Depression, Large and Small
As you probably know, most people experience some form of depression — that is, sadness, feelings of apathy, a “down” mood — at some time in their lives. What we commonly call depression can range from mild “blahs” or “blues” to full-scale despair.
Clinical depression (a syndrome that meets certain diagnostic criteria) involves persistent despondency, a sense of hopelessness and helplessness, feelings of guilt, inadequacy, and possibly suicidal thoughts. If what you are feeling is a case of occasional blues, meaning that you feel “down” and it lasts for a short time, you may be able to ride it out using some of the techniques below.
If you are dangerously or seriously depressed — for example, you have little appetite, sleep for much longer than eight hours a day as a means of escape, find yourself unable to get out of bed or to function in your daily routine, cry easily, or have constant or near-constant thoughts about harming yourself or others — you need to get help right away.
Other signs of depression include lethargy, problems with concentration or memory (or both), lack of interest in activities or things you used to enjoy, and feelings of worthlessness, helplessness, and hopelessness.
Help for Serious Depression
There are several good options for treating serious depression. All of them begin with communication (which may feel difficult when you're depressed but is essential nonetheless). You will want to talk with someone you trust, ideally a professional. Your therapist, doctor, or clergyperson would be a good place to start. One good treatment choice is medication. A great many depression problems arise from chemical imbalances in the brain. If the problem is biochemical, then it's logical that the treatment would be biochemical, as well. Many current antidepressants are said to specifically target those areas of the brain that are responsible for depression.
While it's not uncommon for people to think occasionally about suicide, formulating a plan to kill yourself (or others) is a giant danger sign. If you feel hopeless or desperate, call the National Suicide Prevention Hotline (1-800-SUICIDE), or your therapist, clergyperson, 9-1-1, or the nearest hospital emergency room immediately. There's help for even serious depression.
Of course, if your depression is circumstantial, it will probably help to talk about it, to keep busy if you can, and to try to do good for others. If your depression is situational but serious — that is, if it has caused you to lose interest in the things you used to enjoy, and you have felt this way for more than a week or two, or you find you are thinking often about suicide or other dangerous behaviors — get help right away.
If you feel suicidal, call 1-800-SUICIDE (the National Suicide Prevention Hotline) or 1-800-273-TALK (the National Strategy for Suicide Prevention hotline). Most communities also offer local suicide-prevention services. You can find them easily in the phone book, online or by calling the Samaritans 1-877-870-HOPE (4673) in the U.S. (The Samaritans and other suicide-prevention groups are available in other countries, as well.) You really do not have to suffer alone.
Therapists usually have emergency numbers for patients. Keep your therapist's emergency number on hand. (Don't worry that you might be “imposing.” If your therapist believes you are crossing any boundaries, she will tell you so. In the meantime, she's there to help you.) If your therapist is unavailable for any reason, you need to get to the nearest hospital emergency room; there will be a trained clinician there to help you.
There is evidence to suggest that more people are affected by depression today than at any other time in history. According to the National Alliance on Mental Illness (NAMI), depression is the biggest contributor to disability in the country (and in other developed countries, as well).
The In-Patient Option
For serious or suicidal depression, you may also want to consider (or your clinician may strongly advise) hospitalization. Aside from actual hospitals, there are many mental health facilities that offer therapy and medication in tranquil, pleasant settings. Your therapist might help you decide on one, or you may be able to find listings in the telephone directory or online. (Try such key words as “in-patient,” “mental health,” and “depression,” or look under “Mental Health Services.” Add the name of your state for Internet searches.) Just be sure to check out the facility before deciding on a stay there, as you would any professional service, or ask the referring clinician why this particular facility is recommended. You might want to involve a family member or friend in this decision if you're not feeling up to the task.
Help for Mild or Middle-Sized Depression
For most people, depression will probably lie in the middle ground: not disabling, but not light enough to shake off, either. If this is you, you might be surprised to learn that the same options — and more — are available.
Medication is still one avenue to explore. If you are already on medication for your OCD, it makes sense to talk with your prescribing doctor about changing your prescription or dosage, or perhaps adding another medication. Often, a small dose of a second medicine will act with the first to help you feel much better, so do not dismiss this option.
Sometimes, the body becomes accustomed to a medication and the same prescription no longer works as well as it once did. Or perhaps your medicine was prescribed primarily (or exclusively) for OCD and doesn't necessarily treat depression. Many medications work well for both depression
If you're not currently on medication, now might be the time to consider it. Treating the depression first will likely help you to treat the OCD more successfully.
In some cases, the reason for depression might be medical. Certain viral infections, for instance, can cause many of the same symptoms as depression. A medical exam would not be a bad place to start. Make sure to let your doctor know about any medications (over-the-counter and prescription) that you may be taking, and don't neglect to mention your OCD if your doctor is unaware of it.
Depression can be insidious, as well as dangerous. Just because you're not actively suicidal or homicidal doesn't mean you shouldn't get help for this serious problem. Don't let anyone tell you, “Oh, everyone gets depressed. Just buck up!” If you need help, you should absolutely get it.
In addition to following the general advice given throughout this book, there are several small but significant things you can do to help brighten your way of thinking. Again, if you feel as if your depression has gotten to the point at which it might be dangerous to you or others, seek help from a qualified therapist right away. Otherwise, here are a few more ideas for beating the blues:
Even though you might not feel sociable (and, in fact, probably don't), do not give in to your inclination to isolate yourself. Try to get out, even for a short time, among people whose company you enjoy. A “change of scenery” can also help; try taking a short walk, preferably in the morning sunshine, as exposure to sunlight can positively affect your mood.
Share your troubles. You may want to confide in a close friend or family member. Sometimes, it really does help to talk. (This is not, of course, meant to substitute for a therapist or other qualified professional.)
Join (or become active again in) a spiritual community. Find a local church or synagogue and start attending regularly; religious involvement has been shown to have long-term benefits for those who participate. And you just might find yourself becoming part of a community with similar values.
Get a pet. Assuming you're not allergic and you like and can care for (and are able to keep) a dog, cat or other animal, you may want to explore this option. It's well documented that animals have a therapeutic value for humans. Even watching a tank of fish swimming, it's said, can help generate a feeling of calm.
Although you may feel bleak, remember the saying that “laughter is good for the soul.” Watch a movie that makes you laugh. (The Marx Brothers? Tootsie? A romantic comedy?) Listening to music you enjoy may also help lighten your mood. Don't forget to sing along. Singing can be a great blues buster, too.
Write. Keeping a journal has been shown to have a healing effect. Or work on writing something even more creative: a book, a play, a song or poem, or what-have-you.
Any kind of creative activity, such as painting, writing, or dancing, can help you to feel good. (Dance or other physical activities carry the added benefit of being good exercise. Exercise helps people to feel good, too.) Creativity is thought to release endorphins, the brain's so-called “feel good” chemicals.
Do something nice for someone else. Seek out volunteer opportunities; get ideas and local referrals through charitable organizations, your place of worship, the newspaper, or online. Whether it's dropping in to visit a lonely older neighbor or spending the afternoon preparing bags at your local food bank, if you feel as you're contributing to the world around you (and you are!), you will likely begin to feel more a part of it.
Remember to eat well. Giving in to sugar cravings will almost certainly make you feel worse ultimately, as will
noteating very much. Eating balanced meals and drinking plenty of water will probably help to stabilize your mood.
Dress up. Sometimes it can feel cozy just to laze around (especially when the weather outside is bad) in soft, worn, not-very-presentable clothing. However, like just about anything else, too much of it probably won't be good for you. Even if you're only going to the corner store for a quart of milk, make an effort to look nice. You may just find that you feel better, too.
Act as if you feel better than you do. Sigh contentedly. Smile. Say out loud, “What a gorgeous day!” (Or maybe, “I like rain.”) “I feel great!” Think about one thing, or more, that you feel truly happy (or at least pretty good) about.
If you suffer from seasonal depression or “winter blues,” (also known as “seasonal affective disorder” or SAD) you might want to consider adding light therapy to your routine. (Some people use it for non-seasonal depression, as well.) SAD is common in residents of northern climates where there is insufficient sunlight throughout the winter months. Generally, light therapy involves sitting in front of a specially designed lamp or light box for a specified period each morning, often 30 to 60 minutes. Many types of light boxes are available.
Formerly at the fringes, light therapy seems to be gaining mainstream acceptance. If you'd like to give a light box a try, make sure to look for established guidelines for making this purchase.