Psychotherapists probably
see more cases of depression than anything else in their practices, but it
remains one of the most challenging conditions to accurately assess and treat. A
depressive episode in the context of a major depressive disorder is a period
characterized by low mood and other depression symptoms that lasts for 2 weeks
or more. When experiencing a depressive episode, a person can try to make
changes to their thoughts and behaviors to help improve their mood.
Types of depression
I. Endogenous Depression
People who complain of low
cognitive energy—"I just can't think about that now," or "I just
sit and look at the work"—and persistent negative mood, irritability, and
limited pleasure or interest in daily life are most likely suffering from
endogenous depression, a condition assumed to be biologically, and probably
genetically, based. They tend to be passive and unmotivated: their attitude
toward therapy can be summed up as "What's the use?"
II.
Post-Traumatic
Depression
Post-traumatic stress is
another source of depression that can manifest itself in sudden feelings of
intense helplessness, often set off by emotional or environmental events, which
the person may not even recognize as triggers. Trauma victims can experience
disproportionately powerful mental and physical states from even seemingly
minor stressors, especially when they somehow evoke a version of the
helplessness and sense of danger they felt during the initial trauma. They have
a hard time believing anybody can help them, far less that they'll ever be able
to help themselves.
III.
Situational
Depression
Situation-induced
depressions may result from serious personal losses (job, spouse, death of a
loved one), work burnout, or exhaustion from long-term care of a sick family
member. In addition to causing sadness, discouragement, or a sense of
meaninglessness, these stressful situations can engender physical lethargy and
emotional isolation, which tend to be self-reinforcing: exhaustion and
isolation breed more exhaustion and isolation. Furthermore, this kind of
depressed person doesn't just need to change an attitude, but also the
situation itself by doing something about it.
IV.
Attachment
or Abuse-Induced Depressions
A child who's repeatedly
left uncomforted by adults when distressed first becomes frantic, then resigned
and hopeless, ultimately shutting down emotionally. A child suffering from this
kind of chronic neglect or even more severe attachment failure (physical and
emotional abuse, for example) becomes an adult who tends to feel generally
hopeless, with low expectations of self and others, and susceptible to sudden
plunges into psychological despair.
V.
Persistent
depressive disorder
It lasts for a minimum of 2
years. During this period, symptoms may vary in severity but are always
present. Approximately 1.5 percent of adults in the India may experience
persistent depressive disorder in any one year.
VI.
Psychotic
depression
It causes symptoms of
psychosis as well as severe depression. A person may experience delusions and
hallucinations. Approximately 4 in every 1,000 people may develop psychotic
depression.
VII.
Bipolar
disorder
It is a mood disorder
similar to major depressive disorder. Someone with bipolar disorder may also
experience periods of extreme highs, called mania or hypomania.
VIII.
Postpartum
depression
It causes major depression
symptoms during pregnancy or after delivery. This condition affects nearly 15
percent of new mothers and typically requires treatment.
IX.
Seasonal
affective disorder (SAD)
For some people, the reduced
daylight hours of winter lead to a form of depression known as seasonal
affective disorder (SAD). SAD can make you feel like a completely different
person to who you are in the summer: hopeless, sad, tense, or stressed, with no
interest in friends or activities you normally love. No matter how hopeless you
feel, though, there are plenty of things you can do to keep your mood stable
throughout the year.
Symptoms
of a depressive episode are more extreme than normal periods of
low mood. A major depressive episode is defined as experiencing five or more of
the following symptoms every day (or most days) for two weeks or more:
·
Depressed or irritable mood
·
feeling sad, hopeless, or helpless
·
loss of interest in things once enjoyed,
including hobbies and socializing
·
trouble concentrating or remembering
·
aches or pains that do not have an obvious
physical cause
·
Sleep problems (i.e., sleeping too much or
too little; sleeping mainly during the day)
·
Change in interests (i.e., not being
interested in what you used to enjoy) or low motivation
·
Excessive guilt or unrealistically low
self-image
·
Significantly low energy and/or change in
self-care (i.e., not showering anymore)
·
Significantly worse concentration (i.e.,
sharp decline in grades or performance)
·
Changes in appetite (i.e., eating too much or
too little)
·
Agitation or severe anxiety/panic attacks
·
Suicidal thoughts, plans or behaviors —
including self-harm (i.e., intentionally cutting or burning yourself)
Possible triggers
Depression is a complex condition
with many possible causes. Even though a person may be more susceptible to
depression than someone else, they usually only experience a depressive episode
when a stressful event triggers the condition.
Possible
triggers include:
·
changes in daily routines
·
disrupted sleep
·
poor eating habits
·
stress at work, home, or school
·
feeling isolated, alone, or unloved
·
living with abuse or mistreatment
·
medical problems, such as Alzheimer’s
disease, stroke, or erectile dysfunction
·
some medications, including certain
antibiotics and blood pressure drugs
·
a significant life event, such as a
bereavement or divorce
·
a traumatic incident, such as a car accident
or sexual assault
However, it is important to
note that not every depressive episode will have an obvious or identifiable
trigger.
It’s important to remember
that not everyone who is depressed is suicidal. You can still seek help even if
you haven’t demonstrated any specific suicidal or self-harm behaviors, or even
if your symptoms aren’t as severe or persistent as the symptoms noted
above.
OK, I’m feeling depressed…
so now what?
Now that you know the
symptoms of depression, some positive coping skills can be useful. All of the
following techniques are supported by scientific research and medication
prescribers — like psychiatrists — and these skills are frequently recommended
as important parts of treatment even for patients who continue to take
antidepressant medications.
Twenty Two tips for dealing with a depressive episode
Tackling depression as soon
as symptoms develop can help people recover more quickly. Even those who have
experienced depression for a long time might find that making changes to the
way they think and behave improves their mood.
The following tips may help
people deal with a depressive episode:
1.
Track triggers and symptoms
Keeping track of moods and
symptoms might help a person understand what triggers a depressive episode.
Spotting the signs of depression early on may help them avoid a full-blown depressive
episode.
Use a diary to log important events, changes to daily routines, and moods. Rate moods on a scale of 1 to 10 to help identify which events or activities cause specific responses. See a doctor if symptoms persist for 14 days or more.
2.
Stay calm
Focus on staying calm.
Remember that depression is treatable and the feelings will not last forever.
Anyone who has experienced
depressive episodes before should remind themselves that they can overcome
these feelings again. They should focus on their strengths and on what they
have learned from previous depressive episodes.
Self-help techniques, such
as meditation, mindfulness, and breathing exercises can help a person learn to
look at problems in a different way and promote a sense of calmness. Self-help
books and phone and online counseling courses are available.
3.
Understand and accept depression
Learning more about
depression can help people deal with the condition. Depression is a widespread
and genuine mental health disorder. It is not a sign of weakness or a personal
shortcoming.
Accepting that a depressive
episode may occur from time to time might help people deal with it when it
does. Remember, it is possible to manage symptoms with treatments, such as
lifestyle changes, medication, and therapy.
4.
Separate yourself from the depression
A condition does not define
a person; they are not their illness. When depression symptoms begin, some
people find it helpful to repeat: “I am not depression, I just have
depression.”
A person should remind
themselves of all the other aspects of themselves. They may also be a parent,
sibling, friend, spouse, neighbor, and colleague. Each person has their own
strengths, abilities, and positive qualities that make them who they are.
5.
Recognize the importance of self-care
Self-care is essential for
good physical and mental health. Self-care activities are any actions that help
people look after their wellbeing.
Self-care means taking time
to relax, recharge, and connect with the self and others. It also means saying
no to others when overwhelmed and taking space to calm and soothe oneself.
Basic self-care activities include eating a healthful diet, engaging in creative activities, and taking a soothing bath. But any action that enhances mental, emotional, and physical health can be considered a self-care activity.
6.
Breathe deeply and relax the muscles
Deep breathing techniques
are an effective way to calm anxiety and soothe the body’s stress response.
Slowly inhaling and exhaling has physical and psychological benefits,
especially when done on a daily basis.
Anyone can practice deep
breathing, whether in the car, at work, or in the grocery store. Plenty of
smartphone apps offer guided deep breathing activities, and many are free to
download.
Progressive muscle
relaxation is another helpful tool for those experiencing depression and
anxiety. It involves tensing and relaxing the muscles in the body to reduce
stress. Again, many smartphone apps offer guided progressive muscle relaxation
exercises.
7.
Challenge negative thoughts
Firstly, notice how often
negative thoughts arise and what these thoughts say. These may include “I am
not good enough,” or “I am a failure.” Then, challenge those thoughts and
replace them with more positive statements, such as “I did my best” and “I am
enough.”
8.
Practice mindfulness
Take some time every day to
be mindful and appreciate the present moment. This may mean noticing the warmth
of sunlight on the skin when walking to work, or the taste and texture of a
crisp, sweet apple at lunchtime.
Mindfulness allows people to
fully experience the moment they are in, not worrying about the future or
dwelling on the past.
9.
Sleep Regularly: Try to keep a regular sleep schedule.
Sleep can have a huge impact
on mood and mental health. A lack of sleep can contribute to symptoms of
depression, and depression can interfere with sleep. To combat these effects,
try to go to bed and get up at the same time each day, even at weekends.
Establish a nightly routine.
Start winding down from 8 pm. Sip tea, read a book, or take a warm bath. Avoid
screen time and caffeine. It may also be helpful to write in a journal before
bed, especially for those whose racing thoughts keep them up.
10.
Exercise
Exercise is extremely
beneficial for people with depression. It releases chemicals called endorphins
that improve mood. An analysis of 25 studies on exercise and depression reports
that exercise has a “large and significant effect” on symptoms of depression.
11.
Avoid alcohol
Alcohol is a depressant, and
alcohol use can trigger episodes of depression or make existing episodes worse.
Alcohol can also interact with some medications for depression and anxiety.
12.
Record the positives
Often, depressive episodes
can leave people focusing on the negatives and discounting the positives. To
counteract this, keep a positivity journal or gratitude journal. This type of
journal helps to build self-esteem.
Before bed, write down three
good things from the day. Positives include regular meditation, going for a
walk, eating a healthful meal, and so much more.
13.
Asking for help
Asking for help is an
important step in dealing with a depressive episode.
Dealing with depression can
be daunting, but no one has to do it alone. One of the most important steps in
dealing with a depressive episode is asking for help.
Seek help from:
Family and friends. People
experiencing depression should consider telling family and friends how they are
feeling, and asking for support where they need it.
A doctor. It is essential to
speak to a doctor who can make a diagnosis and recommend treatments. Research
suggests that tailoring early treatment to the individual offers the best
possible outcomes.
A therapist. Talking to a
counselor or psychotherapist can be beneficial. Talk therapy can help address
low moods and negative thoughts. A therapist can also teach coping skills to
help people deal with future depressive episodes.
Support groups. Look for a
local support group for people with depression. It can be beneficial to talk to
others who are experiencing the same thing.
Support lines and crisis
hotlines are another way that people with depression can reach out to others.
Save important numbers to a cell phone, so they are easily accessible in times
of need.
14.
Meaning: Find small ways to be of service to others.
Find personal meaning by
serving something larger than yourself. Remember service doesn’t have to be big
to count. Consider this, “Success, like happiness, cannot be pursued; it must
ensue… as the unintended side effect of one’s personal dedication to a course
greater than oneself.”
15.
Your goals: Find workable goals that give you a sense of accomplishment.
Most people feel guilty when
talking about goals because they set unreasonable or unworkable goals. A goal
is workable if it’s:
Something you can control
(i.e., it doesn’t depend on others)
Manageable (i.e., not
overwhelming)
Realistic for you (not for
someone else)
Measurable (i.e., you know
whether or not it is done or getting done)
If something goes wrong with
your goal, adopt a “what can I learn from this?” attitude (versus a judgmental,
“this is why I’m horrible” attitude). Also, be careful when comparing your
progress with others. We usually compare our biggest weakness with another
person’s biggest strength. This is unfair (and usually not accurate anyhow).
16.
Practice Gratitude
Take time to notice what
went well today, not just what went wrong.
Consider keeping a gratitude journal.
Know that being grateful for your blessing doesn’t mean you have to
discount your problems.
17.
Relationships: Focus on people who lift you up.
Interact frequently with
others that bring you up (not people that bring you down). While it’s OK to
have some alone time, find a balance and don’t isolate yourself or the
depression will linger.
18.
Care for a pet
While nothing can replace
the human connection, pets can bring joy and companionship into your life and
help you feel less isolated. Caring for a pet can also get you outside of
yourself and give you a sense of being needed—both powerful antidotes to
depression.
19.
Join a support group for depression
Being with others dealing
with depression can go a long way in reducing your sense of isolation. You can
also encourage each other, give and receive advice on how to cope, and share
your experiences.
20.
Do things that make you feel good
In order to overcome
depression, you have to do things that relax and energize you. This includes
following a healthy lifestyle, learning how to better manage stress, setting
limits on what you’re able to do, and scheduling fun activities into your day.
Pick up a former hobby or a
sport you used to like. Express yourself creatively through music, art, or
writing. Go out with friends. Take a day trip to a museum, the mountains, or
the ballpark.
21.
Eat a healthy, depression-fighting diet
What you eat has a direct
impact on the way you feel. Reduce your intake of foods that can adversely
affect your brain and mood, such as caffeine, alcohol, trans fats, and foods
with high levels of chemical preservatives or hormones (such as certain meats).
Don’t skip meals. Going too
long between meals can make you feel irritable and tired, so aim to eat
something at least every three to four hours.
Minimize sugar and refined
carbs. You may crave sugary snacks, baked goods, or comfort foods such as pasta
or French fries, but these “feel-good” foods quickly lead to a crash in mood
and energy. Aim to cut out as much of these foods as possible.
Boost your B vitamins.
Deficiencies in B vitamins such as folic acid and B-12 can trigger depression.
To get more, take a B-complex vitamin supplement or eat more citrus fruit,
leafy greens, beans, chicken, and eggs.
Boost your mood with foods
rich in omega-3 fatty acids. Omega-3 fatty acids play an essential role in
stabilizing mood. The best sources are fatty fish such as salmon, herring,
mackerel, anchovies, sardines, tuna, and some cold-water fish oil supplements.
22.
Get a daily dose of sunlight
Sunlight can help boost
serotonin levels and improve your mood. Whenever possible, get outside during
daylight hours and expose yourself to the sun for at least 15 minutes a day.
Remove sunglasses (but never stare directly at the sun) and use sunscreen as
needed.
Take a walk on your lunch
break, have your coffee outside, enjoy an al fresco meal, or spend time
gardening.
Double up on the benefits of
sunlight by exercising outside. Try hiking, walking in a local park, or playing
golf or tennis with a friend.
Increase the amount of
natural light in your home and workplace by opening blinds and drapes and
sitting near windows.
When
to get professional help for depression
If you’ve taken self-help
steps and made positive lifestyle changes and still find your depression
getting worse, seek professional help. Needing additional help doesn’t mean
you’re weak. Sometimes the negative thinking in depression can make you feel
like you’re a lost cause, but depression can be treated and you can feel
better!
Don’t forget about these self-help tips, though. Even if you’re receiving professional help, these tips can be part of your treatment plan, speeding your recovery and preventing depression from returning.
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