Self-Management of Depression

Change is not easy, especially when trying to break bad habits or desiring to keep the good ones going beyond a few days. Most people blame this on lack of motivation. Researchers have written at length about types of motivation such as intrinsic and extrinsic motivation, but most of these discourses fall short of realistic ways to enhance motivation. In this context,  DARN offers a simple yet practical tool to increase one's motivation to change.  DARN  is an acronym which stands for: Desire , Ability , Reasons , and Need . These represent four types of self-talk that people contemplating change engage in (Miller & Rollnick, 2013). Use this approach to ask yourself evocative questions that tap into your intrinsic motivation.  Desire:   Desire is wanting to have something or wanting a change. Examples include, “I want to exercise more” or “I would like to eat healthy.” Ask yourself the following questions to elicit your desire to change. What am I h...

We experience anger when our unrealistic demands, conceptualized in our minds as “should” or “must,” are unmet. Examples include, “I should work harder,” “People should treat me fairly,” “You must do what I tell you to do,” “I shouldn’t be angry,” etc. “Should” and “must” thinking arises from moralistic rules or perfectionistic demands to which we hold ourselves and others. Irrational should statements rest on one's assumption that one is entitled to instant gratification. However, being what it is, life does not respect your “shoulds” or “musts.” Moreover, no law says we should get what we want, any more than other people always get what they want. How do you handle the “shoulds”? 1. Eliminate the words “should” and “must” when talking about expectations and replace them with “I hope,” or “I wish,” or “I prefer.” For example, “I wish things were different,” “I hope I can do well, but I can tolerate not being perfect,” “I wish things were different,” etc. In contrast to a ...

Procrastination is putting off things for another day, or doing things which are not productive as an excuse of not doing what is important. Dr. Wayne Dyer (1995) in his book, Your Erroneous Zones , provides the rationale behind procrastination as a thought process which is something like this: “I know I must do that, but I am really afraid that I might not do it well, or I won’t like it. So, I will tell myself that I will do it in the future, then I don’t have to admit to myself that I am not going to do it. And it is easier to accept myself this way.” This temporary avoidance gives you a quick relief from the anxiety associated with a task, which then reinforces this behavior. We all have procrastinated at one time or the other, but in depression, procrastination becomes more complex due to the self-defeating attitudes of perfectionism (“I can do things only if I can do them perfectly”), hopelessness (“My low motivation and low energy levels are never going get better”), and fear...

A right match between you and your mental health provider is key to your wellness and recovery from depression. If you are looking for a  therapist , the most important thing to inquire is if they use evidence-based psychotherapy to treat depression. Cognitive-behavioral therapy (CBT) and Interpersonal psychotherapy (IPT) are two modalities of psychotherapy that have the most evidence to support their first-line use for treating acute depression (Parikh et al., 2009). There is some evidence to suggest that CBT may be more effective than IPT in individuals with severe depression, but the two are comparable for treating mild and moderate depression (Luty et al., 2007). In addition, ask the prospective therapist the following questions: “How did you get your training in CBT or IPT?” You are not looking for a therapist whose only training was a weekend workshop. “How much experience do you have with these approaches?” “What are your professional credentials?” “What...

When one is feeling low, it doesn’t necessarily mean that one is going through the throes of clinical depression, i.e., major depressive disorder. There are several conditions that may mimic clinical depression but don’t reach the severity or pervasiveness of the former condition or are symptomatically distinct. It is important to recognize these so that one may not unnecessarily get prescribed medications or started on psychotherapy as some of these conditions are time limited or may remit on their own. At the same time, some of these conditions such as complicated grief may need specialized therapy. Conditions that resemble depression but are not depression include the following: Sadness: Depression is more than the normal pangs of sadness one gets when experiencing a stressful situation. Depression is a more pervasive and persistent change in your mood along with changes in your physiological functions such as sleep, appetite, and energy level. Although stress can trig...

With strategies such as Transcranial Magnetic Stimulation (TMS), Ketamine, and psychedelics becoming more prevalent for treatment-resistant depression, it is helpful to take a look at what this entity really means. Not everyone who is being referred for either TMS or treatment with Ketamine may have "true" treatment-resistant depression, and then there is what is called "pseudo-resistance." In simple terms, treatment-resistant depression implies that depression has not reached sufficient remission after adequate treatment. Remission is defined as clinical improvement with few signs of depression still remaining and a lower likelihood of subsequent exacerbations. About 15% of people with depression may eventually develop treatment-resistant depression (Berlim & Turecki, 2007). Treatment-resistant depression has been variously defined, but the most commonly accepted definition is as follows (Souery et al., 2007): A person with depression is considered ...

Anger, irritability, and frustration may not be the core symptoms of major depression in adults, but almost 50% of people with major depression experience these symptoms (Fava et al., 2010; Judd et al., 2013). In addition, irritability may be the main presentation of mood in children and adolescents with depression. Having irritability and anger while being depressed is a double whammy. Overt irritability and anger during an episode of major depression is associated with greater severity of depression, longer duration of the episode of depression, poorer impulse control, a more chronic and severe long-term course of depression, higher rates of lifetime substance use and anxiety disorder, and greater psychosocial impairment (Judd et al., 2013). When feeling depressed, you may be masking your more vulnerable feelings of hurt, guilt, shame, grief, or fear with anger or irritability. Depression causes the emotions that make you feel more vulnerable not come to the surface as...

Family and friends are one's immediate support system. Individuals with depression may avoid sharing their symptoms with their family or close friends due to the perceived stigma. Some don’t share their feelings to avoid burdening others, and then there is this fear of being perceived as weak and needy. Unless you have a very critical and judgmental person who is not accepting of depression as an illness, your family and friends would appreciate your efforts to reach out and be candid about your depression. You must educate your family about depression using scientifically-based information. Local chapters and websites for organizations such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) have information for family members and friends regarding depression. Information about depression is also available on the National Institute for Mental Health website. You also have to advocate for yourself in how you want to be trea...

The acronym “ABCDE” refers to certain types of communication behaviors that increase conflict and marital/intimate relationship distress. These behaviors get heightened when one is depressed as depression rekindles negative irrational thought patterns such as all-or-none thinking, overgeneralization,  jumping to conclusions, blowing things out of proportion, taking things personally, disqualifying positives, and negatively labeling self or others. Here's what you need to avoid during communication with your partner (Beach et al., 1998; Christensen et al., 2014; Starr & Davila, 2008): A ccusation:  Accusations usually are “You always …” or “You never…” statements. Accusations may have some kernel of truth in them, but that gets exaggerated and dramatized by the heat of the argument. Accusations lead to counteraccusations and defensiveness and takes away the focus from one’s own shortcomings and also from resolving the conflict on hand. B lame:  Individual...