Overcoming the Prolonged Blues

The last thing you should say to someone who is depressed is, “just relax”. It’s both annoying and a bad strategy. No one likes being depressed. It’s not a personal choice. Telling someone to “just get over it” or “toughen up” is insensitive, unsupportive, and ineffective. If they could, they would, but they can’t. While people can sometimes recover naturally, they can’t recover by just sitting around and waiting. Your support can make a real difference.

Instead of statements like “give it time”, you could use more helpful approaches like “Wow this sounds really hard, why don’t we give it one more try. I'm here for you.” This is a supportive and actionable thing to say because you’re encouraging them to be resilient, reminding them that they’re not alone, and you are showing them that you understand or are at least attempting to understand their pain. Be a breath of fresh air. Depressed people don’t need to be around negative people. They need positive people around them, and you can be that person. Apart from letting them talk it out with you, you could perhaps tell them to speak with a psychologist too.

Symptoms of depression can vary from mild to severe, and they also vary across individuals. Depression can also be expressed differently depending on cultures. For instance, there are expectations of certain cultures where women can be sad, but not angry, while men can be angry but not sad. This expectation affects how depression is expressed. Most often, when men display anger, they’re actually sad, and when women display sadness, they could actually be angry. Depression is becoming more common across age groups. Whether it’s a teenager or a grandfather, anyone can give you a period in their lives when they felt significantly low, and they were significantly unhappy. Just that in the past, there weren’t diagnoses or treatments, so it was just an intense sadness that had to be dealt with. But what’s the difference between depression and sadness?

Depression vs Sadness

Sadness is a very normal emotion that everyone will experience from time to time. Some things upset us, and we get disappointed. The key difference is in the person’s ability to function. Sadness impacts a person’s emotions, but it typically doesn't deeply affect the person's function in daily activities, and things that they regularly do. Another difference is that sadness is a temporary impact. For example, if I woke up this morning and my dog died, it’s natural that I’m sad for a period of time but this may not affect my job, sleep, appetite and meaning in life in the long term. Sadness is normal, but if someone is sad for an extended period of time and it impacts the way they operate and function in life, that's usually quite serious.

Sadness usually has a more specific trigger. It is usually specific to a certain issue, time or location, while depression is often more global. When you ask someone who is sad why they are unhappy, they can tell you quite concretely what they're sad about. A depressed person would not be able to be so specific. They'll usually say something very generic like “I don’t know what’s the matter, I just don't feel so great.”

For example, if I see a dog collar and it reminds me that my dog is not here anymore, I will naturally feel sad. When I walk down the street and see the local park where I used to walk my dog and realise again that my dog is not with me anymore, I will feel sad. Depression has less apparent triggers. I could be sitting at home and suddenly my mood sinks. I didn’t see a collar or anything. I just feel down. Or perhaps I wake up feeling low and sad. When there’s no specific reason, it’s likely the person has developed some degree of depression.

When it comes to sadness, there is a loss of joy but in depression, the person is experiencing anhedonia, a condition where happiness seems to have left the body. A joke or an enjoyable activity might cheer up someone who is sad but that wouldn’t cause a reaction in someone who is depressed. If you give a sad person a good burger, they might still be sad, but they’ll say that it tastes amazing. A depressed person would not react. It is as though nothing in the world would make them feel happy.

Signs of Depression

Depression is a persistent feeling of sadness, hopelessness, and loss of enjoyment from activities that they once enjoyed or loved. Apart from emotional problems, there could also be physical symptoms of depression and even physical symptoms which cause depression. Meaning that the physical symptom could cause depression or on the flipside, depression could cause that physical symptom. Some classic symptoms would be migraines, chest tightness, shoulder tightness, digestive issues or chronic pain.

To diagnose depression and understand the level of severity, psychologists use Diagnostic and Statistical Manual of Mental Disorders (DSM 5th edition), which has eight items to look into. The more items that are ticked, the more serious the condition. In severe cases, patients might be thinking, planning or attempting suicide. At this point, they don’t see the reason for living and want to end their lives, which makes it a serious and dangerous condition.

The first sign, which is most commonly ticked is a depressed mood, which people can feel from time to time. The next sign, which is a little less obvious unless you live with the person, is a diminished interest or pleasure in things that they usually enjoy. But you may be able to pick up that the affected person has withdrawn or stopped activities he or she used to enjoy.

The third sign is weight loss, sleep disturbances, and significant changes in appetite. Another sign is that their movements or thoughts tend to be stuck going round in circles, typically in a negative way. You will hear things like “What's the point? I don't want to. It's not going to go anywhere. It is all hopeless”. In terms of physical movement, there's a certain slowness or lethargy to their movements. A fifth sign would be fatigue and energy loss, which can be somewhat visible and is quite a common symptom. Another physical sign would be an increase in unconscious activity called stimming: repetitive movements like hand wringing, pacing, leg shaking, or other anxious behaviours.

A less visible sign is the feeling of worthlessness and inappropriate guilt. Many people feel guilty over different things, but under a depression diagnosis, the guilt is usually inappropriate. For instance, it’s not their fault that their parents have cancer, it’s inappropriate to feel guilty about it, but they do.

Finally, the last sign is a diminished ability to think or concentrate. You may notice that the affected person is a lot more indecisive or unable to make clear judgement on everyday items. There is also an interaction between these signs that can cause a spiral downwards. For example, difficulty in thinking clearly and making decisions are interrelated and affect each other. They are also affected by the guilt and sense of worthlessness. Furthermore, if they’re gaining or losing a lot of weight, this affects their self-confidence and the way they view themselves.

Some people don’t realise that they’re feeling depressed until they are asked some of these questions. So if you have a loved one exhibiting such behaviour or if you are experiencing this, it’s crucial for you to be aware of it and know that depression can be cured. Many people recover from depression. Just because someone has depression doesn’t mean it is the end of the world, though it could feel that way. There are many things you can do to overcome depression and even prevent the likelihood of it happening or recurring.

Before learning to cope with depression, you need to know some of the risk factors that can cause it to happen.

Firstly, genetics is a risk factor, and if it runs in the family, then it may be more prevalent. However, personality and character also come into play. If you are more cheerful, positive and optimistic, then the odds of you being depressed are lower. Furthermore, your surroundings can play a part in your chances of experiencing depression. If you experience violence, significant loss, neglect, abuse, poverty and other traumatic experiences, you may be more vulnerable to depression.

Your physical body’s ability will also play a part. For instance, if you have one leg while everyone else has two, you can feel quite impaired which can be depressing. Personal circumstances also play a part. If you got hit by a car, got fired and your wife left you, all at the same time, it can be a depressing scenario. Finally, your biochemistry makes a difference. Our bodies are made of different hormones and neurotransmitters and have fluctuating patterns at different points in our lives, such as during adolescence or pregnancy. Sleep and diet will also affect your mood and emotions. All of these factors can play a part in managing depression.

It’s important to note that risk factors are just factors. There’s no guarantee that you will encounter depression because you have one or more of these risk factors. It’s just good to understand what factors could cause or worsen depression so that you can prevent and cope with it better.

Now, what can you or your loved ones do to cope with depression?

Avoid Unhealthy Habits

Many people who experience depression tend to go into isolation or avoidance, or they want to just make it go away quickly, so they employ short term strategies or shortcuts which are unhelpful. For instance, some people turn to drugs or alcohol. These behaviours may numb the pain but in the long run, they still wouldn’t resolve the depression, which is why you sometimes find drunk people burst out in a crying spell outside clubs at 2am. When you are already unhappy, one of the most important things to do is to seek help, not self-medicate. Other unhealthy coping strategies involve being aggressive or self-sabotaging.

You should only get psychiatric medication under the supervision of a qualified medical doctor. While medication can be immensely helpful, a medication-only approach is not my first go-to solution because not only do drugs have side effects, the underlying issue that triggered the depression in the first place remains unresolved. This may lead to a high relapse rate.

Most people would respond well to talk therapy. Having a professional to explore and re-evaluate your circumstances and challenges tends to create a more adaptive and innovative solution to the triggers that set off your depression.

Talk therapy is a conversation, and on a deeper level, we’re helping people see themselves. Everyone has a different perspective on the world. Different culture, personal background and upbringing bring about different beliefs and assessments of the world and themselves. Some of these beliefs are helpful while some of them are not. A commonly held belief in Asia is – I’m not as capable/useful/smart as others. This belief is, of course, an unhelpful belief and we talk through this belief and help to assess the situation to give them different perspectives.

Therapists can help individuals to build skills to cope with such difficult experiences as well. For depressed individuals, we help them to develop effective help-seeking behaviours. We find out what they do when they feel overwhelmed, how they ask for help, what works and what doesn’t. We go down to the root of why they may choose not to seek help, and assist in building the skill that will help them in the long run. We help them prepare contingency plans in case the same thing happens again. Many people learn from difficult situations, cope better and become stronger, because they now know what to do with themselves in ways that are supportive and natural to them.

Care for Your Body

If you have an unhealthy diet, you'll have an unhealthy body, and if your body is unhealthy, you tend to be more depressed. The gut and brain connection is now being established, and the gut is often referred to as the second brain because of the many nerves that are connected directly to the brain. It is now outdated to think that how you treat your body and what you eat doesn’t play a part in your mental well-being.

Likewise, it would help if you exercised and slept well so that your body and systems are well rested, tuned up and not out of alignment. There is no perfect type of diet, amount of sleep or exercise you need to do. Each person is different. There are however general guidelines that one can adopt, but it is more important to evaluate how your body is feeling and what helps you have the most energy.

World View

Many people are depressed because of the way they view the world. Their view has a lot to do with the ability to handle stress and manage self-esteem. If someone has a high self-esteem, they tend to handle stress a little bit better because they feel confident about themselves. If they have low self-esteem, then they’re at more risk. Self-esteem and confidence can be built up over time and experiences. Having a good mentor, effective coach or personal therapist can help you develop your sense of self in ways that promotes your sense of efficacy and utilises your natural talent more effectively.

Social Media & Social Connections

There is a difference between social connection and social media. While you could get social connections and social support via social media, there is a tendency to compare with others on social media and feel depressed about your own life. Social media is mostly artificial in the sense that most people tend to present the very best and positive parts of their lives. It is myopic and heavily filtered. It’s just not the real thing. Interactions with others on social media also tends to be brief and superficial. People clicking “like” on your photos, videos or posts is just not the same as them interacting with you in person where deeper levels of connection and quality exchange can take place.

The reality is that out of your 1000 followers on Instagram, there is a high chance that most of those relationships are superficial. Speaking to someone on social media is not the same as seeing them in real life. You don’t always need to be surrounded by people, but you do need to be connected with others on a deep level. Many depressed people have relationships that are not going well, or they believe that they have no one to support them in life. Building strong social support is an important strategy to prevent depression.

If you are feeling stressed or unhappy, talk to someone. We each cope differently, sometimes we cope perfectly fine, and sometimes we don't. One of the most challenging groups of people to help in depression is men because men tend not to reach out to others and suffer in silence. Statistically, men are also more impulsive or take more extreme measures when stressed such as taking their own lives thinking they can solve the problem, when in actual fact suicide is one of the most ineffective ways to solve problems because suicide does not resolve anything.

Get the Right Help

As much as spirituality, religion, and alternative therapy may be helpful, they should be practised in tandem with seeing a therapist if the person is severely depressed. Severe depression is a sensitive and risky situation, and you need to be sure that the person gets the right help. Especially if there are signs of danger like physical harm, drinking, drugs, promiscuous sex and other uncharacteristic behaviours. It’s never too early to see a counsellor, psychotherapist, psychologist or a psychiatrist (for medication in certain cases) if they have trouble coping.

The best case scenario is to get help once you start noticing depressive symptoms. At the initial stage, it’s a lot easier to handle. At later stages, it can become more complex and complicated which makes it harder to manage. Those who are depressed shouldn’t just wait for the situation to change but should instead focus on caring for themselves better regardless of the situation. For example, when someone passes on, the people around them will feel sad. This situation won't improve but the person grieving can cope and slowly get back on their feet. It’s never too early to start good habits or to seek help. Depression can be cured, and you can actively tackle it.

1. Care for Your Health

Take care of your physical, mental, and emotional health. Be in touch with your own body, mind, thinking processes and feelings. If you’re eating junk, sleeping late and leading a sedentary life, you could be increasing your chances of depression. Start better health habits, your body will thank you.

2. Start Moving Forward

Avoiding, stalling, being idle, delaying, or trying to do things perfectly doesn’t get you anywhere. Taking action is an important choice. You may not know if it's the right choice or if it will help but moving forward is better than standing still. If you’re helping a loved one then help them to move forward and be a good support system to them.

3. Find Purpose

We are purpose driven creatures. It’s good to ask yourself who you are, what are some values you stand for, why you're here on this planet, what you want to get done, and what’s your unique contribution to the world. This gives you more focus and motivation and helps you cope.