Are You Afraid Of Feeling Depressed?

We all experience small, natural dips in mood.

But people who have experienced major depression may become afraid of suffering future episodes to the point of catastrophizing even minor mood fluctuations. If you (or a loved one) have been paralyzed by mood symptoms in the past, each bump in the road may feel like it portends a crash: a return to feeling hopelessly and helplessly not oneself. Which sucks! Because life’s natural rhythm is not constant. Like an expectation of deep, uniform sleep each night, it is not necessary nor realistic to experience ever-steady mood.

So if you’re feeling down and starting to worry about it, here are some options for how to lighten up: 

THINK STRAIGHT

It’s been well over a decade now since I’ve experienced a major depressive episode, so I don’t still feel hypersensitive to changes in mood, but I remember what it’s like. Being pelted by thoughts like “Is this who I am, who I’m destined to be: ‘a depressed person’? Am I a loser, broken, unlovable, ‘the only one’?” There’s an expression in Buddhism that pain is what life does to us whereas suffering is what we do to ourselves. Even when we can’t immediately change the pain of a bad day, we can prevent the suffering of future-tripping that this means I’m gonna have a bad life. To the best of your ability, try to let go of hating depression, fearing depression, telling stories about depression, ruminating on past actual or future possible instances of depression. And just feel your feelings, which are often pain enough.

Easier said than done, right? Because one of the most frustrating parts of low mood is when you know your mind is negative-filtering but you just can't stop. So even if the doom-y thoughts keep coming, remember to not believe everything you think. Try to look at the thoughts (bits of information that may be true, partially true, or not true at all), not through them (seeing the entire world statically, through the lens of how your mind feels in the moment). Or try meditation as an experiential practice to support observing your experience nonjudgmentally, as neither good nor bad.

DO THINGS

Behavioral Activation is the fancy, clinical term for “doing things” and is the best, evidence-based psychological treatment for depression in existence. Doing things may not make you feel better instantly, so stick with it for a while, and it’s also important to be thoughtful about what you choose. Make sure what you do is within your values (unprotected group sex with strangers certainly counts as behavioral activation but could create more problems than it solves…) and include a mix of things you can do on your own as well as activities with others. Examples:

Do your laundry. Do your nails (as my old boss used to say, “Feel shitty? Look pretty”). Undo your nails, your hair, your iPhone lock screen — anything that feels like it could use a refresh. Do a mitzvah/good deed for someone else. Go to the movies, a dog park, or a café instead of seeing no one three-dimensional for days if you WFH.

Don’t go drinking with a friend who’s on a totally different page mood- and personality-wise unless you are ok maybe being sad-drunk and lonelier at the end of the night. Limit news and social media scrolling as it does not qualify as “doing things” and leaves you vulnerable to further catastrophizing and/or “compare and despair." And maybe don’t sign up for an expensive three-hour boot camp class if you’re on a budget and haven’t managed to shower in a week — start with a brief hike or some online restorative yoga. Depression will diminish any untremendous efforts (e.g., “This is pathetic, I have a master’s degree, why is it so hard to do the dishes?”) but don’t let it push you around. You might need this time to stay close to home, draw near to the people and animals and things to whom you feel securely attached, and shore up a sense of safety and agency before you go back out into the uncertainty, risk, and excitement of the wider world.

Or, if your symptoms aren’t too pronounced, as they say in ACT therapy, take them with you. Connect to your values to bring the cloud of negative thinking and those heavy feelings in your body and mind along, putting one foot in front of the other, one day at a time. Give the presentation just as you are. Go on spring break and meet the moment authentically, not how you’re “supposed” to feel or act. Go out on a first date and focus on being kind and forging a connection instead of looking cool and making an impression.

Lastly, among the behavioral interventions, if oversleeping was evidence-based treatment for depression I would be its biggest, loudest fan. Sadly, it is not, even though the depressed brain aches for sleep (particularly in atypical depression). Instead, set the alarm on your phone and leave it somewhere beyond arm’s length so that you’re physically forced to get out of bed. Then pump some Spotify.

CONSIDER MEDS (or a change in them)

Will you get better without medication? Usually. Will you get better faster with meds? Usually. And since each successive major depressive episode may be longer and more intense than the previous ones — your brain can essentially learn how to be depressed — it is wise to be active in treating it.

Some folks worry that trying meds means they will be obliged to continue forever — not true. People who tend toward perfectionism or overcontrol may feel that taking medicine means they’re flawed, lazy, or even “cheating.” While it’s a topic I prefer to unpack at length with clients in session, for the sake of brevity, consider the absence of similar judgement around diabetics needing insulin, or the way Ozempic et al have helped dispel the fat-shaming myth that everyone who eats and exercises moderately should essentially end up with the same body type. Brain and body chemistry vary. So simple, yet so easy to moralize and oversimplify.

Personally, I enjoyed two four-month courses of old-school Prozac, around age 25 and 30, plus a couple of later “prophylactic” courses for PMDD — meaning I’d take a low dose for up to seven days before my period only, to reduce predictable premenstrual despair; no meds most of the month. Also, for about a year, I took a blood-pressure med called clonidine prescribed off-label for anxiety/overstimulation — primarily to address nerve-fraying sensitivity to the sounds of my two healthy, rambunctious, occasionally PITA young angels. Many life, hormonal, diet, exercise, therapy, and coping skill changes later, I don’t take anything, but a big new change in circumstances could mean I try them again. Not being on meds at the moment just means I feel fortunate, not superior.

If meds haven’t worked or worked well enough for you, there are solid newer options: TMS (transcranial magnetic stimulation), plant medicine/psychoactive treatments such as ketamine, psilocybin, and MDMA, where safely available, testosterone or other supplements, acupuncture, and eventually, Deep Brain Stimulation. Although scary-sounding, ECT (electroconvulsive therapy) is still the most effective treatment for chronic, severe, treatment-resistant depression.

Depression is painful. AND at least it’s possibly the best time, medically and scientifically, in the history of the world to experience it (that's some glass-half-full shit right there). As I wrote long ago in the margins of my Meditation for Dummies book (gotta start somewhere), “I can beat depression!!! I can unlearn helplessness!!!”

And you can, too.