Depression

Load the Dice to Ditch Depression

Overcome depression with a three-step program you can design for yourself.

Posted Jun 11, 2020

What would your life be like if you were a depressed cat? Your energy is low, and you move slowly. Your humans worry about what your lethargy means. They wouldn't blame you. Instead, they'd try to figure out what to do. You don't think you are a worthless cat, and you don't blame yourself for your troubles. You don't live with scars from harsh memories searing your body in emotional pain. You don't pepper your future with thoughts of hopelessness and doom. Humans do that, and you are free from that plague. When your depression lifts, you play with your ball of yarn. Mice, beware.

When you have major depression, what do you do when waiting it out won't work? There is no single miracle cure. Often, it's a mix. Like drops in a bucket, each can help lift your mood.

What are some drops for this bucket? Together we'll look at the thinking that can darken your mood. By lessening the harmful effects of stress, you can feel better. If you have trouble sleeping, there is much that you can do. I’ll share a sample of techniques. By trying new choices, perhaps you'll find your mood rising.  

Thinking About Thinking

Any major stress is hard to take. You have a thankless job. You have setbacks. You can exaggerate these events, too.

Some of your biggest stressors: You feel soaked in hopelessness. Such thinking often goes with a down mood (1). But what makes it mistaken? You can tell by the results. You feel worse. You can fight through this with cognitive-behavioral (CBT) methods (2, 3). You think about your thinking. You find exceptions to being helpless. You realize you didn't think like that before you felt depressed. You free yourself from that self-deception. That's a healthy drop in the bucket.

You believe you can't change. You think life sucks, and that won't change. That's a language of hopelessness. Is your life truly hopeless? Not if you have choices. Looking to find new tools for change is a choice.

When you feel depressed, your thoughts may echo your mood. You tell yourself how helpless you feel. You can't seem to let this idea go. Let's play a game. Imagine our cat batting the letters from the word helpless into a choppy sea. You see them float apart from you. Does that tell you that the thought is not you, but what you think? That's an enormous difference.

As to the action part of CBT, do an audit of what you find depressing. What can you ditch? If you feel stressed out by negative news shows, find another way to discover what is going on. Look at the sunny side, too. What can you do to improve your life that is within your reach? Call a friend? Help people, who can't help themselves? These kinds of drops add up.

Stress and Depression

With teeth bared, a strange dog runs toward you. Your stress alarm goes off. If the dog bites you, your body reacts with inflammation: white blood cells, heat, and swelling protect you from infection. If you escape harm, you have a shut-off switch. Your immune system goes back to normal. It's been that way for millions of years. However, too much of a good thing can be harmful.

When you feel depressed, you are stressed. Your body might react with a low-grade inflammation (4, 5, 6). When ongoing, this can cause a lot of harm. You feel fatigued. This process can trigger a new depression. Plaque can build up faster in your arteries. You can prevent this toxic process from wearing down your body. CBT can help (7). Fatty fish diets and green tea, help. Physical activity helps calm things down. These are some of the things you can do.

Can Food Affect Your Mood?

Junk food can affect your mood for the worse (8). If this sounds like you, check out the Mediterranean diet. It includes fish, vegetables, fruits, and nuts. This diet can help improve your health and mood (9). With two helpings of oily fish (tuna, salmon) a week, you might lower your risk for depression (10). Can fish or krill oil capsules help? There is some evidence that they might (11).

When you are depressed, your vitamin D level may be at a low level. Check this out with your physician. By raising your vitamin D level, you can add a drop to your bucket (12). (Vitamin D can give some protection from COVID-19. [13, 14].)

By drinking a cup of tea daily, your depression may lessen. Both black and green tea work well to reduce inflammation (15). Some think green tea is better. This is an easy drop for your bucket.

Can Exercise Make a Difference?

When your mood is down, can hiking or biking, help? They can help improve your mood (16). You can help your brain out, too (17). You can lessen inflammation by picking up your pace (18). Start slow. Build up as you go.

How much exercise do you need? Usually, about 30 minutes a day. The idea is to get your heartbeat up long enough to help. What is that level? It depends on your age, health, and related factors. When in doubt, check that out. What exercises are right for you? Do you prefer to do strength training? Do you swim? Do you play tennis? Walking seems as helpful as running (19). Some benefit from yoga (20). The answer is, do what you are more likely to do.

How long does it take to start feeling better? You may see results between three to nine weeks. If you are consistent in this program, you are likely to feel better.

Improving Your Sleep With CBT

If you are in a major depression, you probably have a sleep problem. Here are some signs. You have trouble falling asleep. You keep waking up and have trouble falling back to sleep. You wake too early and stay awake. You may have had insomnia before you felt depressed. That's common.

Getting a quality night's sleep can help lift your mood. CBT sleep methods have research support (21, 22). You can do them on your own (23). Let's look at what you can do to get a better night's sleep.

Prepare Yourself for Sleep

Sleep hygiene is a tested way to start to sleep better (24, 25). Here are sample methods. Create a pleasant bedroom for sleeping that is free of noise. Keep the room cool and dark. A few hours before sleeping, do some light exercises. Avoid stimulants five hours before bed. They can ruin your sleep. For example, avoid coffee, tea, and wine. Put a drop in the bucket for each of these.

Sleep When You Are Ready

Let's say you get about six hours of sleep a night and feel fatigued. Try to extend your sleep and see if that helps. You pick 7:00 to get up in the morning. If you need eight hours of sleep a night, you give yourself an extra half hour to fall asleep. You go to bed at 10:30 PM. If you are wide awake at 11:00 PM, get out of bed. Do something boring. Read a dictionary. Then, back to bed when you feel tired. In the beginning, you may lose sleep before you do better. Avoid napping. You slowly expand your sleep until you meet your goal. The numbers work for this approach (26, 27).

Let the Pink Elephant Go

Does it take you too long to fall asleep? You may be trying too hard, and that rarely turns out well. Here's why. Like trying to get an unwanted thought out of your mind, the harder you try, the worse it gets.  For example, don't think of a pink elephant. Work harder. You might have a tough time getting the elephant out of your mind. Likewise, pressing yourself to fall asleep is a sleep killer.  

Here is another view. If you think of the elephant, you think of it. Allow the thoughts. Let them be. Likewise, take a passive approach to sleep. If you fall asleep, you sleep. If you don't, you don't. "Whatever will be, will be."

Last Thoughts (for Now)

If you don’t know for sure if an approach is right for you, check it out. Maybe it isn’t. Perhaps you can juggle a few things to make it work. Now you are problem-solving. If some of these drops don’t make a splash in the bucket, try other ways.  Now you are experimenting. Do you hear two more drops fall into your bucket?

For information on how to use methods for overcoming procrastination for overcoming depression: End both depression and procrastination now. For more tested ways to overcome depression: The Cognitive Behavioral Workbook for Depression

                                                   ©  Dr. Bill Knaus June 11, 2020

References

1 Mahali, C. S., Beshai, S., Feeney, J. R. and Mishra, S. 2020. "Associations of negative cognitions, emotional regulation, and depression symptoms across four continents: International support for the cognitive model of depression." BMC Psychiatry 20 (18): https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2423-x

2 Li, JM., Zhang Y. et al. 2018. “Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis.” Psychiatry Research 268: 243‐250.

3 Kazantzis, N., Luong, H. K., Usatoff, A. S., Yew, R. Y. and Hofmann, S. G. 2018. “The processes of cognitive behavioral therapy: A review of meta-analyses.” Cognitive Therapy and Research 42(4):  349–357.

4 Kiecolt-Glaser, J. K., Derry, H. M. and Fagundes, C. P. 2015. “Inflammation: Depression fans the flames and feasts on the heat.” The American Journal of Psychiatry 172(11): 1075–1091.

5 Miller, A. H. 2020. “Beyond depression: The expanding role of inflammation in psychiatric disorders.” World Psychiatry 19(1): 108–109.

6 Kalkman, H. O.  2020. “The Association Between Vascular Inflammation and Depressive Disorder. Causality, Biomarkers and Targeted Treatment.” Pharmaceuticals 13, 92. www.pharmaceuticals-13-00092%20(1).pdf

7 Lopresti A. L. 2017. “Cognitive behaviour therapy and inflammation: A systematic review of its relationship and the potential implications for the treatment of depression.” Australian and New Zealand Journal of Psychiatry 51(6):565‐582.

8 Francis, H. M., Stevenson, R. J. et. al.  2019. “A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial.” PLOS ONE 14(10): e0222768. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222768

9 Widmer R. J., Flammer A. J., Lerman L. O. and, Lerman A. 2015. “The Mediterranean diet, its components, and cardiovascular disease.” American Journal of Medicine 128(3):229‐238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339461/

10 Tanskanen, A., Hibbeln, J. R. et al. 2001. “Fish consumption and depressive symptoms in the general population in Finland.” Psychiatric Services 52(4): 529–531.

11 Chukaew, P., Leow, A., Saengsawang, W., and Rasenick, M. M. 2020. “Potential depression and antidepressant-response biomarkers in human lymphoblast cell lines from treatment-responsive and treatment-resistant subjects: Roles of ssris and omega-3 polyunsaturated fatty acids.” Molecular Psychiatry https://doi.org/10.1038/s41380-020-0724-6

12 Menon V., Kar S. K., Suthar N. and Nebhinani N. 2020. “Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions.” Indian Journal of Psychological Medicine 42(1): 11‐21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970300/

13 Laird, E., Rhodes, J. and Kenny, R. A. 2020. “Vitamin D and Inflammation: Potential Implications for Severity of Covid-19.” Irish Medical Journal 13(5) P81. http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

14 Weir, E.K., Thenappan, T., Bhargava, M. and Chen, Y. “Does vitamin D deficiency increase the severity of COVID-19? [published online ahead of print, 2020 Jun 5]. Clinical Medicine Journal (Lond): https://www.rcpjournals.org/content/clinmedicine/early/2020/06/04/clinmed.2020-0301

15 Rothenberg D. O. and Zhang L. 2019. “Mechanisms Underlying the Anti-Depressive Effects of Regular Tea Consumption.” Nutrients. 11(6):1361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627400/

16 Choi, K. W.  Chen, C-Y. et al. 2019. “Assessment of Bidirectional Relationships Between Physical Activity and Depression Among Adults: A 2-Sample Mendelian Randomization Study.” JAMA Psychiatry 76(4):399-408. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2720689

17 Zhao, J. L., Jiang, W. T. et al. 2020. Exercise, brain plasticity, and depression CNS Neuroscience Therapy: https://onlinelibrary.wiley.com/doi/full/10.1111/cns.13385

18 Martland, R., Mondelli, V., Gaughran, F. and Stubbs B. 2020. “Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan.” Journal of Sports Science 38(4): 430‐469.

19 Williams, P.T. 2014. “Dose-response relationship between exercise and respiratory disease mortality.” Medicine and Science in Sports and Exercise 46:711–717. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073613/?report=reader#R20

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21 Wong. K. Y., Chung, K. F. and Au, C. H. 2020. “Low-Intensity Cognitive Behavioral Therapy for Insomnia as the Entry of the Stepped-Care Model in the Community: A Randomized Controlled Trial.” Behavioral Sleep Medicine 1‐17. Published online 20 May 2020.

22 Norell-Clarke, A., Tillfors, M. et al. 2018. “Does mid-treatment insomnia severity mediate between cognitive behavioural therapy for insomnia and post-treatment depression? An investigation in a sample with comorbid insomnia and depressive symptomatology.” Behavioural and Cognitive Psychotherapy 46(6): 726–737.

23 Ho, F. Y., Chan, C. S., Lo, W., and Leung, J. C. 2020. “The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials.” Journal of Affective Disorders 265: 287–304.

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27 Stock, A. A., Lee, S., Nahmod, N. G. and Chang, A. M. 2020. “Effects of sleep extension on sleep duration, sleepiness, and blood pressure in college students.” Sleep Health 6(1): 32‐39. https://www.sciencedirect.com/science/article/pii/S2352721819302177