Steps to beat depression

How Do You Know When Your Depression Is Improving?

Depression describes a mood, which we can think of as an emotional climate. We can’t always tell what our mood is based on a single day, just as we can’t know for certain which season we’re in based on the weather; one cold day in the fall doesn’t mean it’s winter, and one day of feeling lousy doesn’t mean we’re depressed. We look for patterns in our emotions and behavior and clusters of symptoms to figure out if we’re depressed.

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On the other side of depression, we might not know exactly when it’s lifting. At first, we might not notice the improvements, like the imperceptible lengthening of days as spring approaches. And then one day, we’re struck by the change, like seeing the first crocus popping through the melting snow. We feel a thaw in our numb emotions, a spark of excitement to be alive.

Just as a heavy snow can come after the spring ephemerals emerge, we can feel the first signs of depression abating and then continue to experience symptoms of depression. With continued time and treatment, we can continue toward a fuller recovery.

Look for these signs, among others, that can indicate relief from depression:

1. Less irritability.

We think of sadness as the most common emotion in depression, but irritability is also very common. As you start to feel better, you might notice that you have more patience, and feel less easily put out with others.

2. Greater interest in activities.

One of the defining features of depression is a lack of interest or pleasure in things we usually enjoy. As you start to feel better, you’ll show more interest in your normal activities and start to enjoy them more. Food might even start to taste better.

3. More energy.

Along with more interest, our energy returns as depression lifts. This increase in energy can help us do more of the things we care about, further improving our mood.

4. Feeling less overwhelmed.

Everything can feel difficult when we’re depressed and feeling inadequate to the task. Less depression leads to us feel more on top of our day-to-day responsibilities, as well as able to respond to challenges as they arise.

5. More normal appetite.

Whether our appetite was increased or decreased by depression, it will start to return to normal as we feel better. If we had little appetite before, we’ll find that food is more appealing and enjoyable. We can also find it easier to resist the foods we had a hard time avoiding when we were really depressed.

6. Better concentration.

The cognitive symptoms of depression can be quite disruptive, making it hard to think and focus. With improved concentration, we’ll find it’s easier to follow a conversation or the plot of a book, and in general, we’ll feel sharper mentally.

7. Return of libido.

Depression often kills one’s sex drive, and non-depressed partners may have a hard time understanding that the lack of interest has nothing to do with them. Thus, a loss of libido can have serious effects on a couple’s relationship. It may be surprising to once again feel that spark if it’s been missing for a while.

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8. Better self-image.

One of the cruel aspects of depression is that it leads us to believe all kinds of negative things about ourselves—that we’re “worthless” or “a loser” or “pathetic”—which, of course, only feeds the depression. As we reconnect with our basic sense of self-worth, we start to question the lies that a depressed mind tell us, and we see ourselves in a more loving and accurate light.

Keep in mind that just as depression symptoms don’t show up all at once, they also don’t leave at the same time. We can’t know for certain which ones will improve first, although several studies (e.g., this one) have shown that sleep problems are often the last to resolve. So if you’re still battling insomnia, take heart—it can get better as the depression continues to recede, and with focused insomnia treatment.

Monitor Your Symptoms

In my clinical practice, I often re-assess a person’s symptoms to see how their recovery is progressing. Whether or not you’re seeing a professional, you can complete one of these measures from time to time to track your symptoms. The form I use in my practice is available for free online: Clinically Useful Depression Outcome Scale. Click here and scroll to the bottom of the page for information about interpreting your score. Talk to your doctor or a mental health professional if your score indicates you’re experiencing significant depression, particularly if you’ve thought about suicide.

I recommend checking symptoms only once every 2-4 weeks; changes from day to day usually reflect short-term fluctuations in our emotions, rather than the more climate-like symptoms of depression. Frequent checking of symptoms can also foster a ruminative focus on one’s “emotional temperature,” which research has shown is not conducive to recovery.

What Does It Feel Like?

I’ve described some of the improvements to look for as depression lifts, but what does it feel like?

Some people compare recovery from depression to getting over a sickness like the flu, realizing with amazement how good it feels just to feel more normal again.

Others use the winter-to-spring metaphor, like the sense of expectancy that comes with the return of warmer air and flowers and birds singing in the trees.

Still others describe feeling like a veil between them and the world has lifted, and they can reconnect to their emotions and experiences.

Whatever we compare it to, getting out from under depression can feel amazing. We start wanting to engage with life again, we actually have the energy to do so, and we remember that life can be so good.

Consider these action steps if you’ve been depressed:

  1. Seek treatment, if you haven’t already. Your primary care doctor can provide a referral, or you can search your area for a therapist here at Psychology Today.
  2. Use a scale like this one to assess your symptoms and progress.
  3. If your insomnia has stuck around even though you’re feeling better, consider finding a therapist who provides cognitive behavioral therapy for insomnia (CBT-I), or use one of the CBT-I apps. Better resolution of insomnia can improve long-term recovery from depression.
  4. If you’ve tried one kind of treatment, but continue to suffer from depression, consider a combined treatment: A combination of medication and therapy typically is better than either treatment alone for people with moderate to severe depression.
  5. When you do start to feel better, continue the practices that led to your improvement. Your recovery is worth the investment of time and energy.

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A Step-by-Step Guide to Depression Recovery

Every year, depression affects about one out of every 10 American adults. “Depression is an emotional state that may or may not be abnormal and that has many possible causes. The most severe form of clinical depression is major depressive disorder,” says Rajnish Mago, MD, director of the mood disorders program at Thomas Jefferson University in Philadelphia, Pa. “Women are twice as likely as men to develop major depressive disorder.”

Only one out of three people with depression ever seeks medical help. But with the right diagnosis and treatment, depression recovery is possible.

Step One: Know the Signs and Symptoms of Depression

The first step in beating depression is to recognize the symptoms. Says Dr. Mago, “Not all these symptoms are present in every person who has major depression, but many of them are:”

  • Persistent sadness
  • Changes in sleep, appetite, and energy
  • Lack of interest and difficulty concentrating
  • Feeling guilty, hopeless, and empty

If you have some depression symptoms, it’s important to know that not all depression is abnormal. “Symptoms of depression can occur in normal people who suffer a loss, and the most typical example is bereavement. A major depressive disorder is differentiated from normal sadness by being more severe and persistent than is warranted by the circumstances,” Mago says. You might have a major depression if you have symptoms of depression all the time and they last for at least two weeks. If you are having persistent thoughts of suicide or death, you should get help right away.

Step Two: Get Help for Depression

“If you think you may have depression, the next thing you should do is to seek assessment from a mental health professional or from your family doctor. Be open about describing your symptoms and to the possibility that they may indicate some form of depression,” advises Mago.

There is no lab test that can tell a health care professional if you have depression. The diagnosis is based on your symptoms. “In most cases, a few basic laboratory tests should be done to rule out the possibility that another medical condition, most typically underactivity of the thyroid gland, may be causing the depression,” says Mago.

Step Three: Get the Right Depression Diagnosis

Different types of depression may require different kinds of treatment. “The therapist should assess the type of depression, differentiating between a normal sadness due to a significant loss, bipolar depression, and different types of unipolar depression,” says Mago. Common types of depression include:

  • Major depression. This is also called clinical depression, major depressive disorder, or unipolar depression.
  • Dysthymia. This type of depression is similar to major depression, but not as severe.
  • Postpartum depression. This is a serious type of depression that affects about 13 percent of women who are pregnant or new mothers.

Another possible diagnosis is bipolar disorder. Although this is a condition distinct from depression, bipolar disorder was once known as manic depression because it alternates between periods of depression and excitability.

In most cases, depending on the type of depression you have, the next step in beating depression is starting treatment. “Patients presenting to their family doctor are likely to be prescribed an antidepressant unless they request a referral for psychotherapy. For mild or moderate depression, psychotherapy can be as effective as medication. If possible, the combination of an antidepressant and psychotherapy is warranted in some patients,” explains Mago.

Step Four: Understand the Types of Depression Treatment

Finding the right kind of treatment is an important step. Treatments can be used alone or in combination, and will depend on your diagnosis and response to the treatments you are started on. Here are some of the possibilities:

  • Psychotherapy. This is therapy that uses talk instead of medicine. Types of psychotherapy include cognitive behavioral therapy and interpersonal therapy.
  • Medications. If you have a more severe type of depression or you are not responding to psychotherapy alone, your doctor may prescribe an antidepressant. These medications may take up to six weeks to work.
  • Electroconvulsive therapy. In severe cases where medication and psychotherapy are not working, ECT is highly effective.

Step Five: Assess Your Depression Treatment

As you continue the steps toward recovery from depression, you should know that 80 to 90 percent of people diagnosed with depression can be treated successfully. But it is not unusual to have some treatment adjustments along the way. “With the first trial of an antidepressant medication, about one third of patients show excellent improvement, one third have substantial but incomplete treatment, and one third have little or no improvement. Of patients who have incomplete response, the majority go on to have substantial improvement with a change in the antidepressant, addition of another medication to the antidepressant, or addition of psychotherapy,” says Mago.

Step Six: Get Complete Care for Depression

“In recent years it has been realized that patients with clinical depression should be treated till they are have virtually no symptoms at all. Otherwise they remain at higher risk of becoming depressed again in response to stresses in their life,” notes Mago.

It’s also important to remember that there are steps you can take for yourself to beat depression and keep it from coming back. These include lifestyle changes such as a healthy diet and regular exercise. You should also educate yourself about depression and establish a good support system. With the proper steps, you can beat depression.

PMC

  • Kupfer DJ. Long-term treatment of depression. J Clin Psychiatry. 1991 52suppl 5. 28–34.
  • Keller MB. The long-term treatment of major depression. J Clin Psychiatry. 1999 60suppl 17. 41–45.
  • Keller MB, Boland RJ.. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry. 1998;44:348–360.
  • Montgomery SA, Dufour H, and Brion S. et al. The prophylactic efficacy of fluoxetine in unipolar depression. Br J Psychiatry Suppl. 1988 3:69–76.
  • Montgomery SA, Dunbar G.. Paroxetine is better than placebo in relapse prevention and the prophylaxis of recurrent depression. Int Clin Psychopharmacol. 1993;8:189–195.
  • Doogan DP, Caillard V.. Sertraline in the prevention of depression. Br J Psychiatry. 1992;160:217–222.
  • Montgomery SA, Rasmussen JG, Tanghoj P.. A 24-week study of 20 mg citalopram, 40 mg citalopram, and placebo in the prevention of relapse of major depression. Int Clin Psychopharmacol. 1993;8:181–188.
  • Feiger AD, Bielski RJ, and Bremner J. et al. Double-blind, placebo-substitution study of nefazodone in the prevention of relapse during continuation treatment of outpatients with major depression. Int Clin Psychopharmacol. 1999 14:19–28.
  • Hirschfeld RM.. Guidelines for the long-term treatment of depression. J Clin Psychiatry. 1994;55(12, suppl):61–69.
  • Hamilton M.. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
  • Montgomery SA, Asberg M.. A new depression rating scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.
  • Karp JF, Buysse DJ, and Houck PR. et al. Relationship of variability in residual symptoms with recurrence of major depressive disorder during maintenance treatment. Am J Psychiatry. 2004 161:1877–1884.
  • Nierenberg AA, Petersen TJ, and Alpert JE. Prevention of relapse and recurrence in depression: the role of long-term pharmacotherapy and psychotherapy. J Clin Psychiatry. 2003 64suppl 15. 13–17.
  • Thase ME. Achieving remission and managing relapse in depression. J Clin Psychiatry. 2003 64suppl 18. 3–7.
  • Kennedy N, Foy K.. The impact of residual symptoms on outcome of major depression. Curr Psychiatry Res. 2005;7:441–146.
  • Judd LL, Akiskal HS, and Maser JD. et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998 50:97–108.
  • Judd LL, Paulus MJ, and Schettler PJ. et al. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry. 2000 157:1501–1504.
  • Beck AT, Ward CH, and Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961 4:561–571.
  • Pfizer Incorporated. Patient Health Questionnaire (PHQ-9). Available at: http://www.pfizer.com/pfizer/phq-9/index.jsp. Accessed Nov 7, 2006.
  • Rush AJ, Trivedi MH, and Ibrahim HM. et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C), and Self-Report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003 54:573–583.
  • Simons AD, Angell KL, and Monroe SM. et al. Cognition and life stress in depression: cognitive factors and the definition, rating, and generation of negative life events. J Abnorm Psychol. 1993 102:584–591.
  • Bebbington PE, Brugha T, and MacCarthy B. et al. The Camberwell Collaborative Depression Study, 1: depressed probands: adversity and the form of depression. Br J Psychiatry. 1988 152:754–765.
  • Iosifescu DV, Bankier B, Fava M.. Impact of medical comorbid disease on antidepressant treatment of major depressive disorder. Curr Psychiatry Rep. 2004;6:193–201.
  • Pollack MH. Comorbid anxiety and depression. J Clin Psychiatry. 2005 66suppl 8. 22–29.
  • Thase ME. Comparison between seasonal affective disorder and other forms of recurrent depression. In: Rosenthal NE, Blehar MC, eds. Seasonal Affective Disorders & Phototherapy. New York, NY: Guilford Press; 1989 64–78.
  • Golden RN, Gaynes BN, and Ekstrom RD. et al. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry. 2005 162:656–662.
  • Miller AL.. Epidemiology, etiology, and natural treatment of seasonal affective disorder. Altern Med Rev. 2005;10:5–13.
  • Foley KF, DeSanty KP, Kast RE.. Bupropion: pharmacology and therapeutic applications. Expert Rev Neurother. 2006;6:1249–1265.
  • Lam RW, Levitt AJ, and Levitan RD. et al. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry. 2006 163:805–812.
  • Ruhrmann S, Kasper S, and Hawellek B. et al. Effects of fluoxetine versus bright light in the treatment of seasonal disorder. Psychol Med. 1998 28:923–933.
  • Murray G, Michalak EE, and Levitt AJ. et al. O sweet spot where art thou? light treatment of seasonal affective disorder and the circadian time of sleep. J Affect Disord. 2006 90:227–231.
  • Swiecicki L, Szafranski T.. Side effects after phototherapy implementation in addition to fluoxetine or sertraline treatment: a report of two cases. World J Biol Psychiatry. 2002;2:109–111.
  • Partonen T, Lonnqvist J.. Moclobemide and fluoxetine in treatment of seasonal affective disorder. J Affect Disord. 1996;41:93–99.
  • Cohen LS, Altshuler LL, and Harlow BL. et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006 295:499–507.
  • Chambers CD, Hernandez-Diaz S, and Van Marter LJ. et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006 354:579–587.
  • Blier P.. Pregnancy, depression, antidepressants and breast-feeding. J Psychiatry Neurosci. 2006;31:226–228.
  • Sanz EJ, De-las-Cuevas C, and Kiuru A. et al. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet. 2005 365:482–487.
  • Einarson A, Koren G.. Counseling women treated with paroxetine: concern about cardiac malformations. Can Fam Physician. 2006;52:593–594.
  • Bairy KL, Madhyastha S, and Ashok KP. et al. Developmental and behavioral consequences of prenatal fluoxetine. Pharmacology. 2006 79:1–11.
  • Hirschfeld MA.. Clinical importance of long-term antidepressant treatment. Br J Psychiatry. 2001;179:S4–S8.
  • Keller MK, Yan B, and Dunner D. et al. Recurrence prevention: efficacy of two years of maintenance treatment with venlafaxine XR in patients with recurrent unipolar major depression. Presented at the 159th annual meeting of the American Psychiatric Association; May 20–25, 2006; Toronto, Canada.
  • Frank E, Kupfer DJ, and Perel JM. et al. Three-year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1990 47:1093–1099.
  • Kupfer DF, Frank E, and Perel JM. et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992 49:769–773.
  • Hochstrasser B, Isaksen PM, and Koponen H. et al. Prophylactic effect of citalopram in unipolar, recurrent depression: placebo-controlled study of maintenance therapy. Br J Psychiatry. 2001 178:304–310.
  • Lepine JP, Callaird V, and Bisserbe JC. et al. A randomized, placebo-controlled trial of sertraline for prophylactic treatment of highly recurrent major depressive disorder. Am J Psychiatry. 2004 161:836–842.
  • Mavissakalian MR, Perel JM, de Groot C.. Imipramine treatment of panic disorder with agoraphobia: the second time around. J Psychiatr Res. 1993;27:61–68.
  • Fava M, Schmidt ME, and Zhang S. et al. Treatment approaches to major depressive disorder relapse, part 2: reinitiation of antidepressant treatment. Psychother Psychosom. 2002 71:195–199.
  • Kupfer DJ, Frank E, Perel JM.. The advantage of early treatment intervention in recurrent depression. Arch Gen Psychiatry. 1989;46:771–775.
  • Stewart JW, Tricamo E, and McGrath PJ. et al. Prophylactic efficacy of phenelzine and imipramine in chronic atypical depression: likelihood of recurrence on discontinuation after 6 months’ remission. Am J Psychiatry. 1997 154:31–36.
  • Clinical Practice Guideline. Number 5: Depression in Primary Care, vol 2. Treatment of Major Depression. Rockville, Md: US Dept Health Human Services, Agency for Health Care Policy and Research; 1993. AHCPR Publication 93-0551.
  • Schulberg HC, Katon W, and Simon GE. et al. Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice Guidelines. Arch Gen Psychiatry. 1998 55:1121–1127.
  • Robinson RL, Long SR, and Chang S. et al. Higher costs and therapeutic factors associated with adherence to NCQA HEDIS antidepressant medication management measures: analysis of administrative claims. J Manag Care Pharm. 2006 12:43–54.
  • Schmidt ME, Fava M, and Zhang S. et al. Treatment approaches to major depressive disorder relapse, part 1: dose increase. Psychother Psychosom. 2002 71:190–194.
  • Paykel ES. Cognitive-behavior therapy in relapse prevention in depression. Int J Neuropsychopharmacol. 2006 E-pub ahead of print.
  • Almeida AA, Lotufo Neto F.. Cognitive-behavioral therapy in prevention of relapses and recurrences: a review. Rev Bras Psiquiatr. 2003;25:239–244.
  • Keller MB, McCullough JP, and Klein DN. et al. Comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000 342:1462–1470.
  • Kocsis JH, Rush AJ, and Markowitz JC. et al. Continuation treatment of chronic depression: a comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and their combination. Psychopharmacol Bull. 2003 37:73–87.
  • Klein DN, Santiago NJ, and Vivian D. et al. Cognitive-Behavioral Analysis System of Psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol. 2004 72:681–688.
  • Fava GA, Rafanelli C, and Grandi S. et al. Prevention of recurrent depression with cognitive behavioral therapy. Arch Gen Psychiatry. 1998 55:816–820.
  • Fava GA, Ruini S, and Rafanelli C. et al. Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. Am J Psychiatry. 2004 161:1872–1876.
  • Otto MW, Pollack MH, and Sachs GS. et al. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry. 1993 150:1485–1490.
  • Fava GA, Ruini C.. Development and characteristics of a well-being psychotherapeutic strategy: well-being therapy. J Behav Ther Exp Psychiatry. 2003;34:45–63.
  • Fava GA, Rafanelli C, and Cazzaro M. et al. Well-being therapy: a novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med. 1998 28:475–480.
  • Teasdale JD, Moore RG, and Hayhurst H. et al. Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol. 2002 70:275–287.
  • Frank E, Kupfer DJ, and Wagner EF. et al. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression: contributing factors. Arch Gen Psychiatry. 1991 48:1053–1059.
  • McCrone P, Knapp M, and Proudfoot J. et al. Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry. 2004 185:55–62.
  • Simon GE, Ludman EJ, and Tutty S. et al. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. JAMA. 2004 292:935–942.
  • Mohr DC, Hart SL, and Julian L. et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2005 62:1007–1014.
  • Kaltenthaler E, Brazier J, and De Nigris E. et al. Computerized cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation. Health Technol Assess. 2006 33:1–186.
  • Christensen H, Griffiths KM, and Mackinnon AJ. et al. Online randomized controlled trial of brief and full cognitive behaviour therapy for depression. Psychol Med. 2006 E-pub ahead of print.
  • O’Kearney R, Gibson M, and Christensen H. et al. Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial. Cogn Behav Ther. 2006 35:43–54.
  • Frederikse M, Petrides G, Kellner C.. Continuation and maintenance electrocon-vulsive therapy for the treatment of depressive illness: a response to the National Institute for Clinical Excellence report. J ECT. 2006;22:13–17.
  • van den Broek WW, Birkenhager TK, and Mulder PG. et al. Imipramine is effective in preventing relapse in electroconvulsive therapy-responsive depressed inpatients with prior pharmacotherapy treatment failure: a randomized, placebo-controlled trial. J Clin Psychiatry. 2006 67:263–268.
  • Sackeim HA, Haskett RF, and Mulsant BH. et al. Continuation pharmacotherapy in the prevention of relapse following electrocon-vulsive therapy: a randomized controlled trial. JAMA. 2001 285:1299–1307.
  • Davis LL, Frazier E, and Husain MM. et al. Substance use disorder comorbidity in major depressive disorder: a confirmatory analysis of the STAR*D cohort. Am J Addict. 2006 15:278–285.
  • Thase ME, Ninan PT. New goals in the treatment of depression: moving toward recovery. Psychopharmacol Bull. 2002 36suppl 2. 24–35.
  • Szabo ST, Blier P.. Effects of serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibition plus 5-HT2A receptor antagonism on the firing activity of norepinephrine neurons. J Pharmacol Exp Ther. 2002;302:983–991.
  • Solomon DA, Leon AC, and Mueller TI. et al. Tachyphylaxis in unipolar major depression. J Clin Psychiatry. 2005 66:283–290.
  • Lin EH, Von Korff M, and Lin E. et al. The role of the primary care physician in patient’s adherence to antidepressant therapy. Med Care. 1995 33:67–74.
  • Melfi CA, Chawla AJ, and Croghan TW. et al. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry. 1998 55:1128–1132.
  • Russell JM, Berndt ER, and Miceli R. et al. Course and cost of treatment for depression with fluoxetine, paroxetine, and sertraline. Am J Manag Care. 1999 5:597–606.
  • Hirschfeld RMA. Long-term side effects of SSRIs: sexual dysfunction and weight gain. J Clin Psychiatry. 2003 64suppl 18. 20–24.
  • Keller MB, Hirschfeld RM, and Demyttenare K. et al. Optimizing outcomes in depression: focus on antidepressant treatment compliance. Int Clin Psychopharmacol. 2002 17:265–271.
  • Keller MB. Rationale and options for the long-term treatment of depression. Hum Psychopharmacol. 2002 17suppl 1. S43–S46.

6 Steps for Beating Depression

In his book, “The Depression Cure: The 6-Step Program to Beat Depression without Drugs,” author Stephen Ilardi argues that the rate of depression among Americans is roughly ten times higher today than it was just two generations ago, and he points the blame to our modern life-style. Everything is so much easier today than it was back when we had to hunt and gather. Why doesn’t the convenience translate into happiness?

His book concentrates on six ways we’ve turned our back on the things that fight depression. I concur with him that the modern lifestyles contributes to the rise of depression, and I wholeheartedly support all six steps he offers. In fact, each one is included in my 12-step program for beating depression. However, I am uncomfortable with his dismissal of medication, because that is such an important part of my program. He agrees that for those battling severe depression, antidepressants are effective, and claims that individuals suffering from bipolar disorder derive unequivocal benefit from mood stabilizers. But he thinks that the majority of those suffering from unipolar depression can get better on their own.

I guess I’m a tad skeptical because I tried that route. Even though I had implemented all six of his steps into my recovery program, I didn’t get well until I found the right medication combination–which included two antidepressants in addition to a mood stabilizer–to treat my bipolar disorder; that is, until I was stable enough to continue all the exercises needed to get and stay well. And the mood stabilizer by itself was not enough to bring me out of a suicidal depression.

I want to highlight his six steps, however, because I do think they are crucial to a recovery program from depression, and I congratulate him on such a comprehensive book.

1. Omega-3 Fatty Acids

Yes. Absolutely. I get a Noah’s Ark shipment of those to my house every month, as I have read the same research. Ilardi writes:

Because the brain needs a steady supply of omega-3s to function properly, people who don’t eat enough of these fats are at increased risk for many forms of mental illness, including depression. Across the globe, countries with the highest level of omega-3 consumption typically have the lowest rates of depression.

Clinical researchers have even started using omega-3 supplements to treat depression, and the results so far have been highly encouraging. For example, British researchers recently studied a group of depressed patients who had failed to recover after taking antidepressant medication for eight weeks. All study patients stayed on their meds as prescribed, but some also took an omega-3 supplement. About 70 percent of those who received the supplement went on to recover, compared with only 25 percent of patients who kept taking only the medication. This study–along with a handful of others like it–suggests that omega-3s may be among the most effective antidepressant substances ever discovered.

2. Engaged Activity

According to Ilardi, engaged activity keeps us from ruminating, and ruminating causes depression. I understand his logic, and he is right that we are more isolated now in our lifestyle than even 10 years ago because technology allows us to do our jobs individually. Says Ilardi:

The biggest risk factor for rumination is simply spending time alone, something Americans now do all the time. When you’re interacting with another person, your mind just doesn’t have a chance to dwell on repetitive negative thoughts. But, really, any sort of engaged activity can work to interrupt rumination. It can even be something simple.

3. Physical Exercise

You all know where I stand on exercise: it’s essential. At least for this brain. I can’t go two or three days without feeling the effect of no exercise. I’ve cited much of the same research as Ilardi in past posts. But here’s a reminder. Ilardi writes:

Researchers have compared aerobic exercise and Zoloft head to head in the treatment of depression. Even at a low “dose” of exercise–thirty minutes of brisk walking three times a week–patients who worked out did just as well as those who took the medication. Strikingly, though, the patients on Zoloft were about three times more likely than exercisers to become depressed again over a ten-month follow-up period.

There are now over a hundred published studies documenting the antidepressant effects of exercise. Activities as varied as walking, biking, jogging, and weight lifting have all been found to be effective. It’s also becoming clear just how they work. Exercise changes the brain. It increases the activity level of important brain chemicals such as dopamine and serotonin (the same neurochemical targeted by popular drugs like Zoloft, Prozac, and Lexapro). Exercise also increases the brain’s production of a key growth hormone called BDNF. Because levels of this hormone plummet in depression, some parts of the brain start to shrink over time, and learning and memory are impaired. But exercise reverses this trend, protecting the brain in a way nothing else can.

4. Sunlight Exposure

Says Ilardi:

A deeper link exists between light exposure and depression–one involving the body’s internal clock. The brain gauges the amount of light you get each day, and it uses that information to reset your body clock. Without light exposure, the body clock eventually gets out of sync, and when that happens, it throws off important circadian rhythms that regulate energy, sleep, appetite, and hormone levels. The disruption of these important biological rhythms can, in turn, trigger clinical depression.

Because natural sunlight is so much brighter than indoor lighting–over a hundred times brighter, on average–a half hour of sunlight is enough to reset your body clock. Even the natural light of a gray, cloudy day is several times brighter than the inside of most people’s houses, and a few hours of exposure provide just enough light to keep circadian rhythms well regulated.

5. Social Support

I can’t count the number of studies I’ve read indicating the importance of social support. Recently Rick Nauert posted the results of a recent University of Michigan study on how gossip does us good. University of Michigan researcher and lead author of the study, Stephanie Brown, said: “Many of the hormones involved in bonding and helping behavior lead to reductions in stress and anxiety in both humans and other animals. Now we see that higher levels of progesterone may be part of the underlying physiological basis for these effects.”

Ilardi writes:

The research on this issue is clear: When it comes to depression, relationships matter. People who lack a supportive social network face an increased risk of becoming depressed, and of remaining depressed once an episode strikes. Fortunately, we can do a great deal to improve the quality and depth of our connections with other and this can have a huge payoff in terms of fighting depression and reducing the risk of recurrence.

6. Sleep

Again, amen! Per Ilardi:

When sleep deprivation continues for days or weeks at a time, it can interfere with our ability to think clearly. It can even bring about serious health consequences. Disrupted sleep is one of the most potent triggers of depression, and there’s evidence that most episodes of mood disorder are preceded by at least several weeks of subpar slumber.

For More Information About Depression:

  • Depression Symptoms
  • Depression Treatment
  • Depression Quiz
  • Depression Overview

6 Steps for Beating Depression

How Highly Successful People Deal With Depression

In the last piece, a handful of psychologists weighed in on whether the super-successful C-suite crowd may suffer from depression disproportionately. And they seem to, for reasons that are counterintuitive, but pretty logical once you think about them. The related issue is how highly-successful people deal with their depression when it does strike – do the types of traits that help a person attain uber-success in the first place – i.e., motivation, stick-to-itiveness and resilience – also enable one to fight depression better? There are two opinions on this. Some say, “no,” since depression strips away those qualities as soon as it strikes, wiping out the very coping mechanisms needed to recover. “When the noonday demon strikes it wipes out all resilience and perseverance,” says Todd Essig, psychologist in New York City, and Forbes contributor.

Others disagree, arguing that very successful people have larger reserves of resilience and motivation to begin with, and that these qualities remain at least somewhat more intact when depression strikes. So let’s consider this: There are some ways in which the super-successful may have a leg up when it comes to recovering, and these qualities are worth paying attention to, and perhaps even learning from.

They develop a GOAL with therapy

Many people go to therapy with the foggy notion that they want to feel better – but they aren’t exactly sure what that looks like, says Richard Taite, founder and CEO of Cliffside Malibu treatment center, who has dealt with major depression himself, particularly in his own early days of sobriety. Taite knows from personal experience, and from seeing countless heavy hitters come through the treatment center, that one of the biggest differences in whether therapy is successful or not is whether a person outlines his or her goals before they go to therapy, or very early on in it. The power crowd is used to outlining goals, and therapy is no different, he says. “Don’t just be in therapy,” says Taite. “You have to find the psychologist who’s not only well-meaning, but actually has the ability to get results you want to get. And, you have to know what it is you want before you go in.

“Figure out what you want: You want a loving relationship with your wife, to really take each other in, and breathe each other in? You want a good relationship with your children; you want to be at peace; you want genuine happiness? You can’t be in the victim position. That’s the most disempowering place you could be. You have to take care of your own side of the street. For a long time, it’s little wins, little wins, little wins – and then all of a sudden, you realize you’re changing, and you start to know how to act when depression hits. When you get in that space, you recognize it, and you know how to identify what’s going on, and move out of it.”

They’re willing to “go there”

Funnily, when the super-successful come to grips with the fact that they’re going to have to delve into their pasts and figure themselves out, they’re often totally down with it. “I’m a psychoanalyst,” says Deborah Serani, psychologist and author of the award-winning book Living with Depression, “so we understand that well-being isn’t just about this moment, but you have to look at arc of a person’s life – you have to go back to early experiences. I find the big difference in the affluent individuals – they’re ironically more eager to explore that area than others who may not have means. It’s kind of like using the narcissism in a good way. Like, ‘we’re gonna talk about me? Great!’” And once they really start to do this, to think more deeply about their pasts and presents, it usually works out pretty well in the end.

They learn to develop meta-awareness of any situation

Exceedingly successful individuals are usually exceedingly intelligent, so when they stop self-sabotaging (and they are often very good at that, too) and start thinking about themselves and their lives in new ways – à la therapy – it can have powerful effects.

Taite, who says he’s had lots of therapy over the years, has learned how to identify triggers for depression as soon as they start. Which can keep him from spiraling into a days-long depressive episode. He’s also seen similar changes in the hundreds of his high-functioning clientele. “I’m the most therapized guy I know,” says Taite. “I’m in therapy 4 hours a week. I’ll give you an example of how fast it works now. When my wife and I are fighting, it usually has nothing to do with my wife and me. It’s because my parents are in the f*cking room and her parents are in the f*cking room. So really there are six people in the f*cking room. So what my wife and I are really fighting about is ancient stuff. If we can just get the other four people out of the f*cking room, then we’ll be able to deal with what’s actually going on.”

In other words, when past traumas creep back up and overwhelm you, you can fall back into a child-like place. “If something that is a four, rises to the level of a 10,” says Taite, “and is absolutely flooding you, then you know you’re ‘in your child,’ because if you were ‘in your adult,’ you would experience the four as a four. “ Knowing how to immediately identify when old traumas flood back, and how to pull yourself out of the situation, can prevent against a days-long (or longer) relapse.

They learn the dose of treatment that works for them

Taite points out that when it comes to recovering from depression, you have to figure out the best combination of therapies – sometimes it’s psychotherapy alone, sometimes it’s medication, and sometimes it’s both. Or maybe it’s other methods. And then you have to figure out, along with your therapist, what will work for maintenance – and it may have to be tweaked every now and then. “You start with a couple or a few sessions a week, depending, and, then you titrate back,” says Taite. “I’ve tried one session a week for myself; it doesn’t work. I like three for me and one for us – my wife and me. That’s the dose that’s most effective.” Not everyone may have the luxury of three or four therapy sessions a week, but if you can put as many “treatments” into a week as you can – therapy, running, knitting, journaling, meditating, praying – that will set you up well for recovery.

They don’t see depression as a personality flaw

Any psychologist you ask will tell you that depression isn’t about a person being weak or flawed – it just happens, and it takes a lot of work to recover. “With depression,” says psychologist Arnold Washton, of Compass Health, “there are some people for whom biological factors appear to be overwhelming. They respond so well to medication or to TMS that it seems to be almost wholly biological. For other people, they’ve suffered a series of blows and losses, so it’s more psychological. But no disease has a singular cause: Just like the idea that pneumonia is pneumonia is pneumonia is inaccurate in medicine, it’s also not the case with depression.” Whatever the cause of your depression, it’s easier to recover when you view depression as a true disorder, rather than a shortcoming.

“These are people with egos that can withstand a lot, says Constance Scharff, Director of Addiction Research at Cliffside Malibu. “At least with people I’ve spoken to, they’re more concerned about addiction because it’s a ‘sign of weakness.’ That’s not the case with depression. Their attitude is, ‘Would you criticize me for having diabetes? No.’ If you beat them up for a mental health issue, you’re going to get a lion back. They have different personalities than the average person.” Luckily, as more people come forward with their personal battles, the stigma is dissolving.

They own the “fake it till you make it approach”

Once a person admits he or she is depressed and commits to recovery, the “fake it till you make it” approach can be helpful in overhauling negative thought processes. “We know from research that negative thoughts are a huge part of depression,” says Serani, “so recovery, then, requires an overhaul in thinking. Learning how to stop the loop of negative thoughts and reframing them to realistic, positive ones is the goal. One can achieve this by identifying the corrosive thinking (I’m never gonna get this account, who am I kidding?) challenging it by defusing its logic (No, wait a minute, I’ve been successful before. In fact, more times than not), and then replacing it with by grounding it in reality… If an uber-professional wants to “Fake it till you make it”, it can be helpful if they’re *not* in denial of their depression. Otherwise, it can spiral toward serious, life threatening levels if untreated depressive symptoms are ignored.”

She adds that people in highly competitive business arenas may be particularly endowed with this capacity, since they are used to problem-solving on the fly. But as for anyone, getting help to replace old, negative thought processes with newer, more positive ones is an important first step in treatment.

They figure out that a better way actually does exist

This is probably the most critical point, for any piece on depression, and for any person who’s depressed: Before you can get treated for depression you have to know that you’re depressed. But as simple as that sounds, it can be easier said than done. You first have to realize that there’s a better way to go through life. Many times, it takes a wakeup call like a trauma or a momentous event like the birth of a child, to make you realize that life doesn’t have to be blah, or worse, all the time.

“Most people are just unaware,” says Taite. “I used to get out of the car to look at street signs. I had my windshield replaced; I had my headlights souped up, and I still couldn’t see. People kept saying to me ‘you need glasses.’ I finally went to an eye doctor; he said, ‘so how long have you been walking around blind?’ How was I supposed to know? If you don’t know anything different….if you walk around not knowing that you’re blind, the only way you know is by getting woken up to it – for me, it was being a drug addict and self-medicating for 20 years. If I hadn’t found a joy for living when I did – my wife and my children – I was going to continue self-medicating. Sometimes it takes something really horrible to wake you up. Or something really wonderful, like the birth of a child.”

* * *

Scharff, who herself has dealt with major depression over the years, adds that it doesn’t have to be a major life event that shows a person that there’s a better way – sometimes it just takes paying attention to the little things throughout the day that give us a glimpse of another way. “The human state of being is not miserable,” she says. “It’s also not joyful and leaping over the bushes – it’s somewhere in between. If you feel bad for more than half the day you should get help. And it doesn’t have to be a momentous event to wake you up – I think there are moments throughout day or week that for some reason we can hear it. In recovery, we call them moments of clarity. I’ve had people say to me at times in the past, ‘You need help.’ And I didn’t hear it. But then someone says it at just the right time, and you GET IT. If you love someone with depression, just keep saying it. They won’t hear it, and they won’t hear it, and they won’t hear it. And then all of a sudden, they hear it.”

WATCH: Goldie Hawn On Mastering The Art Of ‘Happy’

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