Depression

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Depression

Depression used to be such a depressing subject that people often felt compelled to fake a smile and keep their anxious, sad feelings inside. Not anymore. Ever since researchers started to discover the mix of psychological and physical causes for this problem, depression has seemed much less mysterious and forbidding. People are acknowledging it, and talking about it, out in the open.

There's even something called healthy depression, according to Ellen McGrath, Ph.D., former chairperson of the American Psychological Association's National Task Force on Women and Depression. Dr. McGrath is the author of When Feeling Bad Is Good, which discusses in more detail the concepts of healthy and unhealthy depression and offers strategies for action.

"Healthy depression is defined as realistic feelings of pain, sadness and disappointment, accompanied at times by guilt, anger and/or anxiety, that stem from a negative experience such as trauma, loss and unfair treatment," Dr. McGrath explains. People experiencing healthy depression can still function, although usually not as well as they would otherwise.

Unhealthy depression involves being unable to function in one or more areas of life, such as work or relationships, due to the depth of bad feelings. "These bad feelings can be caused by changes in body chemistry, genetic vulnerability and/or too many painful psychological experiences that you are unable to resolve," says Dr. McGrath.

You can take healthy depression as a signal that it's time to make some changes and take some actions in your life, according to Dr. McGrath. While unhealthy depression will benefit from the same approach, it first requires professional help--the sooner, the better.

There are countless ways to tackle depression, from exercise to drugs to support groups. Often it's a combination of things--getting organized, learning new behaviors, becoming more self-aware--that finally breaks depression's hold.

The following tips can help you deal with life's normal ups and downs and perhaps help you bounce back faster from the downs.

Take the high road. Or the low road--it doesn't matter. Just get out there and move. "I tell my patients 'The odds are good to excellent that if you exercise, you will be virtually depression-free in three to five weeks,"' says psychologist Keith Johnsgard, Ph.D., professor emeritus of psychology at San Jose State University in San Jose, California, and author of The Exercise Prescription for Depression and Anxiety.

Studies are clear on this. The less active you are, the more likely you'll be depressed. "And a dozen or so studies show that all but the most severely depressed people who begin to exercise do as well as those who get standard psychotherapy," Dr. Johnsgard says. His exercise Rx: an hour a day of brisk walking.

What if you're too bummed out to boogie? "Get a family member or friend to come and drag you around the block a few times," he says.

Stay up to watch the sunrise. Some studies show that approximately 60 percent of depressed people who deprive themselves of a night's sleep may help thwart their symptoms, but the effects last only until the next time they sleep, says Ronald Salomon, M.D., assistant professor of psychiatry at Yale University School of Medicine in New Haven, Connecticut. And if you use sleep deprivation for more than a night or two in one week, the mood-enhancing effects may drop off significantly, he says.

When to See the Doctor Experts at the National Institute for Mental Health in Bethesda, Maryland, suggest that anyone who experiences four or more of the following symptoms of depression for more than two weeks should seek professional help. Persistent sad, anxious or "empty" feelings Feelings of hopelessness and/or pessimism Feelings of guilt, worthlessness and/or helplessness Loss of interest or pleasure in ordinary activities, including sex Sleep disturbances (including insomnia, early-morning waking and/or oversleeping) Eating disturbances (changes in appetite and/or weight loss or gain) Decreased energy, fatigue and/or a feeling of being "slowed down" Thoughts of death or suicide, or suicide attempts Restlessness and/or irritability Difficulty in concentrating, remembering and/or making decisions

Cultivate friends. "Being able to develop and maintain intimate, supportive relationships with other people is the survival skill of the 1990s," according to Dr. McGrath. "These relationships are critical to our health."

Realize that it takes time and effort to build these special relationships--then get to work! "Do everything and anything you can to develop the skills it takes to have quality relationships," she says. That includes learning communication skills, improving self-esteem and taking the time to be with people, Dr. McGrath says.

Know that action equals power. "Talking about your fears and anger can be helpful, but for women, it isn't enough to avert depression," says Dr. McGrath. "Taking some positive action, on the other hand, creates its own energy, which leads to a feeling of power and control." She suggests ritual actions--burning a list of worries, for instance--and real actions--such as getting organized, getting enough sleep or delegating household chores--as ways to convert uncomfortable feelings into positive action.

Tell your internal critic to take a hike. Do you have a little (or a big) voice inside you that insists nothing you do is right? That you're never going to get what you want?

"Rather than trying to get it to go away, which it never does, change your response to it," suggests Michael D. Yapko, Ph.D., a clinical psychologist in San Diego and author of Free Yourself from Depression. "Rather than just believing what it tells you, say to yourself 'Okay, I understand that there is this critical voice, but I don't have to listen to it."'

People with high self-esteem also have this critical voice, Dr. Yapko says. "But they know to ignore it or at least respond to it as though what it's saying isn't true."

Don't take things so personally. "Because I don't return your phone call, you decide that I must be angry with you. That's personalizing," Dr. Yapko explains.

The problem with personalizing is that it's not a very objective way to look at things. "You jump to the first plausible conclusion, but is that the true explanation?" he asks.

A key strategy for jettisoning this kind of faulty negative thinking is to generate multiple explanations for important things that happen. "Consider a variety of possibilities and look for facts. That, at least, puts you in reality," he says.

Avoid all-or-none thinking. Do you get a C on an exam and feel like a failure? Do you miss out on a promotion at work and feel like a loser? If so, you tend to see things in black and white, with little or no gray in between. Few things in life are so extreme.

"Depressed people tend to have a low frustration tolerance," Dr. Yapko says. "They want immediate answers and immediate clarity. Typically, that's the way they've learned to be. And that's why they get depressed, because life choices are rarely clear and often ambiguous."

Learning to recognize and live with life's uncertainties is a key strategy for avoiding depression.

Get to know yourself better. "People often get depressed when they aren't doing what they want to be doing," Dr. Yapko says. "They may want to play, for example, but feel they must always work." Fortunately, everyday life gives you the opportunity to ask yourself important, self-defining questions, he says. "Who are you? What do you want out of life? What are the things that really matter to you? What things do you need to include in your life that are uniquely you? Make sure you build those things into your life."

Do a medicine chest shakedown. "Many drugs can cause depression," says Arthur Jacknowitz, Pharm.D., professor and chairman of clinical pharmacy at West Virginia University School of Pharmacy in Morgantown. The most likely culprits are high blood pressure medications, anti-arrhythmic drugs, prednisone and similar corticosteroids, glaucoma medications, sedatives such as Xanax and Valium, oral contraceptives and some over-the-counter drugs containing antihistamines.

"Symptoms of drug-related depression may not surface right away," explains Dr. Jacknowitz. "So even if you've been taking a medication for six months to a year and then begin to experience the blues, it could still be your medication." Discuss the problem with your doctor, he suggests. It may be possible to taper off the use of the drug or to switch to another.