Managing Your Depression (17 page)

• Ask your doctor to repeat or clarify points or instructions you do not understand or remember, or that seem vague or uncertain. Do not leave the appointment if you are unclear about any instructions.

• Don’t be embarrassed if you forget or do not understand something. No question is “dumb.”

• Don’t be concerned that your provider will be “angry” with you or will refuse to answer your question.

• People differ in the amount of information or detail they want to know about their illness. Some may only want a basic overview, while others feel more in control of what is happening to them when they know the facts. Decide what is best for you and let your doctor know.

If you have a problem communicating with your doctor, state your concern as honestly and openly as possible, in a nonthreatening manner, without making accusations. For example, you might say …

• “I’m concerned that we aren’t communicating as well as we could, such as when _____.”

• “I need to be able to talk with you about _____, and I feel like I can’t. Can we discuss this?”

• “I would like to discuss _____ at more length. Can we schedule a time for that?”

• “I am having trouble understanding _____. Can you help me understand?”

Tips for Family and Friends

What should I say? What can I do to help?

We each have our own way of coping with stressful situations and illness. We have our own set of personal experiences with illness, relationships, life events, and work. Because of these differences, people have varying needs, and there are many ways to offer help.

Do try to:

• Be present and give your full attention; have your mind “in the moment.”

• Listen. This sounds simple, but it may be hard to do. You don’t always have to respond. Sometimes an empathetic listener is what the person needs the most.

• Let him or her know that you care. Be mindful that greater patience and compassion may be called for during certain times.

• Validate the person’s feelings. Make him or her feel they are worthwhile.

• If you want to offer encouragement, remind the person of his or her special qualities (like a sense of humor) and other successfully managed challenges or accomplishments.

• Know the symptoms of depression, mania, and suicide risk.

• Be aware of the person’s Warning Signs, which precede a worsening episode of depression or mania, and know when to encourage the call for help.

• Respect a person’s choice about how much he or she wants to share. Some people are very private while others will talk more about their depression. If someone confides in you, keep the conversation private. Ask how much the person wants others to know.

• If asked, be available to help the person talk through treatment decisions, but do not offer advice. Respect decisions about treatment even if you disagree.

• Offer to help with routine tasks, but do not take over. Look for ways to encourage and facilitate the person’s self-care.

• Offer to help in concrete, specific ways (pick up grocery items, walk the dog, go with him or her to an appointment).

• Include the person in the usual activities and social events. Let him or her be the one to determine if something is too much to manage.

• Keep your relationship as normal and balanced as possible. The person may appreciate conversations and activities that don’t involve depression.

• Expect the person to have good days and bad days, emotionally and physically.

Do not:

• Offer advice or be judgmental.

• Compare the person’s experience to others you have known.

• Automatically offer reassuring words when someone expresses despair or a dark emotion. Before saying, “you’ll be fine,” think about whether you are saying this to calm your own anxiety and fear. Sometimes it can cause the person to feel dismissed rather than supported.

• Take things too personally. It’s not uncommon for the person to be more quiet or irritable than usual.

• Be afraid to talk about depression or mania or to ask about suicidal thoughts.

CHAPTER 8
Pulling It All Together

What does it look like and feel like to manage your depression successfully, to actually do everything mentioned so far in this book? The strategies are not a magical cure for depression. But they will help you get through the illness with episodes that are perhaps less intense.

The first thing you experience when you manage your depression is being able to go about your day with an acceptance that depression is an illness, one that can be treated and managed. It is not a weakness or a character flaw. When you manage your illness, you do not listen to those who offer misinformed comments or unhelpful advice. This is a big relief for many people. You know that as part of the illness, your mood will change up and down, and that you will have good days and not-so-good days. You try to understand the fluctuations and patterns you experience. Some days you will wake up feeling relatively okay, and other days, you will feel absolutely down. That is the time to remind yourself even more that the down times are part of the picture and that this moment will eventually pass. This is not easy to do.

When you manage your depression well, you follow the Basics of Mental Health each day. This will help you stay well mentally and physically. Managing your depression means you keep up with personal self-care and follow the treatment plan set up by your providers. You sleep 7 to 8 hours every night, eat a balanced diet of healthy food three times a day, limit caffeine and tobacco intake, and do not use alcohol or street drugs. It means that you take all your medications as prescribed, even if you are feeling better. It
includes getting some form of exercise each day, depending on your physical limits.

Another essential piece of managing your depression well is to avoid isolation. You do this by keeping up with your family and friends and other social contacts, even when you don’t really feel like it. If you have not heard from someone in a while, you pick up the phone and call the person. Sometimes other people do not know what to say to you when you feel very depressed, so they may not call for fear of feeling awkward or uncomfortable. At those times, it is important for you to initiate the contact, to keep up those friendships that will sustain you.

Following the Basics of Mental Health means that you structure your day and follow a routine. You get up and dressed at the same time each day and have several things planned, written down in a calendar or agenda book. You pace yourself with a realistic number of activities that you can accomplish. These include your responsibilities and obligations, pleasurable and positive experiences, and mastery experiences (see
chapter 4
). You understand that it is not helpful for you to stay in bed or on the couch all day, with endless hours of free time on your hands. You know how difficult it is to go to work or be active when you are depressed and tired and don’t have an interest in anything. The best advice is to do it anyway, and motivation will eventually follow. Many people have found that they start off feeling too tired to do something, but when they become engaged in the project, the fatigue seems to get better or disappear.

Managing your depression effectively requires that you pay attention to your symptoms and monitor them. You are aware of your specific Warning Signs and Triggers for worsening depression. You have made a plan with your treatment team to intervene when a change in these signs becomes problematic. Managing your illness well also means that you take steps to minimize the chance of relapse occurring. You do this by following the basic preventive steps mentioned above, which will help you maintain emotional stability and decrease your vulnerability to fluctuations. You learn
to use effective coping skills in the short and long term to help get you through the rough patches. This means that you identify in advance what is pleasurable, relaxing, and distracting for you and are ready to engage in those activities when needed. You use problem-solving techniques and avoid negative behaviors.

All of the above prepares you to do the really hard work of managing depression, which is learning how to control the negative, distorted thoughts and self-talk that seem to dominate your mind and upset you. This is not easy to do, and it may take years to develop the skill. You learn to identify a negative thought when it appears and understand that it is the depression talking, that it is not a fact. You learn to challenge the negative thought and replace it with a more realistic one. When you understand the source of the negative thought, you take away the power it has over your thinking and in turn your mood.

You may wonder how you can follow these recommendations to manage your illness when you are depressed and feel no hope. It is helpful for you to believe in the exercises to get the most benefit from them, but not essential. Do them anyway. If you do not feel hopeful about your future,
borrow some hope
from a person you respect, who knows and understands you. Tell yourself, “Jon believes there is hope for me and he is no fool.” Eventually you will find that the hope is your own.

None of this comes easily, but with continued effort and practice you will be able to manage your depression and increase your chance of staying well.

CHAPTER 9
Collective Wisdom

Advice from Some Remarkable People

“Do not buy into these [negative, distorted] thoughts. Not fair to believe them. Wait it out.”—TJP

“The time you are feeling the worst is not the time to give up.” —AAN

“Feelings are not fact. Interpretation is not fact. Judgment is not fact. STOP. Look at the facts. Then modify your assessment/interpretation of the situation.”—TJP

“With depression, feeling ‘good’ is alien and may feel uncomfortable at first. You are not used to it and may feel anxious. The brain sees it as different and ‘not right,’ so the tendency is to go back. Don’t. You have to push yourself.”—MJ

“Practice consciously endorsing yourself.”—MJ

“Action precedes motivation.”—mantra of the McLean Hospital MAP Program (original source: Robert J. McKain)

“Sometimes we experience a combination of physical, emotional, and interpersonal symptoms for such a long time that we don’t even recognize them as symptoms. We get used to them and think they are normal.”—Marjorie Hansen Shaevitz

“Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying ‘I will try again tomorrow.’” —Mary Anne Radmacher

“You cannot absorb praise unless you decide to believe and validate what is being said.”—MGH psychiatry resident

“There is Hope because … we see you in a different way than you see yourself, and if you were to see yourself as we see you, then you could believe and hope that life could be different.” —JEA

“That is just the way you have come to regard yourself. It is not necessarily true.”—APS

Do not buy into these [negative, distorted] thoughts. Not fair to believe them. Wait it out.

A very wise clinical psychologist reminded me of this one day when I was feeling particularly low and hopeless about my situation, overwhelmed with negative thoughts, which he believed were untrue and distorted. My depressed brain believed these thoughts were true and would last forever, something that is common in depression. It was easier to believe these thoughts than to do the work of challenging them, particularly when so depressed.

His point was that these thoughts were the depression talking, and that they would not last forever. He said that it was not fair to me to believe something that was not true, something that was based on the disease, even though my brain was trying to tell me otherwise. He asked me to be patient and wait until the negative, distorted thoughts passed. This was not easy to do, but with our work together and time, they eventually did. I try to remind myself of this each time the negative thoughts become intrusive.

The time you are feeling the worst is not the time to give up!

Again, this advice came from an extraordinarily wise and clever psychiatrist at a dark and hopeless time in my life. I was ready to call it quits, and he was just
not
going to let that happen. He wrote this statement on a paper prescription pad and signed it. I still keep
the paper in my wallet. His point was that we should not make major life decisions, such as giving up, when we are very down and depressed, at our lowest point. When you are feeling the worst, you are not in a position to make the best decisions for yourself and may do something that you will later regret. At the time you don’t realize it and may think that you are capable of making a reasonable decision—your depressed brain is telling you to go ahead with it. His plea was to wait until I was feeling better to make any major life decisions. He was clever, because of course, when you are feeling better, you do not want to give up! So, in this way he got me to keep going and not give up.

Feelings are not fact. Interpretation is not fact. Judgment is not fact. STOP. Look at the facts. Then modify your assessment/interpretation of the situation.

This was a reminder from my therapist when I struggled with believing my distorted thoughts were facts. He reminded me that in depression, negative events are magnified and may dominate your thinking. When you are depressed, you are more likely to believe biased or distorted thoughts are true. Remember: thoughts and feelings are not facts. “Feelings” are created by your thoughts and your interpretations of an event, not by the actual event. Do not confuse feelings and thoughts with facts. Stop and look at the situation in front of you, at the objective facts of the situation. Then make your own assessment based on these facts and not based on any distorted thoughts or feelings. Doing this will bring you to a more realistic view of the situation and cause you less distress.