This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 20: Reducing screen time

Research has shown that social media use can negatively impact mood and self-esteem. It encourages FOMO (fear of missing out), imposter syndrome, bullying and unhealthy comparisons between peers. Doom scrolling leads to heightened anxiety, and entertainment media like shows and video games can reduce productivity and encourage procrastination.

Productivity isn’t everything, and a balanced schedule can contain plenty of relaxing screen time. Do what works for you. I find that I get more screen time overall, and enjoy it more, when I wait till the end of the day to indulge after my tasks are completed.

Life is an experiment. Consider drastically (or not-so-drastically) reducing your screen use for a time, and noticing if any mood improvement occurs. I often recommend that clients refrain from social media, games, internet surfing and other distracting screen activities for part or all of their work day. Admittedly, this is not a popular strategy.

If hours of phone-free time feels too drastic for you, consider turning off your phone for just a one-hour stretch each day. Blast through some of the items on your to-do lists or complete especially difficult work tasks. Try it for a day, or a week. This one change can lead to dramatically improved focus, attention and productivity. At the very least, check your phone time each week and attempt to reduce it gradually.  

If you are currently experiencing a severe depression episode, don’t try this right now, and if your loved one is severely depressed, this isn’t the time to reduce pleasurable activities. Scroll away.

If desired, add “reduce my screen time” to your depression treatment plan. Then decide on a specific screen use strategy and write it on your ongoing to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 19: Engaging in long-term projects and hobbies

According to a study cited in The Happiness Advantage: How a Positive Brain Fuels Success in Work and Life by Shawn Achor, having an activity to look forward to raises endorphin levels significantly. This is especially true when projects and hobbies include creativity, a sense of accomplishment and long-term involvement, such as gardening, crafts, writing, teaching, cooking, sports and many more. Bonus points if the hobby is social and screens aren’t involved.

I am often surprised (and encouraged) by the incredible variety of ways people come up with to entertain themselves. A friend of mine teaches himself tricks on the trampoline, for example. Others plant flower seeds in public urban areas as random acts of kindness. Author David Sedaris has been picking up litter nearly daily for years, and a garbage truck has been named after him. If you don’t have an awesome, fulfilling hobby, consider trying something new, then something else after that. Recreation isn’t just recreation; it’s a deeply meaningful part of the good life.

Volunteer work can be especially satisfying. Psychologist Sonja Lyubomirsky, author of The How of Happiness: A New Approach to Getting the Life You Want, found that people who did five random acts of kindness in a single day were much happier than control groups. The aforementioned Martin Seligman, one of the founders of positive psychology, agreed that acts of kindness increase happiness more reliably than any other exercise he has tested. In Learned Optimism: How to Change Your Mind and Your Life he writes, “Depression … stems partly from an overcommitment to the self and an undercommitment to the common good.”

If desired, add “finding a long-term project” or “engaging in my hobby regularly” to your depression treatment plan. Then add it to your ongoing to-do list as well.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 18: Maintaining financial stability

Financial stability means many things to many people. However, positive psychology research clearly shows that people living above the poverty line are significantly happier than people who live under it, while wealthy people are only marginally happier than middle class folks. For optimal mental health, then, getting your needs met–not continually wanting more–should be the goal.

In Happy Money: The Science of Smarter Spending, authors Elizabeth Dunn and Michael Norton explore the ways we can use our money to increase our happiness and well-being. They argue that while money can bring happiness, it’s not just about how much money you have, but how you spend it. They offer five principles for spending money in ways that increase happiness, including buying experiences instead of things; buying time; investing in others; paying now and consuming later; and designing your environment. The authors also explore the limitations of money in terms of increasing happiness and the importance of non-monetary factors, such as strong relationships and a sense of purpose, in fostering well-being.

Two other personal finance books that I recommend are Dollars and Sense: How We Misthink Money and How to Spend Smarter by Dan Ariely and Jeff Kreisler, as well as the classic Rich Dad, Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not! by Robert Kiyosaki. The latter discusses investing, while the former coaches the reader through spending traps they do best to avoid.

If desired, add “maintaining financial stability” to your depression treatment plan. Then consider specific ways to improve your finances, such as creating a budget, and write them on your short-term and/or long-term to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

***

Treatment option 17: Identifying a sense of purpose

You’ve heard the quote by 19th-century philosopher Friedrich Nietzsche: “He who has a why to live can bear almost any how.” For people with chronic depression, their shifting mood states are a big part of the “how”–the adversity they face on their way to their goal. So they need a “why,” too.

Does your career, your community, your art or your volunteer project give you a deep sense of purpose? Maybe it’s your spirituality or religion that helps you find the underlying meaning that makes your current circumstances more bearable.

If you’re not sure what your purpose in life is, consider journaling about everything you care most about. Is there a theme? One of my clients told me that the purpose of his life was to simply “do no harm.” I pondered this a moment before realizing that the goal’s simplicity hid its nobility. Do no harm. It was a larger ambition than any I’ve ever made for myself–one with potentially far-reaching consequences for his life.

The aforementioned Martin Seligman, one of the founders of positive psychology, argued in his many popular books that happiness isn’t just about feeling good. A sense of well-being includes all emotional experiences; it’s defined not by a person’s feelings but by their sense of connectedness and meaning. One of his many profound quotes comes from Authentic Happiness: Using Positive Psychology to Realize Your Potential for Lasting Fulfillment: “Positive emotion alienated from the exercise of character leads to emptiness, to inauthenticity, to depression, and, as we age, to the gnawing realization that we are fidgeting until we die.”

Don’t just fidget. Live a well-rounded, meaningful life.

If desired, add “finding my life purpose” to your depression treatment plan. Then decide on next steps, such as finding a medication provider, and write them on your short-term and/or long-term to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 16: Increasing your job satisfaction

Doing work you love doesn’t have to mean changing careers. There are many ways to increase job satisfaction. Bringing meaning to tasks you already do can help: think of the restaurant server who finds pleasure in creating an enjoyable customer experience. You can also seek out additional challenges and more workplace autonomy–even small changes can make a big difference. Above all, avoid getting bored.

In the classic work Flow: The Psychology of Optimal Experience, Mihaly Csikszentmihalyi identifies the characteristics of satisfying work. Among other qualities, jobs people like tend to be challenging, attention-absorbing and autonomous, providing the worker a sense of control. When a person feels fully engaged to the point of losing their self-consciousness, they are in a state of mind Csikszentmihalyi famously calls “flow.”

Tasks that people might not normally find enjoyable can become so when the worker has ownership and the power to make decisions. In Delivering Happiness: A Path to Profits, Passion and Purpose, Zappos founder Tony Hsieh says that call center employees who are unscripted and who are allowed to offer small discounts or free shipping at their own discretion show higher degrees of job satisfaction.

Another way to feel better about the work you currently do is to view it as a stepping stone to a greater goal. Coffee shops aren’t just coffee shops: they’re places recent college grads work at while they send out resumes, save for a trip to Spain or apply to master’s degree programs.

If you don’t currently have a clear career path or career goal, take some time to brainstorm ideas. Even if your plan changes (as most of them do), it can provide next steps and, critically, hope.

If desired, add “increasing my job satisfaction” and/or “creating a career path” to your depression treatment plan. Then decide on specific ways to do so and write them on your short-term and/or long-term to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 15: Addressing health issues

It’s difficult to feel mentally well when we don’t feel physically well. But many of us delay needed medical care due to financial constraints, time constraints and even fear. Doctor appointments can feel vulnerable, painful and difficult to schedule. However, prioritizing these needs is an important part of self-care, and can improve one’s feeling of self-efficacy.

If desired, add “addressing health issues” to your depression treatment plan. Then decide on next steps, such as finding a medical provider, and write them on your short-term and/or long-term to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

***

Treatment option 14: Overcoming addiction or improving your relationship with substances

As you likely know, frequent substance use is strongly associated with chronic depression. In the short-term, it encourages avoidance of pressing problems and needed tasks. It also represses or delays emotional expression and the grief process. In the long-term, this avoidance and repression leads to slowed emotional growth, since distress tolerance, healthy habits, interpersonal skills and other important life functions are not learned as quickly. Some people also experience acute negative effects from poor decision-making related to substance-related mental and physical impairment.

Feeling feelings is hard, but it’s an important part of maintaining mental stability. When you allow your emotions to pass through you without judgment, fear or shame, they eventually subside. What you are left with is an increased ability to handle difficult moments, an improved perspective on the distressing situation and greater inner peace.

Resources for substance use disorders abound, and I recommend taking advantage of them. Consult a medical or mental health professional. Attend a recovery group. If needed, seek in-patient care. 

If desired, add “overcoming addiction” or “improving my relationship with substances” to your depression treatment plan. Then decide on next steps, such as finding a medication provider, and write them on your short-term and/or long-term to-do list.

This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

***

Treatment option 10: Undergoing Cranial Electrotherapy Stimulation (CES) or Transcranial Magnetic Stimulation (TMS)

Cranial electrotherapy stimulation (CES) is a therapeutic treatment in which a handheld electric pulse generator is connected to the scalp. Painless, low-level currents stimulate electrical movements in the brain, which possibly help alter existing neural pathways. Patients are prescribed the device, then use it at home for a few minutes a day. Side effects are few, but the efficacy of these devices for depression is not yet proven.

Transcranial magnetic stimulation (TMS) is the in-office version of CES. Due to the effectiveness of this treatment, in recent years, TMS clinics have been established in many areas. TMS is more intense than CES, and memory loss has been reported. 

Related but less often prescribed treatments are electroconvulsive therapy (ECT) and deep brain stimulation, both of which might have greater side effects than TMS or CES.

People with severe, treatment-resistant depression might want to consider one of these therapies. Just do your research first, both on the treatment of choice and on providers in your area.

For a thoughtful, thorough account of these treatments, read the relevant sections in The Noonday Demon: An Atlas of Depression by Andrew Solomon. Just keep in mind that his account was published in 2015, and might be somewhat outdated due to changes in technology.

If desired, add “consider undergoing CES or TMS” to your depression treatment plan. Then decide on next steps, such as finding a provider, and write them on your short-term and/or long-term to-do list.