Depression Part 4: Just do the little bit that you can.

Part 1: Is It Depression?  Part 2: When Depressed   Part 3: Nurture Yourself Back to Life

Part 4:

Exercise: We’ve been told so often that we must exercise, that now we may hear it as a burden. Who can carry any more burdens when severely depressed? Who can go lift weights when it’s a struggle to get the bathroom and brush their teeth? But exercise is not supposed to be horrible. You can’t go wrong if you focus on exercise primarily as a way to make your body feel a bit better. It’s not some kind of punishment for resting, or for eating, or for existing in a body of any shape or size. It does not have to be within a contest. It is not a “cure” for mental illness, though it can help to improve your mood. It is an activity your body can like if done in a pleasant, kind way!

I often suggest to clients that if they are too exhausted to go to the gym or whatever their preferred exercise may be, just walk around the block. If that is still too much for right now, then just go outside and walk around the house and back in! Just do the little bit that you can.

There are very few texts that “get” how to approach exercise when you’re experiencing severe depression, but this excellent article really helps when you need to ramp up from zero: “Depression-Busting Exercise Tips For People Too Depressed To Exercise” (Sarah Kurchak)

Social Interaction: Maintaining social interaction can be a tricky aspect of depression. You need some level of social interaction to help stabilize your emotions and keep you woven into reality. If you are in a marginalized group, it is especially important to have supportive others to validate your experiences and keep you feeling sane, cared for, and safe. However, there is a HUGE difference between how much social interaction you need if you are more extroverted versus the amount you need if you are more introverted.

Extroverts can more easily harness the power of friends and family to help recover from a depressive episode: being around others will energize you and give you a bit of motivation. It’s straightforward. Seek out others to talk to daily and if possible, to see in person. It may be hard to ask for help, but see if you can ask for help with something simple. This could be something like dishes, child care, or taking you to the grocery store. You can also just ask someone to watch a movie with you or go for a walk. Ask several different people to do several different things. Being able to be in supportive company will be very useful in your recovery.

Introverts, however, may have a harder time with this. Since interacting with others can drain you of energy, you may need to be choosy about whom you contact and how you interact with them. It’s still a good goal to speak with another human at least once a day. But it’s okay if this is just talking to a friend on the phone, getting your change from the clerk at the corner store, or even calling a help line. If you have the energy to tolerate having someone in your space, it’s good to ask a friend for a little help. But make sure it’s someone who understands your limits and does not expect you to be entertaining or emotionally fulfilling to them. You can offer that later when you are not in a depressive episode! If it is still very hard to see people or even to just talk on the phone, you can start with just texting or emailing with someone(s) daily. But try not to let a day go by without communicating with others. And keep doing it.

Furthermore, you may also be considering medication.

Medications: There are a lot of non-medical things you can do to manage your depression, and medication is certainly not mandatory. However, medications can be a useful part of managing depression. They will not make you immune to sadness, but if you are especially low or “flat” or suicidal they may pull you up enough to get to your self-management.

Other people in your life may have a lot of strong opinions about medications, but this is your decision, not someone else’s. If someone tells you that you should take medication but you don’t want to, you do not have to. If someone tells you that you should not take medication but you want to try it, you may try it. That decision is between you and your physician, and you need to do what will help YOU to recover.

Most antidepressants and anti-anxiety medications are prescribed by people’s primary care physicians, though often your PCP will require that you are also seeing a therapist if they are to prescribe psychoactive medications. A psychiatrist can address more complex psychoactive medication issues than your primary care physician. A psychiatrist may be necessary if you have resistant depression or other mental health issues, such as hypomania or psychosis. It may take up to three months to get an appointment with a psychiatrist, since they are in short supply everywhere. So if you think you may want a psychiatrist, don’t wait to start looking.

Now you have stabilized yourself as best you can! You have examined the four crucial life aspects influencing mental health (sleep, nutrition, exercise, and social interaction), you have considered whether you’re interested in medication, and you have begun doing what you can to develop a healthy rhythm in those areas.

For today, you are doing the little bit that you can. And you will keep doing it. It’s very hard to manage your mood at all when even one of these aspects is disrupted, so stabilizing them all is the basis of recovery.

Next part: Emotional Aspects: Mood Management

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Just do the little bit that you can. And keep doing it.

 

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A Peaceful Meditation Day to All!

The physical and health benefits of meditation have been noted for years and repeatedly validated by science. You don’t have to switch to an entirely new lifestyle in order to practice meditation! There are many ways to begin practicing, a little at a time.

Many people with anxiety do very well with the structured approach taken by Headspace (Andy Puddicombe). With simple graphics that clearly explain physical, cognitive, and emotional aspects of meditation, you will find the process easy to understand and implement. Even if you do not get a subscription and only use the first sessions that are free, it is well worth a look:

Another meditation tool that many clients report being highly satisfied with is Insight Timer:

And if you’re ready to go a little deeper into the emotional aspects of meditation, I highly recommend anything at all by Tara Brach!

 

Yoga Through the Lens of Western Science

Our physical, emotional, and cognitive aspects are interconnected and interdependent. This is the case whether we use a psychodynamic approach or a cognitive-behavioral psychological approach. If we are experiencing (noticing) dysfunction in one area, the whole system is actually affected. The good news about this is that by changing things in one aspect, we can affect other aspects as well.

This does not mean that we can simply “think away illness” or that if we can exercise “perfectly” (whatever that would be!) then our thoughts and feelings will just “snap out of it” into rationality and/or bliss. What it does mean, however, is that when we gradually move our habits towards health and balance in one aspect, the other aspects will also move more towards health and balance.

That means when behaviors become healthier, thoughts and feelings become healthier. When thoughts become healthier, feelings and behaviors become healthier. When feelings become healthier, behaviors and thoughts become healthier. A change in any one of them changes all of them!

When we consider the interconnected areas of behavior, cognition, and emotion, the most easily and directly influenced aspect is behavior. We can change what we do, which can help to change what we think and how we feel.

Remember, with any behavior change, the idea is not instant change, but rather successive approximation: doing things a bit more like the goal behavior, and then when that sticks, we do it a bit more like the goal behavior. Attempting drastic changes is less likely to create long-term change than creating and conditioning gradual habit change.

This really interesting clip discusses some ways in which developing–for example–a yoga practice can influence not only thoughts and feelings but also our bodies down to the cellular and chemical level:

 

Depression and Mood Screening Clinic 2/28-3/1

 

Wondering if you have depression or a mood disorder?

Give us a call or email to set up an appointment with one of our caring mental health professionals for a brief screening during our depression and mood disorders screening clinic.

Depression can be treated–it’s not “laziness” or a character flaw!

Give yourself a chance to be involved in your own life (and enjoy it more)!  ❤

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Checking In With Yourself

When you’re feeling really depressed, upset, or anxious, it can be hard to come up with ways to understand what is happening with yourself, let alone what to do about it. Even the most basic self-care can be hard to remember when your executive functioning is down.

This is a very helpful list to have handy for those times when you are unable to generate the energy to remember how to support yourself:

 

Depression Part 3: Nurture Yourself Back to Life

Part 1

Part 2

Part 3: Physical Aspects–Sleep and Nutrition

It can be very hard to take care of yourself even at the best of times, especially if you have a trauma history. And when you’re depressed, it can be even harder to take care of yourself. You might feel too drained, sad, and even unworthy of care. But this is exactly when it is most important to take care of yourself, even if you can only do a little bit.

Just do the little bit that you can. And keep doing it.

First, stabilize your physical aspect as best you can. The four most crucial mental health needs of your body are sleep, nutrition, exercise, and social interaction. You may also be considering medication.

Sleep: regular sleep is probably the single most important thing your body needs to maintain mental health. If you have been skimping on sleep in order to get things done, you may need to let a lot more tasks go in order to recover. The purpose of sleep is to release toxins from your brain cells. If you are not getting enough sleep, then you are intoxicated, and not in a fun way–your brain is poisoned. Start developing a sleep routine that is as regular as you can make it, close to the same time every night.

If you are struggling with insomnia, the insomnia needs to be addressed so you can get the sleep you need. It’s not uncommon for depression or anxiety to remit simply by getting your sleep stabilized. Don’t use alcohol as a sleep aid: alcohol is not only a depressant, but it also interferes with sleep cycles, so it can worsen sleep problems.

If depression is causing you to sleep too much, it may be most useful to first address other physical aspects of depression before trying to cut down on sleep. Besides, is it actually “too much”? You may need extra sleep for the time being. If it feels like you are convalescing from an illness, that is because you are.

Nutrition: Your body needs fuel in order to operate physically and mentally. Your mood will be worsened by hunger, even if you are not feeling the hunger. At least get a bit of  protein and some complex carbohydrates. If your appetite has dropped and you are having trouble eating, or caring about eating, then try having something like Ensure, or chocolate milk, or kefir on hand – it can be easier to drink something. If you can eat a little something a few times a day, even if not your usual meals, it will help you not to sink further into depression.

When you’re feeling up to it, treat yourself nicely when you eat. It can be comforting. It may be you’re just eating condensed soup sitting on the couch, but see if you can eat it from your favorite bowl. Or try eating something that reminds you of childhood in a pleasant way.

When you have regained enough energy to attend better to your meals, you can get back to what you would normally eat, but for now it’s okay to just eat something.

If you are suddenly eating a lot more than you normally would, try to be gentle with yourself. There is a reason you are doing this–you feel bad!–and it’s not worth harshly criticizing yourself. Indeed, you will make yourself feel worse and it might compound the issue. Remember the important thing is to fuel yourself and restore your balance overall, and do so gently. The goal is not to sternly restrict. That may backfire.

 

Next: Part 4: Crucial Needs–Exercise, Social Interaction, Medication (?) / “Just Do the Little Bit That You Can”

Depression Part 2: When You’re Depressed

Part 1

Part 2:

Recognize Depression: Depression often creeps up gradually and may affect you for a while before you realize what is happening. What effects do you usually experience? Are your symptoms usually physical, emotional, or cognitive, or a combination? Exhaustion, achiness, overwhelm, lack of motivation, negative thoughts, suicidality? (See Part 1.) If you have a better idea of your own symptom profile, you will be able to catch a depressive episode sooner when it occurs.

It is often a great relief simply to realize why you’ve been feeling bad. Also, it can be encouraging to remember that most depressive episodes remit within two weeks even without intervention!

Accept Depression: Depression can be tricky because we often have a belief that if we recognize what’s going on, we should be able to “snap out of it” by some act of will. While it’s good to try some things you think might help you feel better, the process is healing rather than fixing. You are an organism, not a mechanical device. It may take some time to get through the healing process.

Most people feel impatient about this, because depression interrupts whatever else you’re trying to do with your life. That’s the part most people have a hard time accepting. But depression is a real thing that really affects people on many levels, so work on accepting how your feelings and your functioning are affected. Then you can better decide how to address it.

Beating yourself up for “feeling bad for no reason” or “not getting enough done” will only make things worse! It may be that during some depressive episodes you will  feel bad “for no reason” or that you may not get as much done as you want to. That’s what happens during depression. You can do many things to support your healing, but you can’t just decide to not have depression.

Most people experiencing depression–even severe depression–are mostly functional in some life areas, which can lead to denial or minimization. “They must not be very seriously depressed, I just saw them laughing and joking at a party,” or “I can’t have severe depression since I’m able to work 12-hour shifts on a busy floor.”

Functionality varies from situation to situation and from day to day. You can be functional in one or more life area, or appear “okay” to others. That doesn’t mean the depression isn’t real or isn’t serious.

 

Depression Part 3: Nurturing Yourself Back to Life

 

Depression Part 1: Depression and Functioning

Because we often think of depression as “lying on the couch crying,” many people don’t recognize what they’re experiencing as depression, especially if they’re high-functioning or have “smiling” depression.

But the most prominent and common symptom of depression I see is a lack of motivation. It can be anything from “I don’t care about anything and I don’t want to do anything” to “I’m too exhausted to do even the smallest thing” to “I want to do this one thing and somehow I just…don’t.” It’s also very common to function well at work, only to “fall apart” off the clock.

While actual proportions vary from person to person, few if any depressed people look like the “just sad” stereotype. A graphic in an article by Anna Borges depicts the discrepancy:

 

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It makes sense if you think of what “depress” means: to push down. Depression pushes down your physical, emotional, and/or cognitive functioning, in any combination.

If your physical functioning is depressed, you may feel exhausted and achey or move and speak more slowly than usual (often without realizing it). You may experience sleep difficulties.

If your emotional functioning is depressed, you may feel low, sad, hopeless, pessimistic, guilty, or even strangely flat, empty, and detached.

If your cognitive functioning is depressed, you may have difficulty concentrating, planning and implementing anything, or trouble with memory. The “planning and implementing” piece is the brain’s executive function. This is where the motivation problems come in, and why a person experiencing depression can’t simply “snap out of it” and “motivate.”

Also in terms of cognitive functioning, you may generate a lot of irrationally negative thoughts (and you may believe them uncritically), or have thoughts of death or suicide. It’s especially important to recognize that suicidal thoughts, while scary, are a symptom of depression and usually diminish when depression improves, so seeking help with depression is important.

 

Next:

Part 2: When You’re Depressed

Bedtime Panic Attacks

It’s pretty common for people going through stressful periods to have panic attacks just as they fall asleep or even during sleep, after having managed anxiety successfully during the day. This is because our psychological defenses and coping strategies drop away as we fall asleep, leaving anxiety symptoms free to rise. This can result in anxiety dreams or even panic that wakes you up.

While there is no way to “erase” anxiety, allowing yourself to experience the anxiety in a safe, mindful way during waking hours can help to minimize bedtime panic attacks and allow you to sleep better.

Specifically: allowing yourself to feel the anxiety until it passes, while–for example–talking to a trusted friend or your therapist, journaling, or just crying, can be a relief.

Moderate cardio exercise can also help in that it uses up excess cortisol, which triggers panic attacks. (However, don’t exercise right before bedtime as that may wake up your system and lead to insomnia.)