Depression: Stopping the Downward Spiral

Steve was in the gym by himself the other day when Bob and I arrived for our workout. "Alone today?" Bob asked. Steve nodded sadly.

Steve's wife Amelia suffers from a depression that has been chronic since her adolescent years. Nearly every morning, it's a struggle to get out of bed. Most days, Steve is able to coax her to get up, eat some breakfast and then head down to the community center to work out, play ping pong and swim. Getting out of the house usually brightens her mood considerably and, in fact, there are people at the community center who encounter Amelia having no idea that she struggles so with depression.

Amelia is far from alone. Amid the beauty and many opportunities to be active in our small community, some people find themselves, at certain times or chronically, immobilized by depression.

For some, depression has a biological base. For example, my husband Bob has temporal lobe epilepsy and one of the components of that is severe mood swings including nearly immobilizing depression from time to time..

For others, depression is due to external factors such a major loss, increasingly common at this age. And many of the people living here full time have left behind so many familiar people and a long-time home in the act of relocation -- which can bring up feelings of loss as well.

Although there are many kinds and causes of depression, the type with which people tend to be most familiar is dysthymia.  The symptoms of dysthymia are similar but less intense than those of major depression but tend to last longer. People with dysthymia have a sad or depressed mood most of the time for a minimum of two years. They also have two or more of the following symptoms:

• Low energy or fatigue
• Feelings of hopelessness or helplessness
• Low self-esteem
• Sleep disturbances: sleeping too much or too little
• Lack of appetite or overeating
• Difficulty concentrating

Dysthymia, along with other varieties of mood disorders, can take over your life -- if you let it.

Many people find help with anti-depressant medications and also with psychotherapy. Therapy and medication can be truly life-saving.

First, however, check with your family doctor to see if there may be some physical reason for your depressed mood and if anti-depressant medication would be a good option. He or she may also be able to refer you to a competent therapist.

It's also important to know what you can do for yourself between therapy sessions or if that isn't an option for you right now.

Depression can become a downward spiral of negative thoughts and ruminations. The following are some things I've always recommended for my patients.

• Don't beat yourself up for being depressed. That negativity can only increase the downward spiral of your depression. Depression isn't a character defect. It's a mood disorder that happens to everyone from time to time. And sometimes, especially in the wake of a major loss, it's an understandable reaction. 
• Act as if you weren't depressed.  This doesn't mean denying your painful feelings, but it means acting as you would if not depressed. That may mean smiling at others and engaging them in conversation instead of doing what you feel like doing -- hiding from the world. When you get out and about, you're more likely to have positive experiences that can help lift your mood.  So get up. Get out of bed. Get on with your day. For many people, depression decreases as the day goes on. Acting "as if" can help you to re-engage with life and positive experiences.
• Try thought-stopping.  The downward spiral of depression gathers strength if you feed it with negative thoughts.  Thought-stopping can be as basic as catching yourself in a negative thought and saying "Stop!" Some patients remind themselves non-verbally by wearing a rubber band around their wrist and snapping it when a negative thought occurs. One patient of mine laughed with disbelief when I suggested this technique. It was only several months later that he told me he had been trying it every day since I suggested it and was stunned to discover that it actually worked! Thought substitution can also help. This may mean substituting a positive observation about yourself, about the world, your job or a family member causing you pain for the negative ones. 
• Challenge your negative self-talk: If you find yourself ruminating about your life, your family or your current living situation, realize that there are many ways you can look at a situation. Find an opposing positive view for a negative thought. Play inner attorney and challenge the evidence that you are worthless or life is hopeless. You may find the small beginnings of recovery in your inner debates.
• Ask yourself what function depression plays in your life.  For some, it may be a way of being taken care of. Is there a better way to care for yourself or ask for care from your loved ones?
• Seek out pleasurable hobbies and activities -- even if you don't feel up to them. Losing interest in things previously enjoyed is a major symptom of depression. If you can re-engage with things that bring you pleasure and satisfaction, even when you don't feel at all like pursuing these, you may find little moments of pleasure adding up to much more.
• Use humor to lighten dark moods.  Whether it is watching an old comedy film or show or joking about something in your life that might otherwise cause dark ruminations, humor can give you a different perspective. Many times, I've watched patients respond positively to unexpected humor, taking a brief vacation from their pain and sometimes being able to see the painful situation in a different light.  Some have found value in "awfulizing": turning a troubling situation or negative expectation into such an extreme catastrophe that it becomes a dark joke and the patient is able to realize how impaired depressive habits like catastrophic thinking can be.
• Be gentle and give yourself healing time.  This is especially important when your depression comes from grief and loss. There are no shortcuts to healing. You have to go through the pain and anger and longing and sadness.  But healing means moving through the stages of grieving, even though the process may be two steps forward and one step back for quite some time. Healing means feeling and acknowledging the pain and moving through it -- finding moments of love and joy amidst the pain that give you strength for the next step.
• Reach out to others.  Isolation and hiding can only increase your depression. Reaching out to family and friends is critical.  So is seeking professional help, especially if your feelings of hopelessness are persistent and you're beginning to wonder whether you even want to live.

The most important things to remember about depression are that it is temporary, even if it seems like you've been depressed forever, and that as long as there is life, there is hope.