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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Acceptance: Making People into Trees

Ram Dass (Dr. Richard Alpert) expresses acceptance of self and others with a beautiful metaphor:

 

“…when you go out into the woods and you look at trees, you see all these different trees. And some of them are bent, and some of them are straight, and some of them are evergreens, and some of them are whatever. And you look at the tree and you allow it. You appreciate it. You see why it is the way it is. You sort of understand that it didn’t get enough light, and so it turned that way. And you don’t get all emotional about it. You just allow it. You appreciate the tree.

The minute you get near humans, you lose all that. And you are constantly saying “You’re too this, or I’m too this.” That judging mind comes in. And so I practice turning people into trees. Which means appreciating them just the way they are.”

Remember, emotional and cognitive skills take practice just as physical skills do. Many of us have years or decades of practice in thinking destructively and judgmentally! So practice a little self-acceptance today, and then again tomorrow, and the next day…

 

Self-Care: It’s Okay Not to “Optimize” Yourself

Many people have been making New Year’s resolutions, and some are even sticking to them! For most people, however, they won’t last very long.

It’s completely valid to want to make changes to yourself and to your life, but pay attention to what you are telling yourself in the process. You may be telling yourself that you will finally be acceptable if you can meet your goals. The “if” lets us know that if we don’t meet our goals, we are not acceptable. We often believe (consciously or not) that there are only two choices: exceptionally fantastic, or…crap. (To state it plainly.)

Guess what? You are already acceptable! You are wonderful and miraculous! Yes, even on your bad days.

The idea that you aren’t good enough unless you are the best of the best is an expression of perfectionism, and perfectionism is a life-killer, a progress-killer, a killer of the good. We seek progress, not perfection.

Instead of telling yourself that you “must improve,” try the dialectical approach:

“I am already acceptable as I am, AND I would like to try doing this a different way to see if I like that better.” (No “buts” allowed!)

This makes it clear that it is a choice you are undertaking, rather than a “should.” Also, it is a way of making a choice to try change but without browbeating, judging, and criticizing yourself–all things that, ironically, make change much more difficult.

If you accept yourself as already okay, then you are free to try changing things all year around, as the opportunities present themselves. But–this is key–you don’t have to “improve” yourself in order to be acceptable.

While we’re here talking about accepting yourself, here is a great article about expressing your vulnerabilities:

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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: