Depression

Strategies for living

For people with depression, managing and enhancing their mental health means more than simply taking medication and limiting exposure to stress. Equally important are their beliefs, style of thinking, personal relationships, lifestyle habits, working environment, and the culture in which they live.

Sadly, family members and the general public may lack information about mental and depressive illness and as a result, they may not react in a supportive or understanding way. Such attitudes are often the result of fear and ignorance. Some people's attitudes may change as they learn more about your illness while others' may not. Being prepared for this and having someone in whom you can confide and with whom you can share your frustrations in dealing with the stigma of depression will certainly help.

Clearly, mental health is directly tied to a person's overall health and well-being: enhancing a person's overall health depends on considering his or her total physical, social, emotional, vocational, intellectual, and spiritual functioning since each area is connected to and directly influences the others. Improving mental health therefore involves looking at each of these areas of functioning to determine whether changes need to be made. While this is especially true for people who have been diagnosed with depression, the same also applies to their families and friends. (If you are caring for someone with depression, learn how you can help by reading For Families and Friends, also in this section.)

Let's examine each of the above factors in closer detail.

Physical

Feeling good about yourself and improving your ability to cope with stress involves:

• ensuring proper nutrition
• exercising regularly
• learning to relax
• getting enough sleep
• having regular medical check ups

Social

Feeling comfortable with others, giving and receiving support, and being able to trust all contribute to a person's well-being. Social well-being depends on:

• spending time with family and close friends
• making new friends
• offering help and support to those in need
• appreciating the people closest to you

Emotional

Emotional health stems from self-acceptance and from an acceptance of where you are. Emotional health depends on:

• enjoying time alone
• taking pride in your accomplishments
• learning from mistakes
• remaining hopeful and staying positive
• being kind to yourself

Vocational

Self-worth and self-esteem are directly linked to whether a person feels productive. Enhancing health and well-being may require looking at the work you do and making adjustments if necessary. Such adjustments may mean:

• exploring your career options
• doing useful work around your home, yard, or garden
• volunteering your time to help others in your community
• engaging in creative pursuits such as painting, photography, woodworking, or creative writing

Intellectual

It's important to keep the mind active through:

• reading or doing a crossword puzzle
• seeing a movie or attending a concert
• visiting an art gallery or museum
• learning something new
• teaching something you've recently learned to someone else

Spiritual

Finding sources of inner strength and comfort gives a person a sense of purpose in life and can be done through:

• nurturing hope
• living life one day at a time and making the most of each day
• using meditation or prayer
• keeping a diary or journal to record thoughts, feelings, and ideas

Lifestyle considerations

In addition to ensuring a high level of functioning in each of the areas described above, people living with depression also need to consider lifestyle changes.

Exercise

Consider exercising at least thirty minutes, three times a week. Exercise is a natural way of reducing the symptoms of depression, and it can also elevate mood.

There may be days where you don't feel like "working out". On those days, consider going for a walk instead. Even if you're just going to the corner store to pick up some milk or a candy bar or down the street to mail a letter, the fresh air will help perk you up. Funny as it may sound, you need to use energy to renew energy. When you simply feel too "down" or "bummed out" to exercise, remember that any activity will help you feel better: you might also try lying on the floor and kicking your legs and feet or marching in place while watching a half hour of television.

Sleep

Getting enough sleep is important. Try to adopt a regular sleep routine: go to bed and wake up at the same time every day. Try to develop a ritual for bed time that involves "winding down" and freeing your mind of stress. This bedtime ritual is intended to help you calm down. It could involve relaxing in a hot bath just before bed, reading a book, doing yoga or relaxation exercises, or listening to soothing music as you drift off to sleep. Avoid arguments and other sources of stress just before bed time.

Avoid drinking coffee or other caffeinated beverages in the evening. Try warm milk or an herbal tea instead. Hot water with a slice of lemon may also help relax you and it is also proven to help cleanse the body of toxins.

Develop a plan for those nights you have trouble sleeping. Come up with things you can do if you have trouble falling asleep. For instance, if, after 45 minutes, you can't fall asleep, get up and fold clothes, watch television, or read an article from your favorite magazine.

If you have concerns that your medications may be disrupting your sleep, be sure to talk to your doctor.

Drugs and alcohol

Be sure to discuss with your doctor whether you can safely consume alcohol while taking your prescribed medication. Avoid using drugs or alcohol to "self-medicate". Using alcohol as a way to induce sleep or taking larger doses of medication in order to augment its effects can be very dangerous.

If you believe you have a drug or alcohol dependency, be sure to get help. Talk to your doctor or therapist, or consider contacting an organizaton such as Narcotics Anonymous or Alcoholics Anonymous.

Employment

Return to work as soon as you feel ready. If you have apprehension or doubt, be sure to talk to your doctor or therapist. He or she may recommend returning to work gradually through part-time work or through volunteering. He or she may also be able to refer you to a specialized employment program designed specifically for people recovering from mental illness as well as to sources of emotional and financial support to help you manage your gradual return to work.

With your doctor or therapist, clearly identify the stressors in your job and together, develop a plan to help you cope with them. Consider discussing potential problems with a supportive supervisor and co-workers. Working collaboratively.

If you're unable to return to work, you may need to consider other types of work better suited to your abilities and energy levels. This may mean having to explore career options and meeting with a career counselor. You may also need to find other ways to improve your self-esteem and enhance your mood that are not linked to a career.

Social Life

Maintaining and building friendships is important. Don't be afraid to call people, particularly when you are feeling down. Talking to others can be an effective way of reducing stress and taking your mind off your worries.

Volunteering in your community may not only help you develop new friendships, learn new skills, and enhance your sense of purpose, it can also help you improve communication and interpersonal skills. These skills and the experience and confidence you gain through volunteering can also help you in your present career or in your job search if you need to look for something new, as outlined above under "Employment", above.

Legal considerations

People with depression, particularly those whose depression is severe and recurrent, should be prepared for periods of disability. Planning for such eventualities when you are well allows you greater control over your future. Ensure your planning includes your family, friends, and other people who may have been affected by your illness. You may wish to consult a lawyer about making legal provisions and devising a personal directive for those times you are unable to make decisions for yourself. A lawyer will be able to explain to you what's involved in Enduring Power of Attorney and Trusteeship/Guardianship.

Enduring Power of Attorney

Although laws vary from one jurisdiction (state/province) to another, most areas will have what's known as Enduring Power of Attorney. This allows those who are well now but who may, at some future point, become mentally unstable, to plan how they will be taken care of. Essentially, by authorizing an individual of your choosing to handle your personal affairs in the event of your physical or mental disability, Enduring Power of Attorney allows you to determine how your property and financial affairs will be administered should you become disabled or incapacitated. Enduring Power of Attorney is structured in such a way that it does not come into effect until you become mentally incapable of managing your own affairs.

If you are thinking about Enduring Power of Attorney, consider the following:

• the best time to make these legal arrangements—you need to be of sound mind in order to give instructions to a lawyer
• the conditions under which Enduring Power of Attorney will take effect and the conditions under which it will no longer be in effect—you need to fully understand the criteria that determine whether you are once again able to handle your personal affairs
• be clear about how you want your affairs to be managed when you become disabled and the types of decisions you would like made for you
• be clear about the types of actions that should be postponed and specify under which conditions you should be hospitalized
• consider who is the best person to handle your affairs and whom you most trust to make decisions that will serve your best interests

Trusteeship/guardianship

In some jurisdictions, there are laws that provide for the care of individuals over the age of majority who are unable to take responsibility for themselves or for their financial affairs due to physical or mental disability. These laws allow for the appointment of a guardian or trustee. It's also important to make the distinction between a guardian and a trustee. While a guardian is responsible for a dependent adult and ensures his or her personal needs are met, the guardian is not responsible for the dependent adult's estate. A trustee, on the other hand, manages the dependent adult's estate, but is not responsible for his or her "person".

Anyone wanting to be appointed as the guardian or trustee of a dependent adult must make an application in court. This application must be supported by reports from the dependent adult's doctor and/or therapist. A judge will then assess the information provided and render a decision about trusteeship or guardianship and will also specify the conditions under which these will occur.

Suicide prevention

It's natural for people to consider suicide as a means of escape from emotional pain or personal hardship.

People suffering from depression are particularly vulnerable to suicide. Sadly, an estimated 15 percent of people with recurrent major depression eventually commit suicide, while a far greater number attempt it. The end of a major depressive episode is the time of greatest risk for suicide because, as the symptoms of depression diminish, an individual has increased energy to carry out a suicide plan.

Sadly, suicide claims many lives each year despite its being preventable through effective intervention. Help is available to suicidal persons, and we each have a role to play in suicide prevention. Be sure to review our section on suicide for information on:

Dispelling 5 common myths about suicide
Warning signs of suicide
Suicidal thoughts: what to do
After suicide: a guide for those left behind
Dispelling 5 common myths about grief
Loss: facts and misconceptions
Beyond surviving: suggestions for survivors
Responding to survivors

Women's Web gratefully acknowledges The Support Network of Edmonton for providing much of the information in our section on suicide.