Tag: Depression

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Persistent Depression Disorder: 13+ Hard Truths About PDD Most People Don’t Understand

This article summarizes a deeply personal conversation featured on the Giving Voice to Depression podcast, hosted by Terry McGuire. In each episode, Terry speaks with someone who has lived experience of depression or a mental health professional working in the field. In Episode 356: “Living at 60%: A Raw Look at Persistent Depression” guest Lori shares her story of living with persistent depressive disorder (PDD), offering honest insight into what it’s like to survive—not thrive—on a daily basis.

Unlike the more episodic nature of major depressive disorder, PDD is a chronic, long-lasting form of depression, often described as living life through a heavy, emotional fog. Lori’s reflections are raw and real, shedding light on the misunderstood experience of “high-functioning” depression. Below are the key takeaways and hard truths Lori reveals about this condition.

1. Persistent Depression Is Not Just “Sadness” That Won’t Go Away

PDD isn’t about feeling low occasionally—it’s about feeling low always. Lori has lived in a nearly constant state of depression for nine years, with the occasional major depressive episode layered on top. This overlapping experience is sometimes called “double depression.”

“I’m not, you know, laid out flat where I just can’t function. But it feels like that’s kind of where I stopped, but I’ve never truly regained the emotional feelings of what it feels like to be out in the sunshine like normal.” – Lori

2. People With PDD Can Still Function—But It Comes at a High Cost

Lori explains she operates at about 60% of her capacity most days. To outsiders, she may appear functional, but internally, every task requires immense effort.

  • She finds herself completely drained, whether or not she worked that day.
  • Even pleasant activities are exhausting.
  • Smiling or participating in joyful moments feels performative, not genuine.

“I can do things…but it’s still really hard and I just have to push myself to keep going because I have to. I mean, I don’t have a choice.” – Lori

3. Starting at 60% Means You’re Already Close to the Bottom

Living at 60% makes you more vulnerable to the lows. A minor setback can plunge someone dangerously close to the pit of depression. This constant proximity to the edge is one of the most harrowing realities of PDD.

“It’s scary because you’re closer to the bottom… So just maybe sometimes even a little swing can make a dramatic difference in how much I’m able to function because it’s like starting out underwater.” – Lori

4. Joy Feels Muffled—Like You’re Underwater

In one of the most powerful metaphors of the episode, Lori likens her experience of depression to listening to music underwater. You know the song is beautiful, but you can’t really hear it.

“So like, say I’m doing something with my kids … I can know that I should be feeling joyful about it, like this is a joyous occasion. I know what it should be. I just can’t get there” – Lori

5. Morning Is the Hardest Part of the Day

For Lori, every morning begins with despair. It’s not about needing more sleep. It’s about not having the will to face another day of heavy emotional labor.

“Every single morning I wake up and I’m really disappointed that I woke up again… it feels like I have a beanbag chair full of lead on top of me. It’s like, I’m awake and I can’t … I can’t do anything.” – Lori

6. Passive Suicidal Ideation Is Real and Misunderstood

Lori’s experience includes passive suicidal ideation—not active planning, but a consistent, draining wish to “just not wake up.” This type of ideation is often overlooked or minimized.

  • It’s not a desire to die.
  • It’s a desire for the pain to stop.
  • It’s a yearning for rest from a relentless internal struggle.

7. Depression Isn’t Always Visible—Or Obvious

Lori’s story reinforces how well people with chronic depression can mask their struggles. To outsiders, they may appear fine—cheerful, even productive. But appearances can be deceiving.

“You fake it well enough that someone who doesn’t know you wouldn’t know.” – Terry McGuire, describing the hard-to-see nature of Lori’s depression

8. Well-Meaning Advice Can Do More Harm Than Good

Friends and loved ones often try to help, but the impulse to fix or minimize the issue often backfires. Common phrases like:

  • “Still?! I thought you were better.”
  • “Well, you look fine.”
  • “Maybe try adjusting your meds again.”

…can feel dismissive, invalidating the chronic nature of the illness.

“So to try to fix things is just really, really hard to have people suggest … If there was anything, anything that I could do, you know I would do it.” – Lori

9. Support Is About Validation, Not Fixing

The best support isn’t about solutions—it’s about acknowledging the struggle. Lori stresses how powerful it is when someone simply recognizes her effort to stay afloat.

  • Say: “That sounds so hard. Props to you for showing up anyway.”
  • Avoid: “Have you tried XYZ?”

10. Hope Can Feel Impossible—But Curiosity Might Be Enough

Telling someone with chronic depression to “stay hopeful” can feel cruel. But offering them the idea of staying curious can be more accessible and effective.

“Years ago a guest said, you don’t have to be hopeful about your future, but try to be at least a little curious—and that can be enough.” – Terry McGuire

11. Persistent Depression Deserves Its Own Diagnosis and Compassion

Dr. Anita Sanz, the podcast’s former co-host and a psychologist, emphasizes that persistent depressive disorder is not a failure of treatment or effort. It’s a legitimate, chronic mental illness that demands acknowledgment and compassion.

  • It’s not caused by a failure to try hard enough.
  • It’s not due to ineffective therapy or medication alone.
  • It’s its own category, deserving of understanding and patience.

“It is not milder in the sense of the impact on the person… because it can just literally feel like you’re being worn down.” – Dr. Anita Sanz

12. Even Enjoyable Activities Can Be Exhausting

Socializing, hobbies, or special occasions may seem like a break from depression—but for someone with PDD, even positive interactions can feel like another task.

  • Lori often agrees to activities for her own good.
  • But when the time comes, she regrets committing.
  • The guilt and self-judgment compound the emotional load.

13. Change Is Possible—But It May Be Subtle

While Lori’s condition didn’t disappear, she did attend a treatment program that made a noticeable shift. She now no longer dreads waking up, even if mornings are still difficult.

  • The change was subtle—but significant.
  • It proves that things can shift, even if healing doesn’t look like a complete recovery.

“[Lori] will tell us she no longer goes to bed dreading waking. And when she wakes, while it’s still difficult physically and mentally to get up and get the day started, it’s not because she wishes she hadn’t waken. [Her treatment] did effect a shift.” – Terry

+1: Just Stay—Even If It’s Just One Day at a Time

A central takeaway from Lori’s story and Terry and Anita’s reflections is that sometimes staying alive and continuing to show up is the hardest and most courageous thing a person can do. It might not get better right away—but staying alive means you’re here if it does.

  • Focus on just getting through today.
  • Be kind to yourself in the hardest moments.
  • Understand that managing chronic depression is a full-time job.

“The most important thing is to stay so that you’re here to see the shift. And that’s what we always come back to is, please stay, that’s the most important thing. And then the next most important thing is, let’s not make staying be so miserable because that’s not okay either. I don’t want you to stay and be miserable. I want you stay and have life be actually something worth feeling like it’s worth living. And so then we go from there.” – Dr. Sanz

Final Thoughts

Living with persistent depressive disorder (PDD) isn’t about surviving a rough patch—it’s about enduring a constant emotional weight that never fully lifts. As Lori shares in her courageous and unfiltered interview, the experience isn’t defined by dramatic breakdowns or total dysfunction, but rather by the exhausting, relentless effort it takes to maintain a semblance of normalcy while feeling internally disconnected from joy, motivation, and hope.

This kind of depression can be deeply isolating. When the world expects smiles, productivity, and gratitude, living at 60% feels like you’re failing to meet invisible standards—standards that don’t apply to a chronic mental health condition. Lori’s honesty gives voice to an experience that many silently endure: waking up disappointed to still be here, pushing through the day without access to joy, and feeling invisible because you “look fine.”

But her story also reminds us that even subtle shifts—like no longer dreading the morning—are worth acknowledging and celebrating. While recovery might not mean a return to 100%, it can mean finding better tools, support, and moments of relief.

The most important takeaway? We need to believe people when they say they’re struggling, and support them in ways that emphasize presence, compassion, and endurance—not quick fixes or false optimism.

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Sadness vs Depression: 10 Key Ways to Tell The Difference 

This in-depth exploration is inspired by the Giving Voice to Depression podcast, hosted by Terry McGuire. The podcast serves as a platform to foster open conversations about mental health, recognizing the importance of addressing conditions like depression with clarity and empathy. In this episode, a critical yet often misunderstood topic takes center stage: the distinction between sadness and clinical depression.

The ability to differentiate between these two states is paramount. Misunderstanding can lead to the dismissal of a serious mental health condition, preventing individuals from seeking the help they need. Conversely, it can also result in unnecessary alarm and overreaction to transient emotional experiences that are a normal part of life. 

To navigate this complex terrain, the podcast features insights from respected experts in the field: Dr. Robert Duff, Dr. Margaret Rutherford, and Dr. Maduka Trivedi, each offering valuable perspectives rooted in their clinical experience and research.

1. Defining Depression: Beyond the Common Usage

Dr. Robert Duff, a psychologist, begins by dissecting the common understanding of “depression.” In everyday language, the term is frequently used to describe a temporary state of feeling down, discouraged, or simply “blue.” These feelings are a natural part of the human experience and can be triggered by various life events, from minor disappointments to significant losses. However, Dr. Duff emphasizes the crucial distinction between this transient sadness and clinical depression.  

Clinical depression, he explains, is characterized by a persistent pattern of these negative feelings. It’s not just a fleeting moment of sadness but a prolonged state that can encompass a range of emotional, physical, and cognitive symptoms. These symptoms can include persistent sadness, loss of interest or pleasure in activities, changes in appetite or sleep, fatigue, feelings of worthlessness, difficulty concentrating, and even thoughts of death or suicide. The key differentiator lies in the duration, intensity, and pervasive nature of these symptoms, and the degree to which they significantly interfere with an individual’s daily life and overall functioning.  

“You can feel depressed without being depressed, right?

Without being clinically depressed.

Depression is a feeling that everybody has of being sad, of feeling like the wind’s taken out of your sails, maybe being lethargic, things like that.

But with clinical depression, it’s a pattern of those feelings.”  

2. Depression as a Real and Tangible Illness

One of the most important messages conveyed in the podcast is that clinical depression is a real and diagnosable mental illness. It’s not simply a matter of lacking willpower, being overly sensitive, or failing to “snap out of it.” Dr. Duff firmly states that there are actual physiological differences in the brain of a person experiencing depression.  

Research has shown that depression is associated with changes in neurotransmitter activity, brain structure, and hormonal function. These biological factors contribute to the symptoms of depression and explain why treatments such as medication and psychotherapy can be effective. The podcast emphasizes that recognizing depression as a legitimate illness is crucial for reducing stigma and encouraging individuals to seek help without shame or self-blame.  

3. The Insidious Nature of Depression: A Parasitic Force

Dr. Duff offers a powerful analogy to illustrate the insidious nature of depression, comparing it to a parasite. He explains that depression has a way of draining an individual’s energy, perpetuating a cycle of guilt and negativity, and distorting their self-perception.  

Depression often leads to lethargy and a lack of motivation, making it difficult to engage in activities that typically bring joy or a sense of accomplishment. This inactivity can then lead to feelings of guilt and worthlessness, further deepening the depression. Moreover, depression can warp a person’s thoughts, causing them to develop negative beliefs about themselves, their abilities, and their future. This “cognitive distortion” is a hallmark of depression, and it can be incredibly challenging to overcome without intervention.  

“I like to think of depression kind of as a parasite because it does all of the things to you that it needs to keep itself strong.

It saps your energy, so it makes you feel more lethargic, which makes you not do things, which makes you feel more guilty, which make you feel more depressed, and so it goes in a cycle and it builds itself up and up.”  

4. Triggers and Duration: Key Distinguishing Factors

Dr. Margaret Rutherford, another experienced psychologist, highlights the importance of considering triggers and duration when differentiating between sadness and depression.  

Sadness is often a direct response to a specific event or situation. It might be triggered by a disappointment, a loss, a conflict, or a challenging life transition. While sadness can be intense and painful, it tends to be time-limited. The intensity of the emotion gradually subsides, and the individual is able to return to their normal level of functioning.  

In contrast, depression can sometimes arise without an identifiable external trigger. While it can certainly be precipitated by a traumatic event or significant loss, it can also develop gradually or seemingly out of the blue. Furthermore, depression is characterized by its persistence. The feelings of sadness, hopelessness, and despair linger for weeks, months, or even years, significantly impacting the individual’s ability to function in daily life.  

5. The All-Encompassing Impact of Depression

Depression is not confined to just one aspect of an individual’s experience; it can be all-encompassing, affecting their emotional state, physical health, thoughts, and behaviors.  

Bridget, the podcast’s co-host, uses the word “consumed” to describe the feeling of being overwhelmed by depression. Dr. Rutherford adds that it can feel as though one “forget[s] how to be happy.” This highlights a crucial aspect of depression: it can significantly impair an individual’s capacity to experience positive emotions. It’s not that the desire for happiness is absent, but rather that the brain’s ability to process and generate those feelings is compromised.  

6. Depression Is Not a Choice: Dispelling Misconceptions

A common misconception about depression is that it’s a matter of choice, that individuals could simply “choose” to be happier if they wanted to. The podcast strongly refutes this notion.  

Dr. Rutherford emphasizes that people with depression are not “whiners” or simply feeling sorry for themselves. Depression is a distinct “state of mind” characterized by changes in brain function that affect mood regulation, motivation, and cognitive processes. The inability to experience joy or find pleasure in activities is a core symptom of depression, and it’s not something that can be overcome through sheer willpower.  

“People with depression are not whiners.

They’re not just feeling sorry for themselves. It is a state of mind.

It’s as if you can’t focus on whatever you had in your life that you enjoyed, you no longer enjoy it, and that’s not a choice.

That’s the reality of how you feel.”  

7. The Role of Genetics in Depression

The podcast also touches on the role of genetics in depression. Dr. Rutherford explains that there is often a “genetic predisposition” for depression.  

Just as individuals can inherit a predisposition for other medical conditions, such as diabetes or cancer, they can also inherit a vulnerability to depression. This means that if a person has a family history of depression, they may be at an increased risk of developing the illness themselves. It’s important to note that having a genetic predisposition does not guarantee that someone will develop depression, but it can make them more susceptible.  

8. Depression as a Cloud: A Distorted Perspective

Dr. Maduka Trivedi, head of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center, offers a powerful metaphor to describe the impact of depression on an individual’s perception. He likens depression to a “cloud hanging over your head.”  

This cloud distorts thoughts, feelings, and experiences, casting a negative filter over everything. Even in the presence of positive events or experiences, the cloud of depression can make it difficult to feel joy or find relief from negative thoughts. Dr. Trivedi contrasts this with normal sadness, where positive events can provide temporary respite from negative feelings. In depression, however, the negative thoughts and feelings are pervasive and unrelenting.  

“So I think in general the way I explain to lay people is the following: all of us can have ups and downs in life and when you have a down period you do feel down but there are two easy signals that we tell you.

One is even when you are feeling down if there is some positive thing happening in your life or some positive event occurring or somebody … a loved one calls you, you temporarily or even sometimes immediately get out of that funk and start sort of communicating like you were before.

If you have a small-d depression … a sort of bad day.

If you have Depression it is very hard to do that because your ruminative negative thoughts just overtake no matter what the environment is.”  

9. The Importance of Acknowledging Depression as a Real Illness

Dr. Trivedi emphasizes the critical importance of acknowledging depression as a real illness. He stresses that it is a “brain disease” with distinct and identifiable signs and symptoms.  

Dismissing depression as “just feeling sad” or telling people to “get over it” is not only insensitive but also harmful. It invalidates the individual’s experience and discourages them from seeking the help they need. Dr. Trivedi asserts that depression is not a “weakness” or a character flaw. It is a medical condition that requires understanding, compassion, and appropriate treatment.  

10. Key Symptoms of Depression: A Comprehensive Overview

The podcast references a list of key symptoms of depression, drawing from resources like WebMD. These symptoms provide a more detailed understanding of the multifaceted nature of depression:  

  • Depressed mood: This involves persistent feelings of sadness, emptiness, or hopelessness. It’s more than just a passing feeling of sadness; it’s a pervasive and enduring state.  
  • Loss of interest or pleasure: One of the hallmark symptoms of depression is a significant decrease in interest or pleasure in activities that were once enjoyable. This can affect hobbies, social activities, work, and even relationships.  
  • Significant weight changes: Depression can lead to changes in appetite, resulting in significant weight loss when not dieting or significant weight gain.  
  • Sleep disturbances: Depression can disrupt sleep patterns, causing insomnia (difficulty sleeping) or hypersomnia (excessive sleeping).  
  • Restlessness or slowed movements: Some individuals with depression experience psychomotor agitation, characterized by restlessness or irritability. Others may experience psychomotor retardation, a slowing down of physical movements and speech.  
  • Fatigue or loss of energy: Persistent fatigue and a lack of energy are common symptoms of depression.

In conclusion, this exploration, deeply rooted in the insights of the Giving Voice to Depression podcast, underscores the vital importance of distinguishing between transient sadness and the pervasive condition of clinical depression. Depression is not simply an amplified version of sadness but a distinct and serious illness that can profoundly impact every facet of an individual’s life. 

By recognizing the key differences in triggers, duration, intensity, and the presence of accompanying symptoms, we can move towards a greater understanding of mental health and foster a more supportive environment for those who are struggling. If you or someone you know is experiencing symptoms of depression, seeking professional help is a critical step towards recovery and well-being.

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How to Deal With Depression: 9 Proven Recovery Methods

Depression can feel like an invisible weight, making even the simplest tasks seem overwhelming. If you’re wondering how to deal with depression, you’re taking an important first step—and effective help is available. 

Recovery from depression is entirely possible through a combination of professional treatment, self-care strategies, and support from others. Here, we outline 9 proven strategies that have helped countless people living with depression reclaim their mental well-being. 

Illustration featuring the quote 'Depression tries to convince you that you’re the storm — but you’re really the one weathering it,' with an image of a sad person standing under rain, imagining an umbrella.

1. Understand the Condition: Recognizing Depression’s Impact

Depression is a common and serious mental health condition that affects how you feel, think, and handle daily activities. Globally, depression impacts 5% of the adult population1 and 13% of adolescents. Also known as major depressive disorder or clinical depression, it can cause persistent feelings of sadness, hopelessness, and a loss of interest in activities once enjoyed.

Adolescents can be especially vulnerable to depression due to hormonal changes, academic and social pressures, identity development, and increasing exposure to social media and cyberbullying. For teens, the prevalence of major depressive episodes2 was also higher among females at 29.2%.

Dr. Kay Redfield Jamison, a clinical psychologist and professor of psychiatry at Johns Hopkins University who has written extensively about her own experience with bipolar disorder and depression, shares in her memoir An Unquiet Mind:3

Depression is awful beyond words or sounds or images. It bleeds relationships, blanches pleasure, eats memory, peace and self-respect.

While it can be one of the most challenging mental health conditions, when we understand what depression is and other aspects, it can help support long-term and sustained recovery.

Infographic titled 'How to Start Small When You Have Depression,' featuring simple coping strategies like opening a window, drinking a glass of water, putting on clean socks, stepping outside for one minute, brushing teeth, writing down one feeling, playing one calming song, and sitting up in bed. Includes an illustration of a person sitting under a raincloud holding a checklist.

2. Assess Personal Risk Factors: Customizing Your Recovery Approach

Depression is a complex mental health condition that can affect individuals of any age, gender, background, or income level. However, certain factors may increase the risk of developing depression:​

  • Family history of mental illness or mental health problems: Individuals with a family history of depression or other mental disorders are at a higher risk of experiencing depression themselves. ​
  • Chronic medical conditions: Living with chronic illnesses,4 such as heart disease, can elevate the likelihood of developing depression.
  • Exposure to trauma: Experiencing traumatic events,5 especially during childhood, significantly increases the risk of depression.
  • Substance use: The misuse of substances6 like alcohol and drugs is closely linked to the onset and severity of depression.

Understanding these risk factors is crucial for early identification and intervention, which can lead to more effective management and treatment of depression.

How has managing depression—either personally or professionally—shaped your understanding of mental health and well-being?

As a trauma therapist, I’ve learned that depression often isn’t just a chemical imbalance; it’s a nervous system response to overwhelm, loss, or disconnection. Professionally, supporting clients through depression has deepened my belief that healing comes through safety, self-compassion, and co-regulation. It’s taught me to honor slowness and softness as valid forms of strength.

Amanda Stretcher, MA, LPC-S | Crescent Counseling

3. Identify Your Depression Type: Targeting the Right Treatment

There are several types of depression, each with distinct characteristics:

  • Major depressive disorder (MDD): Severe symptoms that interfere with daily life. MDD is characterized by a persistently low mood, anhedonia (loss of interest or pleasure), feelings of guilt or worthlessness, fatigue, and other symptoms that impair daily functioning.7 Diagnosis requires at least 5 symptoms present most of the day, nearly every day, for a minimum of 2 weeks. It’s one of the leading causes of disability worldwide.
  • Persistent depressive disorder: Long-term (2 years or more) symptoms that may be less severe but still disabling. This chronic form of depression8 involves a depressed mood lasting for at least 2 years in adults (one year in children and adolescents), accompanied by additional depressive symptoms that may not meet the criteria for MDD but still cause significant distress.
  • Bipolar disorder: Involves episodes of depression9 alternating with mania. Bipolar disorder includes episodes of depression alternating with periods of mania or hypomania. The depressive episodes share similarities with MDD, but the presence of manic symptoms distinguishes bipolar disorder from unipolar depression.
  • Postpartum depression: Occurs after childbirth. This type of depression occurs after childbirth, characterized by sadness, fatigue, changes in sleeping and eating patterns, reduced libido, and crying episodes. It’s more severe and longer-lasting than the “baby blues.”
  • Seasonal affective disorder (SAD): Related to changes in seasons, typically starting in the fall or winter. SAD is a subtype of depression10 that occurs at a specific time of year, usually in the fall or winter, and remits in the spring. Symptoms include low energy, hypersomnia, overeating, weight gain, and craving for carbohydrates.
Infographic titled 'Change the Script: Reframing Your Thoughts in Depression,' showing examples of shifting negative thoughts like 'I'm lazy' to 'I'm struggling' and 'I'm weak' to 'I'm surviving something hard,' alongside an illustration of storm clouds parting to reveal sunshine.

4. Monitor Your Symptoms: Tracking Progress for Effective Recovery

Persistent Feelings of Sadness or Hopelessness

This isn’t just “feeling down” for a day or 2. It’s a heavy, lingering sadness that doesn’t seem to lift, even when good things happen. You might wake up with a pit in your stomach or go to bed feeling like nothing will ever get better. Hopelessness can feel like your future has disappeared into fog.

Loss of Interest in Hobbies and Activities

Things that once brought you joy—music, cooking, hiking, spending time with friends—start to feel meaningless. You might force yourself to participate, but it feels like going through the motions. It’s not laziness; it’s as if your connection to pleasure has been cut off.

What treatment strategies or coping tools have you found most effective in reducing symptoms of depression and improving day-to-day life?

In order to effectively treat symptoms of depression, evidence-based treatment suggests engaging in behavioral activation. This is activating one’s brain through different activities, specifically geared towards enjoyable, valuable, and routine activities. When someone becomes depressed, there is decreased brain activity, so it is helpful for one to engage different parts of their brain through several types of activities. Will this cure depression? No, but this will help activate the brain into a non-depressed state for a temporary period of time, which, over time, will help to lift one’s mood overall.

Jennifer Chicoine, MA, LCPC | Peaceful Healing Counseling Services

Sleep Problems (Insomnia or Oversleeping)

You might lie awake for hours, exhausted but wired with worry. Or, sleep might become your escape, and even after 10–12 hours, you still feel tired. Either way, it disrupts your rhythm and makes the days feel even harder to face.

Weight Loss or Weight Gain

Your appetite may vanish entirely, or food might become a form of comfort. You may notice clothes fitting differently, but not care enough to do anything about it. These changes can be subtle or dramatic, but they often reflect deeper emotional shifts.

Fatigue or Low Energy

This isn’t just being tired—it’s like your body has run out of fuel. Even small tasks, like taking a shower or replying to a text, can feel overwhelming. It’s frustrating because you want to do more, but the energy simply isn’t there.

Difficulty Concentrating

Reading a book or following a conversation can feel like trying to think through fog. Your brain just won’t focus. You may find yourself rereading the same sentence or zoning out in meetings, which adds to feelings of guilt or inadequacy.

Feelings of Worthlessness or Guilt

You might start believing you’re a burden or that you’ve let everyone down. Even small mistakes can spiral into overwhelming self-criticism. These thoughts don’t come from truth—they come from depression distorting your self-image.

Thoughts of Self-Harm or Suicidal Thoughts

In the darkest moments, depression can convince you that the world would be better off without you. These thoughts are serious and require compassionate, immediate support. You’re not alone, and help is available—even if it’s hard to ask.

These symptoms must last for at least 2 weeks to be considered a depressive episode.
But if you’re experiencing even one or 2 of these symptoms persistently, it’s worth talking to a mental health professional. If you are having thoughts of self-harm or suicidal ideation or thoughts, please reach out for emergency medical care. You are not alone.

The 988 Lifeline is a resource for you at any time of the day, every day of the week.

5. Identify Root Causes: Understanding Depression’s Origins

Depression results from a combination of genetic, biological, environmental, and psychological factors. Common causes and risk factors include:

  • Imbalances in brain chemicals like serotonin
  • Traumatic life events or prolonged stress
  • Chronic medical conditions or pain
  • Substance use or withdrawal
  • Low self-esteem or negative thoughts
  • Family history of mental health conditions

What message would you share with someone currently experiencing depression who may feel hopeless or unsure about seeking help?

People often mistake sadness for depression. The capacity to feel sad when experiencing a loss of some kind is emotionally healthy. Sadness, like all emotions, has a rhythm of its own and will pass in time. Depression, however, is emotional constipation, i.e., being numb, detached, and unable to feel sad, and it is very responsive to a ‘laxative’, or treatment, such as psychotherapy. For someone who is unsure about seeking help, the best way to find a good therapist is to start by asking trusted friends and family if there is someone with whom they’ve had a good experience. I recommend that you get a few names and meet with those therapists until you find what feels like a good fit for you.

Avrum Weiss, PhD

6. Seek Proper Diagnosis: Working With Healthcare Professionals

A health care provider or mental health professional diagnoses depression by evaluating your symptoms, personal history, and mental well-being. Tools like the PHQ-9 questionnaire may be used, and blood tests may help rule out underlying medical conditions.

  • Self-report questionnaires: These are completed by the individual and ask about the presence and severity of depressive symptoms over a specific period (usually the past 2 weeks).  
  • Patient Health Questionnaire-9 (PHQ-9): This is a widely used, brief, 9-item self-report questionnaire. It directly corresponds to the DSM-5 criteria for major depressive disorder. It helps in diagnosing depression, assessing its severity (minimal, mild, moderate, moderately severe, severe), and monitoring treatment response. A score of 10 or higher is often used as a cut-off for indicating clinically significant depression. The PHQ-2, a shorter 2-item version, is often used as an initial screening tool.  
  • Beck Depression Inventory (BDI): This 21-item self-report inventory assesses the severity of depressive symptoms. Individuals rate the presence of various symptoms on a 0-3 scale. Higher total scores indicate more severe depression. It’s suitable for individuals aged 13 to 80 and has been validated across various populations.  
  • Center for Epidemiologic Studies Depression Scale (CES-D): This 20-item questionnaire was initially designed for use in the general population but is also used in primary care settings to screen for depressive symptoms. It asks about the frequency of symptoms in the past week, rated on a 4-point scale. It can be used for a wide age range, including children.
  • Edinburgh Postnatal Depression Scale (EPDS): This 10-item self-report questionnaire is specifically designed to screen for depression in women after childbirth. It asks about symptoms experienced in the past week.  
  • Geriatric Depression Scale (GDS): This scale is specifically designed for older adults (60 years and over). It is available in different lengths (e.g., 30-item, 15-item, and a shorter 4-item version) and typically uses a yes/no format for responses, making it easier for some older individuals to complete.  
  • Clinician-administered rating scales: These scales are administered through structured interviews conducted by a healthcare professional. 

Many behavioral healthcare providers use the DSM-5-TR to provide diagnostic criteria. For example, here is an example of the criteria for major depressive disorder.11

A diagnosis requires the presence of 5 or more of the following symptoms during the same 2-week period, with at least one of the symptoms being either depressed mood or loss of interest or pleasure: 

  1. Depressed mood most of the day, nearly every day
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day  
  3. Significant weight loss or weight gain (when not dieting or an increase/decrease of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day  
  4. Insomnia or hypersomnia nearly every day
  5. Psychomotor agitation or retardation nearly every day (observable by others.  
  6. Fatigue or loss of energy nearly every day
  7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and not be due to the direct physiological effects of a substance or another medical condition.  

It’s important to note that while these tools are valuable for screening and assessing the severity of depressive symptoms, a diagnosis of depression should always be made by a qualified healthcare professional based on a comprehensive evaluation, including a clinical interview, the individual’s history, and the consideration of other potential medical or psychological conditions.

Screening tools help identify individuals who may need further evaluation and support from a trained medical or treatment professional.

7. Explore Treatment Options: Finding Your Path to Recovery

Psychotherapy (Talk Therapy)

  • Cognitive behavioral therapy (CBT): CBT is a widely used form of therapy that helps individuals recognize and change negative thought patterns and behaviors. It’s especially effective in treating mild to moderate depression and can prevent relapse. Research supports CBT as one of the most effective interventions for depression.12
  • Interpersonal therapy (IPT): IPT helps people improve communication and relationships, often disrupted by depression. It focuses on current interpersonal issues like grief, role transitions, or conflicts.
  • Behavioral activation: This approach encourages individuals to engage in meaningful activities to increase positive reinforcement and reduce avoidance, a common symptom of depression.

Medication (Antidepressants)

Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are commonly prescribed and have been shown to relieve symptoms in people with moderate to severe depression.

The National Institute of Mental Health highlights that antidepressants can take 4-8 weeks to work13 and should be closely monitored by a healthcare provider.

Lifestyle Changes and Self-Care

  • Regular exercise: Exercise boosts endorphins and supports neurogenesis, or the growth of new brain cells. It can be as effective as medication for mild depression.
  • Sleep hygiene: Improving sleep routines can help stabilize mood and reduce depressive symptoms. Going to bed and waking up at the same time each day is a good place to start.
  • Nutrition: A balanced diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids supports brain health. Some studies suggest that dietary interventions may reduce depressive symptoms.

Social Support

  • Group therapy and peer support: Talking with others facing similar struggles can reduce isolation and increase motivation. Group settings also allow for shared coping strategies.
  • Family involvement: Involving supportive family members in the recovery process can improve outcomes and ensure a more stable environment.

Advanced and Emerging Treatments

  • Mindfulness-based cognitive therapy (MBCT): MBCT combines mindfulness techniques with cognitive therapy to reduce relapse in those with recurrent depression.
  • Transcranial magnetic stimulation (TMS): TMS uses magnetic pulses to stimulate areas of the brain associated with mood regulation. It’s FDA-approved for treatment-resistant depression.
  • Ketamine and esketamine (Spravato): These medications offer rapid relief of symptoms and are typically used when other treatments haven’t worked. They must be administered under medical supervision.

8. Practice Prevention Strategies: Building Mental Health Resilience

Can I prevent depression?

While you can’t always prevent depression, there are ways to reduce your risk. Building up protective factors can help build resilience for this condition. However, often times, treatment is needed for long-term recovery and positive outcomes.

These are a few healthy coping strategies that you can try:

  • Stay connected with a support group or loved ones
  • Manage stress through mindfulness14 or gratitude practices
  • Maintain a healthy lifestyle with regular exercise and good nutrition
  • Seek help early when experiencing symptoms
  • Avoid alcohol and drug use, which can worsen mental health

With proper treatment and support, most people recover from depression. However, it can be a recurring condition, and managing long-term well-being is key. Early intervention improves outcomes, and ongoing support can help prevent relapse.

9. Develop Daily Management: Living Well Despite Depression

When should I see my healthcare provider about depression?

Depression isn’t just feeling sad—it can affect every part of your life. If you’re not sure when to ask for help, here are some key signs it’s time to reach out to a doctor, counselor, or mental health professional:

You should see your healthcare provider if:

  • Symptoms last more than 2 weeks. Things like persistent sadness, fatigue, or loss of interest in activities you used to enjoy.
  • You’re struggling with daily life. This might look like trouble at work, in relationships, or just keeping up with basic self-care.
  • You have thoughts of self-harm or suicide. These thoughts are serious and deserve immediate attention. You are not alone, and help is available.

You are not alone. Many people—just like you—face depression. Healing is possible. And reaching out is a brave and important step toward recovery. Talk to someone you trust—a friend, pastor, or mentor—and let them know how you’re feeling.

Schedule an appointment with a primary care provider or therapist. You don’t need to have all the answers—just take the first step. Use support resources if you’re in immediate danger or need someone to talk to.

If this sounds like what you’re going through, take one small step today. Reach out to a professional or supportive friend. You are worth it. And help is just a conversation away.

FAQs

Q: What are the best ways to deal with depression?

A: Effective treatment for depression often includes a combination of therapy, antidepressant medications, physical activity, and support from loved ones. Working with a mental health professional can help you develop a personalized plan that addresses your specific needs.

Q: What triggers depression?

A: Depression can be triggered by a range of factors, including genetics, traumatic life events, chronic stress, substance use, medical conditions, and imbalances in brain chemistry, such as low serotonin levels.

Q: How to get out of depression naturally?

A: Some people find symptom relief through natural approaches like regular exercise, mindfulness meditation, healthy eating, sleep routines, and maintaining social connections. While these can be helpful, severe depression often requires professional treatment.

Q: How do you cope with a depressed person?

A: Offer support by listening without judgment, encouraging them to seek help, and being patient. Avoid trying to “fix” them. Suggest professional resources like a mental health provider or the 988 Lifeline.

Q: What are the symptoms of depression?

A: Common symptoms include persistent sadness, loss of interest, fatigue, changes in sleep or appetite, difficulty concentrating, and thoughts of self-harm or suicide.

Q: What are the different types of depression?

A: Types include major depressive disorder, persistent depressive disorder, postpartum depression, seasonal affective disorder, and bipolar disorder (which includes depressive episodes).

Q: What is the link between smoking and mental health conditions?

A: Smoking is more common among people with mental health conditions and may temporarily relieve stress, but it often worsens mental illness symptoms over time and is linked to higher rates of depression.

Q: What is substance use disorder?

A: Substance use disorder (SUD) is a mental health condition characterized by the uncontrolled use of substances, such as drugs or alcohol, despite harmful consequences. SUD often co-occurs with depression.

Q: When should I call my healthcare provider?

A: Call if you notice depression symptoms lasting more than 2 weeks, if they interfere with daily life, or if you or a loved one has suicidal thoughts.

Q: How can I help a loved one who is depressed?

A: Be present, listen with compassion, encourage professional help, and check in regularly. Avoid minimizing their pain. Share resources like the 988 Lifeline or a mental health provider.

Q: Can exercise help alleviate depression symptoms?

A: Yes. Studies show that regular physical activity boosts mood, reduces anxiety, and supports long-term mental health by increasing endorphins and serotonin.

Q: Are there effective self-help strategies for managing depression?

A: Yes. Journaling, setting small daily goals, practicing gratitude, and limiting social media use can support emotional well-being.

Q: Are there lifestyle changes that can help alleviate depression?

A: Yes. Healthy nutrition, consistent sleep, reducing alcohol and substance use, and nurturing social relationships can all help improve mental health and ease depression symptoms.

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Maria’s Path to Peace: 7 Steps Towards Mental Health Recovery

Maria’s journey through the depths of depression and anxiety offers a powerful testament to the transformative potential of seeking recovery for mental health challenges. Her story, filled with raw honesty and hard-won wisdom, illuminates the path toward healing and a more fulfilling life. From the darkness of suicidal thoughts to the radiant joy of pursuing her dreams and finding true love, Maria’s experience underscores the profound impact of prioritizing self-care and embracing vulnerability. Her insights provide a beacon of hope for anyone grappling with similar struggles, offering practical steps and a message of profound self-acceptance.

1. Recognizing the Need for Change

Maria’s turning point came during her “lowest part of my life,” entangled in a toxic relationship marked by “cheating” and “emotional abuse.” She realized she was relying on her partner to be her savior, a burden no one person can truly bear. This pivotal moment of recognizing the unsustainability of her situation and the depth of her despair was the catalyst for seeking help.

2. The Life-Changing Decision to Seek Therapy

The suggestion from her partner to seek therapy, born out of a moment of crisis, proved to be the “decision that changed everything.” Maria emphasizes the vital role her therapist played in helping her navigate out of the toxic relationship and onto a path of healing. She says, “That therapist helped me get out of that relationship, believe it or not, and I was able to find the right medication dose that was right for me.” Therapy provided her with a safe space to process her emotions, gain perspective, and develop coping mechanisms.

Explore treatment options for depression and anxiety.

3. The Role of Medication and Holistic Self-Care

Maria’s experience highlights the importance of considering medication as a valuable tool in mental health recovery. For her, finding the “right medication dose” was crucial in managing her depression by addressing the imbalance of serotonin in her brain. She astutely compares this to managing a physical illness like diabetes, emphasizing that mental health conditions often have a biological basis that may require medical intervention.

“No one would ever say to you if you have diabetes, to just like get over it. Just make your blood sugar change, like you can’t do that. And if you’re somebody who doesn’t have the proper chemicals being admitted in their brain, then you need a little bit of help. And there’s nothing wrong with doing that, and there’s nothing wrong with taking it.”

Beyond medication, Maria underscores the significance of a holistic approach to self-care, including:

  • Nutritious Eating: Fueling the body with proper nutrition supports overall well-being, including mental health.
  • Exercise: Finding enjoyable forms of exercise, like yoga and weight training, helps to reduce stress, improve mood, and enhance physical health. Regular physical activity has been consistently linked to improved mental health outcomes, including reducing depression and anxiety symptoms1.
  • Abstaining from Alcohol: Maria identifies alcohol as a “toxin” that negatively impacted her mental state, relationships, and physical health. Eliminating alcohol brought her “mind more at peace” and improved her clarity of thought. Research highlights the complex relationship between alcohol and mental health disorders, noting that alcohol can exacerbate symptoms of anxiety and depression2.

4. The Power of Selfishness and Selflessness

Maria shares a seemingly paradoxical yet profoundly important insight: recovery requires “being selfish” in order to “be selfless.” By “selfish,” she means prioritizing her own needs for therapy, exercise, and nourishment – activities she had previously neglected while focusing on others. This act of self-care was essential for her healing.

When Maria first fills her own cup, she can then extend that compassion towards others, creating “selfless” acts of kindness to make the world a brighter place. Prioritizing your own well-being is not selfish; it is a necessary foundation for recovery.

“You have to be able to give yourself grace. You have to be able to forgive yourself. Like we’re humans, nobody is perfect. We’re all gonna make mistakes. And I used to constantly beat myself up for the mistakes that I made. Finally, when I let up, when I just let that guilt go, I can like even feel the relief now.”

5. Recovery as an Ongoing Journey, Not a Destination

Maria stresses that recovery is not a one-time achievement but an ongoing process. It requires continuous self-care, including consistent medication, regular check-ins with a therapist, and maintaining a supportive network. She likens it to the routine maintenance of a car, emphasizing the need for regular “tune-ups” for mental health.

She also highlights the importance of leaning on others, acknowledging her own struggle with wanting to do everything independently. Knowing who you can rely on provides crucial support during challenging times and helps prevent falling “off the beaten path.”

6. A Life Transformed: The Rewards of Recovery

Maria vividly describes the profound transformation in her life since embarking on her recovery journey. She has pursued her lifelong dream of becoming a writer and actress, found a loving and supportive partner, and built a fulfilling life in a new city surrounded by a strong community. This stark contrast to her previous state underscores the immense rewards of prioritizing mental health.

7. Practical Advice for Those Starting Their Journey

Maria offers heartfelt and practical advice for individuals facing similar challenges:

  1. Prioritize Self-Care: This includes taking prescribed medication, seeking therapy, and engaging in activities that nurture your well-being.
  2. Seek Therapy: Persevere in finding a therapist you connect with, even if it takes time.
  3. Consider Abstaining from Alcohol: Even without an addiction, alcohol can negatively impact mental and physical health.
  4. Exercise Regularly: Find a form of physical activity you enjoy to help manage stress and improve mood.
  5. Focus on Nutrition: Prioritize healthy eating habits to support overall well-being.
  6. Practice Self-Forgiveness: Let go of guilt and self-blame, treating yourself with the same compassion you would offer a friend.
  7. Trust Your Inner Wisdom: Take quiet time to listen to your own thoughts and intuition, as you often hold the best answers for yourself.

“Deep down. You’ll find the answers of where you need to go, what path you need to follow, what’s right for you, what you need to do, what you need to stop doing. Deep down, you know all of it because nobody knows you better than you.”

Maria’s powerful narrative serves as an inspiring reminder that recovery from mental health challenges is possible. By sharing her personal journey and offering practical advice, she provides a message of hope and encouragement for anyone seeking their own path toward peace and well-being.

Starting the journey of mental health recovery involves prioritizing self-care, seeking professional support, and cultivating self-compassion. Trusting your inner guidance and being open to change are essential steps forward. For further support and resources, check out Recovery.com.

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Yoga for Depression: Rena Shoshana Forester

My Background, Personal and Professional 

I’m Rena Shoshana Forester. A Teacher, Healer, & Mentor. My healing and recovery journey includes Depression, disordered eating, Poly Cystic Ovarian Syndrome (PCOS), divorce, and Post Traumatic Stress Disorder (PTSD). Today we’re going to focus on depression.

I watched my Grandma suffer from depression for my entire childhood and find no relief in the medication she regularly took. So when I understood that I was suffering from depression, I did not believe taking antidepressants would magically make me feel better, certainly not sustainably.

One of the reasons that I became a Yoga teacher is because I understood that Yoga is a scientific method that has the potential for profound healing, including relief from depression.

The Issue or Challenge at Hand: Learning to Turn Towards Discomfort

First and foremost, it’s important for me to validate any tools and resources that you, your clients, or your family members may use to cope with depression. My intent with this piece is just to make it clear that Yoga can be a part of one’s toolbox for coping with and healing from depression.

Far too many people turn away from discomfort when it arises. I used to do the same. I’ve learned that discomfort generally arises to teach us something, and leaves once we’ve learned the corresponding lesson. In order to go through this learning process, one must first develop the capacity for holding discomfort; in other words: one must learn to turn towards discomfort rather than turning away from it.

Oftentimes, depression arises as an indicator that certain needs are not being met. Turning towards depression invites an opportunity for listening to what the body is asking for and finding ways to sustainably meet the need.

My Experience Tackling Depression

Before I was a Yoga teacher, I was a school teacher. I saw students, colleagues, parents of students, and myself experience depression on a regular basis. In my personal life, I saw multiple family members—not only my Grandma who I previously mentioned—suffer from depression. I basically saw people do one of two things when depression surfaced: either take medication as a way to carry on with day-to-day living, or hopelessly accept that their depression as is.

Neither of those options appealed to me.

I initially sought out meditation, in 2015, as a way for coping with my own depression, inspired by my father. I believed this would be a sustainable approach, but was a bit disheartened by the fact that it might take a number of years before I’d see the results of my efforts. Nevertheless, I committed to regular meditation and am glad I stuck it out to reap the benefits.

Before I found Yoga, I was a competitive swimmer; I’ve always found pleasure and relief from regular physical activity. But in 2015 I took a break from swimming and found my way to a Yoga class.

Was it a coincidence or a strike of fate that I found meditation and Yoga in the same year? Who knows. What matters is that I intuitively understood that there was a connection between the two. I kept up with both practices for about a year and a half before being introduced to The Yoga Sutras of Patanjali.

When I first began reading this foundational book on Yogic philosophy, I was blown away that it had taken me over 25 years to access this information. I started to understand that Yogic postures and meditation were two parts of the same system intended to relieve humans from internal sufferings.

I was working as a classroom teacher at the time, yet felt a strong passion to teach the science of Yoga, as opposed to the science of plants, basic math, and other general education topics I was teaching.

Not a year later, I found myself at an Ashram in India deep diving into the science of Yoga, and committing to becoming a certified Yoga teacher.

Now, nearly 7.5 years later, I can confidently say that the entire scientific method of Yoga, which includes meditation, can reduce symptoms of depression, when practiced regularly, in earnest.

Yoga as a Tool for Depression Recovery 

There are a number of specific Yogic postures, exercises, and techniques that supported me in addressing depression, and they may just work for you, too!  

Before I get to that, the way that one relates both to one’s depression and to the practice of Yoga are no less important than the tools themselves. In other words, the “how” is just as important as the “what.” One must first and foremost cultivate acceptance and compassion for one’s experience of depression, and simultaneously have a sincere openness to the potential power of Yoga. This acceptance, compassion, and openness are fundamental, and no relief will come if this subtle yet significant component is skipped.

One more note before we dive into the postures: the postures and exercises that I’ve included in this post are intended to be restorative. While they may be uncomfortable, especially if they are new for you, there should be no pain. The following three warning signs are indicators that you ought to come out of the pose, and take a moment to rest in whatever position is most comfortable for you:

  1. Strained breathing
  2. Sharp pain
  3. Numb tingling

Aside from these three warning signs, all other sensations are welcome, and a part of the process of letting go, in order to make space for fresh and new energy to enter your body.

Now let’s get into some of the specific postures, exercises, and techniques, written in the order that is recommended for practicing.

Balasana – Child’s Pose

Setting up for the pose: Start in a table tip position with your hands on the ground under your shoulders and your knees on the ground under your hips. Then, bring your big toes to touch and open your knees out wide. Draw your pelvis back towards your feet. If you’re able to, let your pelvis rest on your feet. If you need some support, place pillows or folded blankets/towels in the creases of your knees, so that your pelvis can have something to rest on. Extend your arms out in front. Feel free to place pillows or folded blankets anywhere else where you need to bring the ground up to you like under your forehead or below your hands. You may not need support and that’s fine too. Once you’re in the posture, hold for a minimum of 30 seconds, or up to five minutes. When you’re ready to come out, gently walk your hands towards your body and straighten your spine back up towards the sky. Pause for a moment to feel the effects of the posture.

How it supports depression healing: Balasana (Child’s Pose) is a very nurturing posture. Simply by holding the pose, one can access feelings of safety, protection, and nourishment, this alone can relax the mind and offer relief for symptoms of depression. Additionally, nowadays there’s a lot of research proving the connection between our mind and our gut. Improving gut functioning can also reduce symptoms of depression. While people often speak about nutrition as a way to heal the gut, Balasana is another way to improve gut functioning because it compresses the abdominal muscles and offers a sort of massage to the internal organs.

Prassrita Sukhasana – Seated Twist

Setting up for the pose: Start seated in a comfortable posture, which could mean with your knees crossed, or kneeling, or even on a chair. Engage your core by pulling your belly in towards your spine and up towards your chin while simultaneously feeling both sides and the back of your torso elongate up. Check that your shoulders are relaxed, the front of your chest is broad, ears are over your shoulders, and chin is parallel to the ground. On an inhale, once again feel into the length of your torso and spine and then continue feeling into that length as you stretch your arms up to the sky, with the palms facing each other. As you exhale, turn your body towards the right, placing your right hand close to your spine behind you and your left hand on your right knee. Take another inhale and feel the right hand supporting your spine and straightening up just a bit more. On the exhale, twist from your lower belly first, then your middle belly, next your chest, and finally your neck twists last. Once you’re in the posture, hold for a minimum of 30 seconds, or up to five minutes. With every inhale, use the back hand to support the spine in stretching up. With every exhale, use the front hand to twist a little deeper, always starting the twist from the lower belly, working up into the chest, and twisting the neck last. When you feel complete, on an inhale, engage the muscles in your core and twist your body back through the center. As you exhale, twist your body to the left, now bringing the left hand close to the spine behind you and your right hand on your left knee. Continuing on this side just as you did the prior, holding for roughly the same amount of time. Remember to maintain a sense of curiosity for this second side is essentially a whole new posture for the body. When you feel complete, on an inhale, engage the muscles in your core and twist your body back through the center. Take a moment to pause and feel the effects of this posture.

How it supports depression healing: As already mentioned, mental health is deeply connected to gut health. If you think of your body like a house, the spine is the foundation and the inner organs are the respective houses. So by twisting the spine, it gently massages the inner organs from the inside out, sending vital fluids and energy there, and also assisting with detoxing any gunk that needs to be cleaned out. Energetically, I like to think about how when we twist our body, we’re able to twist our perspective. Oftentimes, a person suffering from depression is stubbornly attached to a certain story, so this shift in perspective, which starts in the physical body, can be a beneficial way to bypass the mind.

Supta Baddha Konasana – Reclined Bound Angel Pose

Setting up for the pose: Start lying on your back with the sole of your feet on the ground, knees bent up towards the sky. Take a moment just to feel your body lying down, being held down by gravity. Once your breathing is calm and regulated, let your knees fall out to each side and bring the soles of your feet to touch. You may choose to place supports such as blocks or pillows below your thighs or your knees. Keep your chin centered and tucking in towards your chest. Let your hands come wherever it’s comfortable: either on your thighs, on your torso, or on the ground. Once you’re in the posture, hold for a minimum of 30 seconds, or up to five minutes. When you feel complete, place your hands under your knees and on an inhale gently bring the knees back up towards the sky. As you take a moment to feel the effects of this posture, you may feel your body calling out to move in a certain way. Listen to these callings. For example, you may want to wrap your arms around your knees as you hug them into your chest and rock and roll, or you may want to keep the sole of the feet on the ground as you let your legs sway from side to side like wind-shield wipers.

How it supports depression healing: Supta Baddha Konasana (Reclined Bound Angel Pose) is a hip-opener. Many people tend to unconsciously store emotions in their hips. Interestingly enough, depression itself can sometimes be a “mask” for other emotions lying underneath. So allowing the hips to open in this restorative way invites the release of deep, often unprocessed emotions. Because Yoga is built on the inherent understanding between the mind, body, and emotions, these emotions are released simply by holding the physical posture.

Three-Part Yogic Breathing

Setting up for the practice: If you are already lying on your back after the previous pose, you can continue lying on your back. If you wish to practice this exercise on its own, it can be practiced seated or standing, with the spine erect. It can be helpful to start by bringing one hand to the belly and the other hand to the chest. Then take a cleansing breath: deeply in through the nose and fully out through the mouth. With the next inhale feel the lower belly expand first, then the middle belly expands, and finally the chest rises. Fully fill up the lungs and at the top of the breath exhale through the nose letting the chest fall first, then the middle belly come in, and finally the lower belly come all the way in, pressing towards the spine. One round may be enough for you, or you can repeat, recommended up to five rounds. However, if you feel that five rounds is not enough, feel free to carry on until you feel complete. Once you do feel complete, relax your hands to wherever it’s comfortable, and observe the effects of this exercise as your breath returns to its natural rhythm.

How it supports depression healing: First and foremost, in Yoga, it is understood that if one can gain control of the breath, then one can gain control of the mind. So by simply controlling the breath, one may alleviate symptoms of depression. On a deeper level, Three-Part Yogic Breathing puts extra emphasis on the exhale. This has two specific benefits. The first is that it allows one to let go of old energy that has been pent up in the body, thus creating space for new energy to come in. Second, by pulling the belly in towards the spine while exhaling, one engages the diaphragm. The diaphragm is a muscle located between your lungs and stomach. The diaphragm is connected to the vagus nerve, located in the brain. The vagus nerve is responsible for many things including activating the parasympathetic nervous system, AKA, relaxation. So, simply put, engaging the belly in deep breathing is a simple tool that can actually relax the body.

Closing Thoughts and Envisioning the Future

I’d like to conclude with a little story, hopefully it will provide you with some inspiration.

When I was in the thick of Depression, I found myself wanting to use these tools often: Yogic postures, breathing techniques, among other things. I found myself needing to rely on these tools while walking down the street, sitting on buses, eating, and in other public settings.  

At first, shame stopped me. I thought people might judge me, think I was crazy, or even call the cops for doing arguably strange things in public.

But I found myself shifting my perspective one day while walking down the street in Tel Aviv. On bench after bench, I saw person after person sitting and smoking a cigarette. Something clicked for me as I felt immense compassion for these smokers: they were just like me. These were not just smokers, they were wounded humans, just like myself, suffering from their own mind-stuff, and leaning on whatever tool they had access to in order to find some relief. Unfortunately for them, their most accessible tool was a cigarette.

I had other tools, and thanks to this article (and probably other Recovery.com articles, too!), so do you.

I asked myself, “Why would I feel shame for using my tools for coping and healing in public?” Walking a fine line to not throw shame onto the smokers, I gently acknowledged that if those smokers felt comfortable publicly harming themselves as a way to cope with dis-ease, then I surely could also lean into feeling comfortable publicly healing myself. So I began, and continue to this day, proudly using my Yogic tools in public. 

My intent is never to draw unwanted attention or disturb anyone else, but I have easily been able to find spaces in airports, parks, restaurants, and offices where I could practice my Yogic tools and find the relief I needed, without needing to hind behind the closed doors of a Yoga studio or the privacy of my own home.

This is the world I envision: where all people coping with depression not only have the tools that they need to heal, but the confidence to use those tools wherever and whenever needed.

In life and in support of you,

Rena Shoshana

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Battling Depression’s Impact on Self-Esteem: Gina Capobianco

Self-esteem is something that everyone likely struggles with at some point in their lives. Some of us struggle more than others. Low self-esteem can prevent us from living our best lives. It can keep us from taking risks in our careers and can lead us to shy away from relationships. 

I have struggled with my self-esteem since I was a child. My struggle with self-esteem is likely tied to different aspects of my life. I don’t think I grew up with much self-confidence. I’m Gen X. When I was growing up, we didn’t have participation trophies or people looking out for our self-esteem. Depression also attacked when I was young. Maybe that is where my struggle with my self-esteem started. 

Depression affects self-esteem. After years of therapy, I have learned that one major factor affecting my struggle with self-esteem is depression. Depression uses its voice to point out all the negatives. For me depression leads to me devaluing myself. The darkness depression covers me with also covers up the positives in my life. I hear depression telling me I am worthless; I am not good enough. I know I am not alone in this. 

Varied definitions can be found for self-esteem1. A common definition for self-esteem is a person’s sense of self-worth2. One study suggested a strong association between levels of self-esteem and the development of depression3.  As a person who has lived with depression for decades I can attest to this association based on personal experience. Even as I write this article messages of self-doubt, a sign of my low self-esteem, fill my head. I question if I should be writing this article. Depression’s voice is in my head telling me I don’t know what I am talking about and that I am not a good enough writer. This voice of depression fills other areas of my life. It is always speaking to me like a cd stuck on repeat. 

Self-esteem is tied to our opinion of ourselves. For many of us living with depression, our view of ourselves is not positive. It has been damaged. We see ourselves through the lens of depression. That lens is dirty. That lens presents a negative picture of who we are and what we can do. As a result, our self-esteem is damaged. 

People with depression face many obstacles. Believing in oneself can be one of those obstacles. When struggling, depression can get louder. It can scream that you are not enough. 

There are people with depression who are successful at many things. They can push through the depression with the help of therapy, medication, or other treatments. This doesn’t mean they don’t struggle with self-esteem. Maybe they are able to push the voice of depression to the back of their mind. Maybe that voice is a low hum in their head that they can work through. 

I struggle to push the voice of depression to the back of my mind. My low self-esteem has told me to start this article over several times. Depression has led to me question myself and my abilities. It is something I have struggled with throughout my life. Through therapy I have learned strategies to help me cope with the negative messages I hear in my head. It has taken a lot of practice within the confines of therapy to be able to use these strategies in my day-to-day life.

Here are some strategies you can try:

Self-talk

One strategy that can help battle low self-esteem is self-talk. I employ self-talk by allowing my thoughts to have a “conversation” with the negative thoughts in my head. Sometimes it is as short as a one-word response, such as “stop” or “no”. I can also say something like “I know you are trying to keep me down, but I am not going to listen to you.” It has taken a lot of practice to use self-talk. My psychologist has modeled it with me. That has been helpful because if left to myself, I would struggle to employ self-talk. I need to practice using it. Self-talk scripts can be useful. Try writing down what you want to say when depression starts attacking your self-esteem. This provides a little assistance when you need it.

Reframing

Reframing involves taking a thought and turning it around. It is similar to self-talk. I have used reframing as I work on this article. When depression tells me I can’t write I take that thought and I turn it around. I tell myself “I can write. I have written for years. I know how to write. The words will come.” For me it is not enough to just say this once. I need to repeat it to get myself to accept it as a truth. Depression has a strong voice. It wants to be right. So, repeating my reframed message is necessary to combat depression’s effect on my self-esteem. The difference between self-talk and reframing is subtle. With reframing there is more of an effort to turn depression’s words around while self-talk can utilize general scripts and be more focused on telling the thought to stop.

Externalization

Another strategy to deal with the thoughts or voice of depression is to place those thoughts outside of you. An example of this might be if I take a thought depression is telling me and imagine myself saying it to my niece or other young person. As I do it, I realize I would never say those words to her. It would be hurtful and unkind. This realization allows me to see that it is also hurtful when I listen to depression saying it to me. Just as I wouldn’t say these things to my niece, I tell myself I shouldn’t allow depression to say them to me. You can try this strategy by imagining yourself saying what depression is telling you to another person. You likely wouldn’t talk to a loved one the way depression speaks to you.

Self-hypnosis

I was first introduced to self-hypnosis about 20 years ago by my psychologist. Self-hypnosis involves getting myself into a relaxed state and then giving myself hypnotic suggestions. To get into a relaxed state I use a form of progressive relaxation. I close my eyes and focus on my breathing. I imagine a safe place. Then I count as I go down ten steps to reach that safe place. This is followed by focusing on relaxing each part of my body. Then I whisper a hypnotic suggestion. It might be something like “I am able to get through X situation. I have the tools I need to do it.” Once I have given myself the hypnotic suggestion, I imagine myself climbing back up those ten steps. When I open my eyes, I can re-engage with whatever I need to do. 

Distraction

Distraction is a strategy I use frequently. Often, I find myself needing to block out the self-esteem damaging messages depression is feeding me. I need something else to focus on in order to block the messages. Music is a frequent distractor for me. If I can get myself to focus on the lyrics instead of what I am hearing in my head, I can push the thoughts to the background. I have created several playlists on my phone. I can choose the playlist that contains songs that will be most effective for me in the given moment. Think of something that is distracting for you. Some distractions that might work include watching a movie, gardening, exercising, cooking, or creating art. Find what works for you.

Practice Is Important

Just as with anything in life that is difficult, employing these strategies takes work. Some strategies will work better than others for different individuals. A key component is practice. We can’t expect these strategies to work without practice. It is important to gain familiarity with how we are going to utilize these strategies. With self-talk, reframing, and externalization it is beneficial to write scripts that can be practiced. This helps us utilize the strategies when we need to employ them. Making self-hypnosis part of our daily routine allows us to engage in it with more ease when we are struggling with our self-esteem. We all need a little distraction at time. Knowing in advance what can serve as a distractor for us is useful. 

Depression can affect many aspects of our lives. Self-esteem is one aspect that can be negatively impacted by depression. Having strategies to fight back against depression’s voice is helpful. These strategies are not going to make depression go away on their own. Practice is important. Depression is complicated and treatment is necessary, but employing these strategies can help us deal with the day-to-day battle.

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Can a Dopamine Detox Improve Your Mental Health?

In our constantly connected world, many of us feel overwhelmed by endless notifications, social media updates, and the pressure to stay engaged 24/7. This constant stimulation can leave us feeling scattered, unproductive, and unable to focus on what really matters. That’s where dopamine detox comes in—a practice that’s gained attention for its potential to help people regain control over their digital habits and find more satisfaction in their everyday lives.

So what is dopamine detox, exactly?

What Is Dopamine Detox?

The term “dopamine detox“1 might sound intense, but as California psychiatrist Dr. Cameron Sepah, who created the concept, explains: “Dopamine is just a mechanism that explains how addictions can become reinforced, and makes for a catchy title. The title’s not to be taken literally.” Also sometimes called “dopaminergic detox” or “dopamine fasting,” it first gained popularity among biohackers in Silicon Valley but is now practiced by people of all backgrounds.

In simple terms, a dopamine detox means taking a planned break from activities that tend to hook us into cycles of instant gratification—like endlessly scrolling social media, binge-watching shows, or stress-eating junk food. The goal isn’t to eliminate dopamine (which is not only unhealthy but impossible), but to reset your relationship with these stimulating activities.

How Does a Dopamine Detox Work?

Understanding Dopamine

Dopamine is a neurotransmitter that, from an evolutionary perspective, is a part of how our brain is wired to keep us alive. Behaviors like sex, eating, and movement required for our species’ survival trigger the release of this “feel-good chemical.” Every time you perform a certain pleasurable activity, it sends the message to your brain that this is good, linked to your survival, and therefore should be repeated. Eventually, these behaviors become habitual. This is why the dopamine reward system plays such an important role in addiction.

Almost every activity we do has an impact on our dopamine, says Dr. Anna Lembke, Professor of Psychiatry and author of Dopamine Nation: Finding Balance in the Age of Indulgence: 

Every time we are doing something that’s pleasurable, we’re reinforcing a reward that will affect dopamine.3 It’s it’s really the primary signal that lets us know that this thing is potentially important for our survival.

In our modern world, however, we’re surrounded by artificial sources of intense stimulation that can overwhelm this natural system. “Now we’re exposed to so many reinforcing substances and behaviors that we’ve all become vulnerable to the problem of addiction,” says Lembke.

The Goal of Detoxing

When we repeatedly engage in highly stimulating activities, our brains can become less sensitive to everyday pleasures. The primary goal of a dopamine detox isn’t to eliminate pleasure—it’s to help your brain recalibrate its response to rewards. 

As physician and educator Dr. Peter Grinspoon points out, this isn’t a new concept: “Taking time out for mental rejuvenation4 is never a bad thing, but it’s nothing new.” Most religions suggest a rest day or holiday without technological distractions so that you can reflect and reconnect with family and community. The trend is essentially popularizing what’s been known in traditional cultures for quite some time: that reducing overstimulation, practicing mindfulness, and slowing down to a more natural pace all lead to better overall health. 

Steps to Perform a Dopamine Detox

Dopamine fasting uses techniques from cognitive behavioral therapy (CBT), including stimulus control—reducing contact with things that trigger the unwanted behavior, and exposure and response prevention—responding to urges by noticing them without judgment.

People who practice this generally follow these dopamine detox steps:

1. Identify Overstimulating Activities

How do you know which activities are overstimulating your dopamine response?5 Dr. Sepah suggests looking for behaviors that:

  • Cause distress (you’re bothered by how much you do them)
  • Create impairment (they interfere with your work, school, or relationships)
  • Feel addictive (you want to cut down but have a hard time doing so)

Common examples of these include:

  • Excessive social media use
  • Compulsive online shopping
  • Binge-watching videos
  • Emotional eating
  • Gaming or gambling
  • Constantly checking your smartphone

2. Create a Detox Plan

The key to a successful dopamine detox is to set realistic goals. Dr. Sepah recommends starting out in a way that’s “minimally disruptive” to your life. This might mean fasting during certain windows or focusing on only one behavior at a time. Some people also practice dopamine fasting 2.0,5 gradually extending windows to fast for longer periods of time.  

When planning your detox, be sure to set clear goals, define your boundaries, and prepare alternative activities you can do when you get the urge to go back to old habits. 

3. Replace With Meaningful Activities

Instead of trying to eliminate all pleasurable activities, which isn’t sustainable or healthy, focus on more fulfilling alternatives—especially activities that are mindful or calming. These might include:

  • Taking care of your mental and physical health: Cooking yourself a healthy meal; getting outside for a walk or gentle exercise
  • Engaging your sense of purpose: Serving others in your community or doing something kind for a friend
  • Deepening connections in your existing support network, or making new ones 
  • Learning: Reading books or listening to podcasts on topics you’re deeply interested in 
  • Creating: Expressing yourself through art or creative writing

These activities not only distract you from the urge to reengage with addictive behaviors but create a sense of balance and a deeper connection with your values and goals.

Benefits of Dopamine Detoxing

Research shows that thoughtfully implemented dopamine detoxes can help reduce impulsive behaviors and increase focus. But these benefits typically come from making moderate, sustainable changes rather than extreme restrictions.

Improved Focus and Productivity

Many people find it easier to concentrate on important tasks when they’re not constantly responding to notifications or seeking quick hits of stimulation. One review of research on dopamine fasting found that “individuals who engage in dopamine fasting may experience a reduction in impulsive behaviors6 and an increased ability to focus on tasks for longer periods.” As your brain adjusts to fewer interruptions, you might notice improvements in your ability to stay on task.

Better Emotional Regulation

The same review found that “Some individuals have reported feeling less overwhelmed and more in control of their thoughts and actions after implementing regular dopamine fasting6 practices into their routines.” Regular breaks from overstimulating activities can help you develop a better awareness of your emotions and reactions. Instead of automatically reaching for your phone when you feel uncomfortable, you might find yourself better able to sit with and process your feelings.

Increased Discipline

When you practice stepping back from impulses rather than immediately acting on them, you notice something interesting: it gets easier over time. People who try dopamine detox often find that the skills they develop—like pausing before reaching for their phone or choosing a walk over mindless snacking—start showing up in other areas of their lives too. This isn’t about rigid self-control; it’s about feeling more intentional about your choices and less at the mercy of every urge or notification. Taking time to be mindful puts you in charge of your daily decisions, rather than feeling like your habits are running the show.

Limitations and Myths About Dopamine Detox

While a wellness trend that promotes intentionality has a lot of upsides, mental health experts warn that misinterpreting its meaning and practices can lead to unintended and potentially harmful results. 

Misconceptions About “Resetting” Dopamine

It’s important to clarify that a dopamine detox doesn’t deplete or reset dopamine levels in the brain. “You can’t ‘fast’ from a naturally occurring brain chemical,”4 says Grinspoon. Rather, it’s about managing the brain’s response to rewards and recalibrating habits to reduce overstimulation.

Dr. Lembke clarifies: “The main misconception is that somehow we can get addicted to dopamine. We’re not getting addicted to dopamine itself.3 Dopamine is neither good nor bad—it’s a signal to tell us whether or not something that we’re doing is potentially useful for our survival.”

What Dopamine Detox Isn’t 

Dr. Sepah debunks some common myths about dopamine fasting.5 According to the psychiatrist, dopamine fasting is not:

  • “Reducing dopamine (the focus is on reducing impulsive BEHAVIOR)
  • Avoiding all stimulation/pleasure (focus only on specific behaviors that are problematic for you)
  • Not talking/socializing/exercising (actually encourages values-aligned health behaviors)
  • Rebranding meditation/asceticism/sabbath (doesn’t involve meditating or not working)”

Instead, it’s more about identifying problem behaviors and taking small steps to replace them with actions that are in your best interest.

Risks of Dopamine Fasting

Authors of a study on the effectiveness of dopamine fasting warn that “some intense types of dopamine fasting which include extreme isolation or strict dieting6 can result in damage to mental health as well as physical fitness.” These extreme forms of dopamine fasting can make people feel more lonely and anxious, and can even lead to malnutrition. That’s why it’s important to take a balanced approach.

“People are adopting ever more extreme, ascetic, and unhealthy versions of this fasting, based on misconceptions about how dopamine works in our brains,” warns Grinspoon. “They are not eating, exercising, listening to music, socializing, talking more than necessary, and not allowing themselves to be photographed if there’s a flash…If your interpretation of a dopamine fast means withdrawing from exercise, social interaction, or hobbies that give you joy, then you’re probably doing yourself more harm than good.“

While some people find dopamine detox helpful in moderation, others don’t resonate with it at all—what’s important is finding what works for you.

Temporary Effects

Like any healthy habit, the benefits of dopamine detox work best when you approach it as an ongoing practice rather than a quick fix. You might notice positive changes pretty quickly—like feeling more focused or less anxious—but the real transformation happens when you regularly check in with yourself and make adjustments along the way. Like learning any new skill, the more you practice being mindful about how you spend your time and energy, the more natural it becomes. 

Is Dopamine Detox Right for You?

The effects of dopamine fasting vary from person to person, and there is no one-size-fits-all approach. Some people might benefit from a structured break from certain activities; others might need a more flexible or professionally guided approach—understanding your own needs can help you decide if this practice makes sense for you.

Who Can Benefit

You might find dopamine detox helpful if you:

  • Are constantly distracted by technology
  • Notice your attention span getting shorter
  • Struggle with impulsive behaviors
  • Want to reduce your dependency on instant gratification
  • Feel overwhelmed by constant stimulation

When to Seek Professional Help

Dopamine detox can be helpful for managing everyday habits, but it’s not a replacement for professional treatment when you’re dealing with serious concerns. “It takes almost 90 days for a person’s brain to rewire itself to normal dopamine levels2 in the absence of pleasurable external stimuli,” says Associate Professor of Medicine Muhammad Ahmad Alamgir. “During this time, the person will face mood swings, irritability and a constant urge to get back to the addictive substance.” This is when it’s useful to get professional help.

If you’re struggling with addiction, severe anxiety, depression, or other mental health challenges, it’s important to work with a qualified healthcare provider who can help you develop an appropriate treatment plan.

Dopamine Fasting: Should You Try It?

Dopamine detox is one tool for managing the constant overstimulation of modern life, but it works best when it’s approached with realistic expectations. The goal isn’t to eliminate pleasure from your life, but to build a healthier relationship with technology and other sources of instant gratification.
Small, consistent changes often lead to more sustainable results than dramatic restrictions. Whether you start with a 24-hour break from social media or designated phone-free hours each day, the key is to find an approach that fits with your lifestyle and supports your mental health. If you’re interested in trying a dopamine detox, start small, stay flexible, and focus on replacing problematic behaviors with meaningful activities that align with your values and goals. And if you’re struggling with more serious concerns, don’t hesitate to reach out to a mental health professional who can provide personalized guidance and support.

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Antidepressants Misuse and Addiction

Some people, especially those in recovery, may worry about developing an addiction to antidepressants. Thankfully, antidepressant addiction doesn’t occur often, but it is a possibility at non-therapeutic doses. This is due to how they can affect and change the brain, leading to a dependence then compulsory use. 

Anyone worried about their antidepressant use can bring their concerns to their doctor, who can start a tapering plan or even switch to a different type of antidepressant. Behavioral strategies, like therapy, can help people transition off antidepressants while still managing their symptoms.

What Are Antidepressants?

Antidepressants primarily treat depression1 and other mood disorders, plus conditions like obsessive compulsive disorder (OCD). They work by balancing disruptions in neurotransmitters and boost the reception of serotonin, which can make people feel happier. 

Most antidepressants work on serotonin and another neurotransmitter called norepinephrine1. When your brain can receive and process more of these neurotransmitters, symptoms of depression can fade. Depression can go fully into remission due to neuroplasticity1, where your brain changes and adapts to sustain these positive changes. 

Common Types of Antidepressants

Antidepressants can have a variety of formulas and interact with different parts and systems within the brain. Your doctor and/or psychiatrist will aim to find the best match for you. A genetic test can help you pinpoint good matches. Sometimes, people cycle through a few antidepressants to find the one that works best.

Interestingly, many antidepressants have off-label uses for conditions besides mood disorders. For example, trazodone can help people fall asleep1. Some other antidepressants help patients with chronic pain.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are often the first line of defense against depression2 due to their low side effects and general effectiveness. Most people respond positively to them, and doctors can smoothly pivot to another if one doesn’t seem to have much effect.

Prozac, Zoloft, Lexapro, Paxil, and Celexa are all common SSRI antidepressants. Potential side effects of SSRIs1 include:

  • Weight gain.
  • Dizziness.
  • Nausea, especially for the first couple weeks after starting the medication. In most cases, it goes away.
  • Sexual dysfunction.
  • Headaches.

SNRIs

Serotonin/norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs1, but also block the reuptake of norepinephrine, not just serotonin. Doing this helps various synapses in your brain access more of these neurotransmitters, making you feel better. Norepinephrine triggers the central nervous system’s fight-or-flight response, leading to anxiety and panic disorders if these triggers don’t come when needed. SNRIs can reduce symptoms of both depression and anxiety.

SNRI brand names include Cymbalta, Pristiq, Effexor, and Fetzima. They can cause most of the same side effects as SSRIs, like:

  • Nausea that typically goes away after a week or so.
  • Headaches.
  • Excessive sweating.
  • High blood pressure.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are a less-commonly prescribed antidepressant3, often used when an SSRI or SNRI doesn’t work. They’re more likely to have side effects, drug-food interactions, and drug interactions, which is why they’re prescribed with caution.

Common MAOIs include Marplan, Nardinm and Emsam. They can have side effects like:

  • Serotonin syndrome (too much serotonin).
  • Dizziness.
  • Vomiting.
  • Constipation.
  • High blood pressure and potential death if foods with tyramine are consumed (cheese, alcohol, leftovers, certain fruits, and more).

TCAs

Tricyclic antidepressants (TCAs) also inhibit the reuptake of serotonin and norepinephrine4, which can boost mood and attention. Some versions of TCAs are also used off-label to treat obsessive compulsive disorder (OCD), insomnia, migraines, and chronic pain.

Common TCAs include Elavil, Silenor, and Asendin. Their side effects1 include:

  • Dry mouth.
  • Difficulty peeing.
  • Constipation.
  • Seizures.

How Are Antidepressants Misused?

An increase in feel-good neurotransmitters like serotonin can cause a reinforcing effect, though rare in antidepressants since this boost in mood is often subtle and feels natural. Misuse often happens outside prescribed doses5; for example, someone may take double or triple their prescribed dose (sometimes even 10x more) to achieve a ‘high’ similar to other drugs. This sensation only happens with high doses of certain antidepressants5, like bupropion.

Someone taking antidepressants for the sensation of being high may dissolve several pills in water and inject it using a syringe, take multiple pills orally, or crush them into a powder and snort it. To maintain their high dosing, they might request refills sooner than needed, take out prescriptions through multiple doctors, or request higher and higher doses without a demonstrated need.

Sadly, some people misuse antidepressants with the intent of taking their lives. In 2011 nearly every emergency room visit for a drug-induced suicide attempt came from prescribed medications; 20% of those overdoses involved antidepressants5, the highest percentage after prescribed opioids.

Can You Become Addicted to Antidepressants?

It’s very unlikely. One study answers this question6 with, “antidepressants do not have a clinically significant liability to cause addiction.” This is because most antidepressants don’t cause pleasurable or rewarding effects6, as addictive drugs like cocaine or alcohol do. And compulsive use of antidepressants, as seen in substance use disorders, is “exceptionally rare.”6

Antidepressants can cause withdrawal symptoms7, which raises an argument for their addictive potential since people may need to keep taking the substance to avoid withdrawals, similar to opioids and other addictive substances. Tapering plans can prevent uncomfortable withdrawals.

Factors Contributing to Antidepressant Misuse

Those who misuse antidepressants often have a history of substance use disorders5 or other comorbid conditions. And, as expected, people who misuse antidepressants typically have a mental health condition like depression. Since symptoms of depression can include suicidality8, these patients can be more likely to misuse their prescribed antidepressants in an overdose. 

Signs of Antidepressant Addiction

If you’re worried a loved one struggles with an antidepressant addiction, you can watch for signs and start an open-minded conversation. If you’re worried about your antidepressant use, you can bring your concerns to your doctor and look for signs of addiction in your own life.

Some key signs of an antidepressant addiction include:

  • Taking more than their prescribed dose. For example, you may notice they take three pills when the prescription bottle only says to take one. 
  • An inability to stop taking the pills, even if negative health, work, or relationship consequences arise.
  • Spending excessive time and money to procure antidepressants. 

Treatment Options for Addiction

If you’re struggling with an antidepressant addiction or any drug or alcohol addiction, you have resources available for recovery. Treatment options broadly fall into 2 categories: inpatient and outpatient care.

Inpatient Care

Inpatient treatment includes treatment in a hospital (often for acute withdrawal needs or overdoses) or attending a residential rehab. At rehab, you’ll live with peers and receive treatment from clinical staff, who monitor your health and emotional needs around the clock. 

Each day often follows a structure, with time for therapy (group therapy, 1:1 sessions with your therapist, and family therapy), fun activities, peer meetings, and downtime. Rehabs last 28+ days, aiming to treat both mental and physical needs for comprehensive healing. You’ll also learn relapse prevention strategies and get connected with outpatient levels of care, if desired, to continue your healing journey.

Outpatient Care

In short, outpatient care is the treatment you attend without living at a treatment facility. You return home after treatment and have more flexibility to work, attend school, and meet family needs. Outpatient care could include

  1. Day treatment, where you undergo therapeutic treatment and practice practical recovery skills for 5-7 days a week. Sessions often last 5-7 hours daily, making day treatment the most intensive version of outpatient care.
  2. In intensive outpatient programs (IOPs), you attend treatment 3-4 days weekly for about 3 hours a day. These also offer therapy, peer support, and an encouraging and supportive recovery environment but with a less intensive schedule.
  3. General outpatient can include 1-2 weekly group therapy sessions, lasting an hour or so each. 
  4. Regular 1:1 therapy sessions with a therapist. You may see them once a week, once every two weeks, or at the cadence best fit to your recovery needs.

Help from Your Doctors

As medication prescribers, your primary care physician (PHP) and/or psychiatrist can also help you. They can ensure that, going forward, all antidepressant prescriptions are carefully considered and that you have a clear plan for how to take them without risking addiction.

For example, your doctor may only prescribe a week’s worth and set up regular appointments to check in and monitor your use. Or you can work out a plan with loved ones, like a spouse or parent, to keep your medications locked in a safe. This can also be a preventative measure for people struggling with suicidal thoughts or with a history of suicidal ideation and attempts.

At your appointment, you can ask questions like,

  • “What is the addictive potential of this medication?”
  • “Are there other medications with less addictive potential that I could try first?”
  • “What signs should I look out for that mean this medication isn’t a good fit?”
  • “What can I do if I start to feel like I’m relying on it too much?”

Find Treatment for Drug Misuse

Recovery exists for all types of addictions, including antidepressant addiction. Treatment can help you navigate the underlying causes of addiction and address emotional struggles with healthy coping strategies and new behaviors. 
You can use Recovery.com to find prescription drug treatment centers and see their insurance information, reviews, photos, and more.

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Navigating the Conversation: Talking to Your Boss About Mental Health Needs

Navigating the Conversation: Talking to Your Boss About Mental Health Needs

By Dr. Malasri Chaudhery-Malgeri 

In today’s high-stress work environments, mental health has catapulted to the forefront of workplace wellness discussions. Yet, many employees still hesitate to approach these conversations with their bosses, fearing stigma or professional repercussions. However, broaching this subject thoughtfully can enhance your well-being and professional performance. Here’s a nuanced guide on effectively communicating your need for support or time off for mental health reasons.

Setting the Stage

Preparation Is Key: Before setting a meeting, clarify what adjustments would help ease your mental burden. Are you looking to lighten your load, extend a few deadlines, hand off specific projects, or take some time off? Concrete solutions will guide the conversation.

Know Your Rights: Arm yourself with knowledge about your workplace policies and any relevant laws—like the Family and Medical Leave Act (FMLA) in the U.S., which safeguards your position during extended leaves for health reasons. This preparation ensures you understand the boundaries and possibilities within your discussion.

Timing and Atmosphere

Choosing the Moment: Timing is everything. Opt for a moment when office rhythms are calm—perhaps a quiet morning or a slow afternoon. Avoid the crunch times, like the hectic end-of-quarter weeks, when stress levels are already high.

The Setting Matters: Privacy is paramount. A secluded spot, away from the hustle of office life, sets a tone of confidentiality and seriousness. A quiet conference room or a scheduled private office meeting can make a difference in how comfortably you can speak.

Crafting the Dialogue

Open Positively: Begin with a nod to the positive aspects of your role and the company. This shows your appreciation and frames the conversation as coming from someone invested in the company’s success.

Clarity and Honesty: Without delving into overly personal details, be clear about how your mental health impacts your work. Stick to specific examples and focus on the effects rather than the causes. Use “I” statements to keep the conversation personal and less accusatory.

Propose Smart Solutions: Bring potential solutions rather than presenting your problems alone. This could involve suggesting temporary help from colleagues, tweaking deadlines, or introducing new tools to improve your productivity without lowering the team’s output.

Highlighting Mutual Benefits

A Two-Way Street: Emphasize how supporting your mental health benefits you and the company. A healthier mindset can lead to sustained, even enhanced, productivity. It’s an investment with a valuable return.

The Preventative Approach: Stress the importance of tackling these issues to prevent more significant problems—this can minimize potential future disruptions.

Preparing for All Responses

Be Ready for Anything: While you hope for understanding and support, prepare for any outcome. If the response is less supportive, be ready to suggest a follow-up meeting after they’ve had time to consider your requests.

Plan B: If the conversation does not yield the hoped-for support, know where to turn next—perhaps HR can offer another pathway or external professional advice may be necessary.

What to Do If You Cry During a Conversation with Your Boss

Crying during a conversation with your boss, especially when discussing personal needs or challenges, can be an unexpectedly emotional experience. While it might feel awkward or uncomfortable, it’s important to remember that crying is a natural human response to stress, frustration, or even relief. Here’s how you can navigate this situation with professionalism and grace:

1. Acknowledge Your Emotions

If tears start to flow, acknowledge them without feeling ashamed. You can say, “I apologize, I’m just very passionate about this,” or “I didn’t expect to become this emotional.” Recognizing your tears helps to normalize the situation, showing that while you are emotionally affected, you are still in control of the conversation.

2. Take a Moment

Allow yourself a moment to breathe and collect your thoughts. You can ask for a brief pause, like saying, “Please bear with me for a moment while I gather my thoughts.” Use this time to take deep breaths and regain your composure. Deep breathing helps control your emotions and signals your body to calm down.

3. Maintain Your Composure

Once you’ve acknowledged your tears and taken a moment to breathe, try to continue the conversation. Maintain eye contact and keep your voice steady. If you feel overwhelmed, it’s perfectly acceptable to say, “I might need a moment, but I’d like to continue discussing this.” This demonstrates your commitment to the conversation and your professionalism.

4. Refocus on the Topic

Direct the conversation back to the main topic. Reiterate your key points or where you left off to demonstrate that, despite the emotional moment, your focus remains on addressing the issue at hand. For example, you can say, “To return to what I said earlier, I believe making these changes could improve my productivity.”

5. Use the Opportunity to Emphasize Your Point

Sometimes, showing emotion can underscore the seriousness of your statements. You can frame your emotional response as a demonstration of how much you care about your work and your commitment to performing well. For instance, “My reaction shows how important this is to me and how much I want to find a way to make this work for both of us.”

The Follow-Up

After the meeting, consider sending a follow-up email summarizing the discussion and expressing your thanks for the understanding shown during the conversation. This serves as a professional courtesy, reinforces your points in writing, and demonstrates your proactive approach to resolving workplace issues.

Crying is not a sign of professional weakness but reflects your sincerity and dedication. By handling the situation with poise and focus, you can move past the moment of vulnerability and continue to engage in meaningful dialogue with your boss.

Seal It with Gratitude

Follow up your conversation with a thank-you email outlining what was discussed and any agreed-upon steps. This shows your professionalism and provides a written record of your proactive approach.

Opening up about mental health in the workplace can seem daunting. Still, with the right preparation and approach, these conversations can significantly improve your work life and mental well-being. By framing your needs within the context of mutual benefits and coming prepared with solutions, you can foster a more understanding and supportive workplace culture.

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Creating a Safety Plan for Times of Suicidal Crisis: Gina Capobianco

I have lived with depression for decades. Suicidal thoughts have accompanied the depression most of my life. While facing a difficult time a couple years ago, the psychiatric nurse practitioner (PMHNP) I was seeing brought up the idea of a safety plan. I had never heard of this type of plan but was willing to try it.

Like many people with suicidal thoughts, when the depression is not bearing down on me, I don’t want to die. It is just when the thoughts get going and the depression turns everything dark that dying seems like my only escape. I needed a plan for dealing with the suicidal thoughts.

My PMHNP explained what a safety plan is and how it works. A safety plan is an intervention that helps a person survive a suicidal crisis by providing them with a set of steps, which they have helped create, to follow during the crisis that will decrease the chances they will engage in the suicidal behavior.  My PMHNP described the plan as my action steps for when I feel that the suicidal thoughts are becoming overwhelming. Together we laid out the plan. It has been necessary for me to use the safety plan a couple of times, and it has been effective each time.

Let’s go through the steps my PMHNP and I used when creating my safety plan.

Purpose of a Safety Plan

First, we identified the purpose of the safety plan. The main purpose of a safety plan is to prevent suicide. The plan provides a way to cope with the crisis of suicidal thoughts using a guide to get help in a way that is comfortable and not overwhelming. The plan allows an individual to reach out to family or friends, who will serve as a support person, as well as provides connections to mental health professionals. The plan lets the support person know how to help you in a crisis.  

It is helpful if the plan is written in the individual’s own words. This ensures the person understands the steps and can enact the plan in a crisis. The words should be simple and easy to follow. The person should keep it in a place that is easily accessible. The people involved in enacting the safety plan should also have a copy. 

Components of a Safety Plan

Identifies When It Will Be Used

The safety plan should spell out when it will be enacted. I discussed this with my PMHNP.  Discussing this with your mental health professional can ensure that you are aware of when to utilize it.  When the plan is used differs for each individual. So, the plan should include when to enact it in language that can be comprehended in a crisis. My plan is enacted when I recognize my thoughts becoming overwhelming and I start thinking about acting on my suicidal thoughts.

Provides Coping Strategies 

Coping strategies are going to vary from person to person. These may include breathing exercises, meditation practice, distractions, or anything that helps the person cope with suicidal thoughts. The plan should include how to know if the strategies are working. If the coping strategies are not working or the person recognizes they are beyond the use of coping strategies, it is time to reach out for support. My coping strategies include journaling and listening to music. When these are not working it means it is time to reach out for help.

Identifies Individual(s) Who Will Support You

When you are in a suicidal crisis, you need to be able to reach out to others for support. When developing your plan, identify a friend or family member who you can reach out to. The individuals on the safety plan need to be willingly involved and consent to being a part of the plan. It is not enough to just be willing to be part of the plan. The individuals need to be able to be an active part of the plan. You need to be able to reach them in a crisis. Share your plan with them and make sure they understand the plan. Your plan should also include who your mental health professionals are and their contact information. In addition, the 988 number, the Suicide and Crisis Lifeline, should be a part of your plan. 

Provides the Questions Your Support Person Will Ask You

Your support person refers to the safety plan when you contact them. My support person has the safety plan on her phone, so she does not have to look for it.  The first question the support person should ask is if you are safe. If you are not safe, they may need to call for emergency support. My plan is set up so that I am asked if I need comfort or support once it is established that I am safe. This gives the person an idea of how severe my suicidal thoughts are at that moment. 

If I respond that I need comfort, my support person will ask me if I need to be listened to or distracted? She then responds accordingly. If I respond that I need support, she will ask me if I need her to help connect me to my mental health professional or if I need her to do it for me.  If I respond that I need help, she reminds me of who to call and may need to provide the number. As I make the call, she stays in contact with me through texting. 

Provides Steps to Be Taken to Get Professional Help

If I need her to make the contact for me, she asks me for my location and what I am thinking. She will relay this information to my mental health professional when she contacts them. 

The 988 Hotline can be called if it seems like I need professional support, and it is at a time when my mental health professionals would not be able to be reached. Some people may not have mental health professionals that can be contacted. In this situation, if the person is not in imminent danger 988 can be contacted. The person can make the call themselves or the support person can call for them. 

If I say or indicate that I am not safe, my support person may need to call 911. While waiting for emergency help to arrive, my support person needs to stay in contact with me. It is important not to leave a person who is in crisis alone. The responders on the 988 hotline and at 911 have the ability to transfer a caller to the other line depending on the need and the level of safety concern.

Plan for Follow-Up

Once intervention has taken place the support person should follow-up with the individual. When my support person does this, it lets me know that I am not alone.  The support person should check in to see how the individual is doing and to ensure that the care provided was helpful. My support person calls me to just talk.

Conclusion

Having a safety plan has made a difference in how I cope with suicidal thoughts. It ensures that I am safe even in my darkest moments. Being a part of a safety plan requires a commitment on the part of the support person. I am grateful that I have a friend who is willing to fill this role. If you deal with suicidal thoughts, talk to your mental health professional about creating a safety plan. Your plan may look different than mine. That is okay. We each have our own needs and cope with our suicidal thoughts in our individual ways. Despite the differences, a safety plan can prevent a suicide attempt and save a life.