The Sadness Will Ebb, The Trouble Is The Time It Will Take -David Levithan
April 15, 2012 6:56 PM   Subscribe

How to deal with depression on a daily basis?

I was diagnosed with depression and anxiety by a psychiatrist late last year. I have been working with this psychiatrist and one of his colleagues (a psychiatric nurse) individually on a weekly basis for three months or so now. Before this, I worked with a psychologist for four months.

I have been taking meds (Cipralex-20 mg) since January, but the overwhelming feelings of sadness are still here and on a daily basis. This is something that I have to deal with and will have to deal with for quite some time, especially since I'm just working on "being in the now" rather than exploring the past right away.

I purchased "The Woman's Comfort Book" which was recommended to me by the psychiatrist that I work with. I'm working on reading that to find good coping methods.

But, what are some other things that I can do in order to deal with feeling depressed on a daily basis?

Sorry if I didn't include that many details, I wasn't too sure what to add which is why this question is very brief. Feel free to ask me any follow up questions if required
posted by livinglearning to Health & Fitness (19 answers total) 27 users marked this as a favorite
Some of the answers in this thread might help?
posted by unknowncommand at 7:03 PM on April 15, 2012 [1 favorite]

Frequent exercise helps me a lot, as did Feeling Good.
posted by alphanerd at 7:13 PM on April 15, 2012 [2 favorites]

what are some other things that I can do in order to deal with feeling depressed on a daily basis?

In my case, when the depression strikes, there's nothing that can fix it in an immediate sense. I basically just need palliative care, which means a massage from my sweetheart (if available), keeping well-fed, and waiting for sleep to take me. Until I have a sleep - whether a nap or a night's sleep - I need to just batten down the hatches and lie low. I take the day off work if possible, or go home from work if I'm already there (fortunately my employment allows for 'no questions asked' personal leave). Make no big decisions, throw nothing out. When I'm depressed, I'm not thinking straight, so I have to minimize my activities until it's passed.

Some people will suggest writing down (or typing) how you're feeling or what you're thinking. But I find that to be a rabbit hole to madness. As I said above, depression = not thinking straight. So minimizing my activities means even minimizing my thought processes.

Like you, I manage depression via therapy, and also make sure to maintain an all-round healthy lifestyle in general (physical, mental, emotional, psychological, spiritual). Therapy may take a long time to get to the bottom of the depression, so you have to take a long view of it, and understand that the day-to-day depression may be around for a while, even though you're often making progress. It doesn't mean you're getting nowhere.
posted by paleyellowwithorange at 7:17 PM on April 15, 2012 [2 favorites]

"Overwhelming feelings of sadness" after four months on one steady dose of medication? Make sure your psychiatrist is aware of how bad things are. Don't settle for remembering to say "I feel like crap" when you next see him/her - bring in a filled out WHO-5 or Beck Depression Inventory or whatever. Celexa didn't work nearly as well for me as Lexapro does, as an FYI. In any case, you have a right not to feel bad indefinitely.

As far as coping, it's worth it to ask to focus on coping skills for a while in therapy. My DBT therapist has interrupted the scheduled work to do distress tolerance exercises, for instance.

I try to make sure to take care of myself - eat basically healthy stuff, but don't deny myself something I want on the grounds I don't deserve it or it's unhealthy or whatever. Go to bed at a reasonable hour, and make sure my pillows are fluffy even though it's a bit of a pain to actually get up and fluff them. Have water at my elbow and try to keep draining it and refilling it throughout the day. Not signing up for more stuff than I can handle, and giving myself permission to flake out when it's too much. Making a special effort to be sure I'm physically comfortable - buying new socks and underwear, washing my hair with the good kind of conditioner, turning on the AC and setting it to the temperature I REALLY want it at. Above all else, taking my meds every single day, trying to leave my apartment every single day, making all my doctor's appointments, and making sure someone outside my brain knows what's happening with me, in case it gets worse. My memory stinks when I'm really depressed, so having a checklist of stuff to try has proved extremely useful. The checklist right now says something like:

- Drink some water
- Eat something you really like
- Make sure you took all your meds
- Turn off most of the lights
- Turn on the A/C
- Turn on really comforting music playlist
- Take a shower if it's been at least six hours or you're feeling gross
- Take a nap if it's been at least eight hours since you got up, and there's at least six hours before you have to sleep again.
- Tell a friend you're feeling like crap
- Go look at KittenWar and watch the funny things you have stored on your emergency YouTube channel playlist.
- It's OK to eat ice cream

I also have a list of TV episodes I can get off of Netflix that usually make me feel better - "Once More With Feeling" from Buffy, for instance. And blanket permission to go wander around on XKCD or TVTropes if I feel lousy. I wrote that stuff down in my "wellness book" - it's in black and white, along with uplifting quotes and the phone numbers for my treatment team.

It's also nice to talk to other people who are there now. Therapists and stuff are great, but they're kind of detached from your experience. Go to a DBSA or NAMI support group, or join a forum specifically for folks with mental illness, or something similar. MeMail me if you want specific suggestions.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:49 PM on April 15, 2012 [7 favorites]

It took me (literally) years before I found an antidepressant that really worked. Prior to going on the antidepressant I'm on now, I had assumed that partial remission was as good as it gets. Not so. I really, really encourage you to talk to your doctor about switching you to something else. Daily overwhelming feelings of sadness says to me that your depression is not being addressed as well as it could be.
posted by Wordwoman at 7:50 PM on April 15, 2012 [2 favorites]

I've been big on natural cures for a few years. I used to have depression and have never taken any prescription medication and I feel much, much better than in the past. I believe it's because of years of researching how to increase serotonin and dopamine in the brain naturally.

1) Exercise. THis one is big. THere have been several studies that have shown that consistent exercise works as well as antidepressants. It creates the serotonin and dopamine that help you feel better instead of preventing the breakdown as some antidepressants do.

2) Sunshine. 30 minutes (more if you can) of sunlight entering your eyes triggers serotonin release and helps regulate your serotonin/melatonin cycle responsible for good quality sleep (also necessary to feel good). Getting some skin exposure gets you vitamin d which is also huge with those feel-good chemicals in your brain. If you can't get sunshine, you can take 5000 IU vitamin d a day to keep up (as long as you read up on how you shouldn't be taking tablets if you also plan on sunbathing ect as there is such thing as too much vitamin d but only if you take vitamins)

3) FISH OIL I did a school report and on this and learned that enough fish oil to have 1 g of EPA helps a lot with even treatment resistant depression.It is safe to take with ant--depressants.

Don't over-do caffeine. it depletes feel-good chemicals.

4. Get your thyroid checked. Many women have un0diagnoised hypothyroidism or a milder form of it because of several factors including lack of iodine in modern diets.

If you want more, me-mail me This is one of my favorite topics ;)
posted by eq21 at 7:57 PM on April 15, 2012 [3 favorites]

but the overwhelming feelings of sadness are still here and on a daily basis. This is something that I have to deal with and will have to deal with for quite some time...

Unless the sadness is situational (ie, a bereavement, unemployment, breakup, etc) this is not so and sounds like exactly the sort of thing that should be addressed with a meds review.
posted by DarlingBri at 8:12 PM on April 15, 2012 [1 favorite]

Thanks for the advice so far. I have tried risperidone and clonazepam in smaller doses in addition to the Cipralex. However, these two particular meds didn't work for me.

The psychiatrist that I'm working with knows that I am open to trying various meds until we find one that works better for me.

But so far, Cipralex has worked better than the other two drugs have. We have a review once a week where the psychiatrist asks me about how I am feeling and if I have noticed any particular side effects.
posted by livinglearning at 8:26 PM on April 15, 2012

As long as we're recommending dubious vitamin treatments, apparently probiotics has been proven to mediate anxiety.
posted by deathpanels at 9:03 PM on April 15, 2012

Anxiety is thought to result from the 'fight of flight' reflex manifesting itself in human behavior. Anxiety is a state of hyper-preparedness – a coping mechanism, really – which can be triggered by many side-effects of modern life. Have you discussed any of your everyday 'triggers' with any of the psychologists you've worked with? If you know what triggers your anxiety, you may be able to simply avoid situations that make you anxious. (For instance: for me, it's crowds.)
posted by deathpanels at 9:11 PM on April 15, 2012

In terms of what might get you through on a daily basis, listening to music can shift your mood in the short-term. I have also found it helpful to remind myself of times when I was doing much better, sometimes with the help of old emails or photographs. When you're depressed, it can be hard to remember that there was ever a time you were happy & hopeful about the future, but recalling who you were in better times can serve as a critical reminder that you can be happy & hopeful again.

I agree that finding the right medication (or combination of medications) & dosage may take a while. Some people find the right regimen almost immediately, but it took me years to find the perfect combination. It is a bit of a crap shoot. No matter how long it takes, being a guinea pig sucks, but the end result is worth it. Keep pushing for better results, and listen to your body. In time, if you are not seeing results, you may want to consider getting a second opinion.

You mentioned you saw a psychologist for 4 months, but, if I'm reading this right, it sounds like you are not doing any type of counseling or therapy right now. If you aren't receiving counseling, I'd suggest finding a therapist. Meds on their own usually don't do the trick when recovering from a major depressive episode. Managing chronic depression and anxiety often requires medication, counseling, and then lifestyle choices/behavioral changes. It is possible, but it does take a while.

The hardest part is the lifestyle choices/behavioral changes. It requires self-care (proper nutrition, exercise, sleep, & hygiene) & a conscious decision to think about things differently. For example. taking your negative emotion or thought and reframing it in a positive way. For me, I sometimes have to take a "fake it until I make it" approach. This may sound cheesy but practicing positivity even when it feels false eventually transforms into a more hopeful mindset. I could say so much, but do not want to blather on; if you want to talk, please feel free to email me. Best of luck.
posted by katemcd at 9:45 PM on April 15, 2012 [3 favorites]

Seconding everything already mentioned in this thread. Self-care is very important.

I read a DBT (dialectical behavior therapy, usually used in treatment for borderline personality, which I don't have, but I was feeling overwhelmed and decided to just just read it) and I found it so helpful. One of the things I've learned is this mantra, which I repeat many times: "Distract, relax, cope."

It works! Give it a shot.
posted by lollipopgomez at 12:22 AM on April 16, 2012 [1 favorite]

Thanks again for the great advice. It's definitely appreciated.
posted by livinglearning at 5:44 AM on April 16, 2012

I have found that vitamin D supplements have helped almost as much as my antidepressants for improving my mood, especially when I can't get enough sunlight. Talk to the nurse about how much you should take.

Try to schedule a (good) friend to come take you for regular walks, swims or trips to the gym. It's harder to skip exercising if someone is standing at your door waiting to take you out.

Exercise is good for your brain and will help you sleep. Sleep will help your body.

Take care of yourself and keep looking for additional supportive reads.
posted by Heart_on_Sleeve at 6:18 AM on April 16, 2012 [1 favorite]

I struggle with depression and anxiety also, and I agree with everybody that exercise will help with both. It makes me feel so much better to know that I've done at least one positive, healthy thing today, and then I sleep better at night.

In addition to all the usual stuff that I've done for years to manage my depression--go to bed and get up on a regular schedule, exercise, eat right, get out of the house, stay as active as you can, etc.--I've recently started doing the 20/10s recommended here and it's really helping me to keep from getting "stuck" (paralyzed by anxiety and depression). That is, when you have to do something that seems overwhelming (because it makes you anxious or because you're depressed and EVERYTHING seems overwhelming), set a timer and work on it for 20 minutes. When the timer goes off, set it again for 10 minutes and spend that time goofing off. It seems silly, but it really helps you to get moving. I'm trying to find a job and that sends my anxiety up to 11, but I can do it if I know I only have to do it for 20 minutes. If that 20 minutes is all I can do that day, then that's all I do.
posted by WorkingMyWayHome at 8:58 AM on April 16, 2012 [3 favorites]

To follow up on what WorkingMyWayHome said: in the partial hospitalization program, we had a five minute rule., based on the idea that you can do just about anything for five minutes. And you don't have to do it all the way. Like, if you know you need to eat around now, you can say "I'll just go into the kitchen for five minutes." And if it's just too much, after five minutes you can come back and sit down. But you often find that once you're in the kitchen, you can open a can of soup and put in the microwave and set it for 90 seconds and take it out and bring it back - all in that five minutes. Or maybe just pour a glass of milk; it really varies on the day.

My therapist in the program told me that when she started working out, she just decided to go look at the equipment in her basement for five minutes. After a few days, she could put on the workout clothing and look at the equipment for five minutes. And then after a few days she could put on the workout clothing, and sit on the equipment for five minutes. And so on.

I find this especially helpful when I'm very very anxious about something: I can look at the bill on my table for five minutes, or I can sit in the parking lot of the store for five minutes, or whatever. I have an escape route - when the five minutes are up, I've won. And then the next time isn't so bad, and maybe I'll even open the envelope and look at the paper inside next time, or turn off my car's engine and step out for a moment.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:39 PM on April 16, 2012 [2 favorites]

Try spending more time outside, preferably in a park or nearby forest. For serious!
posted by edguardo at 8:24 AM on April 17, 2012 [2 favorites]

I'm definitely going to use the 20/10 'system' because I find it so incredibly exhausting doing anything. I still manage to do things, but it takes a very long time to push myself to do these things and it feels exhausting from beginning to end...

As for spending time outside, I have been considering walking outside for just a bit every day rather than trekking it to the gym because that's too exhausting right now. Just getting outside when I don't have work would feel like a huge victory.
posted by livinglearning at 2:51 PM on April 17, 2012

Even sitting in your car in a nature center's parking lot with the windows rolled down helps - nature is like magic that way. I eat lunch in parks to help myself feel better - thanks for mentioning it, edguardo.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:29 PM on April 17, 2012

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