help with some of the stressful things in your life. See if your friends or family will take care of some of the daily hassles, like housework. If your job is stressing you out, figure out ways to scale back some of your duties.
  • Be honest. Opening up to a therapist or other mental health professional isn’t easy. But if you’re not truthful, therapy is less likely to help. People are sometimes uncomfortable talking about sensitive topics such as sexual functioning, side effects, substance use, missing medication doses, or suicidal thoughts – but sharing such concerns openly with your doctor or therapist can only help. If you have doubts about therapy or your therapist’s approach, don’t hide them. Instead, talk about them openly with your therapist. He or she will be happy to have your feedback. Together, you might be able to work out a new approach that works better.
  • Be open to new ideas. Your therapist may have suggestions that sound strange. He or she may push you to do things that feel awkward or uncomfortable. But try to stay open. Give new approaches a try. You may find them more helpful than you expected.
  • Don’t give up. You may feel hopeless right now. You may feel like you’re never going to get better. But feeling that way is a symptom of your condition. If you give yourself some time and allow your treatment to take effect, you will feel better again.

Nothing is helping my depression

Even when you do everything you’re “supposed” to do, symptoms of depression can stick around. Part of the experience of depression is that it feels like it will go on forever, and when you are doing the work and not seeing any changes, it can feel hopeless and not worth the effort.

Many things that help with depression take some time to work. Medications can often take 4-6 weeks for people to notice a difference. Therapy is a process. Lifestyle changes like healthy eating, exercise, or meditation do not change your life immediately. As wonderful as it would be, there is no immediate fix. If you are doing things to work towards your recovery, it’s important to give things time to work. The small, repeated actions can eventually lead to major changes in how you are feeling.

There are options if you are trying and not seeing any progress:

  • If you are taking medication, you may want to talk to your doctor about trying different medications. While this can take more time, it is ultimately worth it to find a medicine or combination of medicines that work for you.
  • Identify other factors that might be contributing to depression. For some, physical health problems might be at the root of a mental health problem. For example, new research links depression to inflammatory diseases or microbiome (gut bacteria) issues. If you haven’t already looked into other physical health concerns, it’s worth checking out.
  • If you are working with a therapist, it’s important to speak openly about whether you find it helpful. Your sessions might be more useful if you let the person know your concerns or frustrations. Just like all relationships, sometimes things are not the right fit and you may need to explore other options. Many people try more than one therapist before they find someone they want to work with.
  • Finding a support group can help you feel less alone in the process and give you the opportunity to connect with others who can offer their experience and hope with you. There are many local support groups for depression and other mental health and health related issues.
  • For some, depression continues despite trying many of these options over a long period of time. An additional option to explore with professionals is neurostimulation, which includes things like Vagus Nerve Stimulation, Transcranial Magnetic Stimulation, and Electroconvulsive Therapy. These all use electric or magnetic impulses to engage the nervous system, and are typically reserved for when many other treatments have not worked.

Wherever you are in this process, know that most people do recover and that research into new antidepressant medications are giving individuals even more options to eliminate or reduce depression symptoms. With the right combination of supports, people live full lives even with depression.

Raison, C. L., & Miller, A. H. (2011). Is depression an inflammatory disorder?. Current psychiatry reports, 13(6), 467-475.

Only one-third of people with major depression achieve remission after trying one antidepressant. When the first medication doesn’t adequately relieve symptoms, next step options include taking a new drug along with the first, or switching to another drug. With time and persistence, nearly seven in 10 adults with major depression eventually find a treatment that works.

Of course, that also means that the remaining one-third of people with major depression cannot achieve remission even after trying multiple options. Experts are hunting for ways to understand the cause of persistent symptoms. In recent years, one theory in particular has gained traction: that many people with hard-to-treat major depression actually suffer from bipolar disorder. However, a paper published online this week in the Archives of General Psychiatry suggests otherwise—and the findings provide new insights into the nature of treatment-resistant depression.

Researchers at Massachusetts General Hospital (MGH) and colleagues analyzed outcomes for roughly 4,000 participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which was conducted both in primary care and psychiatric settings in order to mimic real-world treatment of major depression. The STAR*D investigators had used a simple questionnaire to ask participants about symptoms characteristic of bipolar disorder (such as mania or hypomania) as well as those suggesting psychosis (the inability to recognize reality, such as false beliefs or false perceptions). All participants initially received the antidepressant citalopram (Celexa), followed by up to three additional treatments as necessary.

The MGH researchers did find that many participants in the STAR*D study had multiple symptoms associated with bipolar disorder rather than major depression. Contrary to common wisdom, however, these symptoms did not significantly worsen chances of attaining remission after taking antidepressants. Instead, the researchers found that participants who said they experienced one or more unusual beliefs or experiences in the past two weeks—symptoms that can indicate psychosis—were significantly less likely than other STAR*D participants to attain remission.

“We found that about one-third of participants in the STAR*D study reported strange or unusual experiences,” explains Dr. Roy H. Perlis, medical director of the Bipolar Clinic and Research Program at MGH and lead author of the paper. “That doesn’t mean that one in three participants were psychotic, but that unusual thinking is common in people with major depression. As such, it is important that clinicians are on the alert for these symptoms, because they are associated with poorer response to antidepressants.”

In recent years, both scientific review papers and continuing medical education courses have advised clinicians to re-evaluate a diagnosis of major depression and instead consider bipolar disorder when a patient does not respond to multiple antidepressants. But Dr. Perlis and others are growing concerned that bipolar disorder is now overdiagnosed as a result. “We were seeing an increasing number of patients diagnosed with bipolar disorder, or bipolar spectrum disorder, simply because they had a family member with bipolar disorder or hadn’t responded well to antidepressants,” says Dr. Perlis. (In a 2008 paper, researchers at Brown University estimated that more than half of bipolar diagnoses might be wrong—partly because clinicians attribute symptoms like agitation or racing thoughts to mania rather than to major depression.)

When people with major depression don’t benefit adequately from a first antidepressant, Dr. Perlis advises that it’s wise to take several steps before deciding on the next treatment:

Review the diagnosis. Major depression can be difficult to diagnose because symptoms vary from one person to the next. “It’s critical to revisit the diagnosis any time a treatment isn’t working, and this should include consideration of bipolar disorder,” Dr. Perlis explained. “Risk factors such as a family history of bipolar disorder certainly increase my concern, and cause me to look even more closely. On the other hand, treatment resistance does not automatically equal bipolar disorder.”

Consider other illnesses. It’s also important to consider whether another medical illness, such as anemia or obstructive sleep apnea, might be causing fatigue and other symptoms of depression.

Consider comorbidities. Major depression frequently occurs in conjunction with other psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, it’s important to treat the co-occurring mental health problem in addition to major depression.

Double-check dose. It’s always wise to double-check whether someone is taking the drug at the dose prescribed.

Give it more time. Although the standard advice for patients is to take an antidepressant for six weeks to see if symptoms improve, earlier findings from the STAR*D trial suggest that many people need more time to respond. The STAR*D investigators recommended that people with major depression take an antidepressant for at least eight weeks before considering another strategy.

This time round there was a lot of sleeping, very low mood and I didn’t want to talk to anyone or see anyone. There was self-harm and cutting. That led to three years of not being able to work, being on benefits, constantly ill, four hospital admissions, an absolute three-year hell. Nothing seemed to work. I was tried on a million different medications. I had a therapist who was doing cognitive behavioural therapy (CBT). It didn’t work.

In 2006, I stabilised. The turning point was finding the right combination of medication to make me stable enough to do the things that are good for me. I bought my own place, cut down on drinking, started seeing people and not isolating myself so much, and making the decision that I wanted to get better.

I took on a part-time job in a bar, moved back to Mum and Dad’s, then moved to Maidenhead in Berkshire. I found I could do it, quickly went full-time, started enjoying my life, went a bit crazy, did all the things I should have done when I was 18.

I’ve had a few episodes since that time. It varies. They seem to sneak up on me. I don’t feel them coming, but the people around me do. My therapist can always tell. If I look back, it’s easy to tell: sleep is a massive sign.

I’m predisposed to it. I’m fairly sure it’s something I’ll have to live with. But there are plenty of things I can do to lessen the number and intensity of episodes. I’ve got a great therapist.

The last three episodes have lasted between six and nine months; I’ve had to take time off work each time. The first time, my work made me redundant; the second time they were brilliant, paid me when they had no obligation to, but then they made my life hell. I was off for two weeks last summer.

I don’t know why it happens to me. There are things that happened to me in the past, but they’re things that happen in every family. A lot of it is that I’m quite sensitive and take things in a lot deeper than I should.

Nina Shivji (with her mother): ‘Hope is really important. It can see you through some horrible times.’ Photograph: Personal photo

Nina Shivji, 30, Sheffield

I was first diagnosed with depression when I was 15 and was prescribed antidepressants. It’s hard to identify when exactly the depression began. Sometimes there is no identifiable cause. I was told it could just be a chemical imbalance in my brain.

I lost interest in everything. I love reading, it’s a fantastic escape for me, but during my low periods I found myself unable to concentrate, just staring at the words on the page. I found it very difficult to fall asleep and to stay asleep. My appetite would decrease. I stopped caring about myself and my living conditions, at times I hated myself and felt I did not deserve to feel any better. During my worst episodes, I would cut my arms. At the time this felt like a release, a way of feeling something real again, and of expressing my inner pain in a tangible, visible way.

I can have periods of up to six months when I am mostly fine, but there are also times when I feel low, sometimes so bad that I have to give up work for a few months. I don’t think depression will ever leave me alone for good. I am on the road to recovery, but it is a hard journey. Hope is really important: if you can hold on to it, it can see you through some horrible times. Although that is easier said than done: during hard times I might forget what it feels like to be anything other than depressed or find it hard to see the point in doing anything.

I suppose the depression has stopped me from achieving certain goals. I had to drop out of university. I have had long periods of temping so that I could have time off between jobs as and when it was needed. I have been unable to work full time for many years, but have been working part-time for most of the time.

The thing that frustrates me is that it feels as if I am in a no-win situation regarding Employment and Support Allowance. If I do work (which I prefer to), it is part-time, and I am not eligible to claim benefits, even though a part-time wage is not really enough to live on. In the past I’ve had long periods of time when I was unable to work, which made it difficult to get back into work when I was feeling well enough. The temp agencies told me it might be difficult to find me something due to the “gaps” in my CV, particularly as depression is something that I still carry with me, as opposed to a “normal” illness, which clears up. One agency felt it had to inform prospective employers of my medical information. Medication has played a major role in my recovery, but quite often it is given too easily without enough access to talking therapies (such as Cognitive Behavioural Therapy or Psychoanalytical Therapy). Over the years I tried many different antidepressants before finding one that worked properly for me. I found that, for me, antidepressants allow me to manage day to day life a lot better and stabilise my moods but I still have to work hard to try to manage my low periods. I have to ensure regular social contact with my friends and family. During my low times, I set myself realistic goals and try to do things that give me a sense of achievement, this can sometimes be small, everyday things like going to the shops or putting the bins out as these tasks can be daunting due to anxiety and lack of motivation.I have found talking-therapies helpful in the past but find these can be a struggle if you are feeling quite bad. You have to be in the right place, mentally, to cope with addressing your problems. Also, there can be a long wait for such therapies on the NHS, private treatment can be quite expensive so this not a realistic option for most people, particularly if you aren’t in employment.

Things that I find unhelpful are mainly the attitudes of people who don’t understand depression and think it’s just a matter of “pulling oneself together” or “just getting on with things” or “stop worrying and cheer up”. I think there is still too much stigma attached to having a mental health problem, especially with something like depression because it is not an illness you can see, I think it is quite misunderstood.

I find too much time alone is unhelpful, even though sometimes I just don’t want to leave the house or see anyone, I usually feel better after contact with the outside world. When I was first diagnosed with depression, my parents encouraged me to keep it a secret; they did not want other friends or family members to find out. This made me feel alone and ashamed of how I felt.

I know my parents have always loved and cared for me, it was just that they did not really understand what I was going through. For years when I lived at home they would try to convince me there was nothing wrong with me and it was just a phase that would pass. At times, I wanted to die and my parents would tell me to “pick myself up” and “not be so sensitive about things”. They did not even like using the word “depression” and would say the GP was wrong in his diagnosis.

I understand now that this sort of reaction is common, especially among Asian families. Feelings and moods were not really discussed and any display of emotion was seen as a form of weakness. Over time, my parents’ attitudes changed. Now they are brilliant, supportive and understanding.

My brother has always been very understanding. And I have a great bunch of friends, people who understand my depression and my “quiet times”. I have a lovely partner, who is caring and helpful. He encourages me to look after myself and supports me in getting back on my feet when I’m not feeling so good.

I also have two lovely cats. I have managed not to neglect, mislay or set fire to either of them yet despite some people’s comments that I cannot even look after myself properly.

Erik Baurdoux: ‘For me, the best thing was getting in touch with people who had it in the past.’ Photograph: Graeme Robertson for the Guardian

Erik Baurdoux, 31, London

I’ve had two serious episodes, the first when I was 21, which I don’t remember much about, and the second about three years ago. There were classic warning signs: waking up in the middle of the night, not eating, losing weight, not interested in anything, getting worried about things.

Once we recognised what was happening, it was already very severe in terms of suicidal thoughts. I wasn’t doing anything. I was suicidal and I stayed in bed all day. I would wake up at three or four in the morning and sometimes I couldn’t go back to sleep, I would go for long walks around Hackney. Anything to get out of the house.

For a long time, nothing helped. The best help is to be patient and have some contact with people who can give you some sort of hope that things will pass. For me, the best thing was getting in touch with people who had it in the past and wouldn’t give me any cheap advice such as to go running, medication, therapy. It was writing, keeping a diary, writing emails to people about it. My girlfriend was amazingly supportive. It really strengthened our relationship.

Recovery took a long time. It was only a year and a half later that I felt things were finally getting better. I would have good moments but would crash again. The suicidal thoughts were on and off and triggered by stress. But I was never off work, I had good support from my colleagues, rearranged some of my teaching. Looking back, I didn’t miss a single lecture that I had to teach, but often I was close to getting to admitting myself into hospital. Luckily, I didn’t have to do that.

I’m not sure what caused it. But I’m very much recovered and back to whatever normal is. Of course, we want to do everything we can to stop it returning. We both changed quite a lot. We try to not worry as much as we used to. We try to just enjoy the moment.

I find talking to other people good for me, as well as cycling, exercise, travelling and writing about things. I also find campaigning for mental health has given me something to be proud of. You can take something positive out of things even if they are difficult. My GP was very supportive and I’ve also discovered the benefits of meditation.

My message to others would be that it’s OK to talk about it. It’s important to know that people do get better, and it’s nothing to be ashamed of.

Nikki Llewellyn: ‘I didn’t physically want to do anything. It was very oppressive.’ Photograph: David Levene for the Guardian

Nikki Llewellyn, 29, east London

I first became depressed at 13. I knew something was wrong but I didn’t know what. I was going through puberty and school and stuff. After two or three weeks, I couldn’t take it any more. I took an overdose. I remember waking up and thinking there is definitely something wrong now. I didn’t tell anyone again. I didn’t want to make it worse. My dad had been depressed and after seeing how he was treated, I didn’t want that to happen to me. At the time, it seemed that everyone apart from my mum ignored him. Even the doctors didn’t seem to be helping. He just seemed to get worse.

I didn’t tell anyone for 10 years. I was feeling anxious about things that you wouldn’t normally feel anxious about, a feeling that everyone would be better off if I wasn’t there. Some mornings I felt maybe I was just lazy. I didn’t physically want to do anything. It was very oppressive.

I went to my GP. He wasn’t helpful. He’s a nice person, but he just kept suggesting medication, and I told him I wouldn’t take it. He suggested therapy, which didn’t work. I got better when I was 25. I woke up one morning and looked in the mirror and looked at myself and said: “This is not your life, there has to be something better.” And from that second, I vowed I would not be sick any more. I put on my jacket and gloves and went for a walk around the block. It was so nice and refreshing and I told myself, I can do this.

• Mark Rice-Oxley’s memoir of depression and recovery, Underneath the Lemon Tree, is published by Little, Brown, price £13.99. To order a copy for £11.19 with free UK p&p, go to guardian.co.uk/bookshop or call 0330 333 6846
Samaritans (08457 90 90 90) provide confidential emotional support for people who are experiencing distress or despair, including suicidal feelings

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