Rumination and despairThe Biggest Problem For People Who Are Depressed is usually one that isn’t even mentioned on standard Depression Inventories. In fact, many people who are depressed may not even know it.

It sounds crazy, but the most common symptom of depression isn’t always sadness, or the inability to experience pleasure (called “anhedonia”). For many, it’s the inability to feel anything positive: love, compassion, desire, hopefulness or interest. And if that weren’t bad enough, in place of positive feelings, are waves of negative ones: sadness, irritability, anxiety, dread, fear, and despair. And that list doesn’t begin to describe the physical symptoms people with depression have to deal with: heart racing or skipping beats, vicious insomnia, hypersensitivity to fluorescent lights, sudden or loud sounds, sad or tragic images, digestive problems, unexplainable aches and pains.

no ruminating

The mechanism that fuels all of these symptoms is rumination, the endless looping of anxious and/distressing thoughts. Rumination is our mind’s attempt to explain why we’re feeling so miserable in hopes that we can come up with a solution to end our suffering.

It’s like when we lose our keys. We start by looking in all the likely places: our pockets, drawers, cars, briefcase, purse. And when we still haven’t found them, we start all over again, hoping we missed something the first time.

In case you’re not sure what a loop sounds like, here’s an example:

“What’s happening to me? The only time I felt this bad was when I was depressed the last time. That lasted two years. Oh no! I can’t go back there. It almost killed me! The only things that saved me were my therapist and my dog.

“How will I ever get through this? My therapist moved to Chicago and my dog died in April. Oh, no! I can’t start over. I don’t have the energy to find a new therapist.”

“I haven’t slept more than three hours a night in weeks. If I don’t start sleeping soon, I’m going to lose my job. And if I lose my job, I can’t pay my bills.  Nobody can help me this time. I’m not going to make it!”

If this all sounds familiar, you may be suffering from “mixed anxiety-depressive disorder,” a new diagnostic term (for a common disorder) with the acronym “MADD.” With this kind of depression, you’re both worn out and revved up at the same time. My all-time favorite book on the subject is Hope and Help for Your Nerves, by Claire Weekes, a brilliant Australian psychiatrist who specialized in the treatment of anxiety disorders. I love her book so much that I keep buying used copies on Amazon so I can give them out to clients.

If you’re not familiar with Dr. Weekes’ books and videos, treat yourself.  I’ve read Hope and Help for Your Nerves so many times, I’ve practically memorized it. I love Claire’s description of ‘nervous illness,’ which she writes, “is nothing more but over-sensitized nerves kept alive by bewilderment and fear.” I’ve had this illness. She nailed it with that description.

If you are suffering from this bewildering illness, it’s important to remember that you haven’t always felt this way, and that you will eventually get back to feeling like yourself again. Even people with recurrent episodes of depression get back to feeling normal. You are not crazy, weak, or doomed. You have an illness that takes some time to heal.

What to do in the meantime:

  • Assemble a team of trusted others. We heal best when we are cared for by people whose minds are less reactive and more reliable than ours are. In addition to supportive friends and family m embers, it’s important to have a medical team you can trust. This might include a therapist, a psychiatrist, and a general practitioner. It’s best if all members of your team are kept abreast of your needs and progress. The best way to do this is to choose one person on the team to be your advocate and to communicate with the others.
  • Get a physical to rule out other medical conditions and get help with sleep if you need it. Without adequate sleep, your mental state will only worsen
  • Watch Robert Sapolsky’s excellent YouTube video on depression. Sapolsky is a renowned primatologist and neurobiologist, as well as a professor at Stanford. For personal account of depression, there’s a great Ted Talk by author, Andrew Sullivan, who in 1994, came down with a frightening, overwhelming, lengthy episode of anxious depression, and came through the other side to talk about it.
  • Download The Dipshifting Process, a free tool that helps you exit negative thought loops to stop rumination, and The Upsy-Daisy Process, a practice that helps you make even small gains more prominent and memorable.
  • Do activities that are soothing to the central nervous system: Write. Read. Organize. Alphabetize. Clean. Walk. Cook. Color. Meditate. Count coins.
  • Get out in nature, as much as possible. Nature heals.
  • Stay away from toxic people, even if they’re related to you. Here’s a sign for your door.

do not enter

  • Tell people what you need. If you’d like a daily check-in, ask a friend to call you every day. These small touchstones can make a huge difference.
  • Join a choir. Being part of a choir community is healing. (In fact, all of my clients can join the choir I lead for free. It’s all part of their therapy.)
  • Don’t isolate, even though you may feel like it. Even if the only time you leave the house is to buy a cup of coffee at the corner café, do it. Better yet, bring a book.
  • Get a pet. If you don’t have one of your own, offer to walk someone else’s.
  • Volunteer somewhere where people are delighted to see you. Stay away from activities that make you even more anxious or sad.
  • Check out sites online that deal with depression.
  • Don’t give up. If you’re feeling suicidal, tell someone or go to an emergency room at any hospital.
  • Call a crisis line now. Someone is always available to talk to you, free of charge.

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