LIVING WITH DEPRESSION

 

Winston Churchill called it the Black Dog, others feel it as an emotional black hole, and William Styron described it as “a darkness visible.”  It has many names, but each person who has lived with depression knows the experience too well.  However, most people don’t know its name, or that 80 % of those treated improve within two months, or that it is a widespread malady, sometimes referred to as “the common cold of psychology” (a misleadingly weak analogy). 

Mild symptoms can be a “blue mood,” sluggishness, discouragement, crankiness, and other unpleasant states that are not debilitating and often pass within a few days or weeks.  (If you’re saying to yourself, “I’m like this all the time,” you may be living with Dysthymia, a chronic, mild to moderate depression that can persist for years and feel “just normal”—and which can be treated.)

Abraham Lincoln has spoken to the experience of moderate to severe depression:

 

I am now the most miserable man living.  If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth.  Whether I shall ever be better, I cannot tell.  I awfully forebode I shall not.  To remain as I am is impossible.  I must die or be better it appears to me.

 

Although his words may seem maudlin to our modern ears, anyone who has suffered severe depression knows the painful reality he describes.  He also alludes to the tragedy of suicide, which according to national data, occurs 80% of the time during depressive episodes.  (This is not to say that 80% of severely depressed people commit suicide.)

Common symptoms of serious depression can also include significant weight loss or gain, insomnia or hypersomnia, self-hate, agitation, lethargy, hopelessness, and poor concentration.  The definitive experience may be what is called anhedonia, the loss of pleasure, of even those small joys we thought we could always count on. 

It is remarkable how many people continue to perform their work at high levels while enduring this state of being.  Still, depression has a profound effect on many of us and must be taken seriously.

While treatment, both psychological and medical, is usually effective and should always be utilized, for many people depression and its symptoms are not completely relieved.  And for all who have suffered clinical depression, they must be aware of their vulnerabilities—that is, the internal and interpersonal events that can trigger another episode.  The following suggestions are offered for these people, who must live more consciously to ensure their well-being.  Not surprisingly, what follows also turn out to be good guidelines for living a healthy, self-caring, and satisfying life in general. 

 

HEALTHY BASICS

 

Don’t be discouraged if you can’t get yourself to follow these suggestions fully or all at once.  If you could, you wouldn’t be depressed.  But in any small degree, and for any length of time, if you don’t have to force yourself—or even better, if you feel a desire to—try to integrate these behaviors into your daily life.

Exercise—It’s the best non-medical anti-depressant there is.  From making your bed to jogging, anything will help on a daily basis.  Reasonable weight lifting is also beneficial.  If you can find an exercise buddy or afford a personal trainer, this will likely make it much easier to stay consistent.  Any external positive motivation helps.  There is also evidence that the regular practice of yoga can help fight depression.

Eat Healthy (which does not mean dieting)—Reduce the amount of junk food you eat, but don’t overly deprive yourself.  You feel bad enough already; if you remove too much of the minimal gratification in your life, you’ll end up feeling worse.  Barring a medical condition, most foods are not immediately worse for you than being depressed. 

Sleep—The importance of sufficient and consistent sleep is sorely overlooked in our frenzied culture.  Your sleeping pattern may be your biggest challenge when depressed, but try to get at least 8 hours in each night (and for most people, not more than 10); try to wake up at the same time every day; and get as much light as possible.  If you sleep in a room with morning sun, keep the curtains open and let it help you waken.  Also, putting a bright light on a timer can help.  Light effects the neurotransmitters (brain chemicals) involved in depression.  People with Seasonal Affective Disorder (a specific type of depression) are clearly helped by photo- (light) therapy.

Play—Of all the suggestions here, this one may seem the most unusual, but in some ways it is the most important.  When depressed, all of life is work; simple daily tasks are chores.  The capacity for play seems lost.  Therefore, any play we can enjoy is crucial to our well-being.  Again, start with little things—a crossword puzzle, solitaire, throwing a stick for your dog to fetch—and move up to more social events, if you can, like board games with friends, dancing, or interactive sports.  Norman Cousins, in Anatomy of an Illness, writes of his use of laughter, from video to books, to help his body and spirit.

However possible, try to start the day with something you can feel good about:  yoga, stretching, a walk, preparing a meal, and for some, simply getting out of bed and showering. 

 

SEEK PLEASURE

 

The fact that many people will wince at this simple recommendation to seek pleasure points out how powerful the concept is, and how afraid of it our culture can be.  But for those for whom pleasure—simply feeling a little goodness, or comfort, or hope—is undependable and elusive, it becomes their greatest need.  Who could get out of bed with no expectation of satisfaction, reward, contentment, or even relief?  The ability to feel pleasure and the need for it are so profound that we take its presence for granted, and we fear its excesses.  But the depressed person must actively seek it in non-destructive forms.

Whether the morning or evening is your most difficult time, do your best to schedule whatever pleasurable experience you can into that period.  But make sure you differentiate as much as you can between numbness and true enjoyment.  Millions of people “zone out” in front of the television for hours each day, watching whatever comes on next.  This is not pleasure; it is mostly avoidance of life and passing time because meaning and purpose have been lost.  But a sitcom or romance novel or two can’t hurt; let yourself enjoy it until you can enrich your life with more substantial gratification. 

Be as proactive here as you can.  Wake up and/or fall asleep to pleasant music or soothing nature sounds. Take a calming bath.  Each day, try to schedule at least one thing you can look forward to.  (More suggestions are offered below.)

 

LISTEN TO YOUR FEELINGS

 

While it may sound self-centered, regularly monitor your preferences and level of enjoyment.  Notice if you are liking something or not, and how much.  Since depression can result from being emotionally abandoned, oppressed, suppressed, and/or abused, it’s important not to do these things to yourself by ignoring your own desires, feelings, and needs. 

Try to make your internal and external states as congruent as possible.  That is, when you notice that you are enduring some event, whether it is being with a difficult person or performing a joyless task, try to do something about it.  Often, we forget that we do have some control over our world and that life doesn’t have to be “this way,” even in the small things. 

 

BE AWAKE TO YOUR SENSES

 

Notice and use as many of your senses as you can to help yourself.

 

Sight—Get as much sunlight as possible; use light as your morning “alarm.”  Go for a walk in nature if you can.  Enjoy works of art or vintage cars … .

Scents—Bring pleasant fragrances into your life, whether in aromatherapy candles or the outdoors.  Smelling is the quickest route to the brain and there is evidence that scents can make neurological changes that help our mood.  Just the thought of baking bread or roasting coffee beans or a freshly split tangerine can awaken pleasure in us.

Touch—Whether you’re single or in a relationship, most people don’t get touched often enough, and there is a great deal of evidence to show how much we need it:  our immune system improves, along with our mood, and infants can’t survive without it.  Exchange massages with a partner or use a massage therapist.  Give and enjoy hugs.  Petting your cat or dog can lower your blood pressure, calm you down, and bring comfort.  And because libido is often low during depression, enjoy your partner’s and your own body when you can.

Taste—As with all your senses, learn to truly enjoy the experience but avoid the habit of trying to meet interpersonal needs in this way.  Food is certainly not love, but it can add to the joy and sensuousness of life.  Preparing and eating a favorite meal can be nurturing in many ways.  Flavors are so basic to human experience that they sometimes can uniquely connect us to our capacity for pleasure.  But more is not necessarily better.  In mindfulness meditation, one learns to slowly and thoroughly chew one bite of food and enjoy its multi-layered tastes.  This is a skill worth developing. 

Sound—Silence itself can be peaceful and satisfying; we are accosted by noises throughout the day.  Also be conscious of the sounds you’re exposed to and make them as pleasurable as possible.  Certainly music can be calming and uplifting, and lyrics can help us feel understood and less alone.  Some people also find environmental recordings, such as ocean waves or falling rain, quite soothing. 

 

BE AWARE OF OTHERS

 

For some it is easy to lose themselves in caring for family and friends, or doing volunteer work, but losing ourselves is seldom good and usually results from a lack of self-value.  However, conscious and moderate service to others can raise our spirits and remind us of our value.  There is no limit to the types of service one can perform. Start with causes or concerns that have meaning for you.  On a personal level, being a support to another distressed person can help you both.  Think of a few daily kindnesses you can offer to those around you.  If you have the energy, help someone with a physical task, and cooking for others is always appreciated.

 

ENCOURAGE YOURSELF

 

Bookstores have a good deal of self-help books, some of which can be shallow and ultimately discouraging, but there are many books from literature, psychology, philosophy, religion, etc., that can help to get you through a dark period—not to mention sacred texts from your own faith.  But don’t forget about other sources of comfort and strength:  Do you have gifts from people who have comforted and cared for you?  Keep them around you as reminders.  Religious icons and figures of personal meaning can also speak to us visually, without words.  Examples of courage and creativity in survival can be found in literature and biographies.  Abraham Lincoln, for example, endured severe discouragement, losses, migraines, and depression, but maintained hope and moved forward.

 

EXPRESS YOURSELF

 

The experience of depression is often to close in and close down, to lose contact with our spirit and body.  We may obsess on negative thoughts and not get past them. 

Physically—Put some sort of movement into your life, if it’s not already there.  There is no substitute for freeing up our spirit and getting out of our heads.  Whether you take an aerobics class, dance at a club or to a CD in your living room, or play basketball—try to do something. 

Creatively—All forms of art are about self-expression.  You don’t have to be trained or even good to benefit by trying your hand.  Don’t worry about realism or accuracy; concentrate on colors and shapes and movements; let them reflect and manifest what you feel, no matter how crude or silly you judge your creations.  Do you enjoy writing?  Poetry, short stories, or longer works may help you to express yourself.

Interpersonally—With one person at least, let your feelings show themselves, which is different than reporting your emotions in words.  If this is too threatening, psychotherapy can help with this.  Support groups are a great resource, as well. 

Privately—Keep a journal, not just to document your day, but to express your emotions, noticing them in the moment and figuring out where they’re from and where they lead.  Pay attention to your body states as well.  Sometimes others aren’t around when we need them, but we still need to express ourselves to know ourselves. A journal can help with this. 

 

USE YOUR MIND

 

Meditation—There are many forms of meditation and different reasons for practicing, as well, but most will help you to learn stress reduction techniques and will lead you to further understanding of yourself.  Just a few minutes each day can make a powerful difference in your life.

Dream work—Your mind can provide guiding wisdom through the dreams you have each night.  Whether you believe the source of this wisdom comes from a higher power, evolution, or the human spirit, it is there and it is a resource. 

Do Your Own Research—There are currently numerous sources of information on the causes and treatments for depression.  The internet has many good sites (and many not good ones, as well), and there is your local bookstore and library.  With your psychotherapist or psychiatrist you can sort through what you learn and experiment intelligently with what is relevant for you.  But remember that there is always more to learn, and you will never have all the answers, even if you’ve lived with depression for a long time.  

 

NURTURE HOPE

 

When your mood is dark and you have little capacity to feel pleasure, hope seems far way, and even gone.  But don’t let go, and let others—family and friends, support groups, your church or temple, your psychotherapist—hold onto it for you if necessary.  All of the ideas and suggestions above are offered to aid in sustaining hope, to nurturing it until it becomes a way of life, simply part of your background experience.  In your darkest moments, despite being certain of it at times, you are not truly not alone.  Remember this: