The first thing is to keep going
Many people ask me how I have kept going despite experiencing repeated episodes of depression in my life. Now I’ve retired from my day job (as a psychiatrist) I’ve had plenty of time to reflect on that. What I have learned is that the first step in recovering from depression is simply to try to keep going and not give up hope that things can improve, even if it doesn’t seem like that at the time. I know firsthand how that isn’t easy.
I am going begin with being totally honest here- there are no simple answers to recovering from depression for many people, but that doesn’t mean there is no hope. There are still things be done, or that you can do for yourself but they aren’t always easy. If they were you probably wouldn’t have got so low or anxious in the first place. Recovering from depression can take time. Around 50% of us also will experience another episode. Some, like me, have repeated episodes. Looking back on my life now I can see there have been long periods when I thought I was much better than I was. I carried on working or went back too soon when I still wasn’t able to cope with the level of stress I had to deal with.
What did I have to learn to be able to keep going?
• I’ve had to come to terms with the fact that there were (and are) times when I wasn’t as well as I would like to be and to try not get angry with myself when that happened. Once I begin to blame myself I can get into a spiral of guilt and that only results in my mood going even further down.
• Trying to sort out a problem with another person, something perhaps that has made me very angry with them, is best left until I am able to deal with it more rationally. I’ve made this mistake many times, and continuing to try and deal with an already fraught situation has only made things worse. When I get depressed I can get quite paranoid, and I can say things that I later regret. I know now that is best avoided if possible.
• I’ve learned that I have to avoid making any important potentially life changing decisions when I am feeling low. I have to wait until I begin to feel better, and then discuss this with someone I trust.
• When it was suggested I needed time off work or away from my responsibilities, I had to learn not to immediately say no. Time out helped me to begin to see just how well I was actually functioning (or not as was usually the case), and it came as a shock to see just how hard I had been pushing myself. I still do that, even though I am now retired.
To focus on taking care of myself as well I feel able to. I know it can be difficult to eat when you feel very low, or for some people it is quite the opposite- they want to comfort eat. I have to try and set myself some very simple goals for keeping functioning and trying to maintain a daily routine. And if I am beyond being able to do that- at least letting others help me. I must not refuse assistance from other because I feel guilty about bothering them. They wouldn’t offer if they didn’t want to help.
• Trying not to push myself too hard. Sometimes we set goals for ourselves in lives that are unrealistic, and then when we fail at them we only feel worse. I have to set myself small, achievable goals. For example I couldn’t begin to think about returning to work if I wasn’t able to get out of bed in the morning. This is the thing I find most difficult. I often find myself setting goals for each day that I cannot possibly achieve and I have to let go of them. They do not have to be complete today or this week. I have usually arbitrarily decided these deadlines, and if someone else has set them, I have had to learn to say ‘NO’. I’m not sure I’ve fully learned that one yet….
• Giving myself a break. Trying to do something I used to be able to enjoy but had stopped doing since I became depressed. When I begin to do this regularly it helps.
• Getting some exercise. I hated PE at school, and I’m not at all athletic, but I have learned that I do feel better after exercise, even if it’s hard to make myself do it sometimes.
• Trying to stick with whatever plans are in place for helping me feel better. It’s better to try and give something a good chance to see if it works rather than changing about constantly trying something new, but sometimes we feel like doing this when we feel desperate. If you don’t have a plan in place consider whom you can discuss this with. It might be your doctor, therapist, or someone else you trust. If you don’t feel any better after a good trial of your plan, or you feel quite a bit worse, review your plan- this may mean revisiting your doctor and asking what else you might try.
• It’s better if I try and avoid alcohol as much as possible. Alcohol helps me with anxiety and to relax. However next day my mood is usually lower, and because it dissolves our inhibitions there is always a risk of doing something we will regret later. Half of all people who harm themselves do so when under the influence. Alcohol also isn’t safe with some medications.
• Finally, if I am having thoughts that life is not worth living I share them with someone I am able to talk to, and discuss seeking further help. If there is no-one around for you at the moment, Samaritans are always there, 24/7. Suicidal thoughts can come and go with the level of our mood and this can change from day to day, or from morning to evening. If they start to become persistent and/or you have begun to think about ways you might end your life you need to seek expert help.
When I was still working as a consultant psychiatrist, I learned that I was often the person who carried the torch of hope for my patient. When they didn’t see how things could be better they knew that I still did. That knowledge seemed to be important to them- I hadn’t given up on them. I’ve had to learn not to give up on myself too. That’s important because the world can begin to look completely different with the slightest improvement of my mood. I owe it to myself, and those who care about me, to try and keep going in the hope that something will eventually improve how I feel.
This is the first in a series of occasional blogs about recovering from depression.
My memoir about psychiatry and depression - The Other Side of Silence: A Psychiatrist’s Memoir of Depression is available now.
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