"You need to be able to own the reality that depression is a physical illness like heart disease, diabetes, and cancer. You can’t get over it by 'trying harder' or adjusting your attitude."
(DR. RICHARD H. RASKIN)
Q: How can I tell whether my condition is the result of stress and anxiety in my daily life, or a serious clinical depression?
A: Everybody feels anxious and blue sometimes. What differentiates those feelings from depression is how long they last; if they persist for two weeks or more, you should consult a mental health professional. And there is a list of symptoms to watch for: persistent anger, irritability, a loss of interest in pleasurable things, lack of interactivity with family and friends, feelings of guilt, sleeping problems, eating too little or too much. These can come in any number of combinations. Still, the first thing I look for is the duration of the symptoms.
Q: When I am depressed, should I strive to maintain a "normal" life at home and at work or cut myself some slack?
A: The answer is both. Depression impacts your judgment about what you ought to be doing, at work and socially: How much is enough? What is OK and not OK? How do others perceive me? A lot of this impaired judgment can make you hypercritical of yourself, especially at work. Combine that with feeling as though you are slogging through a swamp, and your perceptions may not be very trustworthy.
Let’s say you are correct in assuming that your work abilities are diminished. Chances are, you can still accomplish some meaningful tasks, however difficult the effort might be. Maybe you can’t work at 100% capacity; maybe you can work at only 75% capacity. Still, that’s an accomplishment, and it provides genuine feedback about your condition. Patients have told me that, looking back on their darkest days, their work didn’t seem so bad after all. It’s sort of like the elephant walking on its hind legs: It may not be performed with grace, but it’s laudable if it’s performed at all.
It is the same in your home life. Try to maintain your regular schedule, from brushing your teeth to picking up the mail; get out of the house and stay active. So maybe you don’t enjoy everything you’re doing, but it’s still better than staying home and focusing on your illness. Then again, if you really can’t function, you have to be compassionate with yourself. You deserve a break; take a sick day, whatever you need. Remember that you have a serious illness. This is not your fault and there is no reason to feel guilty.
Q: When I am depressed I become extremely anxious, at times feeling as if I’m having a heart attack. Is there anything I can do about this?
A: Depression and anxiety often go hand in hand. Anxiety can cause changes in your breathing pattern. Rather than taking lung-filling breaths, you may shift to very shallow upper-chest breathing, which can make you feel as though you are suffocating or that you might stop breathing altogether. Sometimes taking deep, slow breaths can help. Hold a deep breath to the count of six, then exhale slowly to a six count; repeat this for four to five minutes. Increasing the level of oxygen in your body will often reduce symptoms of anxiety and panic. Sit and talk to yourself: This anxiety is not a dangerous event. You are not having a heart attack. It probably was triggered by some unconscious thought or fear. This is a normal body reaction that typically will pass in a few minutes.
Be mindful of what you’re feeling, and accept that feeling in the moment; sometimes that’s enough to help it pass. Bad things happen (they happen whether people are depressed or not) and we can’t always control outcomes. This is where support groups come in, helping you understand that you are not the only one in this predicament. And remember that you always have choices, even if you can’t see them in the moment.
Q: When I am feeling down, making a decision, however minor, is extremely stressful. How can I cope with this?
A: It’s very common for a depressed person to be frightened about any little thing: a random negative thought, a glance from someone, something you read or see on TV, an intonation from someone you are speaking with.
You may not be consciously aware that anything has happened to trigger these feelings. Often the fears make you want to be alone, even isolated from the world around you. It’s very important that you learn to recognize when these feelings are coming, and have a strategy for managing them and staying connected. This can be as simple as having someone to reach out to when danger strikes.
And you may be feeling a lot of anxiety—anxiety and depression often occur in tandem. When this occurs, you should step back and say to yourself, "What is the worst thing that could happen to me?" It’s usually not as bad as you had feared.
