This post is the first in a series about how you can help yourself begin recovery. Depression can be a powerhouse of misery that leaves you feeling helpless, but it’s not one massive force, whatever it may feel like.
Depression is a combination of several conditions, and there are effective ways to deal with each one. It takes a lot of trial and error to find the best treatments, but the steps described in these posts might help you get on the right path a little sooner. Here’s the basic approach:
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Get the big picture of depression symptoms and the dimensions of life they distort.
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Track the symptoms that most disrupt your life and the specific impacts they have.
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Choose the treatments and lifestyle changes that focus on those problems.
Once you have this map in mind, the challenge then is working with it every day, despite setbacks. None of this is easy, or follows a simple logic, but it helps to have a guiding idea of what to do. You may well lose sight of it during the worst episodes, but it’s something to come back to when you’re out of those depths.
Getting Beyond Helplessness
What does your depression feel like? Most people I know answer this by trying to find words to capture the overwhelming nature of the illness. You’re under a cloud or a huge weight or drowning or flattened or feeling dead or living in a fog. You use some powerful image to get across the totality of the experience.
You can’t do anything, don’t want to see anyone, and barely manage to drag yourself through the workday. Depression is a vast force you feel powerless to change. It seems hopeless, you feel helpless, you don’t know what to do.
During my worst episodes, I felt exactly like that and for years couldn’t imagine anything else. That began to change, however, as I learned more about the full scope of the illness. There were not only a lot of symptoms that I had never linked to depression. There were also ways to group them so that I could see how they reinforced each other.
This was no intellectual exercise. I had lived with the disappointment of ineffective treatment for a long time and knew I had to do more on my own. As I learned more, depression felt less like an overwhelming force and more like a complicated problem I could do something about.
Learning the Full Scope of Depression Symptoms
There are a lot of explanations and paradigms of depression symptoms, but most group them as disrupting the healthy processes of your body, thinking, feeling, behavior and relationships. A grouping of this type helps you form of picture of what your depression is like, but you can’t stop there. You also need to know how the symptoms interact, reinforce each other and sustain the illness over time. That’s the dynamic process of depression.
To start with the lists, the best known one covers the nine criteria for identifying an episode of major depression. These symptoms are based on clinical practice as the most reliable ones for differentiating depression from other conditions. They’re not the only ones, but they comprise the crucial indicators that moves you toward a formal diagnosis.
I won’t go into the details of diagnosing different types of depression – that would take several posts. As far as grouping symptoms is concerned, they’re broken out into two lists. The first group includes the two defining characteristics of depression. A diagnosis requires that you have one or the other.
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depressed mood much of the time or
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lack of interest, enjoyment or feeling for anything
There are seven more, and the screening requires that you have at least five of them:
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significant changes in weight or appetite
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sleep disturbance nearly every day
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physical agitation or slowing
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fatigue or loss of energy
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feelings of worthlessness or excessive or inappropriate guilt
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diminished ability to think, concentrate or make decisions
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recurring thoughts of death and suicide or plans or attempts to commit suicide
This is the list you’re most likely to have encountered. You find it in every book about depression and on every mental health information website, along with screening tests that use these criteria. But the list is too short to capture the full scope of the illness. There are many more symptoms you might experience that are shared by countless others.
Getting the Big Picture
I’ve put together a more extensive list here, though you may find it still doesn’t capture everything you’re living with. I realize many of these symptoms don’t define depression exclusively since they could also indicate a different condition. However, all of them can and often do accompany depression.
You may find it as helpful as I did to be able to link all these to the illness. It can be reassuring to know that a problem you thought was part of who you were turns out to be a treatable symptom. But there is a downside to long lists of symptoms.
If you only count them up one by one, you might become more convinced than ever that depression is too overwhelming to deal with. That’s why it’s important to go beyond a bare list. Many symptoms are closely related and act together to intensify their impact. So it helps to group them, and many experts do that according to their effects on the basic dimensions of your life that I’ve mentioned: what they do to your body, thinking, feeling, behavior and relationships.
That’s the way I’ve organized them here.
Body:
- sleep disturbance
- significant weight loss or gain
- fatigue or loss of energy
- physical agitation or slowing down of movement and speech
- unexplained pain
Thinking:
- diminished ability to think, concentrate or make decisions
- ruminating, obsessive thinking
- recurrent thoughts or death or suicide
- impaired memory
- negative thinking
Mood and Feelings:
- depressed mood
- lack of interest or enjoyment in anything
- hopelessness
- irritability and anger
- feeling helpless
- anxiety
- feeling worthless or guilty
Behavior:
- self-defeating behavior
- inactivity
- lack of motivation
- crying for no apparent reason
- blaming and angry outbursts
- attempts at suicide
- substance abuse
Relationships:
- social isolation
- loss of empathy
- unwillingness to communicate
- emotional withdrawal
- social anxiety
You may divide up the symptoms differently, but breaking them out like this can give you a starting point for making choices about treatment. Before you can get to treatment, however, you need to profile your own depression in as much detail as possible. Making a list of all the symptoms you experience shows you how pervasive the illness is, but you probably don’t experience all the symptoms at the same time or always with the same intensity.
It’s important to track them over time while looking also at what else is going on in your life. This is the way to get a sense of the overall patterns that sustain depression.
I’ll explain how you might develop a profile and track depression in the next post.
In the meantime, it would be useful to hear how you’ve thought about your experience with depression. Have you already put together the big picture of your illness? Is that a helpful approach, or does something else work better? Has learning more about depression in this way helped you take a more active role in your treatment?
No one has acknowledged the truth. We are all stuck living in an insanely f***ed up world. That’s the real problem. You really think we haven’t tried to solve this every day of our lives? There is no solution, that’s why we’re all f***ed up. We can’t fix this! We are doomed! This is Hell (for lack of a better word.)
The sooner we admit that, the truer our perspective will be on dealing with it. Drugs, talking, attitudes, change nothing! Admit the simple truth that you are trapped in this nightmare. How amazing we all must be to endure this! Or maybe it’s just futile. But don’t worry about anything anymore, this sh** is all rigged.
It takes mee about 5 seconds to be aware of how I feel and to realize that I need
to respond to the messenger. Feelings, behaviours, thoughts and physical responses on your journey.It is surprising hoow soothing and
therapeutic that simple little thing is.
After about 20 years of enduring a ‘colourful personality’ over which I seem to have no control, I’m trying to figure out if I’m mentally ill. My motivation for this is my two young children. Nothing is more important than being a stable, warm, loving and engaged mum to them. And at the moment, I’m not.
For years I’ve experienced what I’m now calling ‘episodes’. When they kick in, I get angry really easily – at a loud noise, at one of my kids accidently bumping me etc, and I’m constantly managing irritability. I lose interest in things and lack motivation (housework, personal projects, work etc). I self medicate – alcohol, valium where I can get it. I get very negative, ruminating on things constantly, thinking about people close to me in a negative way. I think about death a lot. Not suicide, but I see the date on the paper in the morning and get the sense that it’s ominous, that today’s the day. I see a truck driving towards me and think ‘this is it!’. I think about what would happen if my partner died, I touch wood constantly, fearing the worst for my kids. I hide behind my hands constantly, sometimes I pretend I’m rubbing my eyes – other times when people are talking to me, I literally just cover my face with my hands. I often burst into tears for no good reason. I don’t want to leave my house, and I don’t want my partner to go either. I want us all to just stay home – but then I don’t want to be around them when we are. I probably have about a dozen ‘mental health’ days off work each year – the ones where I make up some excuse (gastro, food poisoning, the flu) because I just can’t face the world. During these times it takes me ages to return calls, and I dread talking to anyone – I avoid filling the car up with petrol because I can’t face the small talk. I dodge familiar faces in the supermarket if I’m not feeling ‘on’. I can’t concentrate, my memory is absolutely shocking – everything you have listed above basically. And I wrote all this down a few weeks ago.
I’m currently trying St John’s Wort. It’s ok, but not arresting the lows, just making me a bit more lucid during the non-lows.
I’ve tried 3 or 4 psychologists over the years in response to two major traumas I experienced – they didn’t work, in fact they seemed to make it worse.
I did an online test on the Black Dog Institute website, and scored really highly on the ‘probability’ spectrum for bipolar disorder (but I don’t see how because I don’t get the extreme highs they talk of..).
I’ve tried exercise and it makes me realllllly happy for a few hours immediately afterwards, and pretty grumpy for a day or two afterwards.
Thanks to your website I’m now going to monitor my moods more frequently using the Optimism App.
I’m also considering going to a psychiatrist and asking for a diagnosis and meds.
I’m not sure why I’m telling you all this – why would you care!? I guess it’s to say thank you for your blog. It is reasoned, and unprejudiced. The hardest thing about this whole process is the secrecy, the inability to use the ‘d’ word, the judgement, the being bounced around by well-meaing NGOs, GPs and the broader public health system that doesn’t seem to know what to do with a non-suicidal-but-still-not-coping-very-well-case.
Thank you,
Ange
1.Get the big picture of depression symptoms and the dimensions of life they distort.
2.Track the symptoms that most disrupt your life and the specific impacts they have.
3.Choose the treatments and lifestyle changes that focus on those problems.
Yes, I believe that all three of these are absolutely necessary in recovering life. And not just re-covering but at times re-building from the foundation up. Many of us have had symptoms of depression since an early age, so the history is there, the disruptions and impact are there and are usually quite obvious. But that #3, choosing changes that focus on the problem areas, that’s where I’m afraid most of us fail. I’m eager to see what you have to say about that. In my own life, my relationship with my aging and frail mother has come to the forefront not only now, in midlife, but at many times in the past. So I am focusing on therapy and lifestyle changes that will aid in dealing with the Consuming All-Mother…if you know what I mean. I am instituting changes that will restrict the flow of information from me to her while leaving open the reverse flow. Being available for her is important, but letting her live her life vicariously through me by seeing her input lived out — that soon to be a thing of the past. At age 52, it is necessary to make these changes to deal with her eventual death as well as to put right the excesses and exigencies of the past. To re-cover and re-build.
Anonymous –
That must be a highly stressful way to live, and I’m glad you’re working on changing the way you handle the relationship with your mother. I’ve found that changing life conditions to reduce stress has been a crucial part of my recovery. The effect of stress on depression – and vice versa – is one of those problems I was completely unaware of until a few years ago. There were other connections with depression – such as the connection with anger – that I never made, despite the fact that I’d dealt with depression since childhood and had extensive psychotherapy over several periods of my life. Perhaps I worked more with earlier generation psychiatrists who focused on probing the past in detail and the way it’s reflected in the present but who weren’t so concerned about attaching everything to a DSM label. Today there’s so much publicity about depression that it’s hard to miss the symptom lists – though the standard one is terribly incomplete. Nevertheless, most people who turn out to have depression go to their doctors complaining only of physical pain. Apparently, there are a great many people who need to learn much more about the wide range of depression symptoms.
Thank you for commenting. I’ll get to the treatment part of this series next week.
John