Medication and psychotherapy are only part of what it takes to feel better. Your attitude and beliefs about your depression and the treatment you are receiving for it can also affect your recovery process.
Start by first saying yes to your whole self.
“Yes” Carries with it a commitment to taking care of your whole self, not just your mind. What have you done for your body today? Your body puts up with whatever you do to it. However, if you are really committed to feeling better than an important place to take action is the care and feeding of your body.
Exercise and proper nutrition are essential to your recovery
Exercise is an important part of taking care of your body. Did you know that regular or daily exercise can elevate your mood for up to 4 hours? Exercise doesn’t have to be exhausting to improve your strength and muscle tone. How you choose to exercise depends on your present health, stamina, and interests.
The important issue is your commitment to do something physically active (for example, going up and down stairs, walking around the block, dancing to music on the radio, or working out at the GM) three times a week.
If this seems impossible, begin with a few minutes of the time. Gradually increase the duration of each session until you are spending 10 to 30 minutes exercising three times a week.
Feeding your body during periods of depression take special attention and care. Many depressed people report either loss of appetite or overeating, especially high fat and high sugar foods such as candies and pastries.
The key to proper nutrition is to follow a well-balanced diet of wholesome food three times a day, with a healthy snacks like fruits or vegetables. Wholesome foods include fruits, vegetables, fish, beef, chicken, and whole grain breads and cereals.
As you eat better and exercise regularly, your body becomes healthier. This healthier living has a significant positive impact on your mood and how you’re feeling.
How you think about things can affect how you feel. Depression is often accompanied by negative thoughts that can be discouraging and lower your self-esteem. Such negative thoughts may have been present even before you became depressed and may continue even as you notice improvement in your mood and energy.
Negative thoughts may show up in your mind as ideas such as “nothing can help me” or “I’m a loser. I’m no good.” When such negative messages pop into our minds frequently, we tend to believe them no matter how untrue they are. Part of your recovery, therefore, involves replacing negative thoughts with positive thoughts
Going from negative to positive can be achieved by training your mind to look at situations and events from a new perspective.
Here’s a three step program to start you on the road to positive thinking:
Step one: recognize the negative thought.
You may be so used to a negative thought that you are not even aware of it. Disapproving messages such as I’m a failure, I’m stupid, all never feel better, I’m not likable, etc., can slip into your mind unexpectedly.
The first step in getting out of negative thinking is recognizing the negative thought. Take a moment and list five negative thoughts that come to mind and how these thoughts make you feel.
Step two: acknowledge how the negative thought makes you feel
For each negative thought, use one or two words for the feeling that followed.
Step three: change the negative thought to a positive thought
Now that you’ve listed your negative thoughts, change them into positive affirmative statements. Examples of how to do this are: “I’m a loser” becomes “I’m okay”; “nothing will ever change” becomes “I can make a difference”; “I’ll never be happy” becomes “I am going to be happy.”
Changing negative thoughts to positive ones may be a challenge for you because you may be so used to self-defeating phrases such as “I can’t, I’m tired, I’m worried, on board, I shouldn’t, I’m frightened.”
As you write the positive thoughts on your worksheet, focus on a positive “can do” approach, and use phrases such as “I can handle it”… “It is possible”… “I am able to,” etc. Write the statement in the present tense as if that is the way things are happening now. Once you can see yourself in a positive way, you have begun to create this reality in real life.
If a member of your family or a friend is experiencing depression, here are some of the most important do’s and don’ts:
Do’s
Be aware of your own feelings of frustration and disappointment because your friend or family member is depressed.
Recognize that you may have to take increased responsibility for maintaining the relationship (initiate telephone calls, visits, etc.).
Encourage your friend or family member to stay with the treatment program including taking medication, attending therapy sessions, exercising and eating properly, avoiding alcohol and other mood altering substances.
Present a positive attitude about the future: there is a high probability of full recovery.
Be willing to be a spokesperson for your depressed friend or family member by helping prepare questions for the doctor and accompanying him or her to the doctor’s appointment.
Don’ts
Don’t avoid discussions about how ill the depressed person is feeling, what is or isn’t working, or treatment.
Don’t expect a quick recovery.
Don’t assume that the depressed person is helpless, powerless, or childlike, and needing everything done for him or her.
Don’t criticize or blame the person for having depressive symptoms such as low energy, negative thinking, poor sleeping patterns, or decreased patience.
Don’t forget all the things that you have liked and valued about your friend or family member.
The best way you can help your family member or friend is to understand what depression is and how it can affect relationships.
Depression is a medical illness. It is not a character flaw or sign of weakness. Like other medical illnesses such as heart disease or diabetes, its symptoms can be effectively treated. People recovering from depression can live full and normal lives, and sometimes even become healthier and happier than before they became ill.
Depression is more than simply feeling sad or blue.
Symptoms of depression include
- sleep disturbance (excess sleeping or inability to sleep)
- decreased interest in activities which previously were enjoyed increased feelings of inadequacy or guilt
- diminished energy
- poor concentration
- appetite changes (over eating or weight loss)
- marked agitation or slowing down of activities
- recurrent thoughts of death or suicide
These symptoms, which are frequently present nearly every day, significantly affect a person’s functioning at work and home. Having a relationship with someone who is experiencing such symptoms can be extremely difficult.
When people get depressed they are often less able to handle frustration and are more vulnerable to stressful events. This decreased ability may show up as irritability, stubbornness, or even anger. You may find it challenging to maintain a supportive and loving relationship with a depressed person.
Next week: How to Help a Depressed Friend or Family Member
The key element to staying healthy is you. It is also the most important factor in your recovery from depression. Feeling good starts with your personal commitment to taking care of yourself: to eat healthfully, exercise properly, communicate your feelings, and work on maintaining good relationships with your family, friends and doctor.
Your recovery is a result of your active partnership in your treatment program. You are taking medication, working in therapy, and developing a healthy lifestyle. Your attitude toward treatment and toward the medication you take has been crucial in your recovery. After being in active treatment for more than half a year , it is time to review your treatment program and determine which parts to maintain and which parts to modify .
For most people who have had a single acute depressive illness, transitioning off antidepressant medication is recommended. This transition should occur only when you have been symptom free for at least 6 to 9 months after treatment is started. Total treatment may need to last a year or more.
Many physicians prefer to take people off medication slowly, over a several-week period. They encourage their patients to pay close attention to any return of the core symptoms of depression. If symptoms return, your doctor may encourage you to stay on the medication for a longer duration to prevent a full blown depressive episode.
The research has indicated that after one depressive episode the risk of recurrence exceeds 50%. After two episodes the risk is greater than 70%, and after three episodes the risk of recurrence is greater than 90%. It is generally recommended that if you have had two or more episodes of major depression you should stay on the medication indefinitely. The benefits of staying on medication and lowering the risk of reoccurrence are so high that to go off medication poses an unnecessary risk for your physical and mental well-being.
The best strategy for avoiding stress is to learn how to relax. Unfortunately, many people try to relax at the same pace that they lead the rest of their lives. What’s it like to feel intensely relaxed? Here’s what you can do to start learning about the art of relaxation.
- For a while, tune out your worries about time, productivity, and “doing right”. You will find satisfaction in just being, without striving.
- Find activities that are good for your mental and physical well-being.
- Forget about always winning. Focus on relaxation, enjoyment, and health.
To learn more about managing stress, have a look at Eleven Ways to Reduce Stress.
If the stress in your life seems insurmountable, you may find it beneficial to see a mental health counselor.
Be good to yourself.
Depression has been part of your life for a long time. You have felt its impact on your physical well-being, on your emotions and on your relationships.
When you are depressed, past, present and future all look the same. Things are bad, were bad and always will be bad. As you move into recovery, you begin to recognize opportunities for improving your outlook, deepening relationships, and restoring day-to-day functioning. You’ll discover that the past has lessons to teach you even while you plan for the future.
While antidepressant medications correct the imbalance in your brain, only you can correct the imbalance is in your life. The antidepressant you take relieves many of your symptoms, such as lack of energy, diminished interest, and depressed mood that have kept you from being your full self. You also have the opportunity to start rebuilding your life with the help of psychotherapy (individual, group, and/or couples) and/or a support group.
Restoring your life and your relationships involves working through the issues that may have contributed to the onset of depression, as well as the problems caused by the depression itself. Choosing the right therapist to help you with this work is an important step in taking responsibility for your health, happiness and emotional well-being.
Taking your medication regularly (even when you are feeling better) and seeing your doctor, therapist, family and friends as allies in your battle against oppression are important elements in recovering from depression. When you reach out to them for help, you’re not alone and you have new resources to overcome depression.
As you begin to recover you realize that depression no longer needs to be frightening or overwhelming to you or your family. The symptoms of depression have been unpleasant, but you have learned that depression, like other medical conditions, has a course of recovery in which you play a crucial role. How you participated in your treatment has very much affected your response to treatment and the course of your illness.
From the onset of symptoms, the depressed person feels challenged and in crisis. How the Chinese look at the concept of crisis is very helpful for someone suffering from depression. In their hieroglyphic-like figure writing they combine two symbols—one for danger and the other for opportunity.
Thus, from the Chinese perspective, depression is a crisis time of danger and disruption, but one in which the individual also has the opportunity to grow stronger, learn more about themselves, and become open to supportive and intimate relationships.
Four aspects of life may be challenged by depression—physical well-being, psychological experiences, social interactions, and one’s belief system.
Physically, you may experience changes in energy, sleep patterns, appetite and awareness of bodily complaints.
Psychologically, changes occur in mood, the ability to concentrate, feelings of guilt or worthless . With depression , you are more vulnerable to negative ideas, including increasing thoughts about death.
Socially, the depressed person may tend to isolate him- or herself and as a result of decreased patience get into more arguments at home and work.
Your belief system can be affected by giving you a sense of hopelessness, helplessness, and alienation from the rest of the world.
Comprehensive treatment requires strategies to remedy the impact of depression in each of these areas. Physical symptoms can be addressed through medication, exercise and nutrition. Psychological symptoms can be addressed through individual and/or group therapy. Social/interpersonal problems can be improved through family therapy and learning to ask for and receive help.
Finally, the alienated, hopeless, and stuck beliefs characteristic of depression can be changed through a partnership in the healing process between doctor and family, support from community and spiritual groups, and recognition of the positive things that one can do to make one’s life more enjoyable.
The healing process proceeds one day at a time and there is nothing more important than your attitude and commitment to yourself. In partnership with your doctor and family, you’ll have faced the pain and fear that depression represents.
You have the opportunity to learn more about yourself, your beliefs, your goals and your supports. This knowledge has made you a stronger, healthier and wiser person. Use the knowledge you have found toward improved health and happiness.
Part of your recovery from depression is paying attention to changes occurring in your symptoms. By the 4th to 6th week of treatment many people have experienced some improvement in their symptoms. If the improvement is only limited, this may be the time to increase the dosage of the medication, add a second medication to the treatment program, or switch treatments
If there is no improvement, or side effects are intolerable, then a change in medication treatment may be indicated.
From 40% to 50% of people taking antidepressant medication will need to change their medication program.
If you are in this group, it is very important to remember that even if you do not respond to the first medication program, your chance of getting a positive response to an alternative medication is extremely high (the likelihood of a good response is better than 90% in some reports).
To help evaluate the effectiveness of your medication, look at the list below and consider how much you have improved:
On a scale of 0%-100%, how much have you improved in these areas?
- Depressed mood ___%
- Interest and enjoyment in activities ___%
- Self-worth ___%
- Low energy level ___%
- Physical agitation ___%
- Concentration ability ___%
- Appetite (increase or decrease) ___%
- Thoughts of suicide or death ___%
- Sleeping poorly or excessively ___%
You may want to print this list and take it with you to your next appointment with your doctor.
Taking your medication and actively participating in promoting your health and well-being represent a necessary commitment to recovery from depression. After treatment has lasted for more than half a year, you will be at an important crossroads. For some, the path will lead to transitioning off medication, while for others the best decision will be to continue treatment into a maintenance phase.
You and your doctor must now review your medical and family history, the severity of your acute symptoms, the presence of residual symptoms and whether you have had previous depressive episodes in order to make the right choice for you at this time.
Here are some of the factors that you should consider in making your decision about continuing care:
1. Have you had three or more episodes of depression in your life?
2. Have you had two episodes of major depression and any of the following:
A. Family history of bipolar illness or major depression
B. Return of depression within one year of stopping medication
C. Onset of depression before age 20
D. Severe, sudden or life threatening depressive episodes within the past three years
E. Suicidal gestures or behaviors during the depressive episode
3. Significant anxiety occurring with the depression
4. Ongoing substance (alcohol, drugs) abuse
5. Presence of even mild residual symptoms
If one or more of the above risk factors are present, the benefits of staying on your medication and decreasing the chance of recurrence should be recognized.
However, if this is your first episode of depression and you do not have any of the above risk factors for recurrence, then transitioning off your medication makes good medical sense. Many doctors slowly reduce medication over a several-week period. It is, however, important for you to pay close attention to the return of symptoms, during the months after treatment is over .
If you and your doctor decide that it’s best for you to continue to take medication, you are entering the maintenance base of treatment which can last one or more years. The frequency of your medication review appointments may vary, from every 3 to every 6 months. During this time you and your doctor will monitor return of symptoms or the emergence of new side effects.
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