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Ask a Therapist is a series of columns offering insights and advice about common psychological concerns. It is not a substitute for seeking professional psychological or medical care.
When people think of clinical depression, they may picture someone who doesn’t want to get out of bed or leave the house for weeks at a time. But as a psychologist, I’ve seen how depression can present in various ways. For instance, a client came to therapy and told me she is socially active, yet feels no lasting sense of interest or enjoyment. She may have a bit of fun with friends in the moment, yet as soon as she leaves, she feels an overarching sense of apathy and hopelessness. This woman has experienced stressful and distressing events over the past year, including separation from her spouse and job dissatisfaction. Is she depressed? Yes.
Characteristic signs of clinical depression include experiencing a persistent low mood lasting at least a couple of weeks, which may involve feeling sad, empty or hopeless; loss of pleasure or interest; decreased motivation; feeling physically slowed down or fatigued; sleep changes including loss of sleep or sleeping too much; weight and appetite changes; and decreased focus and concentration.
More subtle signs can include increased irritability and becoming frustrated about small daily issues, brain fog, unexplained physical pain such as headaches or back pain, withdrawing socially in small ways (such as taking longer to respond to texts), and changes in self-care, such as neglecting parts of your typical grooming routine. With less severe symptoms of depression, you may still be functioning overall, yet internally you are struggling and don’t feel like yourself.
According to The Centre for Addiction and Mental Health (CAMH), depression is one of the most common mental health problems experienced by Canadians.
Seek help from a health care professional if you are experiencing depressive symptoms, particularly if they limit your ability to function, last for a long time, or worsen. There are many treatments that can help, including medication and talk therapy. Mental health professionals are trained in evidence-based treatments for depression, such as cognitive-behavioural therapy (CBT). However, even if you are not meeting with, or not yet meeting, a mental health professional, there are steps you can take to help cope with depressive symptoms.
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Schedule pleasant activities
Engaging in fun or satisfying activities is known to increase mood, yet when depressed, people tend to stop doing the things they enjoy. It is difficult to take action when motivation and energy are low. Yet, the way to gradually improve depressive symptoms is to take small, realistic actions. In clinical terms, this is called behavioural activation. Schedule specific, achievable activities you typically like. For example, even if you don’t initially feel like it, plan to visit an old favourite coffee shop or park. Start with just 15 to 30 minutes. Over time, and with consistent practise, your desire to engage in pleasant activities will build.
Move your body
Physical movement boosts feel-good chemicals in the brain such as dopamine and serotonin. You don’t have to move for long or intensely to feel the benefits. Think about the type of movement you usually enjoy (even if you don’t right now) and try doing it for 10 to 15 minutes. For example, take a short walk or put on upbeat music and move your body. Asking a friend to join you may also help you to be more active.
Reframe unhelpful thoughts
Depression leads to more negative thinking, and reframing your thoughts helps regain a more balanced perspective. To practise, write down an example of a typical unhelpful or negative thought you have. Then, write down some reasons or evidence it may not be entirely accurate. Next, write down a more neutral and balanced thought. Repeat the more neutral thought to yourself whenever the unhelpful one pops into your mind.
For example, you may think, “I can’t do anything right.” When you examine this thought, you realize that while there are some things you wish you were doing differently, such as being more present with your family, you have been showing up to work and making sure there is food on the table each day. You might reframe your thinking to “Life feels hard right now. I wish I was more present, and I am still doing things for my family.”
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Take a three-minute breathing break
If you find your attention becomes caught on depressive thoughts, increasing distress, try a three-minute breathing break. This can help interrupt unhelpful thought loops.
To practise this exercise, pause and, for about one minute, notice what you are experiencing in that moment. Name whatever thoughts, feelings, and sensations you are having. Practise not judging your experience or trying to change it; just notice and name it. Then, for the next minute, breathe and notice the feeling of the air moving in and out of your body. You don’t need to change your breathing; just place your attention on your breath and how it feels to breathe (for example, your chest or belly rising and falling). For the last minute, expand your attention to your whole body and how it feels. You may notice your body posture or any areas of tension. Breathe into any tight spots, then after a minute, go on with your day.
Keep your sleep and eating consistent
Depression can throw off your routine. Yet, maintaining some consistency can benefit your mood and well-being. Since sleep is commonly disrupted when depressed, aim to wake up and get out of bed at the same time each day, even if you didn’t sleep well the night before. Doing so helps strengthen your circadian rhythm, your body’s natural 24-hour internal clock that guides your sleep and wake cycles, and creates more consistent sleep over time. Eating regularly helps stabilize blood sugar and, along with staying hydrated, can decrease irritation and boost energy levels. If your appetite is low, set an alarm for certain times throughout the day to remind you to eat, and aim to have regular small meals and drink plenty of water.
Jennifer Caspari, PhD, is a registered psychologist in British Columbia. She works at Tall Tree Integrated Health in Vancouver and is the author of You Are More Than Your Body.