No one knows how to help, and at some point, survival instincts kick in and most people back away. This is why, ultimately, depressives must help themselves — and especially at times when they are the most vulnerable and helpless. It’s a tall order.
I almost did not survive my first debilitating depression at 22, and have clung on through the many bouts that have followed. Now, at 50, I feel fairly confident that I can manage recurring depression, although I’ll never say I’ve beaten it. Like an addict, I suffer from an illness and consider myself always in recovery.
Here are three steps that I’ve taken over the years to manage recurring clinical depression. My hope is that a fellow sufferer — unlike Robin Williams and countless, nameless sufferers before him—might find relief.
1. When you’re down, just survive!
Action, which ironically is what is required to lift a depression, is nigh impossible for the seriously depressed. I’ve suffered cyclical, severe, atypical (meaning: not related to a specific event) depression my entire adult life — believe me, I’ve been there. One morning during a particularly severe cycle, it took me four hours — and all the willpower I had — to move one leg off the bed and then the other, just so I could stand up. (See how “exercise” can be the worst well-meaning advice for the severely depressed?) In this state, daily existence overtook me like a freight train: dishes piled up, dust bunnies accumulated, and bills mounted. I put every ounce of energy into functioning at work just to keep a roof over my head. It was at this point that a helpful therapist suggested I go on disability because I probably would never be able to hold down a job. Somehow, I hung on. When the depression lifted, I was spent and faced a mountain of tasks that I hurriedly finished before the next depressive episode hit me. It is this relentless cycle that pushes sufferers of episodic depression to the brink of suicide.
The only task for the severely depressed is to keep alive until the mood lifts — for it WILL lift. Depression is a paradox, I’ve learned. If you fight it (with stoicism and a stiff upper lift), depression worsens. If you do nothing, depression worsens. The key is to do a little — but not too much. And, yes, it is a very tricky tightrope to walk. This is where support comes in. Find a counselor, hire a nanny, take anti-depressants, sign yourself over to the hospital for a weekend. Do what it takes to get to the point where your mind, energy, and strength recover, and you find yourself able to do a little more. And then a little more. Finally, when you get back on your feet, you can start becoming your very own therapist and start to manage your illness yourself.
2. Become the expert of your own psyche.
The first time, depression hit me like a lightning bolt — literally, I was fine one day and almost catatonic the next. At least, that’s what I thought at the time. It took years — and I mean years — of serious time, effort, and counseling to detect a pattern to my illness.
Generally I was “fine” until Halloween when, overnight, I became profoundly depressed, a state that lasted through March (yes, six months of the year). Seasonal affective disorder? Possibly. I suffered depressive bouts during other times of the year, too. But, as years passed, I learned that most of my major episodes occurred during fall/winter. In my quest to learn what caused this, during the fall I paid very close attention to myself — moods, energy levels, habits — and my environment — weather, stress, life events. I earned a Ph.D. in Personal Emotional Health. Perhaps this was the hallmark of self-centeredness; all I know is that if I didn’t master myself, no one else would!
I began to focus even more closely on the tiniest clues that signaled oncoming depression. I noticed that my energy started to dip even in August, as the days became shorter, work picked up, and social obligations increased. This was a profound discovery. It meant that my first depressive episode one Halloween was not literally a “bolt out of the blue;” rather, it was a matter of my inability to detect the subtle onset of a depressive cycle.
Eventually, I determined that I became easily stimulated and overwhelmed, and various winter stresses — from inclement weather to the holiday season — accumulated to the point of pitching me into the dark nights of the soul.
Beginning in August, I started taking steps to ease the stress that would lead to an October depression. To ease social obligations, I scheduled three-day weekends in September and October, and I joined more spontaneous get-togethers rather than committing to firm plans. To reduce worry and maintain a pleasant living space, I hired a housecleaner and paid someone else to do my laundry. I dieted and exercised regularly during my “good” months, when I had the energy, so I could draw on those habits and benefits when I was down. And I made regular appointments with a counselor to keep me on point. Eventually, I managed to reduce the length of my winter depression, containing it between Thanksgiving and New Years Day — and to this day, I build in even more self-care during those few months.
3. Be the expert of yourself for the rest of your life.
Maybe no one is ever “cured” of clinical depression; maybe, like addiction, it’s simply a question of recovery and management. Although I have not suffered a major depressive episode in more than 20 years, I am always aware that, like the first time, the bell jar could descend suddenly, at any moment. I learned the signals of oncoming depression, and I pay scrupulous attention to them. As I grow older and my body and lifestyle change, I adjust and fine-tune: for example, I’ve found going gluten-free helps my memory and brain fog. If I find myself in a particularly negative space, I cut out newscasts and watch or read only comedies until the mood lifts. I am always my own best therapist, 24 hours a day. I learned that little actions add up to significant change. I never take “normal” moods and happy moments for granted, and that is, perhaps, the ultimate gift of depression and the mysterious grace of survival.