Depression sufferers are often told to embrace what I call the three “G”’ Trifecta: Get therapy, Get on antidepressants and Get some exercise.
Each of these tactics has empirical support. So there’s a lot to recommend about them. But as I will discuss later, lots of people have a hard time embracing these approaches or sticking with them. First, let’s take a peek at what’s good and promising about these three treatment routes.
Why these approaches are Effective
-Therapy
Many studies show that ‘talk therapy” helps folks with depression. In particular, cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic an productive ways of thinking about their. Research has shown that there’s a powerful connection between pessimism and depression: the more negative your thoughts, the more likely you are to get sucked down into the well of depression. Other studies show that lawyers are much more pessimistic than the general population. As such, CBT is a very good treatment option for many in the legal profession.
-Medication
Antidepressant medications are often an effective way to treat depression for lots of people. It seems to alleviate the brutal physical symptoms – – loss of appetite, inability to sleep and chronic fatigue – – so that one can benefit from therapy. It’s tough to get much insight from therapy when you’re feeling so crappy.
However, recent research has discovered that it often takes two or three attempts before the right medication is found that will relieve a person’s particular depression.
-Exercise
Sweating it out has been proven to lift not only one’s general mood, but alleviate depression. Probably the best book I’ve read on the topic is Spark by Harvard physician, John Ratey, M.D. who writes:
“Antidepressants are curious because we think we’re changing brain chemistry when we take them. The science shows us that exercise does the same thing. By exercising, we’re improving the brain’s plasticity. And while it’s hard to get depressed people to get up and move because, well, they’re depressed, you have to sell them on the value of it. Once they get it, they go with it.”
Why People Don’t Do These Things, or Don’t Stick With Them
If these remedies are so effective for so many, why don’t more people who struggle with depression do them, do them more often or stick with them?
– I Don’t Want to Talk About It.
There are lots of reasons why educated and intelligent people don’t go to therapy. Here are a few of them:
People (lots of them men) don’t go because they just don’t want to talk about what ails them. Culturally, men are often not given permission to be vulnerable and emotive. There’s a limited range of feelings that the culture says are okay for men to vent: anger, irritability and humor. –
Sufferers sometimes can’t find the right therapist and give up.
Those around them do not believe in therapy. I know a lawyer with depression whose wife thinks therapy is a bunch of hand-holding baloney and a rip-off at $125 per hour (Buffalo rates, mind you). As such, he feels discouraged, doesn’t want to hear his wife complain about the cost and doesn’t go.
People are just too fearful of what the consequences would be if they admitted they had depression: “Will I lose my job?” As such, they often deny to themselves or others that something is wrong. – Procrastination: “Maybe it will go away”.
Shame: people feel they will be labeled “defective”, “weak” or “mentally ill.”
Or, for many, they just don’t know any better. The misery they endure is their “normal”. They can’t see how their maladaptive, pessimistic thoughts about life could be anything other than reality – – “That’s just the way life is.” They may even feel bitter when they see others having fun or being happy. They feel cheated. Why can’t I have more happiness in my life? They may feel that happiness is something doled out by the unseen hand of God or lady luck. However it is dished out, they’ve feel they’ve been given a pittance. Not surprisingly, they have no confidence that they have the capacity to create happiness within themselves. “No”, they think when they imagine to themselves that they have good things to look forward to, “That’s not how my life seems to turn out’. This disempowered state is a vicious circle that can only lead to more depression.
-Antidepressants: The Flip of the Coin?
There’s a billion dollar debate going on whether antidepressants work or not. On one side of the aisle are the folks in lab coats – the bespectacled researchers who look at brain tissue through microscopes; pharmaceutical executives in blue suits who smoke big-ass cigars; and the psychiatrists – the high priests of all that ails the depressed mind – – who advocate taking medication to treat clinical depression.
On the other side are patients who swear that the meds did nothing to help their depression and just screwed them up and made them feel like zombies. On the other are holistic practitioners who believe depression isn’t caused by a chemical imbalance in the brain, but by lack of proper nutrition, diet and balance (check out Dr. Andrew Weil) and my psychiatrists who believe that medications, while useful, are over-prescribed.
There currently are no tests, other than trial-and-error, to determine what type or types of medication will prove effective for a particular person. It’s really trial or error. Our family owns a big fat rodent. Did I say he was really fat? Anyway, he is black and white and lives in a large cage in a back room of our house. The colors make him look like a magician in a tuxedo. Hence, his majestic name – – Houdini. I felt like Houdini when my psychiatrist tried different medications on me in a quest to get the right one – a lab animal in which he tried this and then that. Some were real duds; some outright blunders. But I stuck with it. And I’m glad I did because the “right meds” were eventually found for me.
People won’t take medication because of the stigma attached to it. Or, they give up on it before the right medication, dosage or combination is found. Even when the right one is found, folks often stop talking it because of the side effects. I know depressed lawyers who would rather drink or drug rather than take antidepressants.
-Why We Won’t Get Moving
People find it hard to exercise because depression screws up their ability to sleep leaving them unmotivated and just too tired to get to the gym. Years ago, when I first was diagnosed with depression, I recall being bone-tired at the end of a work day and falling asleep a 9 p.m., sleeping on and off throughout the night, getting up at 3 or 4 a.m., shaving, getting dressed and driving to an all-night coffee shop to slurp coffee, get ready for work and wonder “Just what the hell is wrong with me?” But I didn’t have any answers back then. In retrospect, truthfully, the only thing that helped me survive it was to keep walking.
Three Quick Things to get you on the Right Track
1. If you’ve never been to a competent psychiatrist, remind yourself that you can just go for a consultation and hear what they have to say. Whatever their recommendation, you don’t have to agree with it or follow it. But why not get an opinion from someone who has treated hundreds of people with depression and could tell you whether or not you have it and what your options are? You can also get a second opinion. There are “Depression Centers” around the country where you can go for such a consultation and then return to your treating psychiatrist who can prescribe the recommended medication and monitor you. Bring a friend or family member to the appointment. Sometimes, when we’re depressed, we might not truly hear when the psychiatrist has to say. What does your loved one or friend think the doctor said?
2. If you don’t want to go to a therapist, you really have to ask yourself why not. I usually recommend that people call friends to ask for recommendations for a couple of therapists. Go visit a few for a 1 hour consultation to see if you click with that person. Remember, if you give into your depression, you will tend to isolate yourself and “suck it up.” What you really need to do is talk to a therapist who has treated hundreds of folks with depression who can give you some ideas about whether you can benefit from therapy. A good friend can listen and give you their love and compassion. But, they can’t do what a good therapist can do.
3. Make it easier to exercise. Here are three quick ideas. First, always keep your gym bag in your car – EVERY DAY. I’ve found that I’m much more likely to exercise at the gym, if only for 20 minutes, if it’s in the car. Second, don’t shave or shower when you get out of bed. Get dressed like you normally do for work and go get a coffee if you like. I find that I have to work out because I now HAVE TO GO to the gym if I want to get a shower and shave – it’s too late to go home now!
Great article. Thank you for being a strong and brave man by putting yourself, and your story out there. I want to see the stigma associated with depression obliterated. With people like you that can happen.
I have bipolar. I experience way more depression than any other kind of highs. I struggle very hard to get by, and I feel very much alone in my struggle. Like a lemon in a bowl full of oranges.
Hi Rebecca. I just wanted to let you know that you are NOT alone. I, too, was feeling alone, these past few days especially. But you know what? I, too, have your type of bipolar. I have Bipolar II, which, by definition, involves far more lows than highs (and not super manic highs, either). I, too, struggle, and am realizing more and more how low my energy level and the depth and richness of my life are. But hang in there… Your comment helped me. I hope mine helps you in some small way. Take care. Beth
Beth,thanks for your kind support to Rebecca. And me. When we’re struggling with pain, we all feel lonely in one way or another. When we offer such simple thoughtfulness to others – as you have – we really are healers. Thanks for your healing words. Dan
Beth thankyou so much for your kind words. It is comforting to me to be in contact with other people with bipolar. I am going to focus on the positive aspects of my life. That is much more of a challenge than focusing on the negatives. What are some ways in which you cope with the very low days? I hope your day is a good one.
Rebecca
Rebecca and Dan, thank you both for your replies! I am so heartwarmed to see your replies. I just learned about this site yesterday at a Minnesota continuing legal education course on mental illness – and it was worth every penny I spent on the course to find this site!
Rebecca, first, it is wonderful for me, too, to talk with someone else with bipolar. Has your doc called yours “Bipolar II,” as mine has? To answer your coping question, I love reading, so when I am really down, I hibernate in my bedroom and read. My family is really understanding then. In fact, if you are interested, in those times I especially like to read memoirs by others with mental illness, and can recommend a couple good ones and a book by an ER psych doc in CA. Also, if you have one good reliable hobby, I find that if I just force myself to drag myself to that activity with a friend, it makes me feel so much better. For me, it’s horsebacking, and it helps enormously to have a standing commitment to ride with a friend twice a week because it forces me to go when I would otherwise never have the energy or drive to call anyone.
Beth
Hello Beth I love to read also and I love to read memoirs of people with mental illness. That would be wonderful if you can give me the names of some good ones. It has been a long time since I read one.
Thank you for telling me about some things that work for you. I agree that a hobby works. If I am creating something I feel better. I used to make jewelry. I never have the money anymore to purchase supplies. I work at my daughters school every day for one hour. That hour is so good for me. On nice days I walk there.
I never want to go but once I get out and get moving I always feel better.
Rebecca
Hi there to every , for the reason that I am really eager of reading this web site
Hello Rebecca; sorry to be so long getting back toyou with book titles. I was at work all day and then enjoyed a nice fire in the fireplace tonight with my husband, and a movie with my son. 🙂
Here are 3 books I highly recommend.
The Center Cannot Hold, by Elyn R. Saks. This is a wonderful memoir by a very accomplished professor who has battled through schizophrenia and related delusions.
Danger to Self, On the Front Line with an ER Psychiatrist, by Paul Linde. Although not written by a person who himself suffers from mental illness, the author is compassionate and the book is a great read.
Finally, An Unquiet Mind, by Kay Redfield Jamison. This is a memoir by a woman who has bipolar. She plainly has bipolar I, the more severe form of bipolar. You can buy this book from the web site for the Depression Bipolar Support Alliance. I believe the web address is dbsa.org or dbsalliance.org. You can also buy it elsewhere, but I think you help the alliance with funding if you buy it there.
Sure hope you read any of these; I highly recommend all three. The first one truly touched my heart and the second one was fascinating. The third is good also.
Take care. Beth
Thank you for your article. The growing amount of publicity that depression is getting in the media is a step in the right depression. The point I want to make, and the issue I have with your article and all the articles i see in mainstream media is the complete absence of ‘treatment resistant depression”. I have suffered from depression my entire adult life (I am 34) and have found no direct correlation between treatment and mood (a good anti-D does take the edge off). I have tried probably 2 dozen or so combinations of meds, CBT, mindfulness, excercise, diet, routine, different jobs, working fulltime, part time, studying, talk therapy ( bi weekly for 3 years), keeping a journal, drug, daily drinking, abstinence(my current choice), forcing myself to be social, solitude etc, etc. I have had ECT. I have had probably a dozen in-patient stays, group therapy. None of these things have ever been able to reduce my symptoms over an extended period, and none have ever stopped me from relapsing back into a really severe episode. The last time I was hospitalized in a suicidal state, I was working part time in a job a really liked, studying, getting up at dawn and walking and meditating EVERY morning, seeing a therapist, swimming 2-3 times a week, doing yoga etc etc, and I just fell into it again. In contrast, at present I am doing very little ( I volunteer 2 days a week), eating whatever I want, doing no therapy, have a terrible sleeping pattern and am doing zero exercise and I have been as good as I can remember being for years. My belief is that my depression comes in cycles and there is next to nothing I can do about it. I apologize for being so long winded but I truly believe that I have a point to make. That is that there are people for whom depression is so severe that nothing can really be done. I have spoken to dozens of people from the hospital communities that I have been to who have similar experiences and beliefs and these are desperate people, like myself who suffer so severely that they will try anything. We get to the point where we are willing to be electrocuted, trust me, we have tried long term exercise and therapy. Again, I liked your article and know many people for whom your suggestions have worked a treat, but please keep in mind that for some people these things have been tried and failed. It would have been nice to get a mention in your article.
Thanks so much for sharing Max. I am glad you brought up the issue of treatment resistant depression because I believe that many people experience this. A very good friend of mine and I were just discussing this issue. He has struggled with depression since his late teens and he’s now almost 50. He has also tried just about everything, but there seems little correlation between his efforts to deal with it and its frequency and severity. He shares your view: that the depressions will continue to come and go the rest of his life. No doubt, this is true for many of us. I really appreciate your honesty, Max. I hope, in small way, you find some hope in this website and blog. I sense in your message a lot of hopelessness. I have been there many times myself. I don’t have it all figured out. I still struggle mightily with depression – sometimes daily. While nothing is a cure, per se, I do find that there are some things that help. For me, this website is one of them. It’s meaningful to me. It’s meaningful to share with you. Thanks for reading and responding. Warmly, Dan
I like your website! Always informative and easy to read. Keep up the great work!
Most of the depressed know that their lifestyle, diet and lack of exercise is bad for their illness. But it’s not that easy to follow these wise principles while depression silently crawls in and sucks out your energy. For example, I worked out at the gym every two days. Once I got flu or something, and by the time it was gone, I couldn’t force myself back to exercise. I was already way out of energy and I could barely work or maintain the minimalistic social relationship. I would probably end up depressed anyway, cause even workout isn’t miracle cure. But I noticed the moment. The gym and endorphines spraying all over my brain after 2 hrs of workout were enough to COVER the fact I was severely depressed. My point is – it’s extremely fight underlying depression because you only have so much energy and if you’re the kind of person with episodes comming back, and accompanied with severe anxiety, you’re in a deep trouble and your fight is incredibly hard and exhausting.
I’ve had a long battle with depression (I guess about 7 years now that it’s been pronounced). Antidepressants have been totally unavailing, and I’ve tried A LOT of them. I’ve read a lot, joined support and EA groups (which I think are good and endorse), worked with professionals, etc.
I know all of the physical and neuropsychological benefits of exercise and yet, the majority of the time, it feels like lifting the world to get myself to do it. Anxiety over taking initiative and just getting moving I guess. Kelly McGonigal has some good things to say (that I have intermittently been able to use to successfully get going) in her book (I recommend the audio version), The Neuroscience of Change, http://www.soundstrue.com/shop/The-Neuroscience-of-Change/3934.pd (Her other book, the Willpower Instinct is good too).
Anyway, I enjoyed the article.
Thanks for sharing Rob. Like you, I’m in it for the long haul. I wasn’t aware of Kelly McGonigal. I’ll check her out. Have you read the book, “Undoing Depression” by Dr. O’Connor? If not, check it out. Warmly, Dan
Please do not say “psychologist” when you mean “psychotherapist.” Most of the psychotherapy done in the U.S. is not done by psychologists.
Got it!
I’m 15. People usually just tell me to snap out of it, it’s all in my head. I’ve tried, i really have. I dont know if lack of sleep is why i cant move, i feel like its more an unconscious lack of motiviation. Simple things, like homework, i’ll sit in front of a book staring for an hour not doing anything, or when i go to take a shower, i sit on the edge with the water running, thinking im waiting for it to get warm, even if it’s been warm for quite some time. I just sit there. My mind somewhere else.
That’s what it’s like for me at least.
I have a couple other friends who struggle with depression. One of them has been taking antidepressants for a year or so now, and i guess you could say they’re helping. I think her therapist has done this more than the drugs, but she no longer has opinions. I’ll ask her, “Should i switch schools?” and she’d say, “Well it’s your decision, im sure you’ll do well anywhere.” She’s probably just trying to be supportive, but i want yes or no, “What would you do if you were me?” i’d ask. No definite answer. She’s been brainwashed to be a shell of the girl she used to be. She sits there, empty, like there’s nothing going on in her head. Quite like a zombie, yes. And that scares me a lot.
I’m pretty suicidal and my therapist wants to put me on antidepressants or antianxieties, but i dont want to end up like my friend. WHat’s better, feeling sad all the time or feeling nothing. I think the fact that i can say feeling sad should mean something. I think it means i want to be better, i want to try. But it’s hard to get up, it’s hard to stand. I dont know how, or why. But it’s really hard. THanks for listening i guess
You mentioned that cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic and productive ways of thinking. Do most therapists offer this kind of treatment and do you need a referral to get this type of help? My wife has been very depressed since her sister passed away and really needs some help. Finding a professional therapist to see might be a good option for her.
Your wife has situation depression. She will get over it. Just be with her as much as you can. Talk to her about what she wants to hear. I am not sure if CBT will help but give it a try. Antidepressants did not work for me. In situation depression it is a matter of time. This is my exerpience only.