Depression

What is Depression?

First of all, depression is an illness, not a moral failing. People also do not choose to be depressed; who in their right mind would? Depression is a mental illness that robs us of our ability to experience joy, hope, excitement and nearly any other positive emotions. It also robs us of our ability to think clearly. It distorts our thinking and convinces us that there is nothing good about us or our life. In its worst form it can lead us down a path of nihilism, in which we start to question the very meaning and purpose of existence itself. (Feel free to check out my podcast episode on nihilism and depression on my Podcast page).

Depression can be very mental for some and very physical for others. Below is a list of the common symptoms of depression, straight out of the DSM-V:

1. Depressed mood most of the day, nearly every day (e.g., feels sad, empty, hopeless, or appears tearful; in children and adolescents, this may manifest as an irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (anhedonia).
3. Significant weight loss when not dieting, weight gain, or a decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day (which may be delusional and not merely guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective or observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

You do not need to experience all of these symptoms to have depression, in fact you only need 5 to be diagnosed. But even if you don’t have all 5, any one of these symptoms cans be debilitating.

Overcoming Depression

Treatment for depression varies depending on the individual and the therapist’s school of thought. In my mind, every person has their own specific experience that requires a tailored approach. That being said, there are a few commonalities that will be explored. Because of the vicious cycle of both negative thoughts and feelings, we will attempt to examine your negative thoughts and beliefs, while simultaneously looking at ways we can begin to make small behavioral changes to increase your mood and motivation.

Due to the compounding psychological and physical symptoms, overcoming depression can be a catch-22. You need to make changes to get through depression, but you don’t have the motivation to do so. If you’ve every struggled with depression before, you’ve probably heard the following advice from friends, family and even your therapist:

• Change the way you think
• Socialize more
• Get some sun
• Eat better
• Sleep better
• Try a new hobby
• Exercise

While the intention behind this advice often stems from a good place, the message comes across minimizing and sometimes even condescending. We all know we should do the things listed above, but it’s not so simple. Sure it’s easy to exercise when you’re waking up in a good mood, full of energy and motivation. But how do you do that when you feel drained, exhausted, defeated and hopeless? This is the crux of depression – now how do we escape it?

This is no easy task, but I think the first step is offer yourself some empathy and compassion.

Self-Compassion

As mentioned before, depression can come in many different flavors. Some people experience mainly physical symptoms; poor sleep, no appetite, low energy, low motivation, etc. Others experience a more “cognitive” depression; negative thoughts, hopelessness, doubt low self esteem, and sometimes even have thoughts of ending their life. These “cognitive” symptoms can be a huge barrier to moving forward. How do you simply “think positive” when all you can think of is negative thoughts.

Many therapists, particularly those who utilize CBT or Cognitive Behavioral Therapy, will encourage clients to challenge their negative thoughts. This exercise asks clients to analyze their negative thoughts and question the validity or “rationality” of their thoughts. For example if you think “I’m a loser and my future is hopeless,” your therapist might ask you to consider “what defines a loser?,” or “how do you know that your future won’t be positive?” While these questions are again often well intentioned and sometimes valid questions to ask, they often do little in the way of changing what someone believes or feels.

If you have ever been on the other end of one of these “thought challenging exercises,” you’ve probably felt they were dismissive and perhaps even insulting. Thoughts are not so easy to change, particularly when you can’t feel the intended positive emotion. This is why I believe the first step in your attack on depression needs to be self compassion, rather than trying to challenge your thoughts.

This may be easier said than done. Again, you may not feel you deserve compassion or empathy, because your depression is telling you what a worthless monster you are, but I want you to consider the following anecdote:

You’re waiting in line at your favorite coffee shop, when suddenly you hear some commotion coming from the front of the line. You see an angry customer screaming at the young cashier behind the desk “This isn’t what I ordered you f’ing idiot. You’re a worthless and useless piece of garbage. You don’t deserve to have a job!”

What would you think of these 2 individuals?

I’m going to bet my money you would feel empathy for the poor cashier and anger/disgust towards the bullying customer. You might even speak up and say something. That’s because when we see others being bullied, it is easy to spot, but when the bullying is internal, we don’t think twice about it. Try to consider that your depression is actually just an awful bully. This way, it doesn’t matter if you believe what he says is “right” or “true,” because even if it is, it does not justify talking to someone in this way. No one deserves to be bullied and we are certainly not going to allow ourselves to bully ourselves. We are going to try to treat ourselves with kindness and compassion. So, the next time your mind is telling you that you are worthless, instead of challenging your thoughts, try to simply offer an empathetic ear to yourself. We are going to try to treat the depression just like a bully. We are going to stand up for ourselves, just like we would stand up for someone we loved (or even a complete stranger) if we saw them being bullied.

Taking Small Steps

There are two main components of depression that must be grappled with; the mental and the physical. The mental deals with the emotional and cognitive struggles mentioned in the first segment of this blog. The physical component encompasses all those symptoms we experience in our body. There are a few very common physical symptoms that many experience; lack of energy, low motivation, irritability, increased or decreased appetite, increased or decreased need for sleep. These symptoms, along with the cognitive ones, can also lead to behavioral changes like withdrawal from friends/family and lack of engagement/interest in previously enjoyed activities. Because these symptoms are so pervasive and often feed each other, it can be very difficult to begin to make changes in the way you act and the way you feel.

Recall earlier when I listed those “must-do’s”; exercise, eat better, socialize more, etc. While on the surface these are generally good advise, the problem is that the symptoms of depression don’t make these easy. This is why it can be so frustrating when people tell you “just gets outside more!, or “exercise makes me feel better!” The intention is positive, but the advise is detached from the experience of the depressed person, and doesn’t offer much help in how to actually explaining how to begin to do these things.

Think of the last time you were very sick or physically injured. Perhaps you had a bad case of the flu or were recovering from a broken bone. What were your expectations of yourself? Generally speaking, we tend to be more understanding of our limits when our barrier is purely physical. If we’ve broken our leg, we don’t expect ourselves to go for a 5 mile run. If we have the flu, we remind ourselves that we probably won’t get all the cleaning done today that we expected. Of course, there are exceptions to this and sometimes we still may be disappointed or frustrated in ourselves for our lack of productivity, but for the most part we give ourselves a bit more grace.

Perhaps this attitude is what can help us when we are depressed. For a moment, put aside your belief that depression is your fault, and consider that maybe, just maybe, this depression is the result of something occurring in your brain, and out of your control. After all, I think it is fair to say no one wants or asks to be depressed. If this is true, then perhaps we can allow ourselves to lower our expectations for ourselves just enough that we can start to set reasonable and achievable goals. Goals, that if met without any disappointment, could actually make us feel like we are being productive and doing something positive.

If you wake up in the morning and are immediately hit with that heaviness of depression, feeling like you can’t do what you used to be able to do, ask yourself instead “what can I do?” No matter how small. Maybe you can’t do a full hour workout in the gym, but can you take a 10 minute walk around the block? Perhaps you have your entire sink filled to the top with dirty dishes and you can’t possibly do all of them. Could you put a timer on your phone and do 5 minutes and see how you feel? These might sound meaningless or “not good enough,” but the reality is if your expectations remain the same while your body and mind is not in the healthiest state, you will only frustrate and disappoint yourself. So instead, try to be honest with your current limits, set your expectations low enough that you can succeed, and try to appreciate the progress that you are making.

This obviously only scratches the surface of what depression is and what it will take to overcome it. Together, we will explore the depths of what makes you who you are, and how your experience of depression impacts your life. I also would like to note here that while I am not a psychiatrist, I can also help refer you to one if your interested in adding medication to your treatment plan. Depression can be a powerful force and there is no shame is getting all the help you can get so you can get your life back.