Deal With Clinical Depression

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Clinical depression is not a case of "the blues," or just being sad sometimes. Clinical depression means you are depressed at the clinical level – meaning you have a mental health diagnosis. There are quite a few diagnoses that include clinical depressive symptoms including: Major Depressive Disorder, Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder (Dysthymia), and Premenstrual Dysphoric Disorder. There are also depressive disorders that are caused by substance use, medication, or a medical condition. Whichever depressive disorder you have, you can successfully deal with your depressive symptoms by getting support, using coping strategies, and changing depressive thinking.[1]

Steps

Getting Professional Help

  1. Keep yourself safe if you have thoughts of harming yourself. If you are currently having thoughts of harming yourself in some way or of killing yourself, you need to get support immediately. If you ever feel suicidal or have an intent to harm yourself and don't trust your impulse control, get outside support right now.
    • Call your local emergency number, such as 911.[2]
    • Call a suicide hotline such as The National Suicide Prevention Hotline (U.S.A) at 1-800-273-TALK(8255), or use an Get Help from an Online Suicide Prevention Chat Line.
    • Go to the nearest emergency room with an explanation of how you feel. Tell them that you are feeling suicidal.
  2. Talk to a therapist. If you choose to enlist the help of a therapist, be sure to select one that is qualified to work with depressed people, and with whom you feel compatible. The right therapist can't solve all your problems instantly, but she can help you learn to help yourself, refer you to a psychiatrist if needed (for medication), and provide support through tough times.
    • Contact your medical insurance company for a list of approved clinicians in your area. Make sure to inquire about what types of services your plan covers.
    • If you do not have medical insurance, conduct an online search for sliding scale, low-cost, or free mental health clinics in your area. Or contact your local social services or government organization to inquire about financial assistance or programs that help low-income families.
    • If you find a therapist that suits you, keep going as long as it works for you. Find out if you can call between visits if something unexpected happens.
    • Find or ask for referrals to therapy groups. For example, Coping with Depression (CWD) therapy is an effective treatment for reducing existing depression.[3]
  3. Consider getting medication. Medications such as antidepressant SSRIs can be helpful in treating severe depression.[4] Find out if your therapist thinks medication would help you. Ask for the names of psychiatrists that the therapist knows have been helpful to people with a similar history.
    • Even if you are taking prescription drugs already, do not think that pills will be an easy fix. There are many other methods to fight depression that are worth trying.
    • Accept that all psychiatrists are not created equal. Ask your psychiatrist about what sort of treatments he often suggests to people in your situation. Be inquisitive about which medications he uses, whether he will prescribe more than one medication, and how he decides on dosage adjustments. If he doesn't seem like a good fit, it's okay to find someone else.
    • If you decide to use medication as a way to help your depression, different medicines will affect you differently. Some may worsen depression for a period or of time or increase suicidal thoughts before they start helping. If this happens, contact your doctor or therapist.
    • Never stop a medication cold turkey. This may produce negative reactions (shaking, hot and cold flashes, etc.) and can worsen depression. Only modify your prescription or taper off of a medicine under the care of a psychiatrist.

Receiving Social Support

  1. Seek support from family. Social support is one of the most helpful resources when dealing with depression.[5] Support can assist you in feeling that you are valued, loved, and that there are individuals who are willing to help and care for you.
    • Depression is a hereditary mental health issue. Look around your biological family. Are there other depressed people? Watch them and see what they do that seems to work.
    • If some individuals in your family are more supportive than others, seek help from those individuals first. If you don't feel comfortable seeking support from any close family member (parent, sibling), look outside your nuclear family for support from grandparents, aunts, uncles, and cousins. If you still find a lack of support, venture outside of your family to close friends.
    • If your therapist is the only person you can currently count on for support, that's okay. Your therapist may be able to connect you with group therapy, which can provide social support if you don't have friends or family you can count on.
  2. Share your feelings with others. Emotional support is a common coping resource for dealing with depression.[6] This is because it helps to release your emotions in the company of others instead of bottling them up, which can lead to an outburst or a breakdown.
    • Talk to your friends. If you feel even worse than usual, having a friend to listen and support you, even by just being there, can save your life. Sometimes it is hard to get started when you are depressed and there is no shame in having a friend get the ball rolling.
    • Crying with a friend or family member can be emotionally cathartic.
    • If you are ready to be cheered up, ask your friends to do something fun with you.
  3. Cultivate healthy relationships. Studies have found that the quality of your relationships with partners, families, and friends is a significant risk factor in major depression.[7] People in unhealthy relationships or lacking support have more than double the risk of depression than those with healthy relationships. Identifying and eliminating unhealthy relationships may help with your depression.[7]
    • Healthy relationships are respectful, trusting, collaborative, and accepting. They involve physical affection, open communication and fairness.[8]
    • Unhealthy relationships are typically intimidating, humiliating, threatening, dominating, judging, and blaming. They are also associated with abuse (verbal, physical, sexual) and possessiveness.
    • Take an inventory of your current friendships and relationships. Are there individuals who bring you down or criticize you? Perhaps these individuals do more harm than good. Consider if you need to create distance in unhealthy relationships, or build new ones.[9]

Using Coping Strategies

  1. Educate yourself. A good place to start in any quest to fix a problem is through research and education. Knowledge is power, and knowing what is affecting your depression is half the battle. Informational support can help depressed individuals cope with difficult situations.[6]
    • Psychoeducation is the specific term for becoming educated about your particular disorder. [10] You can ask your therapist for psychoeducation about your disorder and work it into your treatment plan.
    • Get books, research articles, watch documentaries, and conduct internet searches to learn more about your specific condition.
  2. Set goals. Goal-setting is an integral component of any therapy to reduce symptoms of depression. In order to achieve a reduction in depression, you must have a plan.[3]
    • Ask yourself what you want to achieve in terms of dealing with your clinical depression. How do you want to deal your depression? Do you want it to be less severe? Do you want to learn new coping strategies? Be specific and set time-limited (one week, one month, six months) and attainable goals. For example, completely eradicating your depression in one month may be an unrealistic goal. However, reducing your depression on a scale of one to ten (ten being most depressed, and one not at all depressed) from nine to seven may be more attainable.
    • Make a plan to reduce your depression. Use the coping strategies listed here as guidelines for creating specific goals. For example, one goal could be to conduct research about your mood disorder at least once per week.
    • Evaluate whether your plan is working. Change the plan if you need to in order to include new strategies that you haven’t yet tried.
  3. Increase pleasurable activities that work for you.[3] How one chooses to cope with depression will rely on specific stressors, culture, personal resources, and unique social situation.[11]
    • Some examples of good activities are: reading, watching movies, writing (in a journal or writing short stories), painting, sculpting, playing with an animal, cooking, playing music, sewing, and knitting.
    • Schedule these pleasurable activities into your daily routine.[3]
    • Spiritual and religious practices, if you are so inclined, have been shown to reduce depression, especially in the elderly.[12]
  4. Work to solve the problem. Sometimes there are specific life events and stressful situations that contribute or increase depression. Using problem-solving as a coping resource during these times can help reduce depression.[11] Focus on what you can control about the situation (your own reactions or thoughts about it) rather than worrying about things you can’t control (such as what other people do).
    • Sometimes interpersonal conflict can increase depression. Use conflict resolution if you have issues with other people.[3] For example, discuss your feelings in an open but non-aggressive way. Use assertiveness by using “I statements,” such as, “I feel sad when you forget to call me back.”
    • Avoid constantly seeking new information in order to put off action; this can be common in individuals who suffer from depression.[6] Work on accepting that, for things to change, you must eventually take action. Informing yourself about all your options is helpful when making a decision, but at a certain point you must move forward and make that decision, whether it's about ending a destructive friendship or trying a new form of therapy.
    • Focus only on what you can control. Re-focus on planning and problem solving things that are changeable, instead of thinking too much about what others are doing wrong or what is happening in your environment (traffic, loud neighbors, etc.).[13]
  5. Exercise. More physical activity is strongly associated with reduced levels of depression.[14] Exercise can even help depression in spite of medical problems and negative life events.
    • Do any exercise you can, including: walking, running, biking, using an elliptical, hiking, or weight-lifting.
    • Try fun exercises you may not have tried yet, such as: Zumba, dance aerobics, yoga, Pilates, and kayaking.
  6. Use mindfulness or meditation. Mindfulness-based meditation may help increase well-being and reduce depression.[15][16] Mindfulness is all about being in the current moment, the here and now. It is focusing on what you are currently engaged in instead of ruminating over the past or worrying about what might happen tomorrow.
    • Mindfulness exercises are great ways for beginners to practice being mindful.[17] Try a mindfulness exercise such as eating a piece of fruit (apple, banana, strawberry, anything you like) mindfully. First, look at the fruit. What colors and shapes do you notice? Then, touch the fruit. What does it feel like? It is soft, smooth, or bumpy? Appreciate how it feels and notice everything you can about the texture. Then smell the fruit and enjoy its aroma. Next, take a small bite of the fruit. What does it taste like? Is it tart or sweet? What is the texture like in your mouth? Eat it slowly while thinking and focusing on the experience of eating the fruit. Notice any other thoughts you might have that try to distract you, and without judging the thoughts, let them go.
    • Another example of a mindfulness exercise is going on a mindfulness walk. Simply take a walk in your neighborhood (as long as it’s safe) or a local park. Just like the fruit exercise, notice what you see, smell, hear, taste, and feel on your skin and body.
  7. Ground yourself. Grounding exercises, or distraction techniques, are useful if you need to temporarily distract yourself from emotional pain.[18] Grounding enables you to take a break from feeling depressed and ruminating and focus on something else.[13]
    • Try a mental grounding technique of naming all of the states, colors, or animals you can think of (from A to Z).
    • Engage in a physical grounding exercise such as running cold water over your hands, taking a bubble bath, or petting an animal.
    • There are many other grounding exercises you can research online.[18][19][20]
  8. Avoid negative ways of coping. Negative ways of coping are linked to increases in depression.[21] Coping negatively can include isolating yourself socially (avoiding social contact), using aggression (such as yelling, violence, or harming others), or consuming alcohol or other substances to excess.
    • Avoid drugs and alcohol as means to cope with depressed mood or other depressive symptoms. Substance use problems are common in people who suffer from depression.[22]

Changing Depressive Thinking

  1. Restructure automatic thoughts. The way we perceive or think about ourselves, others, and the world creates our unique reality. The thoughts we have are directly linked to our feelings. If we think negatively we become more likely to be depressed. Cognitive restructuring is about changing these negative and unconstructive thoughts that increase depression and replacing them with more realistic ideas.[3] If you change these thoughts consciously you may be able to reduce your overall depression.
  2. Combat black-and-white thinking. This means you either think something is all bad or all good. Try to make room for the middle ground. If you think something or someone is all bad, name at least a few things that are positive and focus on these aspects.
  3. Reduce self-blame. Blaming the self may look like thoughts such as, “It’s all my fault. Nobody loves me because I am a terrible person.” These thoughts are incorrect because nothing can be all your fault, there are always other factors in any given situation.
    • At the same time, do not place all of the blame on others.[13] Accept the responsibility you have and try to realistically appraise the situation.
  4. Avoid catastrophizing. This means thinking that the worst thing will happen and trying to predict the future.[13]
    • Work toward thinking of alternative ways that the situation might turn out.[13]For example, if you are sure you will not get the job you interviewed for, consider that the interviewers liked you and you still have a chance.
    • Try to guess how likely it is that the worst possible thing will happen. if you think logically about it, there is probably a low percentage chance that the world will end.
    • Another option is to think about the worst possible scenario and decide that you will still be okay in the midst of such and occurrence. Thus, if the worst thing is that you won't pass that big test, the reality is, you will most likely survive it and persevere. You will not die from not passing the test. You will move on and learn how to do better the next time. Then perhaps the situation won't seem so bad after all.
  5. Reduce perfectionistic thinking. Perfectionism, or thinking that everything needs to be just the way you want it, can lead to depression.[21] This is because if you have unrealistically high expectations of yourself, others, or your environment, you set yourself up to be disappointed. Chronic disappointment can most definitely lead to depressed mood and other depressive symptoms (difficulty sleeping, weight loss or gain, etc.).
    • Set realistic goals and expectations of yourself. If you expect to lose ten lbs. in three days, you are setting yourself up for failure. This would be very difficult and not healthy for your body. However, if you set a more reasonable goal of losing eight lbs. in a month, this is a more achievable option and can reduce your perfectionist thinking.
    • Try to expand your viewpoint to include your positive accomplishments, and not just what you didn't do or think you could have done better. Instead of looking for flaws in your actions, include all the things you did right or did well.
    • Give yourself a break. Think, "I don't always have to do my very best at every moment. Sometimes I will be sick or tired. It's okay to take some time off for myself to recuperate."
    • Set time limits for working on particular projects and stick to them. If you plan on spending one to two hours completing a small school assignment, then give yourself that amount of time and then stop. This way, you can't continually analyze and re-read your work over and over again, as many perfectionists do. Just make sure you give yourself an adequate amount of time for your limit (not only one hour for an entire essay, for example).
  6. Believe in yourself. Be confident in your ability to cope with negative situations and feelings.[21] Your positive thoughts about your ability to cope with depression can actually decrease your depression overall.
    • If you have negative thoughts such as, “I can’t handle this. It’s too much. I can’t cope,” consciously change your thoughts to something more positive and realistic such as, “This is tough and I am depressed, but I have gotten through it before and I can do it again. I know that I will survive this feeling.”
  7. Accept sadness and depressed moods. Depressed individuals may be less likely to think that situations require their acceptance.[6] However, many situations can be dealt with more easily by simply accepting them. For example, when you feel a negative emotion (such as depressed mood or sadness), accepting this emotion as normal and okay can help you cope with it healthfully. Sometimes not accepting negative emotions creates a block in your ability to process the emotion so that it naturally subsides. By not allowing yourself to process the emotion, you may experience longer periods of sadness or a depressed mood.
    • Try working on acceptance by saying or thinking to yourself, “I accept that I am depressed. It hurts, but my feeling is giving me valuable information that something needs to change. I’m going to find out what needs to happen for me to feel better.”[13]

Warnings

  • If you have thoughts of suicide call a suicide hotline, call your local emergency number (911), or go to a hospital.

Related Articles

Sources and Citations

  1. ↑ http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
  2. ↑ http://www.suicide.org/international-suicide-hotlines.html
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 http://www.researchgate.net/profile/Pim_Cuijpers/publication/222653866_Psychoeducational_treatment_and_prevention_of_depression_The_coping_with_depression_course_thirty_years_later/links/02bfe512789c232670000000.pdf
  4. ↑ http://jama.jamanetwork.com/article.aspx?articleid=185157
  5. ↑ http://www.robindimatteo.com/uploads/3/8/3/4/38344023/meta_social_support_.pdf
  6. ↑ 6.0 6.1 6.2 6.3 http://www.researchgate.net/profile/Carolyn_Aldwin/publication/232568978_Depression_and_coping_in_stressful_episodes/links/0deec534f4ec9aa702000000.pdf
  7. ↑ 7.0 7.1 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062396
  8. ↑ http://www.jchs.edu/jchs-voice-program-healthy-vs-unhealthy
  9. ↑ http://www.nytimes.com/2002/09/10/health/some-friends-indeed-do-more-harm-than-good.html
  10. ↑ http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.412.7422&rep=rep1&type=pdf
  11. ↑ 11.0 11.1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447722/
  12. ↑ http://www.researchgate.net/profile/Douglas_Mcquoid/publication/9060143_The_impact_of_religious_practice_and_religious_coping_on_geriatric_depression/links/53d2619c0cf2a7fbb2e9991f.pdf
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 http://media.leidenuniv.nl/legacy/garnefski__legerstee__kraaij_et_al_2002.pdf
  14. ↑ www.researchgate.net/profile/Ruth_Cronkite/publication/7232765_Physical_activity_exercise_coping_and_depression_in_a_10-year_cohort_study_of_depressed_patients/links/0912f5144ca12e2777000000.pdf
  15. ↑ http://onlinelibrary.wiley.com/doi/10.1002/smi.2551/full
  16. ↑ http://www.infactispax.org/volume2/Brantmeier.pdf
  17. ↑ http://ir.nmu.org.ua/bitstream/handle/123456789/141048/53410d0a485679795eeef9f9304e41d0.pdf?sequence=1#page=447
  18. ↑ 18.0 18.1 https://www.e-tmf.org/downloads/Grounding_Techniques.pdf
  19. ↑ http://www.peirsac.org/peirsacui/er/educational_resources10.pdf
  20. ↑ http://www.livingwell.org.au/well-being/grounding-exercises/
  21. ↑ 21.0 21.1 21.2 http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.325.6250&rep=rep1&type=pdf
  22. ↑ http://archpsyc.jamanetwork.com/article.aspx?articleid=482045
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