There may come a time in your life in which the days go by in a monotonous blur. None of the activities that you used to enjoy so much give you any pleasure; nothing excites you; no one makes your pulse race. You feel listless and empty, and perhaps plagued by a vague anxiety and dread. Family members may accuse you of being irritable and snapping at them for no reason, and it's true that at present their demands seem overwhelming. Even the smallest task defeats you: All you really want is to be left alone.
Curiously, when we're depressed, retreat may seem the easiest way out. But health care professionals strongly disagree. If you're feeling hopeless and blue, they say, it's the worst time to be alone with your thoughts. Your reverie will likely be peppered with stinging self-criticism and feelings of worthlessness. Not surprisingly, the increasingly bleak cast to your mental landscape will worsen your mood disorder and sap your remaining energy.
If the scenario above describes your mood and has lasted for two weeks or more, you need to seek professional help: You're in the grip of a punishing depression. Both antidepressants and some forms of therapy can bring you relief. But say you're in treatment and still find it difficult to even get out of bed. The pain of depression has diminished, but you're still distant from your friends and family, since you want nothing more than to close the blinds, pull up the covers, and hunker down.
What can help pull you out of this vicious cycle? For one thing, you can learn to slow the stream of the negative thoughts that darken your mood. But just as important, you can find a way to stay active. Walk the dog, call a friend, work in the garden -- almost anything will help distract you from your dark thoughts. No matter what you do, you can probably expect to feel better.
Choosing some activities that put you in contact with other people is especially important. In his classic book Finding Flow: The Psychology of Engagement with Everyday Life, Mihaly Czikszentmihalyi, a psychologist and researcher who is widely published in the area of work and creativity, explains the benefits of even the simplest encounter with a friend or stranger. "Over and over, our findings suggest that people get depressed when they are alone, and they revive when they rejoin the company of others. Alone a person usually reports low happiness, [little] motivation, low concentration, apathy, and an entire string of negative states such as passivity, loneliness, detachment, and low self-esteem. The moods that people diagnosed with chronic depression have are indistinguishable from those of healthy people, as long as they are in company and doing something that requires concentration. But when they are alone with nothing to do, their minds begin to be occupied by depressing thoughts. This is also true, to a less pronounced extent, of everyone else."
"The reason is that when we have to interact with another person, even a stranger, our attention becomes structured by external demands... By contrast, when we are alone with nothing to do, there is no reason to concentrate... The mind begins to unravel, and soon finds something to worry about."
When you're feeling stuck
As anyone who's been clinically depressed knows, feeling good doesn't come easily -- or quickly. As psychiatrist David D. Burns explains in his book Feeling Good: The New Mood Therapy (Little, Brown and Co.), depressed people often feel that there's nothing they can do to feel better. Nothing seems fun anymore; nothing seems worthwhile. Or else there's so much to do that it's exhausting even to think about. To someone who's depressed, these gloomy thoughts have the force of law.
Of course, some laws deserve to be broken. In Feeling Good, Burns has come up with a very practical plan for people so depressed that the smallest activities -- from taking a shower to eating lunch -- seem beyond their grasp. He suggests keeping a Daily Activity Schedule, a simple but effective tool that can help you organize your day and regain your motivation.
Here's how it works: At the beginning of each day, write down what you'd like to accomplish in each hour. (A daily appointment calendar could be a helpful place to keep these notations.) And what you plan to accomplish, at least until you feel better, may be very basic. From 8 to 9 am, for instance, you may write eat breakfast, balance checkbook, or read the paper. At the end of the day, record what you actually did. Burns further recommends marking each productive activity with an M (for mastery) and each fun activity with a P (for pleasure.) According to Burns, many depressed people do not plan any activities that could give them pleasure; a mix of both practical and pleasurable activities, he says, is important.
After listing your activities you can score them on a scale from 0 to 5. Something really fun or challenging gets a 5; anything dull or simple gets a 1 or 0. You can set different goals that you want to reach each week, raising them slightly each time.
Czikszentmihalyi has also suggested engineering daily activities so that you reap the most rewards from them. Of course, he says, this is easier said than done. "This sounds simple, but the inertia of habit and social pressure are so strong that most people have no idea which components of their lives they actually enjoy, and which contribute to stress and depression," he writes. "Keeping a diary or reflecting on the past day in the evening are ways to take stock systematically of the various influences on one's moods. After it is clear which activities produce the high points in one's day, it becomes possible to start experimenting."
People with an artistic or creative bent don't need to feel at all constricted by a schedule, he adds. "Creative people are especially good at ordering their lives so that what they do, when, and with whom will enable them to do their best work. If what they need is spontaneity and disorder, then they make sure to have that, too."
If you keep your schedule for several weeks or so -- and really try to stick to it -- you may begin to regain a sense of control over the most basic parts of your life. According to Burns, you'll see that you can enjoy yourself and get things accomplished. As he points out, life doesn't seem so overwhelming when you take it one hour at a time.
Exercise: The original antidepressant
If at all possible, make some room in that schedule for some exercise. According to a report in The Physician and Sports Medicine, exercise is a potent remedy for depression. A walk around the neighborhood or a good swim can enhance self-esteem, provide a sense of accomplishment, and burn pent-up anger and stress. Exercise may also boost the brain's supply of serotonin, mimicking the effects of Prozac and many other antidepressants.
If you haven't had much exercise lately, take it slow at first. Your doctor can help you find an exercise program that's right for you.
Whether you decide to go for a jog or read a book, remember: Something is much better than nothing. Whatever it takes, try to resist the temptation to curl up and hide. Depression may drain your energy, but it doesn't have to bring your life to a halt.
National Institute of Mental Health 5600 Fishers Lane Rockville, MD 20857
National Foundation for Depressive Illness, Inc. P.O. Box 2257 New York, NY 10016
Beck, Aaron T., MD. Cognitive Therapy and the Emotional Disorders. Penguin.
Feeling Good: The New Mood Therapy. David D. Burns, MD. Avon Books9.
Artal M. Exercise against depression. The Physician and Sports Medicine. Vol 26(10)
National Institute of Mental Health. Depression. http://www.nimh.nih.gov/publicat/depression.cfm
Mayo Clinic. Depression. http://www.mayoclinic.com/health/depression/DS00175