Dealing with Depression

The D word has stood unique for its obstinacy through my work as a life coach dealing with people suffering from myriad problems. Not in the so-distant past, the C word (Cancer) used to be a popular currency but now we are living in the “Age of Depression” as the number of people reporting depression is skyrocketing. A Ministry of Health and Family Welfare survey says that the Indians, who need professional help for mental disorders, number close to 13 crore i.e. every 11th Indian is a psychological patient. Couple it with the fact that India has too few psychiatrists to handle the epidemic and the picture becomes horrifying. A great majority of them are afflicted with mood disorders, chiefly depression, of which married women are the worst affected (my hunch, too), as they continue to be constrained by so many limitations imposed by families, society and themselves, too.

Though most millennials and lay people are wont to using the D word thing like  loose change, as a life coach, I can tell you confidently – Depression is much more debilitating, incapacitating and wasting than they can possibly think of. For those who aren’t really clued in to it, a bad exam performance, a tiff with a partner or a professor or friend’s remark may be enough to trigger the D thing. But in sharp contrast, for people rendering professional help, it is a much more pregnant, serious, long and persistent phenomenon. So much so that it translates into great personal, social and economic losses leading to absenteeism, poor productivity, poor life quality, sour relationships, separations, divorces and suicides. A NIMHANS, Bengaluru (the apex mental health institution) survey shows that depression is a major trigger in case of a majority of suicides happening in India. And more tragically, a good enough number of such suicides are committed by young people.    

The above illustrates a gross distortion of the real implications of a severely limiting mental disorder. It’s obvious that most of us are oblivious to the great price we are paying as a society for ignoring its grave consequences.

 Identifying the Signs of Depression

Depression or major depressive disorder is a common but serious medical illness which has a negative effect on your feelings, thoughts and actions. In a very general form, depression causes persistent sadness and/or a loss of interest in activities once enjoyed. It can create a variety of emotional and physical problems and can reduce your ability to function effectively at home and at the workplace.

The feelings of being disappointed, dejected or sad over events are quite common in day-to-day life, which lift on their own and don’t require any medication or other medical help. But depression is much beyond that i.e. a state of persistent low mood, sadness lasting more than 14 days.

Depression Vs. Sadness and Grief

Distinguishing between grief and depression is important to help people get the relevant help, support and treatment. A loved one’s death, a job loss or the end of a relationship are difficult experiences and the feelings of sadness or grief are a natural, normal response to such situations. Of course, those experiencing loss may describe themselves as “depressed”, but as noted earlier, sadness is not the same thing as depression. The grieving process is unique to each one and has some features common with depression. Both grief and depression may involve intense sadness and withdrawal from normal activities but they differ in important ways:

1. In grief, painful feelings come in the form of waves, intermixed with positive memories but in case of major depression, mood and/or interest show a serious decline.
2. In case of grief, self-esteem usually remains intact but in major depression, the feelings of worthlessness and self-loathing are quite common.
3. For a grieving person, the thoughts of death may surface while thinking about “joining” the deceased one but in case of major depression, the thoughts are focused on ending one’s life due to the feelings of worthlessness or an inability to cope with depression.
4. Grief and depression may exist together and in such cases, the grief is more severe and lasts longer than grief without depression.

Depression can have varying symptoms ranging from mild to severe:

1. Sadness/ low, depressed mood
2. Loss of interest/ pleasure in activities once enjoyed
3. Changes in appetite, weight loss or gain (unrelated to dieting)
4. Inability to have good sleep or sleeping too much
5. Low energy levels/ fatigue
6. Purposeless physical activity (can’t sit still, pacing, handwringing) or slow movements or speech
7. Feelings of worthlessness or guilt or self-blame
8. Difficulties with thinking, focusing or making decisions
9. Thoughts of self-harm, death or suicide

 Some medical conditions like thyroid problems, brain tumor or vitamin deficiency can have symptoms similar to those of depression. So, before arriving at a proper diagnosis, it’s important to rule out other general medical causes, which may be causing these symptoms.

Causes of Depression

Depression is quite egalitarian as it can affect anyone, even someone living in relatively ideal circumstances. Several factors can play a role in causing depression:

Genes: Depression runs in families. If one identical twin has depression, the other one has a 70 percent chance of having it sometime in life. There is a high degree of heritability (approximately 40%) in a case where first-degree relatives (parents/children/siblings) suffer from depression.

Personality: People suffering from low self-esteem, who are easily bogged by stress, or those who are pessimistic are more likely to develop depression.

Biochemistry:  Distortions in brain chemistry (esp. dopamine mechanism) may contribute to depression.

Environmental factors: Sustained violence, neglect, abuse or poverty can make us more vulnerable to developing depression.

A life coach on how to deal with depression    

As a life coach, I understand well that dealing with depression can be difficult as it drains one’s energy, hope and drive, thus making it hard to take remedial steps to feel better. There are some apparent triggers but they are difficult to point out. Though there is no quick fix there yet, there are ways to help you come out of the emotional morass and rumination that accompany it, which make it harder to make behavioral changes necessary to prevent a relapse. For example, just thinking of the things you need to do to feel better – exercising or chatting with friends – appears impossible to implement.

Of course, it doesn’t have to be taken lightly at all. If you have such symptoms, do make it a point to visit a trained psychiatrist for diagnosis and treatment. But the medications also work best in tandem with changes in your thought processes, exercising, improved dietary habits etc.

Luckily, there are enough glimmers to cut through this unrelenting darkness:

1. Feel Good

Come on, you deserve it! Relax and energize yourself with good stress management, setting your limits and being part of fun activities.

While you can’t force yourself to feel pleasure, push yourself to do things, even reluctantly and it may surprise you to find how much better you feel. You’ll feel more cheerful and energetic as you take part in fun activities.  I can vouch for it as I have been doing them consistently and advise my clients to do so.

Try to resume a hobby or game you loved earlier – music, dance, art, or writing. Go out and have fun with friends in the hills or a park. Spend some time in the lap of nature, read a book, watch a fun TV show, have a relaxing bath, play with your  pet, talk to a friend or family, listen to music and be ready for a surprise result.

2. Eat healthy, fight depression

Your food directly impacts the way you feel. Limit the consumption of foods that adversely affect your brain and mood e.g. caffeine, alcohol, trans-fats, and foods with preservatives or hormones (like certain meats).

Don’t miss any meal as a long gap between meals can make you feel irritable and tired. Have a small meal every 3-4 hours but try to stay away from sugary snacks, baked items, comfort foods like noodles and pasta as these “feel-good” things crash your mood and energy.

A deficiency of Vitamin B i.e. folic acid and B-12 can also trigger depression in some cases. Consult your doctor for a B-complex vitamin supplement or eat better – more citrus fruit, leafy greens, beans and eggs. Omega-3 fatty acid rich foods also help stabilize our mood.

3. Break the cycle

It has been found that depressive people often tend to give a negative taint to everything, including the way they look at themselves and their expectations about the future.

As a life coach, I often tell my depressive clients that in case of such thoughts crossing their minds, they need to remember it as a symptom of depression and that these irrational, pessimistic attitudes or cognitive distortions are actually unrealistic. You need to break out of this pessimistic mould by telling yourself to “think positive.” Often, it becomes so automatic and natural to you that you aren’t even aware of it. So, the trick is identifying the negative thoughts that you’re your depression and replacing them with more balanced thoughts.

Try to get rid of negative stuff like

“My last test was horrible. What a moron I have been!”

“He told me he had a blast with me at the party, but I guess he’s just being polite.”

“The boss must be thinking of me as a pathetic fellow” or “I’m caught for life in this sucking job.”

“I am such a loser. They must be making fun of me!”

“I shouldn’t have gone to the interview. What an idiot I was thinking It could crack it.”

“What a total flop I am!”

Once you identify the toxic, destructive thoughts that lead to depression, start challenging them with something like

“Is there some evidence that this is true? Not true!”

“What would I suggest to a friend having such a thought?”

“Is there another way to understand and analyze the situation or is there an alternative explanation for it?”

“How would I look at it if I weren’t depressed?”

Across my therapy work with depressive patients, I have found such cross-examination to be quite helpful, which has revealed how fast and easily these negative ideas crumble and help you get a more balanced cognitive perspective, which relieves your depressive symptoms.

4. Reach out

Obtaining the support of the family, friends, colleagues and elders plays a vital role in combating depression. It is difficult to keep a healthy perspective and keep up the effort to come out of it as depression brings a tendency to withdraw and isolate, thereby making the connect with family and friends even tougher.

I agree, you may be feeling tired, ashamed or guilty. But remember, this is just your depression talking to you. Try to remain connected with others and be part of social activities; trust me, it makes a world of difference to your mood and outlook. Never take it as a weakness or a burden on others as your loved ones care about you and would love to help you.

And if there is none to turn to, forge new friendships for a better social support network. Even if the other one may not solve your problem, they can offer great help – by being attentive, compassionate and non-judgmental listeners.  

Though phone calls and social media are great connectors, they cannot replace the good old facetime. Talking to someone in person can play a big role in relieving you of depression and keeping it at a distance. Besides, you can think of ways to help others as it can your boost your mood in return big time. Work with an NGO in your area, join a volunteer group, become a good listener for a friend, be a Good Samaritan for somebody and it will do its mite to drive away your depression, too.

Joining a depression support group may help you meet others waging a similar battle with depression so as to reduce the sense of your being alone. You can encourage each other, give and take advice on coping and also share your own experiences to give hope to one another.

5. Get Going

I fully appreciate that for a depressed person, even getting out of their bed or home is quite a task, let alone working out! But remember, exercising has been proven to be a potent antidepressant, which can aid your recovery fast. In fact, regular exercise has been found to be as effective as medication in relieving depression by doctors.

By exercising regularly, you heighten your levels of the happiness hormone (dopamine) in your brain. Remember the runner’s high you experienced- That exhilarating feeling after about half an hour of intense running, jogging etc? Do at least 30 minutes of exercise daily.  To start with, take a 10-minute walk to see how it improves your mood for one-two hours. Explore continuous, rhythmic exercises like walking, weight training, swimming, martial arts or dance, where you get to move both your arms and legs. Also try to have a partner to socialize and keep yourself motivated at a club, aerobics class or in a soccer team.

6. Health Is Wealth

Sleeping too much or too little can be problematic. So, try having 8 hours of sleep as depression often involves sleep problems. Try to learn about healthy sleep habits to have a good, quality sleep cycle.

Keep your stress level under check as it tends to worsen your depression, apart from triggering it. Think of ways to relieve the pressure coming from workload, money, or bad relationships and to regain control of your life. Regular relaxation practice can help you relieve your depression and stress to boost your enjoyment and well-being. Try out yoga, deep breathing, progressive muscle relaxation, or meditation or some such that suits you.

7. Sunny Side Up

Sit in the sunlight to boost serotonin levels to improve your mood. Whenever possible, expose yourself to the sun for a minimum of 20 minutes daily. Take a walk in the open in the lunch break and double up its benefits. Improve the natural lighting in your home and workplace by opening blinds, drapes and sitting near windows.

If these self-help tips and lifestyle changes do not help you, do look for professional help. Remember, seeking help doesn’t imply your weakness. Depression is certainly treatable and curable and you can feel better! Even while you are getting professional help, these things can accelerate your recovery and help you avoid a relapse.

How to Cure Depression?

Studies say that close to 90% people with depression respond well to such treatment and gain some relief from their symptoms. Before a diagnosis or treatment, a health professional has to conduct a thorough diagnostic evaluation, including an interview and physical examination. A blood test may be used to make sure that the depression is not due to some other medical condition, as noted earlier. This evaluation will throw up specific symptoms and explore the patient’s medical and family history, cultural and environmental factors to arrive at a diagnosis and evolve a suitable treatment plan in line with the results of such evaluation.

Read: Simple Lifestyle Changes for Depression Treatment

Medication

As a distorted brain chemistry may contribute to depression, antidepressants may be prescribed to modify the brain chemistry. Antidepressants may take at least 2-3  months to show their effects on the patients. In case a patient feels no improvement after several weeks, the psychiatrist can alter the dosage or add or substitute another antidepressant. Tell your doctor if a medication doesn’t work or if you experience any side effects of the medication.

Usually, patients are asked to continue medication for 6 months or more after the condition has improved and long-term maintenance treatment may be suggested to decrease the future risks they might face.

Psychotherapy

Psychotherapy or “talk therapy” is sometimes used alone to treat mild depression but for moderate to severe depression, psychotherapy is used along with the usual antidepressants. In particular, cognitive behavioral therapy (CBT) is quite popular and effective. CBT helps the patient recognize their distorted thinking to motivate them to change their thoughts and behaviors in order to respond to challenges positively.

Often, psychotherapy may involve others, too – family or spouse, depending on the case. Depending on the severity of the problem, the treatment may take a few weeks or longer.

Electroconvulsive Therapy (ECT)

It is reserved for patients with severe major depression who don’t benefit from other treatments. ECT involves a brief electrical stimulation of the brain under anesthesia 2-3 times weekly for 6-12 treatments. ECT is recognized for its effectiveness as a mainstream rather than a “last resort” treatment in extreme cases.