Help Yourself out of Depression

Experts give advice about steps people can take to help ease their depression.

From the WebMD Archives

Recovery from depression can be a long process. A variety of treatments for depression exists, but they may take time before an effect is noticed. Weeks, if not months, may pass between the time when you see a health care provider about depression and when your mood starts to lift.

While some improvement may be seen after starting antidepressants, they can take at least three weeks to start having an effect on your mood. What's more, the first medication or combination of medications you try may not work for you; in that case you'll have to start over.

In the meantime, there are things you can do, as well as things you can avoid, to help yourself feel better, or at least keep from sinking deeper into depression.

You are somewhat responsible -- but not entirely responsible -- for your state of mind, says psychologist James Aikens, PhD, an assistant professor of family medicine and psychiatry at the University of Michigan.

"You're not responsible for being depressed. Your responsibility is to make some reasonable efforts towards feeling better," he tells WebMD.

Baby Steps

When you are deeply depressed, you may not feel like doing much of anything or being with anyone. But rather than hiding out and doing nothing, it's best to be active, even though you may not want to.

Ask yourself, Aikens says, "not what do I feel like doing, but how much am I capable of doing?" But don't overreach, or else you may end up feeling worse if you don't accomplish what you set out to do. "Aim for 80% or 90% of that goal," Aikens says.

"The tendency to take on overly ambitious goals right away is actually quite common in people who are depressed," says Dan Bilsker, PhD, a clinical assistant professor of psychiatry at the University of British Columbia in Canada. Bilsker co-wrote a self-care guide for people with depression that is freely available online from the university's Mental Health Evaluation and Community Consultation Unit.

Don't assume you will be able to leap out of depression and turn your life around immediately. "Start with some very small, detailed, specific goals," Bilsker tells WebMD.

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Break tasks into smaller ones that you can accomplish more easily. For example, maybe you haven't collected your mail for a while, and you know there is a stack waiting for you. One day, you might make it your goal to simply pick up the mail, and no more. The next day, you might sort it: Separate bills, letters, junk mail, etc. The following day, you might toss the junk mail in the recycling bin and open the bills, but not pay them. The day after that, pay one bill. Then pay two more the next day, and so on.

"So not only break it up, but spread it out," Aikens says.

Reactivate Relationships, Interests

If you've withdrawn from the social arena, you should take small steps toward getting back into it. Don't expect to show up at a party and command the room, but do try to get out and see some people. Meet with someone briefly for coffee, or maybe drop in on a friend to return something you borrowed.

It can help to talk about your problems with someone close to you. "I urge daily contact, at least over the telephone, with a confidant," Aikens says. This person should not act like a therapist. He or she needs only to listen. It shouldn't be someone who might make you feel worse by getting irritated with you or giving you harsh advice.

A support group may help, too. Joining one, says Lea Ann Browning, a spokeswoman for the National Mental Health Association, based in Alexandria, Va., need not be a long-term commitment. "A lot of people can benefit from a support group for six or eight weeks," she tells WebMD.

Also think about things you used to enjoy or find satisfaction in doing, but no longer do. Starting with small steps, begin to get back into doing them.

"Don't expect to enjoy it to begin with," Bilsker says. Like taking your medicine, do it because it's good for you.

If, for instance, a painter hasn't worked on a painting in a long time, she might start by taking out her materials and setting them up. Then she could commit to making a sketch, and so forth.

"You can think of it as 'loosening up' the depression," Aikens says. "You're maintaining and extending your psychological range of motion."

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Walk Away From Depression

Motivation to exercise may be scarce when you're feeling well, let alone when you are depressed, but try to do it anyhow.

"The typical things that we all know are important to taking care of ourselves become that much more important when you're dealing with depression," Browning says.

Exercise is a proven tonic for depression. For decades studies have been showing that aerobic exercise improves mood in people who are depressed.

Researchers recently found that the amount of aerobic exercise recommended by the CDC for general good health -- equivalent to 30 minutes of moderate-intensity exercise at least five days a week -- can bring about big improvements in depression.

The study, published in the January 2005 issue of American Journal of Preventive Medicine, involved people with mild-to-moderate depression who did various amounts of exercise for 12 weeks. All groups in the study, including those in the control group, who only did stretches, had some improvement, but those who exercised as much as the CDC recommends fared best. In that group, 46% of the people reduced their symptoms by one-half, as rated on a scale of depression severity, and 42% no longer qualified as depressed when the study ended.

It's important to start slowly with exercise. Decide what you can do, and as Aikens suggests, do a little bit less than that. If you think you could manage a 20-minute brisk walk, try 15 minutes first, and don't be discouraged if you don't feel better afterward.

"A person shouldn't have high expectations," Aikens says. "They shouldn't expect to necessarily feel cheerful or completely undepressed after going for a walk."

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Seek Clarity

When you're depressed, you likely have all sorts of negative thoughts about yourself and your life -- that you are a stupid failure beyond all hope, for example.

Should you transform your worldview and self-image by "positive thinking" instead? Scratch that, Aikens and Bilsker say. What you need when you're depressed is to get back to clear thinking.

"Our aim is not to give you some other kind of distortion," Bilsker says. "We just want you to think about yourself in a fair way and a realistic way."

Of course, you are not stupid or a failure, and there is hope for you yet. Right?

"You can encourage the return of accurate thinking by asking yourself questions," Aikens says, such as:

  • How can I test whether this idea is valid or not?
  • Was this always true?
  • Are there any exceptions?
  • What's the missing part of the picture?

Actions to Avoid

Depression sometimes drives people to drink, and sometimes alcohol abuse leads to depression. In any case, drowning your sorrows now will not help you feel better later. The same goes for other kinds of substance abuse.

Also do not rashly make major life changes while you are still feeling depressed, like leaving your job or your spouse, unless the situation is really dicey. A bad job or relationship may very well be making you depressed, however, you could be taking a bleak view.

"When you're deeply depressed, you're not in a good position to make this judgment. You need your symptoms to lift so that you can see these situations more clearly," Aikens says.

That's not to say depression renders you incapable of making any decisions for yourself.

"You're just as smart when you have depression," Browning says. "But make sure you're not reacting to symptoms."

WebMD Feature Reviewed by Brunilda Nazario, MD on August 22, 2005

Sources

SOURCES: James Aikens, PhD, assistant professor, family medicine and psychiatry, University of Michigan Medical School. Dan Bilsker, PhD, clinical assistant professor of psychiatry, University of British Columbia. Lea Ann Browning, spokeswoman, National Mental Health Association. National Institute of Mental Health. CDC. Current Opinion in Psychiatry, March 2005. American Journal of Preventive Medicine, January 2005. The Self-Care Depression Patient Guide.

© 2005 WebMD, Inc. All rights reserved.

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