What to Do If You Are Depressed

I often get letters from individuals who are depressed asking me what they should do. If you go on sites like WebMD, they will tell you that depression is a serious medical condition and that you should consult with your doctor. As such, I will assume you have already heard that piece of advice. Here, I attempt to offer folks something more.

What follows is a 15-part blog series that I have developed to serve as a guide for folks who are feeling depressed or who think they might be and are wondering what to do about it. It is written mostly from a “self-help” perspective. You do not need to be in therapy (*although please see note at the end of this post). It is probably best suited for folks in the mild-to-moderate range of “clinical depression” and who have enough “mental energy” to read and think things through.

It does not try to sell you anything, although it does recommend several books you might consider. It also does not promise you a “quick and easy cure.” It is a guide that is divided into two broad parts. The first half of the series attempts to help you first understand what depression is, and use that to connect with understanding your situation and who you are as a person. Once we go through the steps of understanding depression and how it fits for what is going on with you, then the second half moves on to explore principles of “adaptive living.”

These are the guides for doing things differently in the areas:

• Behavioral activation (rather than behavioral shutdown)
• Fostering healthy habits and lifestyles
• Attending to your biology
• Understanding emotions and adaptive coping
• Fostering healthy relationships
• Learning to engage in adaptive (versus maladaptive) thinking
• Developing a value-based philosophy of living

This blog series offers a post every few days for a period of several weeks. One way to think of it is as a series of encounters that build on each other. Please proceed through them at your own pace. The first set of blogs can be engaged quickly. The principles, however, require a much longer time to fully digest and implement. Part of the reason for the length is that finding one’s way out of a “depressive cave” takes time (i.e., usually weeks, often months). This is because climbing out of a depressive cave usually involves learning new ideas and skills, which need to be repeated and practiced.

The posts in the front half of the series are focused primarily on helping you identify the “neighborhood” of depression in which you are located. They involve learning about depression, about your life, and fostering understanding of your situation. The back half of the series focuses more directly on active steps you might take to move out of that neighborhood and into a more fulfilling place. The working assumption, supported by research evidence, is that it is possible for folks to find their way out of the cave of depression. It is, however, hard and takes effort and an adaptive attitude.

Although this blog series has many episodes, it does have a primary take-home message. It is as follows:

Depression is a state of behavioral shutdown that can happen for a host of reasons. The key thing to understand is that, as a state of behavioral shutdown, depression traps people into vicious cycles of avoidance and withdrawal. This means that you need to:

• Learn about the cycles of behavioral shutdown.
• Understand how they trap you, given who you are and the kinds of things that are driving your depression.
• Learn how to engage the world in a different way (i.e., doing, thinking, feeling, and relating).

Understanding what is going on and making these changes are hard to do. However, if you are patient and persevere, and are able to find a path of positive investment that nourishes your soul, then shutdown will reverse itself.

How does one find a path to positive investment? To guide the process we will be using the three “A's”

1. Awareness
2. Acceptance
3. Active change

Awareness involves increasing your understanding about what it going on, especially in terms of your feelings, thoughts, actions, and relationships. Acceptance involves being able to hold and tolerate negative feelings and distressing situations in a measured and mindful way. Active change means trying new things, even when it is hard. We will be considering each “A” in various ways in this journey.

Depression Essential Reads

In Sight: The Biological Diagnosis of Depression and Anxiety

How Exercise Helps Us Fight Depression and Addiction

As such, this journey invites you to adopt the attitude that you are attempting to:

1. Increase your awareness of who you are and of what depression is, where it comes from, and what might be done
2. Work toward increasing your capacity for acceptance of what is, including painful feelings and past losses
3. Increase your engagement with things, even if your first instinct is to avoid and withdraw

With this background in hand, let us move on to Step 1.

Step 1: Realize that you are not alone

We can start with a general point of awareness that is important for not just people who are depressed but for everyone in society. Depression is common. It affects people across all social groups and classes. Consider that the World Health Organization identifies depression as the single most detrimental medical-health condition of all (including cancer or heart disease in terms of its “global burden”).

There are three key points for this first step. The first is that almost everyone is affected by depression, either directly or indirectly. As such, it is crucial that we are aware of this and create a community that is aware of this. Second, it is crucial that individuals dealing with depression know that they are not alone. The experience of profound loneliness is common in depression and, as we will see, it can contribute significantly to depressive states. However, the fact of the matter is that it is something many people deal with.

Third, I hope this insight might provide you with some notions about what you can do. For example, perhaps you could join a support group, either in person or online. If you Google “depression support groups” you might find something helpful there. Here is a post that identifies 7 Facebook pages that might be helpful. And, here is a book on depression, titled You Are Not Alone.

Emphasizing the relationship aspect brings us to one of the themes for this series, which is the attitude of “loving compassion.” This means having a deep respect for the dignity for all persons—one’s self and others—and offering the general wish that folks flourish rather than suffer. As such, I would like to end this first entry with a “metta mantra” from the Buddhist Thích Nhất Hạnh:

May I be peaceful, happy, and light in body and spirit. May I be safe and free from injury. May I be free from anger, afflictions, fear, and anxiety.

May I learn to look at myself with the eyes of understanding and love. May I be able to recognize and touch the seeds of joy and happiness in myself. May I learn to identify and see the sources of anger, craving, and delusion in myself.

May I know how to nourish the seeds of joy in myself every day. May I be able to live fresh, solid, and free. May I be free from attachment and aversion, but not indifferent.

Love is not just the intention to love, but the capacity to reduce suffering, and offer peace and happiness. The practice of love increases our forbearance, our capacity to be patient and embrace difficulties and pain. Forbearance does mean that we try to suppress pain.

This concludes Part I.

Here is Part II.

*If you are in therapy and find this blog series to be of interest, please share with your therapist and discuss it so you are both on the same page. In addition, if you know someone who is depressed, perhaps this blog can be a source of education and conversation about what depression is, why people get depressed, and what they might be able to do about it. Learning how to talk about depression is an important component in learning how to deal with and prevent depression.

In addition, any discussion of depression must include awareness of the fact that significant numbers of people who are depressed have suicidal ideation. Here is a post I did on reasons why folks become suicidal and how to address that. Please get help if you are dealing with suicidal thoughts or impulses (here is one resource).