Getting into Action - Dealing with Depression

What causes depression? The simple medical answer given is often something along the lines of "a chemical imbalance in the brain's neurotransmitters." While this might seem common sense enough, the issue isn't quite so simple. We know that antidepressants work well for some of the people that take them, but the effects are often limited, insufficient, or even completely lacking for a very large portion of people who do take them. The truth is, the scientific jury is still out on exactly why and how antidepressants work to improve depression. It could in fact be because they do lead to increased levels of neurotransmitters active in the brains synapses, but it could also be for other reasons. Such medications may actually improve neurogenesis and synaptogenesis in certain areas of the brain. And some psychiatric medications may have strong anti-inflammatory properties as well. Research has demonstrated at least a strong correlation link between inflammation and depression. It's quite possible that antidepressants actually work due to a combination of these reasons.

What many people don't know about antidepressants is that the only way these medications can prevent depression is if you keep taking them. Depression can be a progressive disorder. That is, once someone has had one episode of major depression, they are more likely to experience a second one. As the episodes of depression stack up, the likelihood of future episodes continues to increase. There is about a 15-25% general chance of experiencing depression at some point in your life. But if you've been depressed at least once before, that likelihood jumps up close to 50% and continues to rise with future episodes - relapses happen. If you are taking an antidepressant, the chance of relapse drops back down to close to original levels (15-25%), but only while you're taking the antidepressant. Once you stop taking them, the risk of relapse rises again back towards 50% and higher. So antidepressants don't seem to permanently fix anything in your body.

It seems that without proper intervention, the human mind and brain can learn to be pretty "good" at being depressed, as it seems to happen more easily with each episode. Here's the kicker though. When delivered solo or in combination with medication, high quality empirically supported psychotherapy reduces your risk of relapse back into depression. If you have been depressed before, but have received good therapy, you have a much lower chance of experiencing depression again than the person who only took antidepressants for a while and then stopped once their symptoms improved. It seems that good therapy can train your brain and mind not to get stuck in the old patterns of thinking-feeling-doing that lead to a depression relapse. And these protective benefits of therapy last after therapy is finished!

One of the main patterns to leads to depression is avoidance behaviors. Something happens in life that leads to increased stress, decreased positive experiences, and/or difficult emotions. A common response is to go into avoidance - we zone out, distract ourselves, sleep more, isolate from others, lie around on the coach, endlessly scroll on our phones, cancel appointments, and avoid stressors. This makes sense, we aren't feeling good and our problem solving mind tells us the "solution" is to do anything we can to avoid having to feel all these unpleasant emotions, sensations, and thoughts.

The problem is that avoidance doesn't really work - the unpleasant emotions, difficult thoughts, and depressed mood are there with us. Even if it seems to bring a little relief, it is only temporary, and then the pain inevitably returns. So the avoidance doesn't fix the pain. What it does lead to however, is disconnection from the very things that reward us and make life full and meaningful - you cannot avoid the "bad" without eventually detaching from the good. So we try to avoid the discomfort and life narrows in a little bit, then we feel worse. We engage in more avoidance behavior and life narrows in a little bit more, so we feel worse. The cycle continues and depression squeezes in on us - this is the depression compression and it is being driven by our avoidance patterns rooted in an unwillingness to experience all of the discomfort, unpleasant emotions, and stress that are a natural part of a meaningful and engaged life.

Here's the secret, everyone does this to some extent! Why? Because it has the illusion of working. Avoidance behavior often does bring temporary and limited relief for those difficult feelings. Also, it seems to work when the problem is not inside of us. If it's too hot in your house, you can avoid it by getting up and turning a fan or AC on. If there is a traffic jam, you can plan your drive to go around it (unless you live in Atlanta). So avoidance seems to work, but it doesn't really, not for very long. And it's only likely to dig you into the pit of depression that you were so desperately hoping to avoid.

So what's the solution? It is actually to get and stay active. But this is not mere activity for activity's sake. This is intentional activity rooted in what's most important to you, pursuing the actions, behaviors, and relational interactions that are going to build and maintain a meaningful life for you! With this activity we must bring an intentional awareness, rooted in the present moment of your experience, not stuck in your head in some sort of mental time travel - here/now moment to moment is how we get to live life. If you are not depressed currently, learn to avoid avoiding. Make meaning and value the primary influencers of what you choose to do, not the temporary avoidance of discomfort. Listen to your experience, not you "problem solving mind." If you look closely and honestly, you'll see that avoidance has never really worked for you in the long run. The truth is, it can't.

If you're already depressed, this is a lot more challenging I know it's difficult, I have been there myself and worked with many clients who have as well, but you're going to have to learn how to feel depressed AND start doing what matters to you. This is why outside help is so important. Your depression is probably going to tell you that you feel too terrible to get into action, that you can't possibly change. This is normal. A good therapist or even a trust friend can help you get going if you'll take the chance of opening up to help. If you can't do therapy now, try to start small. Consistency is key. Make little goals to get up and into action every day - get out of bed, take a shower, cook a meal, go for a walk, call a friend, buy your groceries. Find the smallest next step you can take and then commit to doing it. Even going for a 1 minute walk outside of the house is a start. These little steps, taken each day will start to build on each other, reinforcing each other.

Check back for future resources. We are currently working on an online course in behavior activation for depression that people can move through at their own pace to cope with their depression.