“Depression is not sadness – It’s the constant feeling of being numb.”
What Exactly Is Clinical Depression?
Major Depressive Disorder, or, “Clinical Depression,” is a common illness causing significant distress in an individual’s social, occupational, and/or physical wellbeing. It is more common among men, and is the leading contributor to suicide (Mayo Clinic, 2000). Signs are often seen in adolescents, but also known to occur in children under the age of twelve. Finally, those living with chronic and/or communicable disease are far more likely to experience a significant major depressive episode, especially during the emergence of initial symptoms.
What are the Common Symptoms of Clinical Depression?
The symptoms of depression varies among individuals. However, in order to receive a formal diagnosis of Major Depressive Disorder (Clinical Depression), you must have had one or more episodes in the past six months that lasted at least two weeks long. The episodes must also cause significant distress, not be precipitated by substance misuse, nor better explained by bereavement. The intensity of the symptoms and their impact is rated as mild, moderate, or severe.
The symptoms may include some or all of the following:
- Persistent sad, or empty mood
- Feelings of hopelessness and helplessness (pessimism)
- Irritability, especially in men
- Feelings of guilt and/or worthlessness
- Anhedonia – Loss of interest or pleasure in activities
- Decreased energy or fatigue
- Psychomotor slowing
- Difficulty concentrating and making decisions
- Difficulty sleeping and/or “early morning awakening” syndrome
- Weight changes due to appetite (increased or decreased)
- Thoughts of death, suicide or possible attempts
- Pain, headaches, or cramps with no other known physical cause
Note that the symptoms for Seasonal Affective Disorder (SAD) are similar. However, it should be noted that SAD is a very different problem with a unique seasonal pattern.
**Important: Some may experience only a few symptoms with increased severity when feeling depressed, others with a broad collection of symptoms. It is important to see a mental health professional when formulating a diagnosis of clinical depression. The inclusion of this list does not condone self-diagnosis.
Twenty-Five (25) Tips for Battling Clinical Depression
While there are many approaches for coping with dysphoric mood, we believe the following twenty-five tips carry significant impact on decreasing symptoms. Collectively, the suggested items should be used as part of a healthy pro-active approach to personal care, informed by evidence based outcomes from the fields of Positive Psychology and Behavioural Medicine.
(1) See Your Physician
It should go without saying, (but I will state it here anyway) – See your physician, and/or mental health provider, before embarking on any transformation focused journey. Talk openly about your mood focused goals, and gain feedback about the safety and potential bumps in the road. If part of your goal results in primarily physical outcomes (weight management, etc.), be willing to return to your physician regularly for monitoring.
Most important! Never adjust your medications (SSRI, SNRIs, Benzodiazepines), on your own. For safety, this must be monitored by your physician. “Dr. Google,” does not count! If you are starting a new medication, ask for a follow-up visit sooner than later, even if your doctor does not suggest it at first.
(2) Map Your Symptoms
Part of setting effective goals depends on our ability to know exactly what we are attempting to change. Improving mood is a broad overarching goal. It requires a breakdown of the contributing factors. This improves understanding and insight into your own symptoms dynamics.
One model we promote at Finding My Psych, is the CHANGES Model, developed by Dr. David Christian. Each element of the model targets contributing biopsychosocial factors leading to dysphoric mood. While this model is well suited for mapping contributors to mood, it also is effective in many other areas, including anxiety management, weight loos, etc.
While we would never attempt to teach all the nuances of the model here (let’s save that for a future podcast episode), the breakdown is helpful in gaining basic understanding. The CHANGES elements are as follows:
- Cognitions – What thought patters do you participate in that contribute to your decrease in mood? Or, does your perfectionistic tendencies result in feeling defeated by your self-imposed expectations?
- Health – Are there physiological factors affecting your mood? Have you been screened for thyroid disorder? Has there been a sudden change in your medication or diet?
- Actions – Over time, what behaviours have you acquired that contribute to feelings of depression? For instance, were you previously a very active person and now notice that you hardly ever leave the house?
- eNvironment – Look around at your physical surroundings? Since feeling depressed, do you rarely pull your curtains back? Is your home not as tidy as normal?
- Goals – Are your goals effective? Do you set both long-term and short-term goals with measurable outcomes?
- Emotions – When you make a list of your emotional experiences over the past two weeks, is the list rather restricted, or are you all over the map. While you do not have direct control over your emotions, they are a good source of feedback; consider this element the consequence of another CHANGES factor, or a combination therein.
- Social – What are your friends like? Do you surround yourself with negative people? Or, do you notice that you attempt to avoid contact with others, leaving you feeling socially isolated?
We advise that you map your own experience along the CHANGES elements. Flesh out the details, and take your findings to your physician, and/or mental health provider. From here, target one element you want to focus on (e.g., Actions – Engaging in exercise), and set a short-term goal you can quickly achieve.
(3) Tell a Close Friend
Social isolation is a cycle difficult to break out of. While you might feel overwhelmed or shameful about your mood around friends and family, spending less time with supportive others is self-reinforcing. The less time you spend with others, the less time you want to spend with them.
Avoid the quantification game – Spending time with supportive others is not about the number of connections and actual time spent. Focus on quality. An intimate friendship is one you can return to even after a period of time apart. It should focus on mutual celebration and support when times are difficult. Push through any sense of shame in order to open up about your personal experience.
(4) Master Progressive Muscle Relaxation (PMR)
Anxiety is the most common co-morbidity seen in individuals experiencing clinical depression. Each appears to reinforce the other. We strongly suggest you learn how to manage the physiological symptoms of anxiety for improved wellness. Master the art of Progressive Muscle Relaxation.
This simultaneous breathing exercise, involves the systematic tensing and releasing of muscle groups throughout the body, thus relaxing physical tension. Listen to our audio walk-through in our article, “Smash Anxiety with Progressive Muscle Relaxation – Audio Session.”
(5) Engage Your Fitness (Start Walking)
Find your fitness! Exercise is a strategy that you can engage with today, proven to have profound effects on improving mood. However, it is important to enter your physical fitness plan with a clear sustainable strategy. We suggest that you start with power walking. Attempt to engage in daily physical activity, and record your results in a journal (analogue or digital). This will help you see progress over time.
(6) Decrease Your Sugar Intake
Sugar, taken in excessive quantities, causes fluctuations in mood, driven by a clear physiological reaction called, ‘Reactive Hypoglycaemia.’ Evidence indicates the odds of having a recurrent episode of dysphoric mood, increases in increased sugar intake. It is advised that you measure your intake via a tool such as MyFitnessPal, and attempt to make adjustments incrementally.
(7) Identify Idiopathic Cognitive Distortions
What are the cognitive distortions you participate in throughout your day? For instance, do you tend to see interactions with others in black and white terms (All/Nothing Thinking)? Or, do you commonly refer to yourself as, ‘fat, sad, or worthless,’ (Labeling)? These are common distortions that depressed individuals regularly use, without even noticing.
In order to understand your own distortions, listen to our recent podcast episode featuring the work by Dr. David Burns, “Defining Cognitive Distortions (CBT Masters Series #1).” You will learn about the top ten commonly used maladaptive thought patters directly linked to clinical depression.
(8) Master the Triple Column Technique
Once you are able to identify the distortions you regularly participate in, you are now ready to beat them down! Learn how to use the Triple Column Technique by first identifying your thoughts, identify the distortion, and then replace with a more adaptive response.
(9) Cook a Gourmet Meal Just For Yourself
Self-care comes in many forms. There is no other task more healing than cooking a well planned meal for yourself, and/or your family. Better yet, cook your gourmet meal with a close family member or friend.
While this at first sounds somewhat unorthodox, focusing on a task, such as cooking, takes your mind away from anxiety provoking thoughts. Cooking is meditative in nature, while building quality relationships with yourself and others. The Slow Foods Movement in Italy was build on this understanding.
(10) Sit In Meditation
Meditation is the intentional practice of sitting silent while focusing on the present moment. In meditation, you attempt to observe the thoughts and emotions that you experience with each passing moment. As the 3rd person observer, you notice your experience and let the moment pass by without attachment. While meditation requires significant practice, over time, you will notice the calming effect with each session.
Meditation is free. It can be done most anywhere, and requires only that you sit with intention. If you want a guided process, we suggest you use the popular app, “Headspace.” The free version teaches critical basics designed to launch your meditation practice.
(11) Dare to Be Average!
Do not let perfectionism get in your way of happiness. In fact, perfectionism is the most common maladaptive approach observed in individuals experiencing depression. Perfectionists set themselves up for feelings of disappointment and despair. They also have difficulty acknowledging success of achievements outside of their big-picture goal; they do not see the small successes along the way.
Battling perfectionism requires you to let go of the, ‘A, for B‘. In other words, instead of daring yourself to do better, dare yourself to be average! What are the implications of the, ‘B‘ level performance, over the, ‘A‘ level performance? Sound painful? Then you are a perfectionist!
(12) Go on a News Diet
Stimulus control is the act of avoiding what makes you anxious or puts you in a state of vulnerability. For instance, if you want to manage your weight, it is helpful to avoid isles at the grocery store that trigger the greatest level of temptation (e.g., ice cream).
We suggest that you do the same with news. It is important to remember that news outlets, no matter how trust worthy, design headlines that get, and hold, your attention. This is accomplished by presenting information in dramatic fashion. The problem is that in order to pull you in, most news is presented in the negative and blown out of proportion to the facts. It thus communicates that life is unsafe and foreboding.
Use stimulus control and go on a news diet. Quantify the number of hours you engage with all forms of news media, and systematically decrease that number. You will notice dramatic changes in perception.
(13) Do a Body Scan
Tension sits throughout the body. Where we store our tension is unique to each individual. Doing a full body scan with your mind is an excellent way build body self-awareness. Once we are able to identify where we store our tension, we can then focus on healing that area. How do we heal tension? Guided meditation!
While in your next meditation session, focus on your body and where you feel tightness. Imagine a broad flame passing warm to the affected area. Actually try to feel the warmth. Breath in and out with intention, and notice any change, however subtle. Then repeat your body scan. Incorporate this exercise as part of your lifelong wellness strategy.
(14) Zen Your Emotions
The famous Thai Buddhist monk, Thich Nhat Hanh states, “Emotions are like clouds, they come and go.” This is one of the most powerful mantras for emotional healing. When depressed, it is easy to get attached to feeling sad. It is also typical that we idealize and grasp onto feelings of passing bliss. The truth is that attachment to any emotional state holds us down. Approach your emotions with Zen. As one is experienced, it soon passes for another. All emotional experiences are considered valid, but not to be clung to.
(15) Master SMART Goal Setting
Setting goals is tricky! We have to understand our long-term desires, while building short-term goals along the way. The best way to do this is by using the SMART method! SMART stands for:
- Specific: What, where, and when, do you want to achieve? Write down the details.
- Measurable: Identify the outcome you desire. Do you want to see an improvement in mood? How will you know?
- Attainable: Does the effort needed for the goal, get you the outcome you desire? If not, you might want to break down your goal.
- Relevant: Be clear with yourself about why you want to achieve your desired goal. Is it relevant to the big picture?
- Timely: Create goals with quick results and impact. If it take too long to achieve your goal, you are likely not going to complete it.
(16) Inventory Your Dependable Strengths
Everyone comes to the table with personal strengths. Those living with Clinical Depression typically focus on personal weaknesses, thus leading to decreased mood. One good exercise is to make a list of the strengths that others identify in you, strengths that are predictable. For instance, think about your career. What feedback do your colleagues note when describing you. Are you always on time, go above and beyond on assigned projects, etc.? Now, what are the dependable strengths that your family and friends remark on? Are they the same?
(17) Embrace Your Type
As soon as you can, take the Myers-Briggs Type Indicator. Based in Jungian Psychology, ‘Type’ refers to your inter-personal and intra-personal approach to the world. With sixteen possible outcomes, you have the opportunity to gain insight into your own dynamics. Embrace your type for both personal awareness and understanding others. It is the quickest way improve relationships.
(18) Involve Your Partner
Clinical Depression is isolating. If you are already struggling in your relationship, dysphoria is one more factor holding you apart from those you love. You must do battle in this regard. Never avoid allowing your partner involvement in your treatment, whether self-guided or through regular contact with a mental health provider. In fact, you and your partner can participate in most of the activities listed in this article.
(19) Launch Your Forgiveness Plan
Emotional pain holds us back. If someone has hurt you in the past, it is helpful to remember what the root of that pain actually is, and seek letting it go. We do not advocate forgetting the incident(s) that started the conflict. Forgiveness does not require forgetting. It only requires a willingness to render the incident powerless in determining how you feel day-to-day.
(20) Re-discover Home
Go back to your roots. Remember the happy times from your childhood? Maybe you remember sitting with your grandmother in quite embrace, or making cookies with your sister. Whatever your experience, define it clearly in your mind. No matter how painful our past, there are amazing moments in every child’s experience. Embrace those moments. Attempt to remember the smells and emotions. This exercise helps you re-discover what it means to be home, a home of your own creation.
(21) Compartmentalize Your Mood
Be artful about your mood. Find activities where it is easy to put it aside long enough to perform well. Compartmentalization is best practiced at work. When we go to the office, we are required to leave a part of ourselves at the door. This is actually a skill every professional must master.
We should also learn to compartmentalize our emotional experiences in our personal lives. Not every relationship deserves in-depth disclosure of how we are doing that day. Save that for your partner and confidants.
(22) Embrace Your Higher Power(s)
Question your purpose. What significance does your existence have? Does this include an understanding of a, ‘higher power,’ or a realization of our personal power on others? Embrace all that is in motion outside of you, everything keeping the universe moving forward. You do not need to believe in God, or an after life. You simply must acknowledge that you have an effect on others way beyond your own understanding. Thus, your existence through actions is eternal, powerful, and should be respected.
(23) Move from Coffee to Green Tea
Caffeine intake is a key contributor to persistent feelings of anxiety. It is hidden in many of the common drinks we have throughout the day. While many promote the increased energy provided by regular intake, there is increasing evidence of its deleterious effects on mood.
Attempt to measure the amount of caffeine you are taking in, and decrease it incrementally. One way to do this is by substitution. Green tea has less caffeine than coffee, while continuing to be an effective diuretic. Over time, you will notice less emotional lability throughout the day. You will also sense increased calm, especially in high-conflict situations at home and work.
(24) Start a Support Group
If you live in an area with no available mental health resources, start your own support group for people living with depression. Support groups are not therapy groups. It is a good place to share your own experience while supporting others. We suggest you find a common venue to start your group, such as a church or community centre. Avoid running a support group in your home. If there is a mental health professional in your area, reaching out for guidance on how to provide a framework for the group.
(25) Spend Time with Your Fur Friends
Last, but absolutely not least, heal your heart with your fur family. Our pet friendships carry maximum therapeutic value. Caring for a pet reminds you that in your pain, others benefit from your love and attention. Your pets desire your closeness, and depend on your for their day-to-day survival. Snuggling up on the couch over Netflix is a meditative experience not found in any other relationship we have in life. Caring for a pet is caring for yourself.
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