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The Connection between Depression and Trauma and Neglect

Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.

Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”

A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.

Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.

We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.

Responding to Trauma by Losing Ourselves:

When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.

Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.

How Sexual Abuse Can Lead to Depression:

If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.

The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.

This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.

If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.

Trauma Comes in Many Forms:

Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.

One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.

A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.

These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.

Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.

Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.

What Does Depression Have to Do with It?

When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.

If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.

If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.

If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.

In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.

Depression is often simply telling us that we are not really living our lives as ourselves.

To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.

Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.

One Woman Lawyer’s Journey Through Depression

Acknowledging my depression for the first time during my third year of law school was as terrifying a realization as it was liberating. Between finishing up final classes, getting ready for the bar exam, and preparing for the first semester of my LL.M degree program, I fought every day to simply get out of my own way, and I fought even harder to hide it. I would wake up in the morning in tears, yet by the afternoon I was at school, going through the motions, and relieved to just make it to the end of the day.

This contradiction of being in law school and living with depression was an unbearable secret. At my core, I was beyond ashamed and embarrassed. I would beat myself up over and over again with the same though: how did I mange get myself to law school only to end up feeling this way? I was so lost, and I was experiencing a pain that was as indescribable and unfamiliar as it was pervasive and present. I convinced myself this that feeling this way was the price I had to pay to become a lawyer, to live up to this expectation I had created about myself. So just get through it, I told myself. This is the way it’s to be done. Suck it up. Survive.

In the months to come, however, my depression worsened. Despite having passed the bar exam, started course work toward my LL.M degree, and a relationship with a man who said he cared for me, I crashed. I spent entire days in bed, with no one to the wiser. I stopped answering my phone and emails, and I wasn’t going to classes. Getting out of bed felt like stepping off the edge of a cliff. Life having any sense of forward momentum and progress was something that seemed to happening for other people, and I was left struggling, trying to figure out how to keep up.

Something inside me managed to articulate clearly and loudly that something was wrong with me that went beyond telling myself to suck it up. One morning, moved by forces that to this day are still a mystery to me, I found my way to the university’s student counseling services. A social worker took me in a back room for an intake interview. Directly and clearly, I was honest for the first time about what was happening to me. The next thing I knew I had a calendar filled with multiple weekly appointments with a psychiatrist who immediately put me on an anti-depressant and talk therapy.

Believe me when I say that those talk therapy sessions in the student counseling center changed my life. My therapist saw through me with kindness and compassion in a way I didn’t think was possible for another person to do, and she understood the how and why of what was happening to me. She helped me put words to emotions and thoughts that existed only in my head. I learned that I could say I was dealing with depression, and that with work it was something I could learn to manage.

But my therapist also told me this was only the beginning for me with understanding and successfully managing my depression. She said we had only scratched the surface. Her words were profound and prescient. As my experience with law evolved from getting through the competitive and pressure filled environment of law school to the demands of practice, so did my experience with depression and its affect on my ability to know and to listen to love myself. For a while, I felt good, and depression felt like memory. I found I was more comfortable with and better at being a working lawyer than I was a law student. Practice requires you to touch more upon your true nature more, I think, than law school. There was less posturing and more action, and I am more suited for that reality. I still, however, had a lot to learn about asserting myself and holding my own in intense environments. As the red flags of my depressive behaviors and thoughts would pop up, I realized that no matter what anti-depressant I was on, or what words of wisdom I tried desperately to recall from a therapy session, I was still out of sync with myself emotionally and my surroundings. This was a powerful insight, but I still could not in the moment handle the stresses I experienced on a daily basis successfully or in a way that felt true to myself. Sexism, cutthroat competitive colleagues, long hours, bitter partners who saw heaping insult upon you as affective training and as lawyerly karmic right. The romantic ideal of the practice of law as noble and worthwhile was elusive and false. The reality was all too much.

Even as I become more successful in advancing my career, obtaining a Federal clerkship and a Big Law job, my depression didn’t dissipate and disappear, as I had naively hoped it would (because as all lawyers know, the right job and status fix things, right?). Instead, its presence became more insidious, because when I felt it, I immediately knew it meant that something was dreadfully wrong, and the fear of where it could take me became all-consuming. The energy it took for me to hold my own with colleagues and clients and still at the end of the day deliver good work took over, and any healthy sense of self-care I had learned when I first acknowledged depression in my life was pushed aside. I now felt like a failure at the most fundamental level because I couldn’t control my depression. Even as my experiences with depressive tendencies became more insightful and clearer to me in their meaning, I was still at a loss as to what to do, and I brutally beat myself up for not being able to fix it.

After completion of a project I was on in 2009, I left my job, and I left life as a working lawyer. And again, I crashed. For a time, I swung too far in the other direction, internalizing depression to the point where it became my identity. I didn’t know where depression ended and my sense of self began, and concluded that the entirety of my life would be determined by its presence. Therapy and medication again were options, but this time, I knew in my gut what I needed was beyond the relief they would provide.

Only with time and by stepping back from thinking of myself as both a lawyer and as someone with depression have I have learned that ultimately I am neither one of those things. I have learned that when I fight and ignore my intuition is when I get into trouble. That is what depression at its worst takes from me. It takes away my voice. When outside noise and pressure and people are too loud, and are in turn amplified in my mind by my depressive thinking, I, in the most glorious sense of the word, am gone. The “I” whose evidence of worth is proved by mere existence; the “I” that only has to live and breathe to be worthy, is nothing to me. All I can see is worry and striving and other people’s judgments, and my own judgments, and angst and pain.

I don’t know that I will work in law again, but I entertain the thought now and then. This thought isn’t without a realistic notion of what it will take to get back into the profession, so, equally, I honor the thought that I may never find a fit for myself in law. I’ve also accepted depression in my life as a siren meant to warn me I’m headed for trouble. This clarity isn’t without fear. I’ve had hard times since I left my last job as a lawyer, but I can honestly say that what I’ve learned about myself and life since has so far been worth it all.

By Anonymous

One Trial Lawyer’s Journey From Severe Depression to Greater Fulfillment

I do not consider myself a lawyer. I am a human being who took on the role and career of a lawyer for 25 years. Unlike some people who entered law school with a burning passion to practice law, I ended up there because I was confused about my career direction and had no career counseling. Stop here. If you don’t feel excitement and joy when thinking about a career my hindsight advice is don’t enter it!

After a couple of years in NYC working for a small firm I quit because I hated following orders due to my anti-authoritarian streak dating back to early childhood. When I left for California I passed the CA bar exam, worked briefly for a solo practitioner, and then opened up my own solo practice. During my first few years I took whatever I could get including cases involving wrongful employment termination, wrongful eviction, workers compensation, and personal injury. I gradually steered my practice completely into plaintiff’s personal injury because I come from a family of physicians and I was truly fascinated by the medical aspects of these cases.

After I while I became rather successful as a lawyer, especially because I had a nose for what made a good case, I enjoyed investigating the facts, I cared about my clients (most of them anyway), and I frequently knew more about the medical/psychological aspects of the client’s injury than the defense. My Achilles heel was my biological tendency toward anxiety and depression which, to my mind, are two sides of the same coin.

Although I got excellent results in my cases I was plagued by fears of failure and so I worked myself to the bone when it came to preparing for depositions, hearings, and trials or opposing motions to compel discovery or obtain summary judgment. Although I was never sued by a client in 25 years I always worried that the innately disgruntled ones who complained about everything in their lives might sue me. So I worked extra hard to make sure their cases turned out well. To put in all these hours I gave up on exercise, sat more, and ate unhealthy, high salt, high sugar foods to give me some compensatory pleasure. Stop. If you are doing these things you will damage your physical and mental health. Our bodies crave outdoor exercise in the fresh air and they crave real food, not the processed crap made in factories.

At the beginning of the 1990s I took on some new challenges. I moved to a larger, more expensive office. I became a homeowner. And, my wife became pregnant with our first child. In the mid-1990s, I developed a bridge phobia, a phobia involving the fear I would fall out of the window of a tall office building, and panicky dread over crime in our neighborhood which seemed to be getting worse every day. To help myself through these irrational fears I became a good friend of Jack Daniels. This nearly led my wife to divorce me. The threat of divorce woke me up like a cold shower. I went to see a psychiatrist who put me on Zoloft and I stopped drinking. Things got better. We had a second child, a son. In the coming years I became a very good father. I adore my kids. They adore me. Both kids are flourishing. This is something I am very proud of.

In the decade between 1995-2005 I handled an increasing number of cases involving traumatic brain injury and made significant income. Initially these cases were very exciting. Over time they became a drag. Why? The defense, which had paid up relatively quickly in the early days, now used scorched earth tactics by hiring experts in human factors, biomechanics, neurology, psychiatry, neuropsychiatry, neuroradiology, etc. I had to hire counter experts in each field and I had to pay to depose every over-priced, hostile defense expert who gave me all their specious reasons why each client was a neurotic, a hysteric or a malingerer.

I felt like Sisyphus, the man condemned by the gods to roll a boulder up a steep hill every day. The litigation costs drained my coffers to the point where I was late on my rent, my copier machine rental, my records fees, and witness fees every month. In the midst of these depressing circumstances my mother suddenly died of a brain virus. And then, one day, my wife noticed we were completely out of money and our home equity lines were maxed out. I instantly plunged into what my psychiatrist called a psychotic depression in which I heard a voice from within me tell me to die over and over again, relentlessly 24/7 until after 4 days of it, I went to a hospital emergency room.

The psychiatrists who cared for me in the hospital told me I had snapped as a result of an inborn vulnerability to depression, years of stress from legal practice, and the trauma of my mother’s death and insolvency. They told me never to return to legal practice. My past 8 years have been a journey back from severe depression and into a new, more fulfilling life. Thanks to a private, own-occupation disability policy I was able to pay my family’s living expenses while recovering.

I researched and wrote my book for lawyers, The Upward Spiral: Getting Lawyers from Daily Misery to Lifetime Wellbeing, on stress and depression while studying and practicing Buddhist meditation. I became ordained as an interfaith chaplain and sat with dying patients at a local hospital. More recently I entered an MS program in mental health counseling at Capella University. I anticipate becoming a Licensed Professional Clinical Counselor at the beginning of 2017. I am finding my studies, practicums, and internships in mental health graduate school to be very meaningful and fulfilling.

Law is a very stressful profession which produces severe depression in one out of every five lawyers. What is my message to my colleagues in the law who suffer depression?

First, face the depression. Do not deny it and self-medicate it with unhealthy substance or behavioral addictions.

Second, try medication. For a depression with obsessive, suicidal rumination (like mine) it can be life-saving.

Third, see a therapist (a psychologist, MFT, counselor or social worker) so you can explore and understand the bio-psychosocial roots of your depression and choose the best form of therapy to resolve your depression.

Fourth, consider couples counseling or family therapy so your spouse and children can understand your depression and have an opportunity to educate you as to how it is affecting them. This can lead to improved understanding, communication, and cooperation at home within the family system.

Fifth, consult experts in nutrition, exercise, and sleep to develop ways for you to eat healthier, exercise more, and sleep better. A wonderful book on these topics is Go Wild by Dr. John Ratey.

Sixth, spend more time in nature because there is nothing better to quiet the mind, ease the sore psyche or restore the spirit.

Seventh, take time to actualize your potential as a unique self through whatever activity calls to you, be it photography, calligraphy, water color painting, baking, cooking, etc.

Good luck. I know you can beat depression and be happier.

Harvey Hyman, J.D. spent 25 successful yet stressful years practicing personal injury law in New York and California. Thanks to an episode of severe depression in 2007, he found happiness and joy that had always eluded him.

No Longer Wanting to Die

From The New York Times, a powerful piece by Will Lippincott who writes, “When depressed, the self-esteem I presented to the world belied just how out of control I felt inside.” Read the News

Previously Depressed People Can Help Us Fight Depression

A new study shows that peer support interventions by a previously depressed person to provide support and guidance to a currently depressed person really helps. Read the Blog

How to Ditch Depression and Get a Life: 8 Ways to Deal with the Black Dog

Here are 8 ways to combat depression in your daily life. Read the Blog

7 Thoughts From a Chronically Unhappy Person

From The New York Times, Diana Spechler writes, “My depression habits include avoiding pain and courting diversion. During every bout of depression, I grasp – at yoga, therapy, medication, romance – and hope that my tiny firefly of pleasure won’t wriggle from the cup of my palms.” Read the News

When Medication Isn’t Helping Your Depression

As many people know all too well, clinical depressions do not always improve after the first attempt at treatment. One in three people with depressions (I’ll explain the plural in a bit) find they have not gotten back to “normal” even after four different courses of standard treatment.

Depression is considered “treatment-resistant” if symptoms have not improved after two or more courses of well-established treatments of a sufficient dose and length of time, whether those treatments are evidence-based medications, psychotherapy, or other therapies that have been proven effective.

That “or more” can be problematic. The longer your depression persists, the greater the risk of financial costs, job loss, family stress, marital problems, and even possible brain changes. That’s why it’s a good idea to discuss a diagnosis of treatment-resistant depression with your practitioner after two failures of treatment. The earlier you address it, the better.

There are a number of reasons why your depression might not respond to a particular treatment. For one thing, there is no single type of depression; there are multiple causes. That is why it is actually most accurate to use the plural term (depressions), and why “one-size treatment” will never fit all.

For another, effective treatments that are not followed cannot work. If a person is not taking the doses of medication as prescribed or doesn’t stick with the recommended treatment, a depressive episode should not be considered “resistant.”

If my depression resists treatment, what are my options?

It’s easy to get discouraged when the treatments you’ve tried haven’t helped you reach recovery. (And remember: Better but not well is not good enough.) Above all, don’t give up hope. Here are some things to consider.

Simply switching from antidepressant to antidepressant may not be useful. As shown in the STAR*D study, the largest American study of treatment-resistant depression, more proactive steps appear to be needed once treatment resistance has developed.
Returning to a medication that worked in a previous depressive episode may be more effective than switching to a new one. If it doesn’t work as promptly as before, remember that it may do the job at a (safe) higher dosage taken for a longer time period.
Give treatments a chance to work. While the typical time frame for good response to a medication is stated as four to six weeks, for many people it can take 8 to 12 weeks to see improvement.
If medications or psychotherapy have been ineffective on their own, consider trying them in combination. Medications plus cognitive behavioral therapy, interpersonal therapy or dialectical behavior therapy traditionally outperform either treatment used alone.
Augmentation of your antidepressant with an adjunct or “add-on” medication, often an atypical antipsychotic, may be helpful if you’ve had partial response to a treatment.
Other “augmentation” agents that pro-vide benefits for some people include nutrition supplements such as Vitamin D, Omega 3, and folate.
Electroconvulsive therapy (ECT), commonly known as shock therapy, has long been stigmatized in popular culture. It is an extremely safe procedure, acts rapidly, can be life-saving, and is sometimes the only effective treatment. It does produce memory problems for some.
Other “neurostimulation” treatments, such as Transcranial Magnetic Stimulation (TMS), are coming into wider use. TMS is a non-invasive procedure that typically can be delivered in about an hour each day in an office setting.

Once you find something that works, don’t change a thing. Just as someone with diabetes requires ongoing treatment, most people who have developed chronic, recurring depression need to continue treatment indefinitely.

By John F. Greden, MD. Dr. Greden has been practicing psychiatry for 35 years. His clinical specialties include treatment-resistant depression and maintenance of wellness. The Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences at the University of Michael Medical School, he is also the founder and executive director of the UM Comprehensive Depression Center (depressioncenter.org) and the founding chair of the National Network of Depression Centers.

Building Your Depression Toolkit

One study found that as many as eighty-percent of all people in this country that suffer from clinical depression don’t get any treatment.

Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.

However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me.

As I wrote in a prior blog, these people are really my “heroes”.

I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.

For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.

I put myself in this camp.

Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.

What worked for me to reign in the beast of depression was a change in lifestyle, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.

To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.

If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.

So pick up your pen and start building your own toolbox today.

Regain Motivation With A Depression Action Plan

Everyone feels down at some point in their lives. But if you have major depression (also called major depressive disorder), you likely feel depressed every day for most of the day, especially in the morning. You might wake up and have no energy to get out of bed. And even when you do get up, deciding what to do first can feel like a mountainous task.

At those times of inertia, it’s easy to get discouraged. But giving up the idea of getting anything done can make you feel powerless and perpetuate feeling depressed. Instead, fight back with an action plan that propels you ahead, even when you’d rather lag behind.

Creating a Depression Action Plan

A depression action plan can help take the guesswork out of where to get started each morning. It can also empower you to see just how much you can do, which is important because people with depression tend to compare their current levels of activity to past ones.

“For an action plan to be effective, you first have to understand that major depression is an illness, not a weakness,” says Stephen J. Ferrando, MD, a professor of clinical psychiatry and clinical public health in the department of psychiatry at the New York-Presbyterian/Weill Cornell Medical Center in New York City. Stop comparing yourself to the past. “It’s not your fault you have depression,” he says.

To get started creating an action plan, it’s best to work with your doctor or therapist. “When you’re depressed, it can be difficult to determine where to begin,” says Randy Auerbach, PhD, ABPP, a researcher, an assistant professor in the department of psychiatry at Harvard School of Medicine, and the director of the Child and Adolescent Mood Disorders Laboratory at McLean Hospital in Belmont, Mass. Your doctor or therapist can help you identify both short-term and long-term goals to work toward.

Consider these steps you might want to include in your daily action plan:

Tasks you need to do

Make a list of four or five things you need to get done today, such as work and chores. To avoid getting overwhelmed, break down each goal into small parts. For example, instead of making cleaning the entire house your goal, decide to clean just one room today, says Brian Iacoviello, PhD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

Activities you enjoy

If depression has taken the enjoyment out of all activities for you, write down what you once found pleasurable. Working toward doing the things you once enjoyed can help you slowly regain momentum. You can also try adding new activities, such as soothing stress-coping experiences (e.g., meditation, yoga, and tai chi).

Time with your support network

Research shows that a support network is critical for depression recovery. Make plans with friends and family and show up even when you don’t feel like it. It helps to have a friend who will hold you accountable. “Social support can be an enormous ally when you’re in dealing with depression,” Dr. Auerbach says. A local or online depression support group can also be a good resource.

Exercise

In a review published in in 2013 in the American Journal of Preventive Medicine, researchers reported that even low levels of physical activity, such as walking or gardening for 20 to 30 minutes a day, can help ward off depression. If you’ve stopped exercising, set reasonable goals to allow yourself to slowly get to the level of physical activity you want to reach. You might even combine exercise with socializing by picking a workout activity to do with a friend.

Healthy meals

Eating a balanced diet may help alleviate depression symptoms. Include steps in your depression action plan to create healthy meals each day. To maximize benefits, aim for three meals that include whole grains, fresh fruits and vegetables, beans, lentils, nuts, seeds, lean meat, fish, eggs, and low-fat or fat-free diary. Never skip breakfast. Be sure to drink plenty of water because even mild dehydration can affect mood. Limit your alcohol intake.

Medication

If you’re taking medication, include specific times to take it in your depression action plan. Sticking to your prescribed treatment plan is the best way to speed recovery.

Journaling

Your entries can provide insight for you and your doctor or therapist to review together to determine patterns of behavior that may be holding you back from doing everything you want to do. Record behaviors such as what you’re doing, how successful you’re being at doing those things, and what you think about when you’re doing them. Once you’ve identified any negative patterns, you can work with your doctor or therapist on how to let them go.

Rewards

Implement a system of rewards to give yourself when you’ve accomplished a goal in your depression action plan. Self-care activities — such as a massage, a new haircut, a movie, or any other activity that makes you feel good and follows your plan for recovery — make good rewards.

How to Stick to Your Depression Action Plan

When the temptation to do nothing crops up each morning, realize that you’ll have to push yourself to take the first step to get started. Once you do that, know that your level of motivation will likely increase. To stay on track, be sure to schedule activities at specific times so you don’t get overwhelmed about what to do next or how much you have to get done. Post your depression action plan in a visible place, and set up reminders by programming alerts on your phone.

Also, remember that your depression action plan may not follow a straight path. There may be setbacks, and that’s okay — just do your best to keep going. Then at your regular doctor appointments or therapy sessions, you can discuss your progress and work together with your doctor or therapist to identify what may still be getting in your way and figure out what to do to change it.

At the end of each day, focus on what you’ve accomplished instead of what you haven’t. “The greatest challenge for a person with depression is to overcome pessimistic thinking, helplessness, and hopelessness,” Auerbach says. “But with proper treatment and a good action plan, depression can be conquered.”

By Barbara Sadick

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