What to Expect as You Overcome Major Depression

Learn what to expect as you go through treatment and recover from major depression.

After a bout of major depression, it’s a relief when you start to feel like your old self again. Overall, you’re improving as you go through treatment for major depression, “but it’s often two steps forward and one step back,” says Shoshana Bennett, PhD, a clinical psychologist. “It’s rarely a straight line up.” Just knowing to expect some bad days with the good can help you be more patient with yourself. “These are dips, not relapses,” Dr. Bennett says.

A risky time during depression recovery is when you start having several good days in a row. It’s easy to think that — since you’re not having symptoms — you don’t need treatment for depression anymore, but going off medication or quitting therapy for depression too soon can lead to symptoms coming back.

American Psychiatric Association guidelines recommend that people with depression who have been successfully treated with antidepressants keep taking them for at least four to nine months, and sometimes longer. Similarly, people with depression who have fewer symptoms with talk therapy should talk with their therapist about how long to continue treatment.

Keeping Depression Symptoms Away Besides sticking with your depression treatment, you can take steps to keep symptoms under control. Connecting with friends and family, thinking positively, staying active, eating well, and getting enough sleep all help, but there’s a catch, says Jon Allen, PhD, senior staff psychologist at the Menninger Clinic in Houston: “The nature of depression makes it difficult to do those things.”

Don’t be surprised if these healthy steps feel unnatural at first. Depression fosters hopeless thinking, so you may have trouble believing that they’ll ever get easier. “They will,” Dr. Allen notes, “as you pull out of depression.”

Friends and family might see a change in your depression symptoms and depressed behavior before you do. “It’s remarkably common,” Allen says. “People will say, ‘Gosh, you look better,’ or ‘You sound better,’ and the depressed person is thinking, ‘Well, I still feel terrible.'” It can be very frustrating for the depressed person, who ends up feeling that other people don’t understand how tough things really are.

Building a Depression Support Network A support group is one place to find other people who know what you’re going through because they’ve had depression themselves. To locate in-person and online depression support groups, call the Depression and Bipolar Support Alliance (800-826-3632).

If you pulled away from friends and family while depressed, now is the time to start rebuilding those bonds. Allen suggests making concrete plans; for example, to meet a friend for coffee. “By making that commitment to someone else, you may feel obligated to show up,” he says. It’s added motivation to get out and rejoin the world. Friends and family can also be a source of encouragement on days when depression symptoms or worries about symptoms get you down. Gradually, you’ll start to feel more hopeful, too.

Exercise and Major Depression

Learn how exercise and physical activity can change your brain chemistry and support your major depression treatment plan.

Exercise is prescribed for a wide variety of health conditions — from heart disease to diabetes. Science shows being active can improve your physical and mental health, and make positive changes in your brain chemistry. But if you’re battling major depression, the thought of working out may seem unthinkable. Here’s some information about the benefits of exercise that may change your mind.

Exercise and Nerve Growth    Early brain chemistry research found that mice living in an exercise-friendly environment stopped acting depressed after a stressful social experience — while mice who didn’t exercise stayed depressed. Scientists attribute the mice’s recovery to the growth of new brain nerves caused by exercise.  This and other research has led scientists to understand how brain nerve growth works in humans, too. Adults affect their brain chemistry through experiences — such as physical activities — and how they respond to them. The proteins largely responsible for the brain’s ability to adapt and change are called neurotrophins. Antidepressants affect neurotrophins in the brain — and so does exercise.

Benefits of Exercise Therapy for Depression In addition to stimulating new nerve growth and improving your ability to think, remember, and learn, exercise boosts serotonin, dopamine, norepinephrine, and endorphins in your brain. These neurotransmitters help you calm down and focus. In studies, exercise therapy has also shown an antidepressant effect.

One Duke University researcher, James Blumenthal, PhD, has been studying exercise and MDD for over a decade. “Based on the best available evidence to date,” Dr. Blumenthal believes that “exercise may be generally comparable to medication in the treatment of MDD.” Similar studies continue to find at least modest clinical benefit for exercise and better mental health. But don’t self-treat your depression symptoms or try to get through your recovery with exercise alone. Talk to your doctor about treatment and self-care options — including exercise — that are right for you.

Adding Exercise to Your Treatment Plan Once you start exercising, you’re likely to notice some changes in your symptoms right away. “Simply moving more and sitting less will make a difference in how you feel,” says exercise physiologist and dietitian Amy Ogle, MS, RD. “And if you typically exercise alone, consider working out with a group or partner because the social connection helps lessen depressive symptoms.”

Shoot for at least 2 1/2 hours of exercise in a week. Strength training counts toward that time, too. Just remember to check with your doctor first, especially if you have another medical condition.

“Sticking to a plan and following your progress,” Ms. Ogle adds, “will renew your sense of self-mastery and control.”  You can progress to the following routine:

  • 5-10 min warm-up, gently moving upper and lower body in full range of motion
  • 30 min aerobic exercise, such as walking, light jogging, swimming, biking or a group exercise class. You should be able to talk, but not comfortably sing.
  • 5 min cool-down and stretching

Herbal Remedies and Dietary Supplements

Some people find herbal remedies and dietary supplements useful in relieving the symptoms of depression. Herbs and supplements commonly used for this purpose include:

  • amino acids and their precursors
  • DHEA
  • folate or folic acid
  • SAMe
  • St. John’s wort (Hypericum perforatum)

Scientific evidence supports the effectiveness of at least one herbal remedy (St. John’s wort) and two dietary supplements (DHEA and SAMe) for reduction of depressive symptoms. However, herbal remedies and dietary supplements do not help all people and in some cases, the effectiveness of these treatments has not been completely established.

How Your Doctor Will Diagnose Major Depression

An accurate diagnosis is the first step toward recovering from clinical depression.

Unlike health conditions marked by clear physical signs, major depression (also called clinical depression, major depressive disorder, or MDD) can be hard to diagnose. One reason is that the symptoms of major depression can look a lot like other health conditions — especially other types of depression or grief. Another reason is that many of the most important major depression symptoms have to do with how you feel emotionally, so a solid diagnosis depends on you sharing symptoms information clearly and openly with your doctor.

To diagnose major depression, your doctor will ask you several questions to help rule out other health conditions and pinpoint the type of depression you have. Your doctor may also conduct other medical and psychological tests to better understand what’s causing you to feel depressed. Here’s what to expect from a depression screening:

  • Questions about your symptoms. To be diagnosed with major depression, you must have certain symptoms for at least two weeks. Your symptoms must also be severe enough to interfere with normal activities, work, and your ability to take care of yourself. To make a major depression diagnosis, your doctor will ask you about your feelings, thoughts, and behavior.
  • A physical exam. A physical exam won’t tell your doctor whether you have major depression, but it will help your doctor assess your overall health and rule out obvious illnesses and injuries that may be related to your depression. A physical exam is likely to include a check of your height, weight, temperature, blood pressure, heart rate, breathing, and abdomen.
  • Blood tests. Some health conditions, such as hypothyroidism (a slow thyroid) or kidney disease, can cause symptoms of depression, so your doctor may also want to do a blood test to check your hormones or complete blood cell count.

Many people don’t realize they have major depression, so some doctors include depression screening as a part of a regular office visit. Answering these two questions honestly if your doctor asks them can help you get the diagnosis and treatment you need:

  • In the past month, have you felt down, depressed, or hopeless?
  • In the past month, have you felt little interest or pleasure in doing things?

A “yes” response means you may need further depression screening.

Top Ways to Get Your Energy Back — Now

February 21, 2010 12:00 AM by Mehmet C. Oz, MD, and Michael F. Roizen, MD

You’re grumpy at the groundhog (who needed extra weeks of winter?) and a little short with your spouse, and you have been spending more time with the mac-and-cheese casserole than the treadmill. Winter can do that. But it doesn’t have to. Use these strategies to cuff the classic energy thieves that are still hanging around this time of year, and get your mojo back before spring hits:

Energy thief #1: Short, dark days.
What happens: Short days can cause seasonal affective disorder (SAD) — neurochemical changes in your brain due to lack of sunlight. This results in depression in up to 6% of Americans (the further north you go, the more likely you are to be a SAD sufferer). From late fall until spring, people with SAD become depressed, sleep too much, withdraw from friends, and battle low energy and relentless carb cravings.
Turn it around: Light therapy — sitting in front of a special box that shines ultra bright lights — has long been considered to be the best way to combat SAD. But a new University of Vermont study reveals that cognitive-behavioral therapy (CBT) may be even better. CBT is a type of psychotherapy that helps people outsmart depression by teaching them to change their negative ways of thinking. In fact, in this study, CBT alone was able to stomp out SAD with a success rate of 81% (compared with 49% for CBT plus light therapy and 32% for light therapy alone). Why wouldn’t more therapies be better? Researchers surmise that trying to balance two therapies was just too confusing, but CBT alone allowed people to focus on the coping skills they needed to banish their winter blues.

Energy thief #2: You can’t get enough comfort.
What happens: When the mercury heads south, we crave calories, carbs (they help our brains make the calming neurotransmitter serotonin), and fat. In fact, a 2006 University of Massachusetts Medical School study found that once the days become shorter, we pack away an average of 86 extra calories a day and weigh more than at any other time of year. We also snarf down more total and artery-clogging saturated fat.
Turn it around: Just cozy up to good-for-you carbs and healthy omega-3 and omega-9 fats that will satisfy your biology and your brain without packing on a gratuitous layer of blubber.

Trade meatloaf and pot roast for hearty whole grains like whole-wheat pasta and brown rice, or try polenta, a veggie burger, or salmon. Or warm up with a satisfying bean-based vegetable chili or Tuscan white bean soup. Since beans and whole grains are digested slowly, they’ll keep you full longer, so you’ll eat less overall. And if it seems like there are slim pickings in the produce department, now is actually the prime time to load up on nutrient-packed starches, including sweet potatoes and winter squash (roast or bake them with a drizzle of olive oil). Finish your feast with seasonal winter fruit (think apples, pears, oranges, grapefruit, and tangerines, or even frozen berries) topped with a sprinkle of heart-healthy walnuts or almonds and you’ll get all the carbs and fats your body craves — but you’ll do it the healthy way.

Energy thief #3: You stay in. On the couch.
What happens: Your workout plan bites the dust. We log less exercise in winter than any other time of year, with a paltry 45% of Americans and 36% of Canadians keeping active. Pretty ironic, since exercise can lift you out of the winter doldrums by boosting energy, improving mood, and helping you sleep better.
Turn it around: Start with your schedule. Make regular exercise appointments on your calendar the same way you’d ink in any other non-negotiable activity. But give yourself a bit of a break: Don’t think exercise needs to be a hard-core trip to the gym. Taking the dog for an extra-long walk or doing crunches and lifting weights in front of the TV count, too. Still uninspired? Try the 10-minute rule. Make a deal with yourself to get moving for at least 10 minutes. Chances are, once you start, you’ll feel so much better that you’ll keep going.

15 Simple Ways to De-stress

Hypnotize Yourself

Brow furrowed? Pulse galloping? Barely able to breathe? It’s time to relax. We’ve gathered easy strategies to keep tension from taking over.

Forget swaying pocket watches and deep trances. “Hypnosis is a state of highly focused attention,” says David Spiegel, the director of Stanford School of Medicine’s Center on Stress and Health. If done properly, hypnosis can clear your mind, lower your heart rate, and decrease muscle tension. Close your eyes and picture a movie screen with something stressful, like rush-hour traffic, on the left side. Now, visualize a solution playing out on the right, like discovering a new route with no traffic. Eventually, you’ll feel a moment of intense absorption, he explains, like when you’re so caught up in a good movie that you forget where you are. Try doing this for five minutes, three or four times a day.

(Really) Forgive Someone

Although it may be tempting to rehash the details of how your sister’s boyfriend snubbed you, letting go of negative feelings really does lower stress. “When our minds keep rehearsing troubling interactions, the body’s calming system becomes impaired,” says Charlotte vanOyen Witvliet, a psychologist at Hope College in Holland, Mich. A cursory hug won’t do, though. You have to sincerely replace your anger toward the wrongdoer with an attempt to understand the reasons behind his actions. “Forgiveness helps you see more of the truth, not less. When we are upset, our vision is limited in scope,” says Witvliet.

Open the Window

Just looking out your window can have a relaxing effect. In a study led by Peter Kahn, an associate professor of psychology at the University of Washington in Seattle, participants in an office were shown one of three views: a natural setting, a digital display of the same scene, and no view. When stress levels were artificially increased, those looking at the real natural scene returned to their normal heart rate more quickly. Those who looked at the digital display did no better than those looking at a blank wall, suggesting the brain is not easily fooled. “We do best mentally and physically when we’re connected to nature,” says Kahn.

Send Yourself Flowers

“Without question, stress is mitigated by nature,” says Mehmet C. Oz, coauthor of “You: Stress Less” (Simon & Schuster). Scientists at Harvard University delivered flowers to one group of women and gave candles to a second group. Within a week, the first group felt less anxious and depressed, perhaps because humans are comforted by vegetation—a means of survival in caveman days. Oz suggests keeping a plant on your desk and cut flowers at the dinner table.

Pucker Up

A kiss (or two) a day can keep the stress away. You’ll feel less isolated, which is a common source of anxiety. According to Laura Berman, a professor of obstetrics-gynecology and psychiatry at Northwestern University, women in particular respond to locking lips by releasing endorphins. She recommends at least one ten-second kiss a day — deep and emotional, but not necessarily sexually arousing. “Just enjoy the physical connection,” she says.

Take a Time-Out

You don’t need to slip into bed to get the benefits of a good rest. Kate Hanley, author of “The Anywhere, Anytime Chill Guide: 77 Simple Strategies for Serenity” (Skirt!), suggests a simple exercise you can do at your desk that is just as refreshing as a nap:

  • Keeping both feet on the floor, stack your forearms on the edge of the table.
  • Scoot back in your chair so your spine is extended.
  • Rest your forehead on your arms for a minute or two.

This opens the neck and shoulders, where physical tension commonly builds up, and creates space in your rib cage for deep breathing. Visualize your next task going well, or simply focus on your heartbeat. Either way, this exercise gives you a break.

Take it Easy

Working out is a great way to take a bite out of tension—but think twice before you sign up for a boot camp. “When you are mentally tired, intense exercise adds to the stress you are feeling,” says Samuele M. Marcora, a physiologist at the University of Kent in England. After a draining day, he suggests a moderate-intensity workout, like walking or light running. “It won’t improve your fitness level, but it is good for the mood.”

Say ‘Om’

Yoga is a proven stress buster, but not all poses give the same relief. Inverted stances, such as back bends and headstands, may have a greater effect on your mood and anxiety, say researchers. The part of the nervous system that relaxes the body and mind may be stimulated when the spine is bent, explains Chris Streeter, a professor of psychiatry at Boston University School of Medicine.

Go Into the Light

“Stress can be triggered when our bodies don’t know what time it is,” says Julie Holland, an assistant clinical professor of psychiatry at New York University School of Medicine. “Exposing your retina to sunlight resets your circadian rhythm so your brain is on a schedule.” Take a walk outside without sunglasses for 20 minutes a day, three times a week. Phototherapy lamps and vitamin-D supplements also help.

Watch a Tearjerker

If you’re still crying your contacts out on your 100th viewing of “Blue Valentine,” try watching it a 101st time with a new outlook: A recent study suggests that thinking positively while watching a sad movie may help you cope with setbacks in the real world. Women who had experienced stress were shown sad scenes from movies such “I Am Sam” and “Fatal Attraction” and asked to come up with happy endings and good advice for the characters. Test subjects who were best at this showed fewer signs of depression than women who watched the movies passively, says Allison S. Troy, a researcher at the University of Denver. Solving other people’s problems is always easier, she says. Practicing as you make your way through your Netflix queue may sharpen your skills.

Treat Your Allergies

Itchy eyes and a runny nose aren’t the only plagues of allergy season: Stress may rise with the pollen count. Alvaro Guzman, a psychiatrist at the National Center for the Treatment of Phobias, Anxiety and Depression in Washington, D.C., says research shows that patients with seasonal allergies often report stress, mood dips, and depression when symptoms flare. “When we have an allergic reaction, chemicals are produced in our blood that can aggravate mood changes,” he says. If you notice your stress levels peaking when the weather is changing, Guzman suggests getting tested for allergies.

Drop an F-Bomb

Saying what you really think about the boss over a couple of martinis has its advantages. After observing groups in various workplaces, Yehuda Baruch, a professor of management at Rouen Business School in France, found that people swear as a coping mechanism to release stress. When upset with a difficult customer, one test subject pretended to carry on a conversation as if the client were still on the phone, but with profanity to describe exactly how she felt. In the real world, Baruch warns to use common sense. “Stay professional and never swear in front of someone who would be offended.”

Get Busy

You’re sitting on the couch watching The Real Housewives of Beverly Hills reruns — just like last weekend. And instead of becoming absorbed, part of your brain stays focused on the looming deadlines that have been nagging at you at work. Susan Nolen-Hoeksema, a professor of psychology at Yale University and the author of “Women Who Think Too Much” (Henry Holt), says, “Overthinking without being able to resolve anything draws us deeper into a feeling of being overwhelmed.” A pastime that requires you to pay attention or engage with other people—like tackling a new recipe, taking a foreign-language class, or playing tennis—lets you escape from your own spinning head and break the cycle.

Surround Yourself With Beauty

Admiring a photo of a model or a movie star just as you would a work of art could relieve tension. Half a group of people who viewed photos of females wearing makeup said they were less stressed afterward, according to a study at the University of Louisville in Kentucky. The other half did not report the same benefit, but they didn’t feel any worse, says Patrick Pössel, a professor of psychology who conducted the study.

Be a Pescatarian

Battling stress can be as simple as ordering fish at a restaurant. On “The Truth About Food,” a program on the Discovery Health Channel, researchers measured hormone levels in London cabdrivers, who have highly stressful jobs. When put on a diet of four portions a week of oily fish like mackerel, a source of omega-3 fatty acids, the drivers produced less of the stress hormone cortisol and more of DHEA, a hormone the body cranks out to combat stress. “When the body sees omega-3 fatty acids, it feels calm,” says Oz. Walnuts, flaxseeds, and tofu are other excellent sources.

4 Benefits to Being Imperfect

4 Benefits to Being Imperfect

I vividly remember being in the first grade, and at the end of the year, I won my first award for accumulating the highest GPA in the class. That was when I took my first hit of perfectionism, and it felt good, almost euphoric. For the next seven years of grammar school, I chased that high and made that little, square, marble trophy my goal. Somewhere along the line, my self-worth became entangled in that useless trinket.
 
It started with my grades, craving the A  because the A wasn’t good enough. Then, it spread to my looks, my athletic abilities, my personality, etc., and I started living in polarities (good vs. bad, fat vs. thin, nice vs. mean, and ugly vs. beautiful). When my environment began mirroring them back to me, I assumed they must be true, and my identity became wrapped up in how “good” I could be at everything. “You’re so smart, sweet, and pretty,” I would hear over and over again, and all I could think was that I wasn’t smart, sweet, or pretty ENOUGH.
 
The quest for perfection is an endless journey many of us have been on since childhood. We somehow think our mistakes or shortcomings are failures or make us less than rather than viewing them as lessons to be learned unique to us an individuals. I was a self-proclaimed perfectionist, and it originated from a message I received purely from society (in no way did my family make me feel this way) that I interpreted as meaning I was only valuable if I was perfect – pretty, intelligent, sociable, and successful. If I received any grade but an A in school, I considered it an F and beat myself up over my perceived “failure.” Then, I started to develop anxiety around EVERYTHING because the idea of not being up to par shook me to my core. I knew nothing but achievement, but what if one day it stopped? Then, who would I be? I feared failure, but most of all, I feared that I would never be “enough.”
 
Perfection is really just a way of asserting control over areas of life where we feel we have the power to do so. Often, we equate love with perfection causing us to chase impossibly high standards to feel valued and accepted. It is a diversion to fill an empty void that really originates in the spirit with outside experiences. Perfection becomes tied to self-worth, and a shameful belief of inner inadequacy fuels the perfectionist tendencies. Perfection was my drug, and I self-medicated with it so that I did not have to feel. Now, I find my worth in the fact that I simply am and that worth is not contingent upon my achievements. It is strong and never fluctuates because I am and always will be a divine creation.
 
Below are four benefits to being imperfect.
 
1. Less Stress – Ditching the “shoulds” and all-or-nothing thinking will allow you to find more peace and enjoy your daily accomplishments and successes while you learn from your mistakes and less than perfect outcomes.
 
2. Improved Relationships – When you can accept your limitations and imperfections, you give others the permission to be imperfect, as well. As your expectations and impossible standards for yourself lessen, so do those you held for the people in your life. Our outer world is a reflection of our inner world, so when we begin to value ourselves regardless of what we do or achieve in any area, we then begin to value others for who they are and not what they do.
 
3. Increased Energy – When all of your energy is no longer concentrated on worrying about what you SHOULD be doing and how you SHOULD be doing it, you free yourself up to focus on what really matters.
 
4. Healthier Self-Image – Accepting and appreciating our imperfections creates room for self-nurturing, compassion, and love. You can begin to appreciate the qualities, characteristics, and experiences that are unique to you without the need to be perfect.