Coming out of the Dark:
How to Recognize, Address and Conquer Depression
by Natasha J. Thomas, MD
“I can remember when it happened…I had just taken a shower, and when I stepped out I realized I could see color again…
in a way I hadn’t in months.”
- Actual account of beginning the recovery from depression.
When we think of depression, most of us think of feelings of sadness. It can be so much more. When we’re depressed, we can feel it in every part of us - body, mind and spirit. In the article below, I discuss some of the background information about depression and offer solutions to one of the most common and disabling conditions in the US.
Latest numbers report that depression can occur in over 6% of adults per year. That’s almost 15 million people! In fact, it’s so many people that Major Depressive Disorder is identified as the leading cause of disability in our nation in people ages 15 to 44, costs us around $70 billion dollars in lost productivity and medical costs, and can shorten one’s lifespan due to increased risk of suicide, fatal heart attacks and even hip fractures in women. Women of any race or ethnic background tend to be affected by depression twice as often as men. Postpartum depression contributes to this trend. And even though the average age of onset is in the early 30s, children, teens, young adults and elders can experience onset of depression. Untreated episodes are expected to last 6 months or more. If severe enough, depression can be fatal due to suicide – which claims more lives than chronic liver disease, Alzheimer's Disease, high blood pressure and homicide.
So, what exactly causes depression? We can’t nail it down to just one cause. In fact, thinking of depression as the result of a single factor can lead to ineffective treatment strategies, delayed time to resolution and poor prognostic outcomes. In general, biological differences, hormonal fluctuations, genetics, environmental and situational stressors, low levels of self-esteem and resilience and other medical or mental health problems can be singular or cumulative causes of depression in any one person. Basically, just about anything about being human, or that touches on a human vulnerability, can lead to depression. This is why awareness and prevention are so important.
Generally, depression leaves us feeling sad and disinterested in those things that we normally find fun and engaging. We may also begin to struggle with broken sleep, guilty feelings, physical pain and slowness, fatigue, poor concentration and memory, changes in appetite and even thoughts of death and suicide. Two weeks or more of these types of feelings and experiences usually marks a true episode of Major Depressive Disorder. Depression can be part of other mental and physical issues as well. When severe enough, depression can cause us to hallucinate and perceive things about the environment that no one else notices.
Patients have also reported that when depressed, they struggle with negative thoughts, feel life has no purpose, notice they are irritable or sad around others but long for connection and feel hollow inside. They feel they'll be sad forever. They believe family and friends won’t miss them or will be better off without them. Unfortunately, this lie in the mind can lead to desperation for relief and suicidal thinking and behavior. We can take action in a healthy way long before things deteriorate to this place, thank goodness!
To truly address and conquer depression, we’ve got to tackle it from all angles. Below, I give some ideas for a holistic approach. We need to engage every possible strength and resource we have – within us and within our communities.
Don’t make it a solo project
Begin with a conversation with a close friend, spouse, family member or clergy member and share your experiences. Yes, this may make you feel a little exposed but treating depression while you remain isolated from a support system is not likely to succeed. Many of my patients have shared with me that participating in support groups has been a life-saver for them. Not only have they met others experiencing some of the same feelings of depression, they have learned new coping strategies, been able to see their depression from other perspectives and feel hopeful after sessions.
Advocate for yourself
Consider talking to your primary care physician or setting up a session with a counselor or psychiatrist at the first signs of depression. Before your appointment, write down all the symptoms you’ve been experiencing, what makes them better or worse, how long they’ve lasted and how they are impacting your life. Take what you’ve written to a professional. If you see a primary care physician, they may offer you a screening tool (a short written multiple-choice test) to see if your symptoms meet diagnostic criteria for depression. If they do, it may be recommended that you start a medication, go to counseling, do a combination of both or see a psychiatrist. A treatment team can share with you all the approved and recommended strategies for depression. If nothing else, I want you to remember two things from this article. There is nothing wrong with taking medication to treat depression AND medication cannot fix everything.
Eat to heal
Eating healthily with fruit, vegetables, legumes, whole grains, seafood, lean meats and poultry (if you’re not vegan or vegetarian) gives us a head start. Eliminating processed foods and preservatives, refined sugars and sweets, soda, excessive caffeine consumption, “energy drinks” and excess alcohol continues the process. Ideas for improving your diet abound!
Create a discipline
Finding a daily discipline is more valuable in eradicating depression than is often publicized. If you’re a person of faith, set aside a time for prayer and meditation, participate in your congregation and small groups weekly, and seek out regular mentorship and counsel from trusted members of your clergy. If you’re not a religious person but consider yourself more spiritual, consider a type of meditation or spiritual practice. Do it at least 10 minutes per day, three times a week or more.
If neither of these strategies interests you, think of something that does interest you and make it into a new project in some way – a project for which you must regularly set aside time. Studies have shown that lack of daily structure leads to depression. Just going to work or school every day does not count as a daily discipline. Lying around in bed on weekends and holidays is one of the worst things for depression. It’s been recommended so many times before but it really does help – find a physical outlet. Get up and get your brain moving – even if you have to force yourself!
If you enjoy reading, it would be great to educate yourself on depression and complete a workbook or course on getting symptoms to remit. Read about how resilience improves your chances of recovering from depression. But if you’re not much of a reader, that’s OK! We don’t have to read everything these days - consider an audio book!
Focus on what you’re grateful for more than you focus on anything else. In some ways, our thoughts create little pathways in our brains. Those thoughts are associated with the release of hormones and the production of emotions. If you are intentional about thinking of things that make you feel good, it will be easier to recover.
See the potential
The key to conquering depression is to accept within yourself that it has the potential to be an eye-opening journey. You will learn many things about yourself, build deeper relationships with those who love you and see that you can survive heavy experiences. You do not have to be overtaken. Don’t say, “I am depressed” but think, “I am experiencing a depression and I will find the resources to come out of it.” Some of the best insights and therapeutic techniques to treat mental health issues have been created by people who have experienced depression, anxiety or other issues themselves.
Find a hand to hold
Have you ever been in a home without electricity at night? I have - when I was in school in Miami and we had been hit by a hurricane. I’m not sure why I wasn’t prepared but without flashlights, I was feeling my way through, trying to find candles or some light source. And those moments in the dark were so scary – with howling winds and slashing rain outside. In a hurricane alone, it is easy to wonder if you’re going to survive. That is not an exaggeration. In the dark, I noticed strange sounds were amplified, I felt completely vulnerable, and my mind began to play tricks on me.
Sometimes being in a depression can feel like that. You may literally feel like you can’t “see” yourself through this process – which may at times be turbulent, scary or even feel hopeless. I know that a depression can be so overwhelming that at times it is impossible to do any of the things I recommend. So, in that case there’s one simple thing to do. Reach out to someone who can speak truth into you – and who can get you the help you need. It may be a crisis line or a friend or family member. It doesn’t really matter what their relation is to you, it just matters that they care and will help.
Depression can have a major impact on lives but we are not helpless! Please read up, then reach out – on behalf of yourself or someone else.
For more information follow these links from the Depression and Bipolar Support Alliance (DBSA), the National Alliance on Mental Illness (NAMI) and the American Foundation for Suicide Prevention (AFSP):
* If you or a loved one is in a mental health crisis, please call 911, go to the nearest emergency room or reach out to 1.800.273.TALK or other national crisis hotlines.
*This article is for informational purposes only, is not intended to diagnose or treat any condition, and does not take the place of a medical assessment or treatment by a licensed professional.