Managing Depression Series II

Managing Symptoms of Depression

If you struggle with depression, you know how miserable it can be to have to deal with the variety of symptoms that go along with it. You probably find that some symptoms are a lot harder on you than others. Fortunately, there are some things you can do to help manage many of the symptoms of depression.In this program, each of the symptoms of depression will be presented, along with tips on how to manage them.First, there are some important things that you should keep in mind...

1. Be patient with yourself. Don’t expect too much from yourself right away, or you may set yourself up for disappointment and negative thinking that can make you feel worse.
2. Feeling better takes time. Don’t allow yourself to get upset if you don’t see improvement in your mood right away. Also, don’t be discouraged if you see some “backsliding” in your progress. Feeling better may involve “two steps forward, one step back.”
3. Identify daily patterns in your mood. Some people find that their mood is more depressed early in the day, while things seem better in the afternoon. Your pattern may differ, but learn what times of day are best for you. This will allow you to plan some activities when you feel best able to handle them.

Depressed Mood

Feeling sad, down, “blue,” empty, is a hallmark symptom of depression. Irritability, tearfulness, or a depressed facial expression can also reflect a depressed mood.What does NOT help depressed mood:

• Staying in bed longer than 8-10 hours day 
• Isolating yourself from family and friends who might be supportive to you.
• Being inactive. Avoiding regular mild-to-moderate exercise.
• Avoiding activities that have been enjoyable to you previously.
• Ruminating on negative thoughts.
• Eating in unhealthy ways.
• Not seeking appropriate professional treatment.

What can help improve depressed mood:

• Recognizing that depression causes you to have problems with your mood. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with negative mood.
• Setting small goals based on your situation. For instance, if you have trouble getting out of bed, or you aren’t taking care of yourself, your goal might be to set an alarm and get out of bed at a reasonable time, or take a nice shower in the morning. If you are able to do more, then your goal might be something like meeting with a good friend at a scheduled time, or going to an uplifting movie. You can increase the number of types of goals you set based on your readiness to handle them.
• Finding a way to be more active. This may simply be walking around the house, taking a brief walk down the street, or even joining a yoga or aerobics class.
• Seeking support and connection with people who understand your situation. These can be family, friends, self-help groups, online discussion groups, etc.
• If you stopped participating in an activity that you once enjoyed, consider starting it up again.
• Eating healthier foods. Staying away from processed junk foods or fast foods. Looking for organic foods and introducing more fruits and vegetables in your diet. Drinking plenty of water each day, and staying away from sodas and too many caffeinated beverages.
• Looking for ways to change negative thought patterns that maintain depression. Working with a therapist who uses cognitive-behavioral techniques (CBT). Taking a look at the CBT Workshop on this website that walks you through simple strategies you can learn and use to help modify negative thinking.
• If you notice that your mood isn’t improving, or that it is getting worse, be sure to seek professional help from your doctor, or a psychiatrist or psychologist. Untreated depression can become worse, last longer, and make for a worse prognosis than if it is treated in its earlier stages.

Feelings of Hopelessness, Helplessness

Feelings of hopelessness and/or helplessness can be some of the most frustrating feelings you experience when you are depressed. A sense of hopelessness reflects a negative view of the future, that nothing will get better. Feelings of helplessness reflect a negative view of yourself. Self-esteem suffers, self-confidence is affected, and you may not believe you have any control towards helping yourself feel better. You may give up and think, “What’s the use?”What does NOT help feelings of hopelessness/helplessness:

• Continuing to ruminate on negative thoughts about yourself or the future.
• Looking for evidence that such negative thoughts are true.

What can improve feelings of hopelessness/helplessness:

• Recognizing that depression causes you to have negative thoughts and feelings about yourself. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have as many strong, negative thoughts that affect your mood adversely.
• Using strategies such as those found in cognitive-behavioral therapy (CBT) to help you identify negative thinking and modify such thoughts towards improving your mood. There is a strong connection between our thoughts and our feelings, and CBT has been shown numerous times in research to help improve depressed mood.
• By identifying our negative “thinking styles” through the use of CBT, we can learn to recognize when our thinking is negatively affecting our mood.
• Taking a look at the CBT Workshop on this website that walks you through simple strategies you can learn and use to help modify negative thinking.

Loss of Interest or Pleasure

When you become depressed you may lose interest in things you once found enjoyable. Activities such as going out to dinner or a movie, visiting with friends, working, or doing hobbies are just not as interesting or enjoyable as they once were. This includes losing interest or desire in having sex.What does NOT help loss of interest of pleasure:

• Withdrawing from family, friends, or otherwise isolating yourself.
• Discontinuing your regular activities whether they are big or small.

What can improve loss of interest or pleasure:

• Recognizing that depression causes you to have problems with finding things interesting or pleasurable. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with loss of interest or pleasure.
• Continuing your regular activities. You may find you need to cut back on the number of activities you have or your involvement in them, but try not to eliminate them completely.
• Being careful not to withdraw from people who can support you while you are depressed. Seeking out support from family, friends, support groups, online communities, etc.

Appetite and Weight Changes

When you are depressed, you may notice changes in your appetite. On the one hand, you may never feel very hungry. You can go long periods of time without wanting to eat anything. You may forget to eat, or if you do eat just a few bites may fill you up. You may even feel that you have to force yourself to eat. For some people, the thought of eating is unpleasant, and having to prepare a meal seems to require too much energy. In such cases, you may lose a significant amount of weight.On the other hand, you may have an increase in your appetite and gain a lot of weight. You may even find that you crave certain types of food such as sweets or carbohydrates.What does NOT help with appetite and weight changes:
For those who are losing weight…

• Skipping meals or snacks.
• Eating junk food, fast foods, or other processed foods.

For those who are gaining weight…

• Eating junk food, fast foods, or other processed foods for meals or snacks.
• Purchasing foods that contain a lot of sugar, carbohydrates, or unhealthy ingredients.

What can improve appetite and weight changes:
For those who are losing weight…

• Recognizing that depression causes you to have problems with weight loss. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with weight loss.
• Eating several small meals throughout the day rather than trying to eat three large meals.
• Sticking with foods that you enjoy and that you may have an appetite for.
• Choosing healthy foods that will provide you proper nutrition and calories. Eating fruits, vegetables, foods with protein and vitamins, and drinking plenty of water.
• Planning ahead what foods you will have, and schedule times for eating. You might write this down on a piece of paper and post it in your kitchen.
• You might introduce meal supplement drinks like Orgain, Boost, or Ensure into your diet. These are nutrient rich and can provide you some of the nutrition you might otherwise be missing. Be sure to consult with your doctor to determine if using a meal supplement is appropriate for your needs.

For those who are gaining weight…

• Recognizing that depression causes you to have problems with weight gain. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with weight gain.
• Being sure to stick to eating healthy, unprocessed foods, especially if your appetite is increased. Introducing fruits, vegetables, or other healthy snacks into your diet. Drinking plenty of water.
• Don’t go to the grocery store while hungry. This can help you make healthy choices about the foods you purchase rather than giving in to a temptation to buy foods that are high in sugar or carbohydrates.
• Introducing some mild to moderate exercise into your daily routine. Simply taking a brief walk can help burn some calories and manage food cravings.
• Distracting yourself with other enjoyable activities at times when your food cravings might be at their height. This can include mild to moderate exercise, meeting with friends, going shopping, going to the museum or library, etc.
• Some weight gain can be related to the type of antidepressant medication you are taking. If weight gain is causing you distress, be sure to speak with your doctor about this. Don’t stop taking medication without consulting with your doctor. Sometimes, a new medication can be tried.

Sleeping Problems

Not being able to get enough sleep at night is the most common type of sleep disturbance if you are depressed. This may include having a hard time falling asleep, waking up during the night and having difficulty falling back asleep, or waking too early in the morning. Another type of sleeping problem includes oversleeping in the morning or sleeping during the day. Even with excess sleep, you may still feel tired and sluggish during the day.What does NOT help sleeping problems:
For those who are not getting enough sleep...

• Taking sleeping pills without consulting with your doctor.
• Staying in bed while you cannot fall asleep allowing yourself to become increasingly frustrated with not being able to sleep. This can create a negative association with being in bed and excessive frustration or anxiety.
• Having an irregular sleep/wake schedule.
• Not exercising on a regular basis.

For those who are sleeping too much...

• Having an irregular sleep/wake schedule.
• Not exercising on a regular basis.
• Staying in bed more than 8-10 hours a day.
• Taking naps during the day.

What can help improve sleeping problems:
For those who are not getting enough sleep...

• Recognizing that depression causes you to have problems with sleeping. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with sleeping.
• Keeping a regular sleep schedule. Avoiding naps during the day.
• Being sure to exercise each day.
• Engaging in a relaxing activity before getting in bed and attempting sleeping. This can include reading a good book, doing some mild exercise, taking a warm bubble bath, listening to music, doing some relaxation exercises, etc.
• Reducing noise, distractions, etc. in your room and around your house. Making sure the temperature of your room is suitable and that you are comfortable in your bed.
• Refraining from doing other activities in your bed (e.g., reading a book, eating, watching television). Only use your bed for sleeping to create the positive association between being in your bed and sleeping.
• Don’t eat or drink too close to bedtime as this may cause you to need to get up and go to the bathroom during the night.
• Staying away from caffeine, alcohol, and nicotine in the evening, and perhaps in the late afternoon as these can cause you to have problems sleeping.

For those who are sleeping too much...

• Recognizing that depression causes you to have problems with sleeping. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with sleeping.
• Keeping a regular sleep/wake schedule.
• Avoiding naps during the day.
• Being sure to exercise each day, even a little bit.
• Developing a pleasurable morning routine that you will engage in when you do get up. This might include fixing breakfast, watching a favorite television show, getting online and reading news items, calling a friend, instant messaging with family or friends, reading the newspaper, taking a walk, visiting a friend, etc.
• Setting an alarm at a reasonable hour. Being sure to get up and move around, even get out in the sunshine for a time.
• If you find it hard to get out of bed, have a family member or friend come wake you up or call you.

Decreased Energy

Having low energy and feeling tired and fatigued are very common symptoms if you are depressed. You may feel quite tired even without having engaged in any physical activity. Simple day-to-day tasks are no longer simple. Even such things as getting washed and dressed in the morning can seem overwhelming and may take twice as long as usual. When you are able to do things around the house or at work, you may become very exhausted or tire quickly.What does NOT help decreased energy:

• Remaining sedentary, not exercising.
• Eating unhealthy, processed, or junk foods.
• Not getting enough sleep at night 

What can help improve decreased energy:

• Recognizing that depression causes you to have problems with your energy and ability to do some things you’d like to do. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with energy.
• Beginning a very mild exercise routine. This can include walking around your house and building toward taking a brief walk down your street. Don’t try to do too much too fast. Check with your doctor about planning a proper exercise routine for your needs.
• Being sure to eat healthy foods. Introduce fruits, vegetables, and other healthy, nutrient rich foods into your diet. Stay away from junk foods or processed foods.
• Being sure to get enough sleep at night 

Feelings of Worthlessness, Guilt

You may tend to think of yourself in very negative unrealistic ways. You may become preoccupied with past "failures," personalize trivial events, or believe that minor mistakes are proof of your inadequacy. You also may have an unrealistic sense of personal responsibility and see many things as being your own fault. For example, a car salesperson may spend a great deal of time blaming himself/herself for not meeting certain sales quotas even when the overall sales of cars in the area is down and other salespeople are having similar difficulty.What does NOT help feelings of worthlessness or guilt:

• Continuing to ruminate on negative thoughts about yourself.
• Looking for evidence that such negative thoughts are true.

What can improve feelings of worthlessness or guilt:

• Recognizing that depression causes you to have negative thoughts and feelings about yourself. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have as many strong, negative thoughts that affect your mood adversely.
• Using strategies such as those found in cognitive-behavioral therapy (CBT) to help you identify negative thinking and modify such thoughts towards improving your mood and self-esteem. There is a strong connection between our thoughts and our feelings, and CBT has been shown numerous times in research to help improve depressed mood.
• By identifying our negative “thinking styles” through the use of CBT, we can learn to recognize when our thinking is negatively affecting our mood.
• Taking a look at the CBT Workshop on this website that walks you through simple strategies you can learn and use to help modify negative thinking.

Problems with Thinking

Depression is notorious for causing difficulty in thinking, concentration, memory, and decision making. Depression also causes you to think in negative or pessimistic ways, which can contribute to maintaining a depressed mood. Any of these problems can make it difficult to believe that you will ever feel better again. However, when the depression lifts, much of this negative thinking is likely to disappear.What does NOT help with thinking problems:

• Being hard on yourself for having such difficulties.
• Making major life decisions.
• Taking on more things than you can handle. This can include attempting to manage now what you have been able to do in the past when you have not been depressed.

What can help improve thinking problems:

• Recognizing that depression causes you to have problems with thinking concentration, memory, and decision making. It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with your thinking.
• Refraining from making important decisions about your life until you feel better able to think things through sufficiently. Ask family and friends to help you weigh the pros and cons of important decisions.
• Being careful about trying to handle as many things as you have in the past. You may need to cut back on your obligations.
• Being patient with yourself and using some strategies for memory, including writing things down in a notebook, using notes to remind yourself of things and posting them where you will see them. Organizing papers and information in useful ways. Giving yourself extra time to do these things.
• If you struggle with negative or pessimistic thinking, consider ways to help change your ways of thinking. Cognitive-behavioral therapy is designed to address this kind of thinking that tends to maintain depressive symptoms. Find out if your therapist can offer this to you. You might also check out the Cognitive-Behavioral Therapy Workshop on this website.

Suicidal Thoughts, Plans, Attempts

Thoughts of death, suicide, or even suicide attempts can be common if you are depressed. The frequency and intensity of thoughts about suicide can be wide-ranging from believing that friends and family would be better off if you were dead, to frequent thoughts about committing suicide, to detailed plans about how you would actually carry out the act of suicide. People who are less severely suicidal may have short, but regular (a few times a week) thoughts of suicide. A person who is more severely suicidal may have made specific plans, collected materials (i.e., pills, gun, rope), and decided upon a day and location for the suicide attempt.The motivation for a person to want to kill him- or herself may not be for the desire to actually die. It may be due to the wish to give up in the face of what seems for the person to be overwhelming obstacles, or the desire to end the emotional pain that seems to have no end.What does NOT help suicidal thoughts:

• Keeping the thoughts to yourself and not sharing them with another person, particularly someone who can help. This can include family, friends, clergy, your doctor, or a mental health professional.
• Not working with a mental health professional to address suicidal thoughts and other depressive symptoms.
• Making plans for a suicide attempt.
• Gathering items for a suicide attempt.

What can help improve suicidal thoughts:

• Recognizing that depression causes you to have thoughts of suicide It is not some character flaw or “failure” on your part. When you are not depressed, you may not have such problems with thoughts of suicide.
• If you are having suicidal thoughts, making plans for an attempt, or you have intentions for a suicide attempt, it is extremely important that you seek help immediately. You should call 911, speak with your doctor, speak with a mental health professional, or go directly to your local hospital emergency room.
• If you are currently working with a mental health professional for your depressive symptoms, call him or her and discuss your suicidal thoughts or plans.
• If you aren’t currently seeing a therapist, please do so. A good therapist can help you understand and manage suicidal thoughts, as well as address other symptoms of depression.

Conclusion

Hopefully, the tips presented here will help you manage some of your own symptoms of depression. While you may find it challenging to implement some of these strategies, please remember to be patient with yourself. Feeling better does take time. It is important to take good care of yourself with good nutrition, exercise, sleep, and reasonable amounts of activities, as well as generally being kind and gentle with yourself. Also, be very careful about letting negative thoughts get in your way. Don’t let setbacks keep you from doing things that can help you feel better. You can do it!

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