Category Archives: We Get Better

Depression Treatment Options Roundup: Option Twenty

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.

Depression Treatment Options Roundup: Option Nineteen

selective focus photography of paintbrush near paint pallet — *Photo by Steve Johnson on Pexels.com*

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.

Depression Treatment Options Roundup: Option Eighteen

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.

Depression Treatment Options Roundup: Option Seventeen

colorful cutouts of the word purpose — *Photo by Magda Ehlers on Pexels.com*

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

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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.

Depression Treatment Options Roundup: Option Sixteen

man carrying gray pipe — *Photo by Yury Kim on Pexels.com*

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.

Depression Treatment Options Roundup: Option Fifteen

close up photo of a stethoscope — *Photo by Pixabay on Pexels.com*

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.

Depression Treatment Options Roundup: Option Fourteen

clear wine glass on black surface — *Photo by George Becker on Pexels.com*

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

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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.

Depression Treatment Options Roundup: Option Thirteen

pink gemstone — *Photo by E Pro on Pexels.com*

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

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Treatment option 13: Trying alternative healing modalities such as hypnosis, reiki, acupuncture, massage, hypnosis, energy healing, supplements like Omega 3s and vitamin D, indigenous healing practices and more

Alternative healing methods are often recommended for people with depression. However, your mileage may vary. If you decide to try reiki, hypnosis, acupuncture, massage or something similar, consider it an enhancement technique–part of a larger plan for self-care. Reported benefits include reduced pain, increased relaxation and improved focus. Some of these methods might also help people gain the inner peace and emotional strength to make needed changes in their lives, such as improved outlooks, habits and self-talk.

Though research on their effectiveness is mixed at best, and they are not government-regulated, St. John’s Wort, 5-HTP, vitamin D, omega 3 fatty acids and other supplements are often used as treatments for depression. Many people report mental health benefits, but keep in mind that brand matters: significant differences in potency and quality exist. Also, health claims made on labels and in advertising are not fact-checked by any agency or third party, and even content labels can be wrong. Always consult with a licensed medical provider for more information on safety, effectiveness and possible interactions.

If desired, add “try alternative healing modalities” to your depression treatment plan. Then decide on next steps and write them on your short-term and/or long-term to-do list.

Depression Treatment Options Roundup: Option Twelve

macro photography of a psilocybin mushroom — *Photo by Marek Piwnicki on Pexels.com*

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

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Treatment option 12: Taking therapeutic psychedelics

The hippies were onto something: when properly taken, psychedelics–ketamine, magic mushrooms, LSD, MDMA and others–can provide significant (and fast) relief from depression for many people. They are especially recommended for people with severe, treatment-resistant depression.

The effectiveness of these substances comes from their ability to quickly and dramatically alter the user’s neural pathways. When taken in a carefully crafted therapeutic environment that includes professional assessment, planning, oversight, and counseling, they can help people replace unhelpful stories and perspectives with new, vastly different ones. History is rewritten.

According to current studies and Michael Pollan’s excellent, comprehensive book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, psychedelics are not addictive and have a low risk of physical harm. However, mental harm such as paranoia or psychosis can occur, and people with bipolar disorder, schizophrenia and certain other mental disorders should not take them. Consult with your mental health provider on legal and safe use.

Ketamine is a legal psychedelic commonly used for starting and maintaining anesthesia during medical procedures. Recently, anesthesiologists across the U.S. have set up clinics to administer ketamine off-label for mood disorders. Other medical providers specially trained in psychedelic-assisted therapy are offering ketamine treatment in smaller, private settings. These treatments can be expensive, and are rarely or never covered by insurance at the time of this writing. However, like other psychedelics, ketamine’s effect on depression is reportedly swift and significant. In clinics, it is administered intravenously.

Esketamine is a legal psychedelic that is almost identical to ketamine on a molecular level. It is approved for use in the U.S. as an antidepressant when prescribed by a properly credentialed psychiatrist, and it is not as expensive as ketamine. It is administered in the form of nasal spray.

Psilocybin is the active ingredient found in magic mushrooms and magic truffles. Research on psilocybin for depression is in its early stages, but is quite promising.

Though MDMA is shown to have similar efficacy as that of other psychedelics, it is often sold as ecstasy or molly, and these drugs are unsafe. They sometimes contain methamphetamine, a highly addictive substance. In addition, some research has shown that repeated use of MDMA can lower one’s baseline mood, though this finding is controversial. Finally, it is known for creating a next-day hangover effect in some people, in which users experience depression, irritability and lack of motivation for a day or more following their use. Still, psychedelic advocates are currently seeking the legalization of MDMA and other psychedelics in addition to ketamine.

Before trying a psychedelic, read about its possible long-term effects, which for some might include psychosis and suicidal thoughts. Do not purchase these substances illegally, and carefully follow your prescriber’s recommendations regarding dosage, substance interactions and more.

If desired, add “consider psychedelic therapy” 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.

Depression Treatment Options Roundup: Option Eleven

crop unrecognizable black man sharing complains with female psychologist — *Photo by Alex Green on Pexels.com*

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

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Treatment option 11: Undergoing Eye Movement Desensitization and Reprocessing (EMDR) or another form of trauma therapy

EMDR is a surprising therapy. The most surprising part: it works. Studies show that this unique technique, which involves making side-to-side eye movements while a therapist helps you process your trauma stories, reduces some trauma symptoms with relative rapidity. If you suffer from PTSD, or you think that your personal history might be contributing to your depression, you might want to consider this treatment option.

To locate an EMDR-trained therapist, a good place to start is PsychologyToday.com. This website is the most-used referral site for counselors, psychologists, psychiatrists and other mental health professionals and the search function seems to work fairly well.

Once you have identified providers, ask them about their EMDR training, experience and credentials; the practitioner’s skill level is a significant factor in its effectiveness. Your counselor should have experience with other forms of trauma therapy as well, as EMDR is contraindicated for some people.

When undergoing any form of trauma therapy, carefully consider your level of tolerance. Plan for possible lingering emotional effects and choose the environment and timing that is right for you. Practice your preferred emotional coping skills before and after therapy and provide feedback to your counselor about what you feel able to handle on any given day.

If desired, add “try EMDR” 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.

Depression Treatment Options Roundup: Option Ten

photo of head bust print artwork — *Photo by meo on Pexels.com*

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

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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.

Depression Treatment Options Roundup: Option Nine

pink round medication pill — *Photo by Pixabay on Pexels.com*

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

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Treatment option 9: Taking antidepressants

Though the exact mechanisms by which antidepressants work is as yet unknown, and studies are complicated by the placebo effect, evidence of their effectiveness is mounting. Most psychiatric professionals recommend them and see good results, and their patients do, too. It is a basic tenet of the therapeutic process to trust your client, and enough of my clients report significant benefits of antidepressants to convince me of their effectiveness.

The people who feel stuck and unable to make the kinds of changes that lead to an improved mood, as well as the people who have made many positive changes but still see no improvement, are the people that could benefit most from medication. In many cases, the advantages far outweigh the risks and side effects.

There are many reasons clients choose not to take medication for their anxiety and depression, though, and the choice is a highly personal one. In general, I recommend that people base their decision on side effects, effectiveness and other medical considerations, and not on social, moral or idealist considerations. Taking medication for a mental health condition is not inherently wrong or right, healthy or unhealthy. Listen to your body.

If you’ve been prescribed an antidepressant by a primary care physician (PCP) and it doesn’t seem to be working well, find a psychiatrist or psychiatric nurse practitioner (PNP) instead. While psychiatrists are medical doctors, PNPs are nurses, and many of my clients tell me that PNPs spend more time with them and ask more questions.

Go to your first appointment prepared with information on your options as well any questions you might have. Tell your story honestly and don’t be afraid to inquire about all possible treatments in case your first line of treatment doesn’t work out. You are allowed to be your own advocate. You are also allowed to say no.

When taking antidepressants, it is important to follow your medical professional’s advice concerning use, including guidelines around length of use, dosage and (if needed) discontinuation. Antidepressants are believed to work less well in successive rounds, so cycling medications is highly discouraged. Also, at least half of the people who try medication need to try more than one before finding one that works for them, so don’t give up after your first attempt, and follow your prescriber’s advice around increasing dosage until an effective level is found.

For general information and discussion on the topic of medication, read the relevant sections in Andrew Solomon’s excellent and thorough book, The Noonday Demon: An Atlas of Depression. For more specific information, consult your doctor or mental health professional.

If desired, add “consider taking antidepressants” 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.

Depression Treatment Options Roundup: Option Eight

person walking between green forest trees — *Photo by Luis del Río on Pexels.com*

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

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Treatment option 8: Using nature and light therapy

Many people with and without depression report that their moods are affected by the presence or absence of natural light. And when you get that natural light outside, you might also receive the benefits of fresh air, open skies and exercise–no small extras.

Spending time out-of-doors, especially in natural environments, mentally separates us from our usual tasks and routines, helping to clear our heads. Even a short walk or quiet moment free of our four walls can interrupt an anxious or despondent moment by bringing our mental focus away from the emotional centers of our brain (the limbic system) and into the sensory centers instead.

In the book Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions, Johann Hari describes the various ways modern life creates disconnections that can lead to mood disorders. One of the most significant of these, he says, is our disconnection from nature. At least in part, spending more time outdoors might reduce depression by offering perspective: wide open spaces make us feel smaller, which helps our problems feel smaller, too. It’s a mental shift that happens almost without our noticing.

Light therapy can also be accomplished indoors with man-made lights designed for this purpose, including tanning beds at licensed professional tanning salons; however, your results may vary.

If desired, add “spending time in nature” and/or “using light therapy” to your depression treatment plan. Then set specific related goals and write them on your ongoing to-do list.

Depression Treatment Options Roundup: Option Seven

tilt shift lens photography of five assorted vegetables — *Photo by Alexander Grey on Pexels.com*

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

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Treatment option 7: Eating well

No judgment here, and no specific advice: when it comes to your diet, do what works for you. Consider whether or not your eating habits affect your mood, and if so, what changes might help. Undereating can cause depression, and overeating can, too. Avoid perfectionism and choose goals that are realistic and doable.

Of course, when it comes to food, it’s not just about physical health, but about mental health, too. Do your food-related thoughts, choices and plans help you feel more emotionally stable and healthy, or less? Answering this question can provide helpful information when assessing whether or not you’ve established habits that work for you.

If you suspect that you could benefit from a rigorously scientific perspective on nutrition, try How to Eat: All Your Food and Diet Questions Answered by Mark Bittman and David Katz. Everything by Michael Pollan is also great.

Finally, if you suspect that you might have an eating disorder, take a moment to fill out a confidential screening or start the search for help at nationaleatingdisorders.org. Food is a big part of life, and it’s hard not to be depressed or anxious if this area of functioning isn’t going well.

If desired, add “eating well” to your depression treatment plan. Then set specific food-related goals and write them on your ongoing to-do list.

Depression Treatment Options Roundup: Option Six

white bed linen — *Photo by Kristin Vogt on Pexels.com*

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

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Treatment option 6: Improving your sleep

A complete sleep might be longer than what you’re used to, but you know when you’ve had it: you feel fully able to get out of bed and start the day’s tasks. Increased energy can increase motivation, which often increases productivity. Productivity, in turn, produces confidence and optimism. In addition, emotional energy–patience, distress tolerance, etc.–can be enhanced through proper rest. In people who are chronically tired, increased sleep might be the most effective mood booster available. It might also increase the effectiveness of other depression treatments.

Cognitive behavioral therapy for insomnia (CBT-I) is the behavioral modification therapy of choice for sleep problems. If you think you might need professional help for this issue, find a mental health counselor trained in this modality. Different people benefit from different CBT-I interventions. Briefly, CBT-I practices include:

Adjusting your sleep schedule as closely as possible to your natural circadian rhythms;
Going to bed at around the same time every night, and getting up at (as nearly as possible) the same time every morning–even on the weekends;
Using various techniques to reduce sleep anxiety;
Staying busy during the day and refraining from napping;
If needed, reducing your time in bed and/or getting out of bed during wakeful night hours to reset; and
Tracking your sleep patterns in a sleep journal.

Substance and caffeine use can significantly impact sleep, reducing the length of your phase three deep sleep and increasing the length of your less restorative REM sleep.

Finally, if you are consistently sleeping poorly even while maintaining good habits, consider setting up a consultation with a sleep specialist. You might be suffering with a sleep disorder like sleep apnea without knowing it.

If desired, add “improving my sleep” to your depression treatment plan. Then set specific sleep-related goals and write them on your ongoing to-do list.

Depression Treatment Options Roundup: Option Five

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

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Treatment option 5: Exercising regularly

When I talk with clients about exercise, I always feel a bit redundant. Most of us know that it’s one of the best non-pharmaceutical mood enhancers available. We also know that the long-term benefits–better physical health, better sleep–will likely increase our quality of life overall.

While some people report feeling a “runner’s high” after a good workout, others don’t seem to receive this benefit. If you are in the latter category, you still might notice a milder, yet significant, sense of well-being. In addition, for many people, exercise is associated with a sense of self-efficacy–even empowerment.

As discussed previously, don’t wait to feel motivated to take a long walk outside, or to follow along with a yoga YouTube video in your apartment. That feeling might never come. Unfortunately, the human mind isn’t as logical as we tend to believe: it knows the relevant facts, but it doesn’t vote for them. Instead, it votes for what’s comfortable.

Veto the vote for comfortable. If you’re not quite ready to start your new routine, consider a soft entry. Choose your days and times to exercise and put your exercise shoes or clothes on at those times every week, even if you don’t leave the house. Gradually, add small amounts of exercise (a walk around the block?) to this routine. Habit is what matters most.

From a mental health perspective, being consistent is the most important part of exercise–much more important than time spent, frequency, difficulty and other factors. Anytime you follow through with your exercise goals you have made progress–even on the days or weeks you don’t increase difficulty or see changes in your body. Your body has built or at least maintained its fitness levels that day, and more significantly, your mind has strengthened its relevant neuropathways.

After around twenty-five years of consistent exercise, it’s almost impossible for me to imagine discontinuing the habit. Over time, movement becomes more than a healthy self-care practice–it is part of your identity. You can take breaks, but it soon pulls you back; when you don’t do it, something feels missing.

That’s a good feeling.

If desired, add “exercising regularly” to your depression treatment plan. Then set specific exercise goals and add them to your ongoing to-do list.

Depression Treatment Options Roundup: Option Four

black dart pink attach on yellow green and red dart board — *Photo by Skitterphoto on Pexels.com*

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

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Treatment option 4: Setting long- and short-term goals

Researchers in the field of positive psychology have made their careers discussing what constitutes the good life. Many of their findings are included in this book, and high on the list: pursuing meaningful goals. Though mindfulness research has shown that living in the present moment is a helpful habit to cultivate, we also benefit emotionally from some amount of future planning. Achieving goals–both daily tasks as well as major milestones–gives us the satisfaction of accomplishment, which can increase a sense of self-worth and self-efficacy.

When considering what you would like to work towards both in the short- and long-term, it might be helpful to follow the SMART framework. Try to identify goals that are specific (clear and well-defined); measurable (how will you know when you’ve reached it?); achievable (can you really do this?); relevant (does it get you closer to a larger goal?); and time-bound (yes, there’s a deadline).

Of course, people with depression often struggle with motivation. There’s a catch-22 at work here: you know you’ll feel better after you get started on the day’s tasks, but you don’t always have the emotional bandwidth to do so. For many people, though, motivation isn’t motivation. Instead, motivation is a reward pathway that follows the initial action. That’s right: motivation is a misnomer. It’s the feeling of satisfaction that comes as a response to completing a task, not the excitement that spurs us to get started. Some people do experience a feeling of motivation before doing their first task of the day, but that might be because their brains have learned over time that task completion satisfaction follows action.

Habit is key here. The more often you complete tasks on your to-do lists, the more your mind will anticipate the pleasure of doing so. Jeff Haden writes about this concept in The Motivation Myth: How High Achievers Really Set Themselves Up to Win, as does Daniel Pink in his popular book Drive: The Surprising Truth about What Motivates Us.

When thinking through ways to get more done, consider the following strategies:

Keep to-do lists and use them daily.
Start the day with a relatively easy task–an initial win to get your motivational ignition lighted. Then move on to the more challenging stuff.
When feeling unable to start a difficult task, tell yourself you’ll spend just a minute on it (even thirty seconds if that works better for you). Often, you’ll find that getting started is the hardest part and after the minute passes, you’ll want to keep going.
Ask a friend to be physically present with you while you catch up on time-consuming needs like laundry, organizing and the like.
Create time blocks of a predetermined length during which you focus on work alone: no texting, emailing, scrolling, etc.
Get more sleep. (More on this later.)

In What Makes Your Brain Happy and Why You Should Do the Opposite, author David Di Salvo has some additional advice. Get fast feedback, he says–even if you have to ask a friend to congratulate you on a task well done. When accomplishment and encouragement happen close together in time, your brain is more likely to associate the two. Also, keep in mind that some people are motivated more by achievement and some are motivated more by enjoyment. In one study, achievement-motivated people presented with a word puzzle that was described by researchers as “fun” didn’t do as well as when it was described as “a challenge;” for enjoyment-motivated individuals, the opposite was true. If you’re the fun-motivated type, find the fun in your to-dos. If you’re the achievement-motivated type, find the challenge. This framing might also be relevant if you decide to reward yourself for following through on an important goal. Would an enjoyable activity or indulgence work best? Or would it be more effective to track your progress in a phone app?

Though more focused on organizational change, the book Switch: How to Change Things When Change is Hard by Chip and Dan Heath might be worth a read as well. Research- and evidence-based, it discusses ways to increase your emotional desire to change, how to build new habits by “shrinking the change” and “tweaking the environment,” and more.

Finally, if you suspect you might have attention-deficit hyperactivity disorder (ADHD), consider seeing a specialist.

In your treatment plan notebook, on your phone or in another handy location, create a long-term to-do list, a short-term to-do list, and an ongoing to-do list. Add tasks that relate to your treatment plan as well as other work and life tasks that need to be done. Check the lists daily and get in the habit of accomplishing at least a few items every day. Update the lists frequently.

Depression Treatment Options Roundup: Option Three

high angle shot of a notebook and a pen beside a mobile phone — *Photo by Ivan Samkov on Pexels.com*

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

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Treatment option 3: Keeping a daily mood log

Rating and recording your mood two or three times daily and tracking it over time is a treatment option that is often overlooked. This might be because–let’s face it–the follow-through can be a bit of a pain. If there weren’t so many good reasons to use this strategy, I wouldn’t waste your time. But there really are so many good reasons.

The first reason I like mood logs is that they provide additional data when assessing the value of a particular treatment or set of treatments. Sometimes, it’s hard to know what’s working and what isn’t; tracking your results supports this goal significantly.

The second reason to use a mood log is that doing so allows for much-needed moments of introspection throughout the day. How am I doing? What do I need right now? Is there an emotion here that I need to address? Becoming more aware of your mood states and cycles can help you plan activities accordingly.

Finally, and possibly most important, the mood log provides evidence that, contrary to what you might feel during especially difficult times, depression is not a constant state. Instead, there are times of contentment and even joy mixed in with times of loneliness, sadness or worry. For some people, this knowledge alone is revelatory, as depression’s refrain is that sadness is permanent (unending), pervasive (carrying through every part of life), and personal (part of who you are).

The first rule of the mood log is: be as consistent as you can be. The second rule is: be as honest as you can be. It’s important that you trust the accuracy of your entries; otherwise, you won’t be motivated to apply the data to your treatment plan choices and to believe that you really are making progress.

If desired, in your treatment plan notebook, start a mood log. Check in on your emotional state either twice a day at about 10am and 6pm or three times a day–morning, afternoon and evening. Assign a number from one to ten that best represents your mood, with ten being blissfully elated; five being even-keeled, without either depression or elation; and one being deeply depressed. Be as accurate as possible without overthinking it.

In the weeks to come, periodically review your mood log. Notice any patterns that emerge. Certain activities and times of day might trigger certain emotional states on a fairly reliable basis. Note this information, and use it to inform your daily schedule and your depression treatment plan.

At least once a month, calculate your average mood score. Reflect on whether or not your mood seems to be stabilizing over time and possible reasons for this. Again, use this information to inform your depression treatment plan and make changes as needed.

Depression Treatment Options Roundup: Option Two

clear glass jar filled of coloring pens beside of white sketch pad — *Photo by Jessica Lewis Creative on Pexels.com*

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

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Treatment option 2: Creating your individualized treatment plan

Many books on depression management are incredibly helpful. But often, they’re limited in scope. They focus on one intervention, such as meditation, exercise or cognitive therapy, and attempt to convince us that it’s all we need. However, most people who experience chronic depression know that it’s more complicated than that. While depression responds well to many individual treatments, over time, a more well-rounded, comprehensive approach is usually needed.

For this reason, I invite readers who suffer from some form of depression to create an individualized treatment plan that meets their personal needs and preferences. It might be helpful to seek the support of a psychiatrist, licensed mental health counselor or another mental health professional in this endeavor. My hope is that by taking a whole-person approach, rather than identifying one treatment at a time, depression sufferers will experience sustainable, long-term symptom reduction.

Four dozen treatment options is a lot to take in. Keep in mind that perfection is never the goal. As you work through these pages, try to remain a bit lighthearted about the whole thing. It can be fun to make optimistic plans. Later, you can revise your expectations and your goals, adjusting them to the reality of daily life.

One more important point here: though all of the treatments included in this book work some of the time for some of the people with depression, six options are backed by more research than are the others. I call them the Big Six, and they are: maintaining healthy relationships and a sense of community; sleeping well; taking antidepressants as directed and at an adequate dose; exercising regularly; going to therapy; and doing written cognitive therapy exercises. Spending time in nature is also surprisingly effective (see Lost Connections by Johann Hari for more on this). Psychotherapy’s high rates of effectiveness are enhanced when the client connects emotionally with the counselor and when therapy is used as a meta-strategy that includes and encourages other changes. I should also note two other less accessible heavy hitters for treatment-resistant depression: taking psychedelics in a therapeutic setting and undergoing transcranial magnetic stimulation (TMS). More on all of these to come.

Strongly consider each of these when creating your treatment plan.

Grab a journal or a notebook (or even just some loose leaf paper) and start your individualized treatment plan. This can look however you want it to look, but my suggestion is to keep it simple: write “Depression Treatment Plan” at the top of the first page, and write “Emotional Coping Skills” at the top of the second page. That’s all for now; as you work your way through this book, you will write down the treatment options you would like to try on these lists. More specific tasks related to your treatment plan can go on your to-do lists or elsewhere in the notebook.

Depression Treatment Options Roundup: Option One

animal between trees — *Photo by Simon Rizzi on Pexels.com*

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

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Treatment option 1: Making your decision to get better

Ancient hunters, it is said, didn’t always run to catch their prey. Often, they walked over long distances using a technique called “persistence hunting.” Humans weren’t the fastest or the strongest animal in the wild, but our stamina made up for that shortcoming. In the immortal words of the long-running show Survivor, we were able to “outwit, outplay, outlast.”

The people who successfully manage or overcome their depression are those that have the qualities of a survivor: persistence, determination and grit. They use these qualities to pursue relevant knowledge and take action in spite of any internal resistance that might be present.

They do what it takes to survive.

For many of us, maintaining our mental health is a lifelong project that encompasses almost every area of our lives. Before exploring available treatment options, then, take some time to consider whether or not you are fully ready for this commitment.

Ask yourself this question: Am I willing to do whatever it takes to manage my depression in a healthy way? This could include introspection and honesty, putting aside old habits, forming new habits, consistently working toward goals, questioning long-held unhelpful beliefs and much more.

Take as long as needed with this task: minutes, hours, days, weeks or even longer. Only you know what you are able to commit to and when.