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With Mayo Clinic psychiatrist Gabrielle J. Melin, M.D.

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June 25, 2008

Recover from depression one step at a time

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By Gabrielle J. Melin, M.D.

Need more help?

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Go to the nearest hospital or emergency room
Call your physician, health provider or clergy
National Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

Recovering from a depressive episode or managing depression long-term takes energy and planning. You may think, how am I going to find energy or motivation when I feel so poorly?

Depression can strip you of your self-esteem, self-confidence and motivation. Approach this in the same way you would approach a friend, loved one or child. You would approach helping that person in a reasonable, caring manner. Do the same for yourself. The key is to begin with small steps.

Say you want to begin exercising, attending to bills or mail, increasing your socialization or housework. Would you tackle all of these simultaneously? Of course you wouldn't. Pick one that is a priority to you. You then will need to set up a reasonable plan as to how to proceed with accomplishing your goal.

Let's go with exercise first. Overall, your goal may to improve your health. Your goal may be to walk a mile but how would you do this? You would train by walking one step at a time. I had a patient who had been an avid runner prior to having a moderately severe episode of depression. He essentially had given up on running and was not engaging in any exercise. He was ready to begin exercising again. His initial goal was to run 30 minutes 5 times per week. I asked him to rate on a scale from 1 to 10 (10 being the most likely and 1 being the least likely) the likelihood that he would accomplish his goal. He rated his goal as a 4. We know that a rating of higher than 7 is where we want to be in order to increase our chances of goal completion. After further thought, he changed his goal to stretching for 10 minutes two times in the next week. He then rated the likelihood that he would accomplish the goal as a 9. One week later, we reviewed his goal and he was able to successfully accomplish it!

The idea is to be your own cheerleader, be kind to yourself. You deserve to feel good and to be happy. Set up reasonable goals and then honestly rate them using the 1-10 scale. It is OK if you need to change your goal. Find a support person to share your goal with. Studies show that this will make it more likely that you will follow through. Once you have accomplished your first goal, you will find your self-esteem and confidence are boosted. Don't stop now, set up your next goal. Set your self up for success! You can do it!

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22 comments posted

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December 31, 2008 9:30 p.m.

I know that recovery takes one step at a time, but how long does it take? I have been on antidepressants, and been in theraapy for almost three months now, and I don't feel any better. I have already been in the hospital twice for suicidal thoughts. I have set goals for myself and done little things to try and make myself feel better, but the motivation just isn't there, even for the small things. The truth of the matter is, I don't even like who I have become. I used to be a self supporting, independent person who loved to have fun. Now I'm so anxious,with such a lack of motivation that I can hardly even hold down a job. How did this happen to me? Then the idea that depression comes in episodes and once I make it through this it could happen again makes me not want to bother at all. I'm hardly making it through this time, I don't think I could do it again.

- Rachel

November 20, 2008 10:36 a.m.

Depression,what a word that I just really never would accept or face. Sweep under the carpet, sit in the corner and keep your mouth shut, noone cares,they have problems of there own,thats what I was taught growing up! I grew up in a stressful inviorement, 90% of my family memebers have depression but we never really learned how to deal with it,talk about it,face it. Well now is the time to break this chain for me and my children. I recently lost my husband of 16 yrs in a vehicle accident with our 3 children losing there father. Unfortunatly my children have always been around a depressing mother and a father with OCD, and now I really have shut down. My mother has a pill for everything and I grew up with not wanting to be on medication for anything but watching my children spiral down, its time for action!!! I finally decided to get on medication.Ive tried 3 different types before and I know thats the process so now well see with this new one. Im first trying the counseling thing for the kids, but I may have to turn to a psychiatrist that specializes in grief and depression for all of us. With them growing up in the invironment of depression and having a family history of depression,we need help. I need to step up and try to get this under control so that my kids can have some kind of way of knowing how to control this throughout there lives,unlike I did. I am the top of the pyramid and it starts with me learning how to cope and control this for the sake of our future.

- Natalie

October 13, 2008 6:19 p.m.

Today is a really bad day for me. It doesn't take much these days to make me cry. So tired of feeling this way, everything is so hopeless i just want everyhing to go away forever,

- Ann Mn

September 1, 2008 3:16 p.m.

I was grieving the death of my parents and went to my doctor saying I needed help and even asked about cognitive therapy. My doctor told me that I needed to be on medication(zoloft) and that I could try therapy later after my depression was controlled by the drugs. I went off the drugs I got even more depressed than before I had been on them and then my depression cleared and life got better. A while ago I was low and felt like taking my own life and I told my husband about it. Shortly thereafter we had a really bad fight where he kicked me and hit me. We were both out of control and he called the local crisis line. He told them what was going on and I guess they asked him if I was suicidal. He told them that I had talked about it. So next the police show up and take me away in a squad car to the hospital in the afternoon. I had to wait in emerg for hours till I was admitted to the psych unit where I had to wait for more hours till I talked to the doctor on duty who after talking to me told me I wasn't crazy, gave the option of going to a women's shelter or getting a bus pass to go who knows where and then released me at 9:00 PM. I went to my doctor who was sympathetic but told me this experience should be a lesson to me not to do anything like that again. I have been in crisis with traumatic flashbacks feeling like a victim. I don't where to turn as I can't got through something like that again. I don't dare call the crisis line.

- Azaelea

August 28, 2008 1:36 a.m.

Im so sick of waking up to another day. I just dont know what to do with myself. I am 24 living at my grandmas and have had my sis around me pretty much 24/7. I feel Ive wasted my life smokin pot but what now? Ive given up pot and want to be someone but the drive to do it isnt there. I find it hard to get interested in anything and have no idea what I want to be. Ive been off work for 3 months and have also developed an arthritic problem. God I need to get it together and learn how to look after myself. Well Im starting back at work next week 4hrs a day 3 days a week wish me luck.

- luke

August 16, 2008 2:41 p.m.

i am very depressed and it is causeing my family to break up and that is the last thing i want i need help i cant let go of the past my ex husband beat me and raped me he cheated on me constantly well he isnt the only one to blame every man that has ever been in my life starting with my step dad has hurt me in one way or another well i finally found someone who loves me who treats me great but if he is 3 mins late getting home i freak out that he has found someone else this stresses him out it is making him not want to be around me cause i am constantly bitching i dont know what to do i just assume he will do the same thing every other man has done. i feel fat ugly and well not very deserving of someone so great i know my kids deserve him but do i? how do i let go of the past and stop freaking out on him he has a great relationship with his ex wife (the mother of his 4 children) and i hate it she has said she wants him back and i have to be honest im scared so anytime she calls just to chit chat i freak out every time he has to go see her i freak out i dont want to be like this any more what do i do?????

- stacey

July 7, 2008 7:44 p.m.

I know that depression is real and have delt with it a lot especially lately. I am seeing my parents age and deteriorate and it is very depressing. One thing I am committing too is exercise- I think even a bit every day helps especially if you can reach your goals. I have started a run/walk routine and I am going to join the Running Room's FREE run/walk support groups which are held on Wednesdays and Sundays. It is a start anyway- hopw this helps someone out there-

- Annie B.

July 7, 2008 4:30 p.m.

I'm so glad for Don that his depression turned out to be only "situational." He is very lucky. Getting past the denial stage of finding out that you have really truly clinical depression may be one of the biggest struggles there is. Once I learned in therapy that I had NOT deserved this, NOT done anything to make it happen, and that I was NOT ever going to convince my family or origin that my depression was real, I began to learn NOT to discuss it with anyone other than my family members who actually understood. I also had to come to terms with the fact that I NEED the meds, and that when I don't take them, I fall apart and become almost suicidal. When I take them, I still have depressive episodes, but the support and counseling of my husband, my children and my church family have made all the difference. I've learned where NOT to go for help, but it took me a long time. It is unfortunate but true that there is still not only a stigma attached to depression, but there is a worse belief: that it does not exist. Those of us who have battled it all of our lives can attest that it is VERY real, but that with a good psychiatrist, the right medication (which may need to be adjusted frequently until you find just the right one for you) and a good therapist, you can and will make it! If your spouse and children come to any of your doctor or therapy visits, they will learn just how real it is, and also what they can do to love and support you. God bless you all!

- Kate

July 4, 2008 3:44 p.m.

I made a discovery that radically changed my life: I felt depressed and my primary doctor thought I was depressed. Depression meant I needed to be fixed with drugs and talk therapy. I then realized I really was UNHAPPY and there were real reasons for being unhappy and I was not addressing those things in my life that were making me unhappy. Once I listed those reasons, I was able to start the process of making the changes I needed to make in my life. Many people do have real depression because of chemical or other reasons and we would want them to get all the help they can ge but, many other people need to drop the label of being depressed and do what is necessary to make their life better. Yes, I did see a therapist who suggested how I could make the changes I needed to make and it worked. The last point: There is a huge difference between being depressed and sad; sadness is good and necessry and not pathological......

- Don DeLong

July 4, 2008 8:49 a.m.

Dianne: Depression is an all-consuming thing. I don't think this article was designed to minimize depression. I think it's written with the goal of encouraging us to get through this one day at a time...because sometimes that's all we can do. It's a reminder for us not to judge ourselves harshly and to treat our minds and bodies gently. It's sort of like giving us permission to take baby steps and telling us it's okay to do so. However, I do understanding where you are coming from. Sometimes thinking seems too overwhelming, much less trying to do normal daily activities.

- NativeRose