Depression

Dealing With Depression During Physical Distancing

Here are a few things that can help people with depression during the outbreak.

Posted Mar 29, 2020

This post is second in a series. Be sure to check out the first one: Living with Mental Health Challenges During the Pandemic: The Basics.

For people who are depressed—not just sad or down about the current circumstances, but living with a current or past diagnosis of depression—the situation we are in has specific risks, and it holds some opportunities as well. 

Depression is a physical condition that is reflected in negative thinking patterns, low self-worth, loss of interest, hopelessness, low energy levels, sleep disruption, concentration, and changes in appetite. It affects 264 million people around the world and is one of the leading causes of disability (1).

In people who are genetically predisposed (and sometimes in people who are not), the stress of major life changes or losses can trigger or exacerbate depression. The loss or suspension of a job, loss of social support, isolation or being in close quarters with others, removal of day-to-day coping strategies and routines, a steady stream of negative content on the news and social media—these all pose a high chance for depression getting worse.

Living with someone with depression, especially if it is getting worse, can be difficult as well. Watching a friend or loved one "spiral down" and feeling helpless to do anything about it, or having it directly impact the household culture, can lead to (often futile and frustrating) efforts to change, cheer up, or nag the person into feeling better.

At the same time, this period of stay-at-home orders, reduction in job duties for some, and "going to ground" holds some opportunities for improving symptoms of depression if approached thoughtfully.

Here are some thoughts for dealing with depression during these challenging times. Choose just one or two of these to focus on each week and see how it goes.

1. Take small opportunities to be good to yourself. This is important whether you are stuck alone or shoulder-to-shoulder with family and housemates. Take five minutes to meditate or just breathe. Snuggle the pets. Take a walk around the block. Watch that video that always makes you smile.

Nurturing yourself in small ways can have a big effect on your body chemistry, lifting your endorphins and relaxing your tangled muscles. Especially with depression, small things matter. Researchers have used mobile phone technologies to identify the "smallest building blocks underlying the onset and course of mental ill-health," finding that depression "may be the result of the continuous dynamic interplay between micro-level moment-to-moment experiences" that together make up behavioral patterns over time (2). Even something that helps a little bit is worth doing.

2. Find a way to move your body a little bit each day. What is the best form of exercise? The one you will do! Research shows that 30 minutes of exercise that makes you warm three times a week or more is ideal for combating depression, but even 10-15 minutes may help (3). That could be dancing to three songs, walking quickly around the block three times while listening to a favorite podcast, or here are a few brief routines.

You've got this! See if you can do it when you wake up, anchor it to the behavior you already do (like always doing it right after brushing your teeth, or setting the alarm on your phone, and when it rings, do the routine right then). You can also do squats while folding laundry (fold, squat, fold, squat), or walk in place while doing dishes.

4. Do things. In addition to adding manageable amounts of movement, also stay engaged with other activities—even just a few satisfying things a day. As a depressed person, it can feel frustrating to hear that old Nike slogan "Just Do It." But there is some real science behind gently pushing yourself to take action, almost any positive action.

The theory of behavioral activation (4) has a lot of scientific support—it means that instead of working to elevate your mood so that you feel like doing things, flip that around and instead focus on doing things that will then elevate your mood. Work on a hobby or small home improvement, do some journaling, cook something with a recipe that you've always wanted to try, or plant seeds in an old egg carton. Do something that brings a little magic into your life—hang fairy lights, pull a chair next to a window to watch the sunrise, make a little desktop or windowsill shrine of things you love. These small actions can alleviate the feeling of being lost or helpless. 

5. Add some foods to your daily eating that science says hold promise for helping with depression. Note: this is not about going on a diet or trying to institute an entirely new eating plan. This is adding foods that are protein-rich, antioxidant-packed, or full of vitamin D, B12, selenium, or omega-3 fatty acids.

Eat them at the beginning of each meal. Things like beans, fatty fish, lean meats, nuts and seeds, broccoli, cantaloupe, blueberries, leafy greens—find more here. Try adding even a small amount of just one of these foods to the beginning of one of your meals, each day or a few times a week. Do this for a month and notice any changes in your moods or eating patterns. Then you can gradually try adding these foods to the beginning of a few more meals.

5. Keep an eye on the mental chatter. Being depressed can be like having a very grumpy to downright cruel news announcer in your head. Instead of trying to stop the mental chatter, see if you can turn down the volume by letting those thoughts play like a radio in the background or a train (of thought) in the distance. Let it keep chugging away, and keep bringing your attention back to the present moment, your breathing, your love for others, things that make you laugh. Remember, the depressed mind lies. 

Keep a special eye out for comparing yourself to others. A common feeling that grows from depression is the sense that "everyone else" is happier, more supported, more prepared, and/or making more productive use of their time. Particularly when you are viewing the world through the rosy window of social media, it can feel like other folks have got things figured out while you are lost at sea. You cannot know what other people are really going through, and you are the only one living with your specific needs, history, and abilities. 

Also, remember that this is temporary. Depression can convince you that you have always been miserable and will always be miserable. When the future is uncertain, depression fills that space in with imagined difficulty and despair, leading to hopelessness. Remind yourself that this is a temporary situation and that your emotions around it are going to change.

6. Connect with others. This can be challenging in a time of mandatory social isolation, but it is even more important to be talking and listening with others—even when you don't really feel like reaching out. Even just a few minutes of talking on the phone with an old friend can even out your mood and help keep you from getting lost in your own thoughts.

Ask the people around you how they are handling the crisis. Talk to people about what you are thinking and feeling—this is a good practice for anyone, and for a person suffering depression, it can be essential to survival. One thing that can work is reaching out specifically to help others who might be struggling. Let them know, "I just wanted to reach out and say how much I appreciate you and see if you needed any support." Paradoxically, your attention to helping them will also help you.

Keep communicating with your community support groups, 12-step meetings, or recovery programs—here are a few specifically for depression (5, 6, 7). One study of over 5,000 people showed that depressed respondents with no group memberships who joined one group reduced their risk of depression relapse by 24 percent, and if they joined three groups, their risk of relapse reduced by 63 percent (8)! It really helps to connect with others who are in the same boat.

7. If you are living with or giving support to someone experiencing depression, the most important thing is to engage with them, listen a lot, and validate their feelings. Don't try to cheer them up or snap them out of it, or tell them what they should do. Just tell them what they are feeling is normal and human, and it will not last forever. Tell them they are valued. A depressed person may keep their symptoms and challenges secret so as to not trouble others, so actively reach out to them and invite them to share. Try using the acronym from motivational interviewing "OARS": open-ended questions, affirmations, reflections, and summaries.

During this time of rapid change and uncertainty, many people will experience a deepening of depressive symptoms or the reawakening of a dormant mental health challenge. The key is in taking small, manageable actions every day to counteract your body's fatigue and your mind's quiet desperation. Giving yourself a little love and a lot of acceptance creates a bigger payoff than you imagine. This is a time to feed yourself, not to fix yourself.

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