At the moment depression is a life sentence without a cure; the best we can do is keep it in abeyance for as long as we can, and if we’re very fortunate, that might be for the rest of our lives. But there are many things we can do to help ourselves, and here are some of the things that helped me. Everyone will find them helpful; if you’re not suffering from depression, then maybe these will help you to live a better life.
1. Drugs
If you are really depressed, and if it has been going on for some time, you almost certainly need medication, and you have to see a medical practitioner to get it. In the UK that means your GP or a psychiatrist, who then writes to your GP. They will almost certainly start you off with an SSRI (selective serotonin re-uptake inhibitor, such as Prozac). There are many anti-depressants out there, and they work in slightly different (and mysterious) ways. They take time – weeks, even months – to take effect, so don’t be too dismayed if nothing has happened the next day. You should hopefully start to see an improvement within a few weeks. If the first one doesn’t work, then you will need to try another. It’s preferable that you have someone to monitor your mental state and behaviour, because you are often not the best person to judge if you are getting any better. Different drugs have different side effects on different people, and if you find yours unbearable, again you should discuss changing drugs with your medical advisor. There are alternatives you can get without prescriptions (e.g. St John’s Wort) but see below for warnings. After many years and changes of medication, I have settled on Duloxetine (Cymbalta) for depression and Quetiapine for anxiety.
2. Other people
You cannot fight severe depression alone. You hopefully have already seen your doctor, but probably should be seeing a psychiatrist as well. I have tried different sorts of clinical psychology and therapy, and have eventually found a cognitive-based therapy system that looks at your childhood, attitudes, and relationships to be a revelation. Different things though seem to work for different people. You will need your friends too and you need to be open with them that you are depressed. Fight that stigma!
3. Changes
There are many changes I have made that I think have contributed to my shift towards wellness. The biggest is to do with “work” – for want a better name: that thing that someone else pays you to spend your time doing. In the first instance you might need a period of time off work – look into your sick leave entitlement, and do contact your Human Resources department. People with long-term mental health problems have rights, and you cannot be discriminated against just because you’re ill. I took a long hard look at my academic job and decided I had had enough. There are many things I liked about it, but an increasing number of things I no longer enjoyed and that seemed to me to be pointless. On the other hand, I love writing and journalism, so I decided to “retire” and become a full-time writer. It’s a financial risk, and it might not work out. I might be poor for the rest of my life. But at least I feel that I am in control, and doing only what I think is worthwhile. You might say I’m lucky being able to do this, but what is your health worth? What big changes can you afford to make? Are the big house and fast car really worth what you’re having to endure? And big changes don’t apply just to work either: is that toxic relationship really worth staying in?
4. Exercise
I think you have to be starting to get well to make some of these changes, or at least not in the pits, but I decided I had to lose weight and get fit. I, like many depressed people, am pretty useless at self-discipline. So I joined a gym and signed up with a personal trainer. It’s one of the best calls I’ve ever made. I’ve lost over 30 pounds so far and my weight is still going down. I feel so much better; I have more energy and after each exercise session my mood is lifted. There’s plenty of evidence for the positive effects of exercise, so get to it.
5. Light and air
Many of us who are depressed really benefit from more light. I try and maximise my exposure to sunshine, even sitting outside when it’s sunny but in the cold depths of winter. I have a light box that I use even in summer when it’s dull. I try and get as much fresh air and to get outside as much as I can even when I’m busy working at home.
6. Diet
I have tried many diets, and I find the science complicated, confusing, and contradictory. One certainty is that you have to cut sugar and refined, processed food right out of your diet. I have also greatly decreased the amount of carbohydrates I consume. My breakfast will be something like prawns, berries, another piece of fruit, and nuts; my lunch fish, sweet potato, and homemade baked beans; dinner lean white meat or fish, lots of vegetables, and nuts. It’s a bit boring and expensive, as I don’t like spending large amounts of time cooking for myself. I also take good quality fish oil supplements. I have cut back on the amount of wine I drink but still find some each evening calms me down; it’s a fairly harmless self-medication in moderation. There are supplements that might lift mood (I take methyl folate, sAME and vitamins B12 and D for this purpose) but these are no substitution for medication. It’s worth doing some research and seeking advice if in doubt: there’s evidence that St John’s Wort shouldn’t be combined with SSRIs.
7. Mindfulness and meditation
I find meditation difficult – sometimes it hurts my mind too much to sit still with nothing but my thoughts, even for as little as ten minutes – but I try. And I do gain a great deal from being mindful – trying to live in the moment and be present. The evidence suggests that mindfulness training might be as effective as medication. There are many good books and resources on mindfulness training, so give it a try.
8. Thoughts
I have tried to change my cognitive structure – saying “I am not my illness”, working out what the really important things are in my life and changing those things, trying to be honest with myself, and trying to be kind. I try and push obsessive thoughts away, “kindly, but firmly.” I accept responsibility for things I do wrong and acknowledge the role of others when things go well. Or rather at least I am trying to do these things!
9. Routine
What is the best routine for doing creative work of any sort? A routine is essential if you are or have been depressed. It’s boring and others might mock you for it, but you’re the one that’s ill or have been ill. It took me a lot of experimenting to find the perfect routine.
10. Sleep
My problem, with my medication, is staying awake at night and waking up in the morning. However, I used to have terrible trouble getting to sleep. The most important thing is to choose regular times and stick to them, come what may. I have a particular problem with waking in the morning, so I set my alarm for 7.15 and get up at 7.25. Occasionally I really struggle, but I will always be out of bed by 7.55 am. Never sleep in and never have a late night.
11. Gratitude diary
Keep a gratitude diary – somewhere towards the end of each day, you list three things that day for which you’re grateful, no matter how small.
12. Things change
And in my most desperate days, I remember that time passes. It has always got better in the past and will do in the future. It’s important to do the things you have decided help you, particularly if you feel yourself becoming ill again. If you’re getting a bit down and start skipping your exercise, you’re going to be in trouble. So write out a list and tick the things off every day. Good luck with the fight. Featured photo credit: Trevor Harley via trevorharley.com
