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.

Is Your Major Depression Treatment Plan Working?

Track your progress with a journal of your clinical depression symptoms.

As you start to overcome major depression (also known as clinical depression, major depressive disorder, or MDD), you can boost your success by being an active member of your own treatment team. Once you’ve worked with your doctor and/or a psychotherapist to put a depression treatment plan in place, the next step is to watch for signs that you’re feeling better. Overcoming depression may take some time, but keeping regular tabs on your progress will help your depression-treatment team fine-tune the right mix of antidepressant medication and psychotherapy for you.

Keep a Depression Symptoms Journal

Day-to-day variations in your depression symptoms can be misleading, so it may be more helpful to assess your progress at the end of each week instead of daily. To keep track of subtle changes in your symptoms, use a depression symptoms journal for at least the first month of treatment. Write in it daily.

Use this checklist to assess your progress around the same time each week:

___I feel more rested in the morning.
___I’m interested at work and able to concentrate.
___My energy level seems to be improving.
___Feelings of lethargy or restlessness were less noticeable.
___I tried to eat regularly and healthfully most days of the week.
___I took my antidepressant medication daily (if applicable).
___I exercised at least 3 times this week.
___Feelings of loss, sadness, guilt, or worthlessness were not distracting.
___I engaged in an activity with friends or family.
___Overall, this week was better than last week.

If you’re taking an antidepressant, take note of the following potential side effects and contact your doctor or therapist right away if you have them:

  • Feelings of worthlessness or thoughts of self-harm
  • Worsening depression
  • Changes in your sexual interest

Modifying Your Depression Treatment Plan

Research shows that a combination of antidepressant medication plus psychotherapy offers the best chance for lasting relief from major depression, says Gerry Neely, MA, LMFT, who works with clients in her Seattle practice. For people who feel a stigma about taking medication, Neely adds, “finding the right medication can serve as a short-term bridge to feeling better and being able to fully engage with life.”

If you don’t see improvement right away, don’t give up hope. Research funded by the National Institutes of Mental Health (NIMH) shows that switching antidepressants or adding a medication to your depression treatment plan can help. If your symptoms persist, your doctor will review your current plan and your overall health to be sure nothing was missed. Your psychotherapist can try a variety of techniques to find the right match.

Boost Your Energy Level in 11 Steps

Learn how to recharge your batteries so you can keep on going like the Energizer bunny.

Tired of Having No Energy?

Everyone feels tired now and then, but are your energy stores totally depleted? Think of it this way: If you blow a fuse in your house, you can’t expect to get power back by lighting a few candles and searching for food with a flashlight. You’ve got to find the bad fuse, replace it, and reset the system. Same goes for your energy. Before you reach for the big Cs to snap out of your sluggishness (you know . . . cookies, candy, carbs, and caffeine concoctions), we’ve got an 11-step plan to pep you up.

Consider Your Sleep Habits

It’s pretty basic, but you need to get your ZZZs. Sleep loss is a major energy drain. Our bodies and brains need 6 to 9 hours of sleep to restore good brain-cell functioning (i.e., the ability to perform physically as well as mentally, since both coordination and thinking require those brain cells to work well). Getting on a regular bedtime schedule will help set your internal clock so your body knows when to sleep and when to wake. Find out what’s causing any sleep issues you may have.

Train Your Brain

Tell your body you want to watch Glee reruns all night and — thanks to mechanisms called feedback loops — you downshift energy production. This explains why you can feel too tired to move even though you’ve been sitting around all day. Tell your body to move and it responds by giving you the energy to get moving. Your body teaches your brain. That’s how healthy behaviors become automatic habits. This may be tough the first few times you try, but it gets easier.

Stay Hydrated

Getting to the point where you’re just starting to feel thirsty (a mere 2.6% drop in hydration levels) is one of the quickest ways to take the spring out of your step. In fact, being even just a little dehydrated can lead to unpleasant feelings, such as fatigue, crankiness, and foggy thinking. When you feel yourself dragging, grab a tall glass of water. Another plus of H20: people who drink water throughout the day consume a whopping 9 percent fewer daily calories.

Cut Back on Sugar

A sugar-filled diet gives you about a birthday candle’s worth of energy, while a healthy diet is more like an eternal flame. Work on limiting simple sugars (they end in –ose, such as glucose, sucrose, maltose, and dextrose — ribose is OK), syrups, and any grain that’s not 100% whole. Ribose is the exception because it’s a special sugar made in your body. It doesn’t come from food, but does come in supplement form and can help build the energy factories of your body. It’s not for everyone, so talk to your doctor first.

Trade TV Time for Exercise

No time to exercise, but plenty of time to watch TV? Exercise can do a world of good to boost your energy, so even on days when you don’t feel up to it, try to do some kind of physical activity, such as walking, strength training or cardio to kick your feel-good endorphins into high gear. 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.

Spend Time in the Sun

Short days can causes seasonal affective disorder (SAD) — neurochemical changes in your brain due to lack of sunlight. From late fall until spring, people with SAD become depressed, sleep too much, withdraw from friends, and battle low energy and relentless carb cravings. To prevent SAD and get energized, try to spend some time in the sunshine. If there isn’t any, ask your doctor about light therapy, which involves sitting in front of a special box that shines ultrabright lights.

Sip Tea

Black, green, and white teas all contain the energizing amino acid L-theanine, which isn’t found in coffee. Green tea contains free-radical-fighting compounds that help you stay younger and avoid the aging and decrease in energy that accompany chronic disease. Although green tea has one-third the caffeine of black tea, it’s been shown to yield the same level of energy and attentiveness.

Get a Daily Dose of Magnesium

For a little extra get-through-the-day energy, top your veggies with toasted sesame seeds. They’re loaded with magnesium — a mineral that cells need in order to convert food to energy. Other magnesium-rich foods include: whole grains, dark leafy greens, pumpkin seeds, and cashews. Magnesium not only boosts your energy, it also helps strengthen your bones and keep your heart, nerves, muscles, and immune system functioning well.

Take a Power Nap

Close your office door or slip out to your car for a quick snooze. Power naps, or “cat naps,” can boost your mood, memory, and productivity. They also increase your alertness and energy while lowering your blood pressure. To get the most out of your siesta, keep it short (10 to 30 minutes), aim for midafternoon, and get comfy (kick of your shoes, loosen tight clothing and darken the room). Can’t take a nap? Opt for an afternoon walk or office-gym workout.

Eat More Mini-Meals

To stay energized all day, you have to eat often. That means shifting away from three big meals toward five to six balanced mini meals. To maintain steady energy levels, pair complex carbs that are high in fiber (e.g., beans, peas, and whole grains) with unsaturated fats (e.g., avocado, walnuts, or mixed greens with olive oil). Add protein, such as lean meat, nuts, fish, and edamame, as an accent rather than as a main dish.

Still Tired? Talk to Your Doctor

If you’ve tried everything under the sun to boost your energy but still feel tired, it’s probably time to make an appointment with your doctor. Share how you’ve been feeling, when your fatigue began, and what factors may be causing it. Don’t be afraid to ask questions and to find out what treatment options may be available to you.

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.

Living with Major Depression

Major depression can take a toll on your life. Learn about your symptoms and your treatment options.

7 Ways Major Depression Impacts Your Life

Major depression (also known as clinical depression, depressive disorder, or MDD) doesn’t just affect you. It impacts your friends and family, and anyone close to you. It follows you to work and school. “Depression affects a person across the board,” says Rob Doyle, MD, clinical instructor in psychiatry at Harvard Medical School and staff member at Massachusetts General Hospital. Left untreated, it’s an equal-opportunity destroyer, he adds. Until you recover from major depression, be aware of how it affects your life.

Alcohol and Substance Abuse

Substance abuse is common among people with depression, says William Marchand, MD, assistant professor of psychiatry at the University of Utah and author of Depression and Bipolar Disorder: Your Guide to Recovery (Bull Publishing Co.). People with depression may self-medicate to feel better. Sometimes addiction is the main disorder, and depression follows. “Drinking or taking illegal drugs may have a short-term effect of feeling better, but there is good evidence that it worsens depression,” Marchand says. A drink or two a day doesn’t mean you’re an alcoholic, but your doctor should assess this. To help you recover, your doctor needs to know if you need treatment for substance abuse, depression, or both. It’s important to tell your doctor if you drink or use drugs.

Problems at Work or School

Depression can cause sleep problems, making it hard to fall and stay asleep. If you don’t get enough ZZZs, you’ll think unclearly and feel sluggish the next day. Major depression causes lost productivity at work. “If you’ve got a boss keeping an eye on things in this tight economy, the first to be let go will be those perceived not to be pulling their weight,” Doyle says. If you arrive late or take too long on tasks, coworkers may notice. “They don’t know you’re functioning on 3 hours of sleep,” Doyle says. Resentments may form, affecting work relationships, and you could be pegged as lazy or disorganized. To make matters worse, “you may not even know you’re depressed and buy into the idea that you’re lazy,” Doyle says.

Depression and Loneliness

If you have major depression, the things you used to enjoy aren’t enjoyable anymore. Say you’re a huge Red Sox fan and the team is on a losing streak. Someone not suffering from depression will get over it, especially after a few wins. “But a depressed person doesn’t care either way,” Doyle says. “If you offered them free tickets, they’d say, ‘No, give them to someone else.'” There’s a general loss of interest in life. “The depressed person is just going through the motions, not engaged,” Doyle says. “They’d rather sit at home and isolate themselves in their room.”

Thoughts of Self-Harm

A person with depression may feel like there’s a dark cloud hanging over his or her head. “It can become quite painful,” Doyle says. Friends and family may become impatient, especially if it’s the kind of depression with a genetic component that gets triggered even when life is good and things are going your way. You may start to think life is too difficult or have thoughts of harming yourself. Discuss with your doctor a plan for what you will do if these thoughts occur. If you think you might hurt yourself, call the 24-hour National Suicide Prevention Lifeline at 800-273-8255, go to the emergency room, call your healthcare provider, or call a designated family member.

Family Problems

“Depression almost always changes a person’s thinking,” Marchand says. It changes the way you act at home. You feel negative about yourself, and see the entire world through a negative lens. On top of this, work issues can lead to family problems, especially if there is job loss. Often, family members of people with depression don’t understand what’s going on. Statements such as, “What’s wrong with you?” or “Snap out of it!” only increase feelings of worthlessness and sadness. Learning about depression can help stave off comments like these. To promote understanding and support, it may be helpful for a family member or friend to go with you to some of your doctor’s appointments and therapy sessions.

Relationship Problems

When major depression sets in, your spouse or partner may wonder what he or she did wrong. “There’s a real set-up for misunderstandings and arguments,” Marchand says. Loss of sex drive can be frustrating for your spouse, adding fuel to the idea that you aren’t attracted to or don’t care about them anymore. Your partner may even blame his or herself for your behavior. Relationship problems only lead to more depression, and it becomes a vicious cycle. This is a good reason for your spouse to have an understanding of major depression and symptoms of depression, and to go with you to occasional doctor’s appointments or therapy sessions.

Depression and Anxiety

“Anxiety disorder is common with depression,” Marchand says. If you have it, it’s important to establish that upfront, since some antidepressants can initially worsen anxiety. Treatment for anxiety and major depression may include medications, psychotherapy, or both. For people with less severe symptoms, medication isn’t always necessary. Talking through feelings of sadness and anxiety with a skilled therapist is sometimes enough to alleviate the condition. “The brain changes in response to our experience,” Marchand says. A new experience changes your brain function. In this way, psychotherapy can help you find constructive ways of coping with the stress that brought on the depression or anxiety, and help you feel more like yourself again.

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.