Managing Your Depression (5 page)

What is considered moderate or vigorous activity? The intensity depends on how much effort you are putting into it. To estimate the intensity of your physical activity, use the Talking Test. If you are able to talk while exercising, that is a
moderate
activity. If you are out of breath, that is a
vigorous
activity.

Or you could count your heart rate during exercise to determine whether you are exercising at a moderate or vigorous intensity. Do this by placing two fingers on the side of your neck or on the inside of your wrist and count the beats for one minute. Take this number and compare it to the percentage of your target heart rate.

• Your target heart rate is 220 minus your age.

• Exercising at 50 to 60 percent of your target HR is moderate intensity exercise.

• Exercising at 70 to 85 percent of your target HR is vigorous intensity exercise.

Track Your Progress

As you keep up your exercise program, your strength, endurance, and energy level will improve. The more you do, the stronger you will become, and the more likely you are to do the activity. Tracking your progress is a good way to monitor your activities, adjust your exercise as you improve, and keep up your motivation. One way to do this is to record the type and duration of your physical activities in a weekly agenda or exercise log. Another way is to use the USDA’s online tool, Super Tracker (
www.choosemyplate.gov/SuperTracker/physicalactivitytracker.aspx
), which offers a way to track your exercise and your calories over time.

Routine and Structure

Routine and consistency in daily life help make your life more manageable and in control. It is thought that small changes in one’s daily routine place stress on the body’s ability to maintain stability, and that those with mood disorders have a more difficult time adapting to these changes in routine. Paying close attention to daily routines, and to the positive and negative events that influence those routines and cause you stress, increases your stability. This is the basis of social rhythm therapy, a treatment for bipolar disorder, which has some benefit to mood disorders in general.

Many people with depression have a difficult time going about their daily activities. However, endless hours of empty time alone will only worsen your symptoms. So it is essential to maintain a regular routine and structure to each day, even when you don’t feel like it. Schedule your time and try to follow that schedule, but also be flexible with yourself. Keep your schedule in an agenda or appointment book that you carry with you. Having a daily structure and following a routine will also help you better manage the lack of interest and decreased energy that often comes with depression.

Plan your time each day to include a
balance
of these things:

• Responsibilities and obligations: things you do at work, home, school, with family

• Daily self-care

– Meals and nutrition

– Medications, treatments, therapy

– Personal care: showering, shaving, brushing your teeth, getting dressed

– Sleep

– Exercise

• Social contacts: keep regular contact with safe people and situations. Avoid isolation. Being with people you like has a positive effect on your mood.

• Positive experiences

– Pleasant and pleasurable activities: It is not enough to eliminate the negative experiences in life—you also need to include positive and pleasurable experiences.

– Mastery activities: Engage in activities that are somewhat difficult for you to do and are a challenge. They give a sense of being competent and effective. Learning a new skill or overcoming an obstacle is one way to achieve mastery.

– Purpose in life: include activities that give you a sense of purpose.

Keep your daily schedule …

• Prioritized. Understand what is most important for you to do.

• Measurable. Put a timeframe around each activity (instead of open-ended time).

• Attainable and realistic. Start with the things that you can do
now
, in your current state.

– Pace yourself.

– Break large, complex tasks down into small steps that are more realistic and manageable.

– Don’t overschedule—this creates more stress and the potential for failure.

– Learn to set limits and say “no” when you are overextended.

• Concrete and specific. Clearly define each goal and task.

• Flexible. Understand where you are and what you can do at any given time and modify your schedule as needed. Do not compare your current self and abilities to past levels of performance or functioning.

To make it easier to include them in your daily structure, list activities, exercise, and people you enjoy (see form on
page 27
).

Avoiding Isolation

With depression, there is a tendency to withdraw from the activities of your daily life and to avoid contact with friends and family. You may prefer to stay at home, not get dressed or answer the telephone, and just do nothing. Getting in touch with others or responding to those who are trying to help you is often quite difficult. Symptoms of depression such as fatigue and lack of interest may contribute to your withdrawal. This type of alone time is often lonely, closed off, and adds to your sense of sadness. Resist the urge to isolate and withdraw from your life. Isolation is not healthy for you or your brain. Social isolation and lack of social support increase the risk of developing depression and may prolong episodes of depression. You need to have social contact and support to maintain your emotional well-being and protect against major depression.

Examples of isolation and withdrawal include:

• Staying alone at home most of the time, without others around

• Avoiding conversations with your family or friends, in person or by not making or returning telephone calls

• Not going out to be with other people

• Skipping your usual errands and human interactions

 
ACTIVITIES AND PEOPLE I ENJOY 

Things I like (or used to like) to do:

Types of physical exercise I like (or used to like)—
only those things I can do now:

People I like to keep in contact with:

• Avoiding activities you once enjoyed

• Canceling plans with others for no particular reason

• Not making new plans

• Canceling doctor’s appointments

Isolation versus Solitude

All alone time is not the same. Spending
some
time alone each day, without feeling lonely, can be beneficial. Solitude, rather than isolation, has a purpose and provides a sense of contentment and enjoyment. It allows you to think, self-reflect, and relax or replenish yourself when overwhelmed. Solitude is something you choose to experience, in contrast to the isolation of depression. Everyone needs a bit of alone time in their lives. A quiet walk outdoors, reading, or working on a favorite hobby are examples of solitude that can be valuable to your well-being. Even though solitude is alone time, it is not the same as the isolation and withdrawal that comes with depression.

People vary in how much they value and feel comfortable being alone. That is built into your disposition, the way you were born, and each person is different. You have to know yourself and your personal preferences. For example, a farmer tending to his cattle or crops all day or a fisherman at sea may feel quite content and not lonely or isolated, even though he does not see other people for days at a time. He is not bothered by being alone in his chosen place. This may be a healthy decision for him. Another person may not feel the same way and needs to be surrounded by others, such as by living in a large metropolitan city. People choose lifestyles with varying degrees of solitude, based on what is healthy for them.

How Do You Avoid Isolation and Withdrawal?

The first step is to recognize when it is happening. If you notice yourself spending more time alone, not by choice but because you are fatigued and have no interest or energy, this is isolation. If you find yourself avoiding people and activities for no particular reason,
this is withdrawal. Know the signs of isolation for you and include these on your Action Plan for Relapse Prevention (see
chapter 5
).

Once you have identified your alone time as isolation and withdrawal, take steps to prevent it. Avoiding isolation when depressed can be a challenge. Do not wait until you “feel like it” to get out and be with others. Push yourself a little and just do it, a little bit at a time. Make it a point to return telephone calls from friends and family who are helpful and positive. Set your expectations to do the activities you can do now and modify them as needed. It can be overwhelming to do everything you managed when well, so break your activities down into small steps. Get out of the house. Do one or two errands at a time, not a dozen. Say hello to the store clerk. For now, walk for ten minutes around the block rather than tackling your usual exercise routine. Eventually, it will all become easier to do.

A written routine and schedule can help you manage the tendency to withdraw. That way, you have something concrete to follow for the times when you are so tempted to isolate. The key is to stick to your schedule even when you don’t feel like it. Hold yourself accountable for following through. Then give yourself credit for this accomplishment!

CHAPTER 2
Mood Disorders

Depression and Bipolar Disorder

Mood disorders
is a term that includes major depression and bipolar disorder, conditions of the brain that involve a disturbance in your mood or state of mind. These two conditions are grouped together because they share some of the same clinical characteristics.

Major Depression

Major depression is most often a relapsing and remitting yet treatable illness. A relapsing and remitting condition means that the symptoms come and go. Depression affects your thoughts, feelings, behaviors, relationships, activities, interests, and many other aspects of life. Someone with depression often has trouble functioning in the ordinary activities of daily living. An episode of depression may last weeks, months, or longer. Many people have repeat episodes over time and feel well in between—the pattern is unique to each person.

One way to see patterns in your illness and its relationship to life events is to track your daily symptoms on a Mood Chart (
page 46
). Tracking these details is a good way to follow your progress and response to treatment. This information can then be used in making treatment decisions with your physician or as a point of discussion in psychotherapy sessions.

One long-held theory of depression is that it involves an imbalance of chemicals in the brain, called neurotransmitters. These chemicals are found throughout the brain, including the part that regulates your emotions and behavior. The chemical imbalance may happen when certain life experiences occur in a susceptible person. What makes a person susceptible is not fully understood.