Manage depression

Depression is the fourth most prevalent disease in the world.56 It seriously damages the quality of life of millions of people and drains economies through the costs of mental health services and lost productivity.

We may have more freedoms, more wealth and more opportunities, but it seems that in the western world, the last one hundred years has brought more depression, not less. One study of 9,500 people showed that about one percent of people born before World War 1 suffered from depression throughout their lives. For the generation born in the 1950s the figure was seven percent.

Are you dwelling on negative thoughts about yourself, or your future for prolonged periods? Depressed people tend to think in absolute terms about loss, hopelessness, worthlessness and fatigue, and they think they’ll always feel that way.

Depression is common in adolescence, during pregnancy and after giving birth, but it is not the inevitable outcome of loss or failure or hormonal changes. It’s perfectly normal to grieve, feel sad, feel rejected and go through life’s transitions without the long-term suffering and distorted thinking psychologists associate with depression.

Most people recover from depression whether it is treated or not, but if you have had one depressive episode, your chances of having another are increased to about 50/50.58 Depression can be a very serious disorder. You may be able to manage mild depression with cognitive therapy, but talk to your doctor if you think you have something more serious or managing it yourself doesn’t work.

First, as you sense you are heading towards an emotional slump, you must recognize the symptoms of depression and call it depression. You’ll find that many of the suggestions for managing mild depression will help with sadness too.

Usually, the event that triggered your mood will be abundantly clear, but not always. Sometimes small things can set of a depressive reaction so that you lose track of the cause. If you do know the cause, you may be able to deal with it directly, but let’s assume that you can’t or that solving the problem hasn’t been enough to take away the symptoms of depression.

• Stop the rumination

People who ruminate worry excessively about their depression. They often isolate themselves to think about their symptoms and ask researchers and therapists, ‘What if I don’t get over this?’ It’s a passive reaction to depression. Ruminators are not thinking about action they could take or reframing, they are simply stuck in a state that’s easy to slip into and can be difficult to escape.

Susan Nolen-Hoeksema of Stanford University studied bereaved people and found that the more they ruminated, the longer their depression.59 Ruminators are on a cycle of distorted thinking and unrewarding relationships. They need support from others, but believe they are getting less of it than they should have. It may be just their perception, but because constant rumination is draining for friends, family and colleagues, it may be true. Ater a while, everyone else wants to see some action.

Women are about twice as likely as men to suffer major depression and the highest risk for them is in their mid-to-late 20s.61 Researchers and therapists report that many more women than men ruminate. Rumination prolongs depression, but it’s too easy to conclude that rumination accounts for the difference between men’s and women’s depression.

Researchers from the University of Nijmegen in the Netherlands have come up with a strategy to help us avoid rumination.62 To test it, they told students that they had scored low on a bogus intelligence test and found that those who had the opportunity to reinforce their belief in their self-worth in other ways were less inclined to ruminate about the results. (Yes, they did tell them later that the test results were worthless.) So, actively reviewing our achievements and the personal skills and qualities we are most proud of can be a useful reaction to the early symptoms of depression.

Help your family, friends and colleagues to do the same. It’s okay to feel proud of what you’ve achieved. It’s difficult, partly because depression distorts our thinking. It’s odd, but although depressed people doubt themselves in many ways, they tend to be very confident about their depressed interpretation of the world and their setbacks. Forcing yourself to focus on your qualities may be difficult when you are feeling low, but that kind of rethinking is at the heart of cognitive therapy.

Depressive thinking tends to create a cycle and it’s essential to break out of it as early as possible. It’s not simply a matter of thinking happy thoughts. ‘I’m going to be positive today,’ does help if you are a little sad, but with depression the benefits don’t last. The research shows that correcting your thinking errors is likely to be far more effective.

When your partner said you don’t do your share around the house, was she really saying, ‘Please help me, I’m tired’? Even if it’s true that you never help around the house, why should you believe that you can’t do anything right? Surely, that’s a gross over-reaction?

While you are being sceptical you can also remind yourself that you are great with the kids and you oten take them away to the park or on walks to give your partner a break. The scepticism is to help you think more positively and more accurately. It’s not about inding excuses or dreaming up ways to show how wrong other people are. If the criticism is fair, you might want to put things right, but most of all, you need to correct the depressive thinking that put you into the depression cycle.

In section three we saw how resilient people explain their successes and setbacks. You can use the same technique to reframe depressive thinking.

Reframing should include recognizing and dismissing the depressive thinking errors. It’s not shallow ‘positive thinking,’ it’s simply being sceptical. Is there really any evidence that you don’t have the ability or potential? Surely, it’s not true that you fail at everything you do? Talk about your setbacks as setbacks (so temporary) not failures.

Does explaining our successes and setbacks in pessimistic ways really cause depression? It’s safer to say that pessimistic thinking and depression are strongly associated. As it happens, very strongly associated.

Explanation for your setback

‘It’s my fault.’ (Internal)

‘It will always will be like this.’ (Stable) ‘It’s the same in everything I do.’ (Global)

Depressed self-talk

‘I don’t have the ability to be promoted.’ ‘I’ll never get promoted now.’

‘I never succeed at anything. ‘I’ll always be a loser.’

One group of researchers has confirmed the link between pessimistic thinking and depression after analyzing 104 studies involving 15,000 participants.

Try some brainstorming and talk to someone you trust about what you can do to improve a situation that leads to depressive thoughts. Depressed people often see only one solution.

Even one solution may seem impossible. It’s partly because depressed people tend to see their situation in extreme terms. Watch out for these words: loser, never, always, impossible, disaster, failure, ruined, destroyed, useless, hopeless, clueless.

• Exercise

Therapists, counselors and researchers recommend finding ways to raise our energy and give ourselves some pleasant events to look forward to. Some recommend uplifting music, letting the sunlight in to help our bodies function better, and changing our routines so that every day has an element of novelty.

Depression is a low-arousal state so you should use a workout at the gym or a run in the park to pump your body up to a more normal level. More than 1,000 studies have shown the mental health benefits of regular aerobic exercise. Every controlled study has found exercise to be effective for mild to moderate depression. It may be effective, but it is difficult to begin if you’re depressed. Find ways of exercising that you are more likely to enjoy and ensure that you have some variety.

• Be sociable – with care

Being around others, and especially helping out, seems to work well. It helps to stop the ruminating. It also gives us a sense of achievement and helps us to feel appreciated.

There is a risk in socializing while depressed. The old saying, ‘Misery loves company’ checks out.

William Swann from the University of Texas and his colleagues came up with a creative experiment that shows how far depressed people will go to use relationships to perpetuate their depression. They asked students to read the results of a personality test they had taken a few days before. The evaluations were supposedly written by clinical psychology students. The researchers had arranged that each student would read one negative evaluation, one neutral and one positive. They then asked them to say which of the evaluators they would most like to meet and get to know. The non-depressed students wanted to meet the evaluators who had made the most lettering comments, but the depressed students preferred to meet those who had found the most faults and would be most likely to dislike them – surely an efective way to remained depressed.

That tendency to perpetuate depression shows up in other ways too. For instance, it would make sense for people feeling depressed to compare themselves with others who are worse of and feel better as a result. But it seems they don’t. In 1992, two researchers discovered that depressed people are more likely to make themselves even more miserable by thinking of people who are better of. They described that behavior as ‘puzzling’.67

The inclination to find things to make you feel worse, illustrates the challenge of managing depression. It’s not easy to snap out of it. You need to be very focused and determined to raise your energy level, find the right people to be around and make healthy comparisons.

• Believe it or not

It probably sounds too superficial to be true, but smiling does work. There’s research evidence to support it. Try this simple experiment: hold a pen between your teeth lengthways so that you imitate a smile. Okay, it’s a silly thing to do so you’ll smile anyway, but keep the pen there for say 10 minutes and check how you are feeling at the end. A German study using the pen idea produced encouraging results. The same researchers found that it worked the other way too. Their subjects were less happy after holding their pens end-on with pursed lips.

Manisha Dubey’s says that as particular facial muscles relax or tighten they raise or lower the temperature of the blood supply to those brain centers that regulate our emotions.

Manisha’s explanation is not accepted universally, but many researchers agree that facial expressions don’t just reflect moods, they can cause them. The effects are probably relatively minor compared with distressing thoughts or memories, but being willing to smile should be part of our depression- fighting repertoire.68

More recent research by Rene Brown has shown that a few minutes of power poses significantly reduces our body’s production of the stress hormone cortisol. It’s further evidence that the body influences the brain.