Tips to Avoid a Depressive Episode
I’ve felt really good for most of the last year and a half now, and for literally the first time in my 52 years, my depression is in remission. That’s a BIG freaking deal!
But that does not mean I’m completely out of the woods, and it certainly doesn’t mean that it can’t come back and take me down at any time. While I’m feeling decent and going about my life, my depression is outside doing pushups, waiting to pounce on me.
I must remain vigilant.
You may have read previous posts where I talk about feeling like there’s a hole in my heart. This still happens, although it doesn’t last nearly as long as it used to.
That feeling is an indicator that my depression has arrived and is trying to take over. Maybe it’s a little weird, I don’t know. It’s a very distinctive feeling, an actual physical sensation. My heart feels incomplete and very heavy. It really sucks.
Do you know this feeling, too? (Maybe I’m not as weird as I thought.)
I feel this hole all day, every day when I’m depressed, and it is the most powerful sign that my mental health has taken a severe nosedive. I know I need to take action as soon as I notice it.
THE BUILDING BLOCKS OF MY SURVIVAL
On the one hand, that hole is a bad thing. I feel so very sad, I can feel it in every ounce of my being. It can almost be too much to bear, and I often end up in the fetal position, “protecting” my heart.
But it also serves as a reminder to pay more attention to what I’m thinking and feeling and to be more present in each moment. It means I need to take immediate action, or else my depression will get out of control.
Two of the more concrete things I can do are to contact my TMS clinic and see my therapist more often.
Although I have found a TMS provider that’s semi-convenient to me (it’s thirty minutes away), there aren’t really that many TMS clinics out there. And not only can they be hard to find, but there can also be a waitlist to get in.
And let me tell you, having to survive an indefinite waiting period while your depression invades your brain and makes you wonder if life is worth living is an incredibly difficult feat. The sooner you get an evaluation done and fill out the necessary paperwork, the sooner you can get in for treatment.
In the words of singer K.Flay, “Girl, it takes guts just to survive.”
As I’ve written before, TMS is far and away the most effective treatment for my depression, and I am eternally grateful for it. Being so depressed that you don’t want to live is the worst feeling ever.
Therapy is another very important tool that helps keep me afloat. I’m doing so well right now, I’m only seeing my therapist, Jacqueline, once a month. She helps me keep my head on straight and moving toward my goals.
I have this theory: If you’re not moving forward, you’re standing still. And when you’re standing still, you’re liable to start sliding backward.
When I start to feel overwhelmed or if there’s a major change coming up for me, I see her more often. I know for a fact that therapy helps me get through the roughest of days, and I’m not ashamed to admit it. Hell, I’ve been in and out of therapy (mostly in) for more than 35 years.
Some people might say, “Thirty-five years? You should be cured by now! Obviously, therapy is not working for you.” But they couldn’t be more wrong. Thirty-five years of therapy is a big reason I’m still alive.
SOME PRACTICAL TIPS
When you feel that hole where your heart should be or you’re in that place where it feels like you’ve been stabbed in the heart, you need to take some steps to minimize how terrible you feel. Here are some very basic things you can do to try to feel better:
- Share your thoughts and feelings with someone you trust and make sure you’re not keeping any secrets or building up any resentments. Those can come back to haunt you.
- Check into doing therapy if you’re not already. There are many types of therapy to choose from, so make sure you pick one you think will work with your personality as well as your issues. It’s also supremely important that you find a therapist you trust, one who really cares about your safety and wellbeing. If you’re not happy with yours, try another one. I know it sucks and it can take some time, but it is so worth it to have a therapist you can really open up to.
- Make sure you’re using your time in therapy wisely. Sure, you can spend half of your session pussyfooting around what you really want to talk about, but is that useful? I don’t think so.
- Make absolutely sure to take your meds as directed every. single. day. Psych meds, diabetes meds, meds for high blood pressure – all of them – just take them already!
These are just the fundamentals. They will help, but working through depression – especially if you’ve had it for a long time and/or have what is called treatment-resistant depression – requires more than simply doing the basics.
Here are some more specific things you can do:
- Make your own Safety Plan. Read this post and see if any of my ideas resonate with you. Use the Google machine and search for “suicide safety plans” (even if you’re not suicidal) and use one as a template. Once you’ve created your own plan, you can quickly see what remedies are available when you feel like shit – you won’t even need to use a lot of precious brainpower, especially if you’re in crisis. I don’t know about you, but it seems like sometimes I forget what helps me. Having it all written down in one place makes it that much easier to take positive and proactive steps. Put it up someplace you’ll see it on a regular basis (if it’s kosher to do so) and keep a copy on your computer or phone for easy, anytime access.
- Actively challenge your negative, destructive thoughts. There’s nothing more useless (and damaging) than ruminating on negative thoughts. Before you know it, those thoughts have snowballed and you’ve convinced yourself that you’re the worst person in the world who doesn’t deserve to be happy or even mediocre. That’s a really tough place to be, because we tend to believe what our brains tell us. But remember, you don’t have to believe what you think. It’s okay to question authority – even when that authority is you. On one of your good days, make a list of things you can tell your depression when it starts to act up. You can be as polite, as assertive, or as profane as you want. We all respond to things differently. The point is to pick the method you think will work best for you. Make sure to keep this list handy. You never know when you’ll need it.
- Distract yourself. It’s hard to dwell on how awful you feel when you have to focus on something else. When I’m having a rough emotional day, I distract myself with whatever I can think of. That could mean doing a puzzle, playing catch, getting lost in a book, binge-watching something on Netflix, taking a nap – any number of things. The hardest part for me is that I usually feel the hole in my heart again even after doing that activity. So, I have to come up with additional activities all day long to keep my brain occupied. This is where the aforementioned Safety Plan comes into play (it can act as a roadmap), as well as previous Depression Warrior posts like this one and this one. Come up with your own list of things you can do to distract yourself. (Allow me to suggest a few guidelines): (1) These activities cannot be destructive to you or to anyone else (no picking fights, no self-medicating with substances you’re trying to stay away from, etc.). (2) Make sure they are things you are interested in. This gives you better odds of actually doing them. (3) If money is an issue (and when is it not?) it’s a good idea for your list to include free and low-cost ideas.
- Teach yourself some coping skills (it IS possible!). Order the book DBT Skills Training Handouts and Worksheets (2nd Edition) by Marsha Linehan and look up a topic you struggle with or open it to a random page. Read it and do the related exercise. Practice this exercise for a week – no cheating. (You’d just be cheating yourself out of feeling better.) Pick a different skill each week for a month and see how you feel or if you’ve learned anything about yourself. This book has a very comprehensive index that will allow you to quickly get to the section and the specific skill that will help the most in your current situation. There is also a section that shows you how to identify exactly what you’re feeling (is it depression or is it anxiety? Anger or shame?) and figure out what, if anything, triggered it. Note: I HIGHLY recommend getting the spiral-bound edition; with all of the handouts and worksheets, the Kindle edition isn’t as useful.
- Continue doing the routines you have in place so you feel like there’s a purpose to your day and that you are ready to take it on. Develop a morning routine that’s easy and simple to follow. This can set you up for a good day, and who doesn’t need that? It will help you feel productive, put you in a good mood, and give you a reason to get out of bed. Feel free to experiment and consider using different routines throughout the day to help you keep moving forward.
The sky’s the limit! Think of as many distractions, challenging statements, resources for your Safety Plan, etc. as you can. And remember to be flexible. If what you come up with is not helping, you can always change it or add on to it as the days and weeks pass.
Keep a working copy of these strategies on your desktop and/or your phone for easy access. Look them over even on the days you feel okay. Think of them as insurance policies against your depression coming back or getting worse.
YOU CAN DO IT!
There are ways through depression, even for you! Even if all you can do is distract yourself with 2,347 different things each day, that’s better than the alternative – giving up.
You can make it through this, no matter what your depressed brain tells you. For Pete’s sake, you’ve made it this far – you must be doing something right!
There are umpteen million thoughts and actions we can attack our depression with. Some days, we will lose the battle against this disease of the brain. We will fall into the trap of believing we are not worthy of love, compassion, or connection, and we will act accordingly.
But you know what? The more you practice challenging this bullshit, the easier it gets. And, if you practice enough, it will become automatic. Then you have a built-in weapon against one of your most dangerous enemies – untamed thoughts – that will activate itself whenever you need it.
If you’re having a really hard day and you’ve tried everything you can think of but nothing is helping, remember the words of one of the occupational therapists I encountered years ago during one of my many psych unit stays:
“Even if you can’t make it better, try not to make it worse.”
Truer words were never spoken.
Previously Published on Depression Warrior