The First Thing You Should Do When Depressed

You are travelling along the freeway. You’re hooning along at 110km per hour (maybe even faster?). Your car stalls. It comes to a dead halt as you pull over onto the side of the road. You put the car into 5^th gear, turn the ignition, and head off.

What happens next?

If you’ve ever driven a manual car you’ll know that the answer is “the car stalls, again”. The reason for this is that a car needs to build momentum to be able to move in 5th gear. It’s fun to drive in 5th gear; you can drive fast, a little bit of gas propels the car a long way. But you can’t start in 5th, you have to progress through the gears.

Depression is a condition characterised by flat, sad or irritable mood and a lack of pleasure from otherwise pleasurable activities (called anhedonia). This emotional change is combined with four or more other symptoms, like sleep changes, appetite/weight changes, cognitive changes (like concentration difficulties and thoughts of worthlessness and suicide) and motivation/energy changes. Depression is a negative feedback cycle where negative thoughts bounce off low mood, and both bounce off isolation, decrease in activity and other behavioural changes (see here for more).

When you are depressed you can’t click your fingers and suddenly be not-depressed. Beating depression means breaking the negative feedback loops. That takes time. Trying to beat depression by trying to make a grand change, like leaving a job or moving city might work. But maybe, like the driver, you’ll stall. Big life changes are 5th gear tasks. Maybe if you try to carry on as if you’re not depressed, it will go away. Maybe pretending you’re not depressed will work. Or maybe, again, you’ll stall. Maybe you’ll lose all hope and confidence that things could get better.

The first thing you should do when depressed is to acknowledge you are depressed and “put your car into 1st gear”. Being in first gear means taking care of the basics in life. It means focusing on the things that you can control. It means aiming low at first, and thus maximising you chance of having a win (not matter how small). It means ceasing activities that are clearly harmful or counterproductive.

Being in first gear means:

1. Having a consistent bed time and wake time. You can’t control whether you sleep, but you can control when you go to bed and when you set your alarm. Aiming for a regular sleep cycle is an essential first step towards dealing with over and under sleeping issues that are a part of depression.
2. Doing some exercise. There has been much evidence for several years now that cardio exercise can be a great antidepressant. More recently, there has been evidence for weights training having a similar effect. But you don’t have to do anything extravagant. Even walking around the block a couple of times a week is good. Just do more than you did yesterday.
3. Eating reasonably healthily. Maintaining three meals a day keeps your body energised and reduces the likelihood of emotional eating.
4. As much as is possible, reduce alcohol, drugs and other addictive activities like gambling and gaming. These substances make you feel good in the short-term, but in the long-term stop you from learning more helpful ways to cope.

When clients come to me for depression, the first thing I encourage them to do is to work on improving routine. Changing routine does not make depression lift straight away. Also, changing routine often doesn’t lift depression on its own. Even if routine is improved, you may well still need to seek therapy or medication. However, depression passes quicker if routine is improved. In many cases, improving lifestyle makes the most significant change. As you ascend the gears, progressively bigger changes can be attempted (and should be attempted).

When you are depressed, the first thing you should do is improve your lifestyle and routine.