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Understanding and Conquering Depression

“The only thing more exhausting than being depressed is pretending that you’re not.”

Anonymous, Twitter

Depression-What it is and what it isn’t.

Depression is a common illness worldwide, with more than 264 million people affected. Peoples’ experiences and feelings can differ greatly from mood fluctuations to some feeling suicidal. Affected people can suffer greatly and function poorly at work, at school, or in their relationships. Suicide is the second leading cause of death in 15-29-year-olds. We know at some point, everyone experiences problems with irritability, sadness, or self-blame. Such responses usually don’t last that long. Clinical depression occurs when these feelings, along with a set of additional symptoms, become intense or remain for several weeks. With depression, mood symptoms interact with cognitive, behavioral, and physical symptoms. For example, people with depression report feeling sad, irritable, or hopeless. They may have thoughts of worthlessness, lack concentration, or ruminate about suicide. Behaviours may include a lack of motivation, restlessness, or social withdrawal. Clinicians will typically ask individuals about changes in their appetite, sex drive, energy, or sleep patterns. 

Depression can come in different forms.

Major Depressive Disorder – has occurred for a longer duration with declining interest in activities, appetite, sleep quality, and concentration that persist for most of the day, everyday. MDD can be treated successfully, in many cases, with a combination of medication and psychotherapy. 

Dysthymic Disorder is a chronic, milder form which has occurred for at least two years. Individual may feel that “it’s always been this way.” Low interest in activities, self-criticism and feelings of inadequacy may be particularly dominant.

Bipolar Disorder – the individual feels cycles of moods including depression, and mania (i.e. euphoric excitement) or irritability that can last a few weeks to several months. There are different types of Bipolar Disorder. If diagnosed with this disorder, ask your health care professional for more info on the type you are experiencing.

Seasonal Pattern Depression – people report depressive symptoms at certain times of the year characteristically in fall or winter and remit in spring. Younger people seem to be at higher risk for depression in the winter months. 

Postpartum Depression – postpartum can present with severe anxiety, and many feel especially guilty about their depressive feelings at a time when joy of having a new child is expected.

Premenstrual Dysphoric Disorder – women report depressed mood, decreased interest in activities or higher levels of anxiety which can impair functioning. 

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: Author.

What keeps the engine of depression running?

Negative Self-Talk. If negative talk constantly sends you negative messages and these become internalized, you can be more susceptible to depression. 

Poor Diet. Eating well balanced, regular meals is important in managing depressed mood.

Drug Abuse. Alcohol and other mood-altering drugs can depress us physiologically. A reliance on these substances contributes to people experiencing depression.

Sleep Difficulties. Poor sleep hygiene robs our energy and motivation needed to maintain our physical health and fully commit to helpful coping strategies.

Lack of Exercise. Exercise stimulates the production of endorphins in the brain as well as a cascade of physical and psychological benefits. 

Stress. Chronic stress depletes our energy level, making it more difficult to cope. Chronic stress decreases a sense of control which contributes to low mood.

Poor Social Support. We need support from people we trust. That supports helps us work understand our feelings, show me that I am not isolated and ready to make needed changes. 

Lack of Purpose and Goals. When I know more about my values, goals and abilities I can better plan on ways to make personally fulfilling contributions.

Strategies for Depression that work

Case Study: Debbie is a 39-year-old H.R. Manager for a small pharmaceutical company. She has suffered from low mood and the loss of both parents within a span of three years. She describes her work as very stressful and is co-parenting two teen girls. After consulting with her doctor, Debbie was prescribed an antidepressant medication called Sertraline (Zoloft) and was advised to attend either group or individual sessions of Cognitive Behavioural Therapy (CBT) sessions with a registered professional to help with symptom relief. At her sessions, her therapist advised her to do the following:

Accept full responsibility for her depressed mood. Debbie heard that taking responsibility leads to better controlling one’s self-efficacy. Slowly, Debbie was able to accept that recovery was the goal and would follow a step by step process. She began to take risks through experimentation like beginning an exercise program and walking with her girls regularly.  She began to recognize new ways of thinking about her stress through reframing instead of blaming and catastrophizing. Debbie found a group counseling program and received individual psychotherapy which was both validating and helpful. She developed a toolbox of strategies like stress reduction techniques and goal setting. She began to clarify her interests, values, and goal and further refine her recovery plan. She even began to consider taking some HR development courses at the local College. 

step by step

Case: Atul is a 25-year-old High School teacher who was referred to Change Works Interactive in the spring of 2019. At the time, Atul had met with his family doctor who suspected that he was experiencing symptoms brought on by bipolar disorder, a condition that had also impacted his mother for years. He was waiting for a psychiatric consult which was scheduled to occur in 2 months. In the meantime, Atul was prescribed Cipralex, an antidepressant, as well as Seroquel to help calm and control symptoms. Together with his psychotherapist, they worked on a mix of strategies. First, he was advised to take better care of his physical health; to limit alcohol use that in the past was used to help mask his symptoms. Atul started choosing to spend his spare time doing things that helped contribute to his happiness and wellbeing. For Atul, it was picking up his guitar which long since sat in the corner of his room. He walked his dog more frequently. He read more about the successful management of both depression and mania. He tried to recognize; even celebrate his successes.  Atul was coached to accept and expect setbacks to happen.  He was told these are normal with bipolar disorder and that he should try to remain focused on successful coping strategies. Atul came to realize that in the past, he was both hesitant and skeptical when presented with coping strategies that were a slightly anxiety-provoking or required effort. Shifting his attitude and skill-building activities were keys to success.  

Here’s a plan to help manage depression

Step 1: Take time to better understand yourself and your symptoms.  Do these symptoms primarily impact your thoughts, feelings, body or behavior?
Step 2: Take some time to think about the different factors that contribute to and maintain depression.  What factors are relevant for you?
Step 3: Take steps to implement strategies that people use to help themselves overcome depression.  See your health care professional for help.
Step 4: Choice one small goal for the upcoming week.  Record it. Find the motivation to stick with it and get it done.
Step 5: Every week, set small goals and record progress. and monitor your progress.  Give yourself permission if you need to alter your approach somewhat.
Step 6: Take credit for your success as you continue to set manageable goals.

“There is hope, even when your brain tells you there isn’t.”

John Green

Kevin Waldbillig

Kevin Waldbillig

Registered Psychotherapist, Director of Change Works Interactive