How can I nip a depressive episode in the bud?
June 13, 2013 8:30 PM   Subscribe

The past few weeks I've been starting to feel the sorts of things that I associate with previous depressive episodes, and I am hoping that there might be some way I can stop it before it really becomes a problem again.

I've suffered from depression for most of my life, and managed to claw my way out of a two year long depressive episode about a year and a half ago with medication and therapy. I am still taking medication, although not currently in therapy and am not to a point yet where I feel I need medical/psychiatric intervention.

However, I am starting to feel randomly bleak and miserable, unmotivated, constantly tired, and unable to enjoy things. Since I'm still on the cusp, I'm hoping I can turn things around before they get worse.

Are there any things that might work to head off a depressive episode? Any thoughts or suggestions on how to improve my mood/outlook/ability to function or get back in the swing of things?

I would prefer to avoid exercise (endorphins seem to have passed me by) unless it is something that will be pleasurable in and of itself. I also need to avoid most outdoor activities during the summer - bright sunlight and heat trigger crippling migraines for me. Beyond that, I am open to any suggestions or advice that might be helpful or effective.
posted by madelf to Health & Fitness (28 answers total) 34 users marked this as a favorite
Some options:
Gratitude journal (generally, write down five things every day for which you are grateful)
Make sure you're eating as many fresh non-processed foods as possible
Decrease or cease alcohol intake
posted by jaguar at 8:37 PM on June 13, 2013 [1 favorite]

I came to suggest exercise... In fact I myself have felt a depressive episode coming on and finally went for a run tonight and feel better for it. However, not everyone's cup of tea, I know.

I do believe some kind of physical outlet can help greatly. It doesn't have to be traditional exercise. Go to a roller rink and skate around in circles to the cheesy pop music. Swing on a swingset in a playground at dusk. Just go for a long, brisk walk in the early morning or twilight hours. I'm pretty sure, like, P90X would make me more depressed right now, but expending energy physically is what does it for me. It relieves my insomnia and I guess it sort of feels like the nervous energy I spend worrying and degrading myself is expended at something harmless instead. I'm sure there are non-physical ways of doing this too but the point is I have to make myself tired.
posted by telegraph at 8:43 PM on June 13, 2013 [2 favorites]

The very slightest of physical activity can have an immediate, noticeable effect on my mood. As little as twenty sit-ups, a couple minutes of silly dancing, or a walk up the street. You don't have to join a gym or anything, just move around for a minute or two and see if it gives you a boost.

When I'm feeling low but not all-the-way depressed, it helps me to check in and talk myself through my moods. I ask myself questions like: How am I feeling? Can I think of anything that could have contributed to this mood? Is there anything healthy I can do that might help me feel better? Can I handle today? Do I think tomorrow will be better? Just the process of asking and answering questions like these reassures me that I'm still okay and hanging in there. When I can't do it, that's when it's time for outside help.
posted by Metroid Baby at 9:03 PM on June 13, 2013 [5 favorites]

Depression usually effects sleep. One manifestation is not getting enough sleep and waking early in the morning with a terrible feeling of dread. Another one is hypersomnia. Sleeping late, never really getting very awake and going to bed early never having been very awake the whole day.

A counter-intuitive help for some depression that involves hypersomnia is to force yourself to sleep less. Set your alarm for an hour earlier and don't let yourself go to bed early. There are studies that to much REM sleep can be depression inducing.

There is a cognitive therapy book on depression that has exercises and ideas about what you can do on your own, but also guidelines about when its time to get help and who to see. I think its Depression by Aaron T Beck. In any event your library or bookstore will likely have a number of books, some with ideas for trying to head off depression on your own.

If you do see your general practitioner for some reason do let him know. There is a possibility the depression could have a cause like low thyroid as just one example among many.
posted by logonym at 9:16 PM on June 13, 2013

Get a professional massage! Releases all sorts of feel-good chemicals and physical human contact is great for the psyche. Try to get a recommendation from someone whose judgement you trust, though; a bad massage is really quite bad.
posted by windykites at 9:28 PM on June 13, 2013 [1 favorite]

It's really helpful for me to stick to a routine. I find that when I'm depressed, I'm really good at rationalizing myself out of the routine, and that contributes to the listlessness. Making a commitment to the routine helps a bunch. I also start scheduling things that I typically enjoy, even if if feels awful trying to plan it. I put it on the calendar and try to stick to it.
posted by frizz at 10:13 PM on June 13, 2013 [4 favorites]

Hm. Some things that occur to me, in no particular order:
- Make lists of things you have to do if you're having trouble with motivation. Include little things like "have a shower" and "don't get back into bed after having shower". That way you can cross things off and feel like you are meeting your goals, which gives you energy to do the other, sometimes harder things on the list.
- Pay attention to your sleep and intake of caffeine and alcohol, since both will frequently disrupt your sleep. Try to keep regular hours, even on weekends.
- Take the chance to do some comfort reading/DVD watching/music listening. On the subject of music listening in particular, be careful not to pick things that exacerbate the depression. It may just be me, but I have music that I really need to avoid when I am feeling down even though it's fine when I'm normal/happy. Maybe a thing.
- If direct sunlight is a problem, try to have light at least. And maybe find out if you have a vitamin D deficiency? Could be a problem if you need to avoid sunshine.
- Make a conscious effort to do random nice small things for people. Write a thank you note and put it in snail mail. Compliment someone on their hair or jewellery or whatever. Give the checkout chick a genuine smile and "thank you, have a great day".
- If you have a pet, spend time with your pet, especially in physical contact with your pet. Unconditional love is a great thing. If you don't, visit a friend who has one and spend some time patting the animal. Small children can work for this too. You can combine this with the thing above: "I'll come over and babysit for you so you can go out".
- I agree with those who say even walking round the block (in twilight) can be helpful on the exercise front. I sometimes feel trapped in my own head and badly in need of perspective; somehow getting out of the house and exposed to other things helps. Especially if you pay attention - try to notice something you've never noticed before if it's a familiar street. Anything to shift the focus of your attention. I don't think of it as exercise even though I'm sure that's partly what's going on, I think of it like a spell-breaker.

Good luck and I hope you kick it in the head and give it one to go on with!
posted by Athanassiel at 10:47 PM on June 13, 2013 [3 favorites]

I concur with cutting out alcohol and eat as healthily as possible. What helped me immensely was supplementing with iron. Floradix is an easily digestible iron source. It helped with my energy and I felt like I got my life back. I took it for three months but I felt so much better after one week. Before I was so exhausted even after a good sleep, and every thing was a struggle.
posted by krikany at 10:52 PM on June 13, 2013

The only things I can add are:
Talk, to friends or therapists or family.
Try to focus on the temorary nature of this mood.
Good luck, if you need a willing ear feel free to mail me.
posted by BenPens at 12:40 AM on June 14, 2013

Get plants or a pet - they will depend on you getting over your bad mood enough to take care of them. They will appreciate you and won't judge*.

* unless you get a cat
posted by domnit at 1:03 AM on June 14, 2013 [2 favorites]

Best answer: Are you getting enough social connection with people who add to your life? I notice from your question last year that you were working a "boring" 3rd shift job; if that's still the case, I know it can be killer on your social life and leave you feeling like your sole social contact for days on end is nothing more than the exchange of formalities with the grocery store cashier. Having a strong social network has been shown to be correlated with both better physical, and especially mental, health. If you're an introvert, that may take the form of fewer but deeper connections. But they're still important, and if you work odd hours in an isolated job, you have to make an extra effort to make sure your days are not an endless cycle of work, sleep, and solitary entertainment.

Also, even if you need to avoid outdoor activity in hot or bright sunlight conditions, if at all possible try to spend some time outdoors each week in natural surroundings, at times of day and doing soothing activities that are not migraine-triggering for you (relaxed early morning or late evening strolls through the woods or a public garden, for example).
posted by drlith at 5:42 AM on June 14, 2013 [2 favorites]

The best thing I can do when this happens is take a day off in the middle of the week and get out of the house. I usually sleep late, put on makeup (not an everyday thing for me), take the bus to some other neighborhood, wander around, hang out in a coffee shop, and knit.
I think it's the getting out of my rut that does it. Plus the makeup because that makes me feel cute.
posted by Ms Vegetable at 5:53 AM on June 14, 2013 [1 favorite]

I've battled mild depression most of my adult life (it seems to run in my family), and I nth everyone saying exercise. I once put on my walkman and walked from Dundrum to the centre of Dublin city, almost an hour and a quarter walk. I had to bus it home, but boy I felt better afterwards. Maybe swim a few laps in an indoor pool, if going outside isn't your bag?

Do something that gets you out of your own head and focusing on other people. Music always kicks me out of my own head, so conducting my two choirs is a kind of therapy for me. Maybe for you it's volunteering to read a book to kids at the library, or organizing a film night in a local parking lot, or hosting a stitch 'n bitch, or gardening, or something. Just something that gets you focused on others.

But getting sleep and taking care of yourself is also good therapy. For example, if you are the kind of person who likes a long bath, make that a ritual before bedtime; something to look forward to, and a respite from the crazy of the day. Or set aside some time to watch a movie, but make it special - lights down, popcorn, the whole shebang.

Just some ideas, but really, you need to get to know what triggers your depression, and then treat your depression like your inner toddler; find ways to distract, refocus, redirect.

Good luck!
posted by LN at 6:00 AM on June 14, 2013 [2 favorites]

Keeping busy really helped me out, and also Hapyr is surprisingly good as a deterrent! I have been using it for 10 days and feel a lot more grateful and happy. So that might be a good long-term strategy that will change your background radiation from blehhh to something happier.

Take care of yourself man!
posted by dinosaurprincess at 6:08 AM on June 14, 2013 [1 favorite]

As soon as one little depressive thought shows up - STOP THINKING IT. Force yourself to aggressively combat this thought and then think of something else. No excuses. Be a warrior.
posted by St. Peepsburg at 6:53 AM on June 14, 2013

Would you be open to trying something like acupuncture?

Even though I'm medicated and have a wonderful therapist, I still struggle with depression on a daily basis. Sometimes I slip into that deep, dark oubliette, from only which time provides an escape. I know for a fact that exercise helps pull me up, but sometimes I'm in way too deep to even leave my bedroom.

Though I like to keep far from woo and have my feet solidly planted in the realm of science, I decided to give acupuncture a shot (yes, I know that there's some proof of some stuff doing something, but I'm still a hard skeptic in general). I was in the darkest place that I had been in a few years. I am absolutely amazed at the result. I walked in completely empty inside, not even caring if I got hit by a truck (and maybe even secretly wishing for it). An hour later, I was bouncing off the walls, overloaded with energy and happy. Really and truly happy. I'm not cured, of course, but it sharply pulled me out of where I had been and gave me the ability to function and be social and do lots of things I generally cannot do when I'm in the grip of depression. Whether acupuncture actually "did something" or if the effect is placebo in nature, or if it was just doing something different, I don't care. It may or may not help you, but the only downsides are a) leaving the house and b) getting poked with needles.
posted by Cat Pie Hurts at 6:54 AM on June 14, 2013

Sleep deprivation has been a helpful tweak for me when I'm drifting into low-energy states. (NYT article via MeFi) "Sleep deprivation can elevate your mood even if you are not depressed, and can induce euphoria."

I also take a multivitamin - I think B complex vitamins are considered important to mental health, but just the ritual of taking a regular vitamin helps me feel virtuous.

The MeFi Health Month folks might be a great support group for trying out some adjustments to your lifestyle.

Good luck!
posted by spamandkimchi at 6:59 AM on June 14, 2013

Ice Skate. Swim. Listen to some traditional chanting music from whatever region of the worl you like and learn to chant along. Do a little cleaning or tiddying and then congratulate yourself on how you manage to work and take care of home. Sauna (or hot tub or hot bath/shower) followed by cold shower. Take some time to make being tired an event - pour a relaxing beverage (tea, lemonade, whatever's clever at the moment) occupy the whole couch, and catch up on a tv show or movie you've wanted to see. Go to a market and get some wierd fruit or vegatable you never tried and figure out how to eat it.
posted by WeekendJen at 8:21 AM on June 14, 2013

I hate to say "exercise" after you said it doesn't work for you... but the fact that you say "endorphins seem to have passed me by," makes me wonder if maybe you're thinking there would be a direct mood boost or endorphin buzz.

For me there is absolutely a connection between regular exercise and staving off depression, but I can probably count on one hand the number of times I've felt the endorphin high that other people talk about. It's more that if I don't get at least a few hours of exercise a week, I will get depressed. If I'm exercising regularly, I seldom get depressed, and when I do it usually doesn't get too bad or last more than a week or so (I hit an exception earlier this year, but that was with some other heavy stuff going on in my life). But it's a regular maintenance sort of thing for me, I don't think it has much to do with the endorphins.
posted by Kriesa at 9:30 AM on June 14, 2013

I'm throwing this out there just in case it can help you: Are there any comedies that you know and love and would make you laugh out loud? I find that helps when I'm stressed out, and it's worth a try if you're noticing a negative internal state. Blackadder, Father Ted, Black Books, and Knowing Me, Knowing You make me laugh out loud - those are British shows available on Netflix in the U.S. HBO's Veep is also very funny.

What are yours?
posted by joseph conrad is fully awesome at 4:27 PM on June 14, 2013

Ask for help before you need it. If you're thinking "You know, if this gets really bad, I'll call my friend So-and-so and tell them I need someone to talk to just to get some of this off my chest" or "Well, if this was worse than it is, I'd be justified in taking a day off work to do something relaxing and rejuvenating" or whatever — fuck it. Do that stuff now.

In the same vein:

I am still taking medication, although not currently in therapy and am not to a point yet where I feel I need medical/psychiatric intervention.

So you're taking psych meds, but not seeing a psychiatrist regularly? (I'm guessing you just have your general practitioner write you a prescription once every few months?)

That's not really a great idea. If you're strongly-enough prone to depression that you need to take psych meds at all, you need regular non-emergency appointments with a psychiatrist, and you need to go to those appointments even when you're feeling good — and you need to start thinking of that stuff as basic personal maintenance, right up there with bathing regularly and getting your teeth cleaned once a year.

Waiting until you're absolutely miserable before you see a psychiatrist is like waiting until your appendix ruptures before you go to the doctor, or waiting until all your teeth are calling out before you call a dentist. Go set up an appointment right now, even though you aren't totally convinced you need it yet.
posted by Now there are two. There are two _______. at 4:42 PM on June 14, 2013

Any chance the medication you're on just went from a patent to generic? My Lexapro has been excellent for the last many years, but just went off patent and I was given a generic replacement. It took about two weeks before I realized I just didn't feel right - the old depression was settling in again. I talked to my pharmacist and, just for the heck of it, he switched to a different manufacturer of the generic drug and voila! Things are back to normal.

I've never ever had a bad experience with a generic drug before.
posted by aryma at 5:23 PM on June 14, 2013

Are there any comedies that you know and love and would make you laugh out loud?

Oh, yes, I second that. I don't do so well with fictional comedies, but watching stand-up comedy helps a lot. Netflix streaming has a bunch.
posted by jaguar at 6:12 PM on June 14, 2013

Response by poster: That's not really a great idea. If you're strongly-enough prone to depression that you need to take psych meds at all, you need regular non-emergency appointments with a psychiatrist, and you need to go to those appointments even when you're feeling good — and you need to start thinking of that stuff as basic personal maintenance, right up there with bathing regularly and getting your teeth cleaned once a year.

For clarification, my therapist was not my psychiatrist, and did not prescribe my meds. By saying I am no longer in therapy, I meant only that I was no longer having twice weekly appointments for talk therapy, not that I am neglecting to have my meds monitored.

I also don't drink, so at least that is sorted as well.

On the exercise front, I actually do walk frequently. I don't drive, and I have a dog, so I usually get quite a bit of walking in every day. Part of what I meant as far as exercise not working for me is that it usually just makes me feel even more exhausted and miserable - which doesn't help when exhausted and miserable becomes my default state.

Thank you everyone for all of your suggestions! I've actually been trying a couple of them out today to see how they work. I spent about an hour playing with tiny, fuzzy animals this evening, and spent my lunch break getting some fresh air in the park near my office. I made some plans for the weekend with my mother to bake, and I'm planning on getting some cuddling time in with my dog before I have to be back to work. It's a start, and I'll definitely be trying some of the other suggestions as well.
posted by madelf at 7:28 PM on June 14, 2013 [6 favorites]

For clarification, my therapist was not my psychiatrist, and did not prescribe my meds. By saying I am no longer in therapy, I meant only that I was no longer having twice weekly appointments for talk therapy, not that I am neglecting to have my meds monitored.

Good! Sorry for the lecture, then. :)
posted by Now there are two. There are two _______. at 7:45 PM on June 15, 2013

Response by poster: No worries! It is very good advice, even if not necessarily applicable to my situation.
posted by madelf at 7:52 PM on June 15, 2013

Response by poster: Just a quick update after a few days:

The suggestion I actually had the best results with was getting out and getting some fresh air. Even though it's summer and I can't be out in the sun, I work right next to a beautiful park and have been eating my lunches out there every day under a nice shady tree while reading a book. It has really helped with the day to day blah feeling while I'm at work.

I also scheduled a few shortened work days, so I can get a break and a change of routine, and have made a point to bug some friends for a bit of social time. I'm only working the overnight job once a week, but I do tend to isolate myself when I'm feeling down, so forcing myself to be a bit more social has been pulling me out of that funk as well.

Thanks again everyone. Your suggestions were all extremely helpful!
posted by madelf at 6:32 PM on June 20, 2013 [3 favorites]

Good for you! It can be hard to do those things when you're feeling unmotivated, but it sounds like you're making a really strong effort.
posted by jaguar at 6:55 PM on June 20, 2013

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