Medical practice and education have truly entered a new era, one which I longed for during my medical education 20 years ago. In addition to attending my favorite Lifestyle Medicine course at Harvard Medical School this summer (these always leave me feeling giddy, I'm nuts about preventive medicine and will share some of the things I learned, soon), I enrolled in a magnificently enlightened Adult Mental Health training for physicians that was offered by my local health authority.
When I became depressed as a medical student and resident, I was told that depression was a disease that one virtually never recovered from and was primarily treated through medication. There was very little else.
Something in me refused to believe that this was all there was, and since then I've passionately gathered evidence and tools that help people (and myself) conquer depression without medication, whenever reasonable, safe and possible.
I almost fell out of my chair when I attended the first Learning Session of the Practice Support Program Adult Mental Health Module this summer, when the physician who was leading the training proclaimed the motto of "skills, not pills" (meaning we need to empower patients with self-help skills, instead of just handing out pills). Hallelujah and Amen!
The other day I was reading through the course materials for depression and anxiety (their "Cognitive Behavioral Interpersonal Skills Manual") and one sentence leaped out at me:
Depression feeds on withdrawal and inactivity.
I'd never really seen it from this perspective before, but it was bang on.
When you're depressed, you slowly withdraw into yourself. You don't go out and do the things that you did before, you stop reaching out to others, you lose your confidence to try what you might have previously embraced or had the courage to face.
And you slow way down. It's hard to find the energy to do anything, whether that be having a shower, or putting on makeup, or going for a walk, or doing much else than just sitting on the couch watching TV. I'm generalizing here, and some people experience depression quite differently (some might feel more agitated and anxious), but this has been my experience and the experience of many others.
It's one thing to be told that you need to get up and force yourself do small things for yourself, to help you start lifting yourself out of the pit.
It's another to be told that giving in to the withdrawal and inactivity is actually feeding the depression, and will make it worse.
I don't know about you, but for me that second sentence makes a massive difference. It shines a new perspective on the tendency to withdraw, the powerful gravitational pull to just sit on the couch in pajamas and watch TV. It shifts the nature of that force from the status of "I'm feeling too low to do anything else, even if I know I should, and this feels somehow comforting" to "Yikes, if I keep sitting on the couch like this day after day, and keep avoiding calls from my friends, it's going to feed the depression and make me worse." It makes giving in to it dangerous, the withdrawal and sitting around isn't just an unpleasant, passive state.
If you are in that zone with depression where you find it hard to do almost anything, but want to get better and want to stop feeding the monster (whether or not you are on medication, and presuming that you've talked to your doctor or a psychologist already), here are some strategies from my recent training that might be helpful to you:
1) Set small goals
Don't expect too much of yourself. Set yourself up for small wins, it will help you to feel more in charge of your life again and make you feel better about yourself. Self-care is a great place to start. If you've gotten out of the habit of showering, take a shower. Brush your teeth. Wash the dishes. Notice how much better it makes you feel. Then do it again.
2) Spend your energy within your resources
If you're normally a high energy, productive person, depression can be incredibly frustrating and discouraging. It's so much harder to do anything, and you may feel like a failure because of that. Again, be gentle with yourself and realistically assess how much energy you have on a given day. Don't push yourself beyond that, but see if you can use your resources toward doing things that count. If you are really depleted, you may only be able to get some basic self-care done and that's ok. If you have a little more energy on a particular day, maybe spend a little time on a hobby you used to love. But don't spend energy you don't have, as you'll end up feeling worse than before. Make a point of being proud of yourself for every thing you do manage to do, no matter how small. It all counts, each positive action is a deposit toward healing and recovery.
3) Develop awareness about your choices
As I mentioned above, depression feeds on withdrawal and inactivity. If you're able to, try to develop an awareness of your choices and where they lead. For example, when mealtime comes around, you can choose to eat a "real" meal, or a bag of chips that's in the cupboard, or skip eating entirely. When you come to the moment of making a decision, try to be aware of which choice will move you toward healing (eating real food) and which will feed the depression (eating chips for dinner or skipping meals). Can you make the choice, in that one moment, that positively supports your body and mind and helps you get well?
Another choice might arise in the evening - how are you going to spend your time? It's probably easiest to just sit in front of the TV, but that inactivity and withdrawal (unless you're watching an interesting show with a loved one, and actively sharing the experience) would more than likely feed the depression. Could you pick up the phone and call someone instead? Or invite someone over to hang out with you? Or spend a little time reading a good book that stimulates you, the kind you used to read before you started feeling so down?
Please know that I am not intending to make you feel guilty about being depressed and make you feel bad for (naturally) falling into inactivity and withdrawal if that's where you're at, being depressed is hard enough as it is. Believe me, I know. But I'm hoping to plant a tiny seed that will empower you to do something, however small, that will be a win for you and get you on the road to wellness, however slowly. Whether or not medication is part of your healing (and for many people it appropriately is) there are many small things you can do, to empower yourself and find hope.
Dr. Susan Biali, M.D. is a wellness expert, life and health coach, professional speaker, and flamenco dancer. She has been featured as an expert on the Today Show and other media outlets, and is available for keynote presentations, workshops, and private coaching. Visit susanbiali.com to receive a complimentary eBook: "Ten Essential Easy Changes—Boost Mood, Increase Energy & Reduce Stress by Tomorrow."
Copyright Dr. Susan Biali 2017