How to fight depression?

February 5, 2009 7:43 AM

What are the best ways to fight a relapse into depression?

I am a medical student studying outside the US on the sunny island of St. Maarten. In college, I was diagnosed with severe depression and anxiety disorder. I was medicated for two years with Lexapro and was able to emerge from it. Here I am three years later and I don't feel like anything has changed. I am social with a fairly large group of close friends down here, but I am incredibly lonely. I have been seeing the doctor on staff down here, but I don't really like him and avoid him like the plague. What do I do when even the beach and the sun don't help?

posted by Heliochrome85 to Health & Fitness (16 answers total)

Do you get enough exercise? Since I've started going to the gym, I've had a much easier time coping. Yay endorphines.
posted by sunshinesky at 7:52 AM on February 5, 2009

IANY anything but I'd say overcome the resistance to the doctor and get back on some meds - lexapro if it worked the first time - and get frequent aerobic exercise.

Funny how beautiful places can be the most depressing.
posted by RandlePatrickMcMurphy at 7:52 AM on February 5, 2009 [1 favorite]

I think in some ways you have to learn to live with it as almost a physical condition, and learn how to determine if you are going to experience an episode of depression or anxiety, and some cognitive tools to weather the storm. These cognitive and behavioural skills are one way to deal with depression, as are seeking help from a professional, and appropriate medication if needed.

But depression and anxiety can be lifelong conditions. The sooner you can develop your own tools to deal with the mental equivalent of a chronic, painful illness, the better your quality of life will become.

Because, sometime soon, perhaps tomorrow or next week, your depression will lift and you will be able to enjoy the beach.
posted by KokuRyu at 7:53 AM on February 5, 2009

2nd exercise...
posted by Echidna882003 at 8:06 AM on February 5, 2009

I've learned to recognize if I'm starting to get depressed. When I do see/feel it coming (I've always likened it to a giant wave that is crashing toward me) I don't allow myself to feel sorry for myself. Not always easy but it is what I've learned works for me.

I can't recommend exercise enough. I run 4x week and it keeps that wave at bay.
posted by collocation at 8:11 AM on February 5, 2009

Reduce internet, increase exercise, reduce intoxicants especially depressants (booze) and stimulants (nicotine and caffeine), get more sleep, recognize you need people you can really talk to, not just be social with (and question whether those people are right in front of you but you are too concerned about "burdening" friends or whatever), think about talking to someone professional as a counselor as opposed to or in addition to as a doctor, find a different doctor.

Anxiety is notoriously recidivist. If you were doing things to help control it before (i.e. meditation, breathing exercises) and stopped because you felt like it was under control, start again.
posted by nanojath at 8:11 AM on February 5, 2009 [1 favorite]

What has worked for me with both depression and anxiety is jumping back into what helped before as soon as I notice early warning signs. That can mean being attentive to sleep patters, exercise, food, and sunshine; getting back into therapy; getting back onto meds; using the cognitive tools I've learned in past therapy.

For me, medication has been an indispensable tool for recovery and relapse-avoidance. I'm sorry you're not comfortable with the doctor there, but if he's your only option, you might have to suck it up and talk to him.

Good luck.
posted by not that girl at 8:13 AM on February 5, 2009

My solution has always been get more exercise and get back on the meds. But, I've come to the conclusion that I have a chronic shortage of mood stabilizing neurotransmitters. I'm not on it right now b/c I'm nursing, but Cymbalta has been a wonder drug for me.

Also, it seems that when I was in school I was more susceptible to major lows- from the stress and pressure. It helped to talk to a therapist about my habits of mind that seemed to always link academic achievement and self-worth. I wore myself down constantly whipping myself to achieve more, do better, be at the top.

You are steeped in the pressures of med school so, if you are at all like I was, you might consider some cognitive-behavioral therapy.
posted by hellboundforcheddar at 8:13 AM on February 5, 2009

I had a friend who went to AUC (guessing that's where you are?) and she found the isolation of being on the island really difficult to deal with. Her solution? She took scuba lessons and got herself certified and met a bunch of people that weren't also at med school that way. It was a way for her to take advantage of living in St. Maarten, got her out of that "I must study all the time" mode and I think it helped her enormously.
posted by meerkatty at 8:25 AM on February 5, 2009

Recentering works for me. When I feel it coming on I just assume I've strayed too far from my core and try to get back to it a bit. So I'll ask myself what that core is, and receive confirmation that I'm depressed because the answer is always "Nothing". But then I remember the things I used to like to do and pick one up again. Sometimes it's as simple as spending a few hours working on my car. Just enough to recenter, and it goes away just like that. Staying hydrated (very hard in the islands) and *regular* exercise also help.

Remember: the grass is always greener on the other side of the fence. Forget the grass; enjoy the journey!
posted by jwells at 9:15 AM on February 5, 2009

I suffer from depression, too, and experienced the same weird crush of over-activity yet constant misery in law school. You'd think with no time whatsoever to dwell, you'd be ok. Oh, no, my friend. I think the crazed pace of professional school makes The Big D worse because of the competitive and never-ending nature of the studies that go on there.

Someone once told me to make friends with depression. I kinda followed that, but I inverted it. I made enemies with it - which I know is really hard to do when you're in a fetal position with the blankets heaped over your head. It never really goes away, but recognizing you're falling down the well is a huge first step.

Nthing exercise. Depression hates exercise. Being a med student, I imagine you're a pretty goal oriented soul and what works well for goal-oriented souls is a destination. Have you ever run before? No? Great. Sign yourself up for a five miler or whatever goes on on the island a few months from now. Then find one of the myriad training schedules on the interwebs and stick to it. That way you're not just running with no specific date or goal in mind. Or find a swim competition or sailing competition or whatevah goes on there and lock yourself into that training schedule. BTW, you'll probably be not so much liking this at first as it will seem like yet another thing on your very long to do list. But please hang with it.

I also second meerkatty's suggestion of taking yourself outside the med school loop. In all honesty, professional school types are kinda...depressing. All we talk about is class and how tired we are and how much coffee we drink and blah blah. Find people who are not of that universe to put things in perspective. Although the notion of taking yet another 'class' or 'lesson' might sound overwhelming at first, go fo' it.

Good luck to you!
posted by December at 9:33 AM on February 5, 2009

I've found that I need MUCH more exercise than the standard half hour, 3x per week. Minimum of 45mins to an hour of cardio, 5 days a week at least, are what help me (in addition to meds). So perhaps you could try upping your exercise significantly -- and make sure you're on the right medication, if the Lexapro didn't work as well as you needed it to.

Can you switch doctors?

Also: ditch the people and situations that drag you down. Give yourself some breathing room.
posted by mdiskin at 9:53 AM on February 5, 2009

Nthing what folks have already said about exercise, talking to a doctor (and/or a therapist?) and getting out of your med school loop. (with regards to people as well as activities)

I just want to add something else to think about: you said "I am social with a fairly large group of close friends down here, but I am incredibly lonely."

You might have a lot of friends who you see often, but do you have friend who you are truly, honestly very close to? As in, you are entirely yourself around them and you feel like they just "get" you, that you have a special connection to them, that they are the people who share your secrets and vice-versa? I have a large social group of good friends, too, but I find I have a hard time opening up to them one-on-one and actually making an intimate connection with anyone. This has made me feel lonely despite a very active social life, and I think that most people I know would be surprised to learn that this is the case for me. I'm working on this issue with my therapist right now and I wonder whether you might be experiencing some of the same. I went through a bought of depression and anxiety 6 of 7 years ago, and came out of it successfully with Lexapro's help, but I've had minor very brief semi-relapses since then, and I think my lack of truly intimate friendships has contributed to that, because I just don't have anyone who I really, truly, completely trust and share my life with. I am not depressed now per-se, but I feel like my life is not as full as I want to be, because of these problems, so I'm working with a therapist now in order to not only improve my friendships and help me feel more content with my life, but also to prevent a true relapse back to depression in the future.

Sorry to ramble - but you reminded me of me, a little, and so I hope this is helpful. Good luck!
posted by inatizzy at 10:04 AM on February 5, 2009 [1 favorite]

I am nth-ing sharpening your cognitive tools to deal with the issue. Though the blue seemingly comes out of the blue, chances are there is a definite trigger that causes it.
In your case, you seem to have stumbled upon it already - you're lonely.
Why?
I don't know you and I have no idea. But it's worth exploring. You can bite the bullet and talk to the doctor about this, or anyone that you can talk to. Or even yourself.
Echoing December, depression can be your good friend/enemy. I personally would never trade a small dose of depression once in a while for anything. It forces me to think, to re-evaluate my life. I've grown to be a better person because of it.

A second thing that you can do is to have something to fall back on to take your mind off of things. Now this is different for different people. For some people it's exercise (which I strongly advocate as well since it has many distinct advantages as well - endorphines being one of them. ) For others it could be throwing yourself more into your work. Or hobby. Or volunteer work. Or family. Or write stories. Whatever floats your boat.
Bear in mind that these are temporary fixes - a way to temporarily escape. Hopefully in a few days of doing so you'll emerge refreshed and ready to tackle your depression.

And lastly - good luck to you
posted by 7life at 10:05 AM on February 5, 2009

In addition to the excellent advice above, take a look at your nutrition. There are a number of deficiencies which contribute to or exacerbate depression: B12, D, calcium, etc. You're probably not low on D where you live but depending on your diet and your body's quirks you could be low on other things.

I've dealt with severe iron, B12, and D deficiencies and each time I resolved one of them my energy and mood improved a lot. Exercise helped too but figuring out nutrition was the missing puzzle piece. It's something to look in to even if you eat with a healthy intentnion.
posted by rhiannon at 11:41 PM on February 5, 2009

You know, if medication worked before, maybe you should get back on it. Exercise is good in itself, but is not necessarily going to help your depression. Neither is nutrition, living in the tropics, or having lots of friends. None of it helped me, but medication did.
posted by jacalata at 7:36 PM on February 6, 2009