"Lifestyle medicine" can be as powerful as prescriptions" New research makes it clear that daily habits can boost or diminish mental health. A healthier lifestyle can ward off depression , even in those with genetic predisposition. “We are what we repeatedly do.” —Aristotle Your answers to these seven questions have serious implications for your mental health: Do you get between 7 and 9 hours of sleep a night? How much junk food do you consume? Do you make time for friends and family ? Do you exercise regularly? How many hours a day do you sit at your desk? Do you smoke cigarettes? How much alcohol do you consume? A new study published in Nature Mental Health found that a healthy lifestyle can prevent depression , even in those who have a genetic predisposition. While pharmaceutical advertisements have led many to believe that major depressive disorder is caused by a lack of neurotransmitters, it has become increasingly clear that depression is much more than a chemical imbalance. Remember the classic Zoloft commercial from the early 2000s showing a sad blob with a cloud following it around? The voiceover explains: “While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance.” Zoloft transforms the sad blob into a smiling blob and the cloud literally dissipates. More recent evidence paints a more complicated picture that debunks this model: Antidepressant medications work for some people, but not because they correct a chemical imbalance. What remains unclear is exactly how they work. What is clear is how daily habits can boost mental health. Researchers examined data from almost 290,000 people—of whom 13,000 had depression—over a nine-year period, and identified seven healthy lifestyle behaviors linked with a lower risk of depression: 1. Prioritize sleep. Sleeping seven to nine hours per night reduced the risk of depression including single depressive episodes and treatment-resistant depression by 22 percent. Of all the depression-reducing factors, getting a good night’s sleep on a regular basis made the biggest difference. 2. Cultivate connections. Frequent social connection reduced the risk of depression by 18 percent and was the most protective against recurrent depressive disorder. Put simply, happiness doesn’t only come from within, it also comes from “with.” 3. Drink less. Moderate alcohol consumption decreased the risk of depression by 11 percent. Less is clearly more. Greater than one drink a day for women and two drinks a day for men can actually increase the risk of depression. 4. Eat wel l. Refined carbs, processed foods, and sugary drinks are bad for the body and the brain. People who maintained a healthy diet were 6 percent less likely to report an episode of depression. Increasing evidence shows that the Mediterranean diet can boost mood and dial down symptoms of depression and anxiety. 5. Move regularly. Frequent exercise can improve daily mood and also cut one's risk of depression by 14 percent. A related study published in the British Journal of Sports Medicine found that physical activity was 1.5 times more effective than medication in reducing depression. Not surprisingly, the sports that give people the biggest boost typically involve others—tennis, soccer, and other team-related activities. 6. Don’t smoke. Never smoking decreased the risk of depression by 20 percent. Enough said. 7. Get up, stand up . A sedentary lifestyle was considered independent of exercise. Taking breaks and stepping away from screens regularly reduced the chances of depression by 13 percent. If you’re reading this sitting down, please stand up and stretch. These lifestyle factors are more than icing on the cake. I would argue that they are the cake. People who maintained most of these seven healthy habits—five or more—had a 57% lower risk of depression. We all know that a healthy lifestyle is important for our physical health. It’s just as important for our mental health. Bottom Line: While many with depression benefit from medication and therapy, lifestyle medicine can make a meaningful difference in reducing symptoms and preventing them altogether. Samantha Boardman, M.D., - Website -

How we experience fear may be altered by the language we use to talk about it. How we experience emotions like fear and love may vary depending on a speaker's native language. Hearing a threat in one's native language seems to intensify psychophysical correlates of fear. Fear is something that can be altered by cultural and linguistic experience. Lately, there seems to be plenty to fear in the world: threats of war, political divisiveness, mass shootings. But it turns out that how we talk about what we fear might actually moderate our reactions, offering clues to how we are socially and culturally conditioned to experience that emotion . A fearful history The word fear has a long history in English. In Anglo-Saxon times, “fær,”as it was written, primarily referred to impending peril or sudden danger. But the root of the word dates a lot farther back than English, all the way to a much more ancient root, pēr, from a hypothesized language known as Indo-European that existed about 6,000 years ago. It is believed that this root meant “to pass through or travel,” suggesting that fear ultimately developed from the sense of a sudden (frightening) experience you passed through. The perseverance of this word over time certainly suggests it usefully describes a longstanding human emotion , but research suggests how different language speakers conceptualize fear is less consistent than we might expect. Is fear universally negative? We might assume that basic emotion words like “love” or “fear” translate similarly across languages, but whether these emotions are viewed positively or negatively (a language’s “emotion semantics”) can show cultural variation based on what people have learned to associate with those words. Some research has examined how this happens by looking at what is called colexification patterns across languages. Colexification occurs when a language has more than one concept associated with a word, typically arising from how and in what contexts people use those words. For instance, in English, “anxious” is often used to mean “worried” (as in “I am anxious about the test”) but also to mean “eager,” as in “I am anxious to see that new movie.” Thus, it colexifies those two meanings. However, in Dargwa (a language spoken in Dagestan), the word which means “anxious” can’t mean “eager” but can be used to mean “regret.” This suggests that many English speakers conflate anxiety and eagerness in a way not experienced by Dargwa speakers – and, since being eager is not always a bad thing, they may not view anxiety as negatively as Dargwa speakers. A fearful pattern? In looking at such patterns across the major language families (languages related historically), researchers found that the word “fear” was often associated with anxiety, envy and grief in Indo-European languages (e.g., the family including English). But in Austronesian languages (languages spoken in the Indonesian archipelago such as Malay, Tagalog, Balinese and Javanese), “fear” more often was associated with just the concept of surprise. In other words, in languages that associate the concept of fear with an emotion like “surprise” rather than a more negative emotion like “grief, it may moderate how speakers perceive that emotion toward a less negative sense. The foreign language effect Another fascinating finding is that hearing something in your native language seems to make you experience emotions like fear more intensely than hearing about it in a foreign language. This seems to be related to a richer encoding of experience in your native language than when you learn a second language and/or that there is an increase in psychological distance to an event when a non-native language is used. This emotional distancing effect of a foreign language has long been noted – in fact, Freud wrote of bilingual patients shifting to their non-native language to describe anxiety inducing topics. However, this so-called “linguistic detachment ” associated with using a foreign language has only recently been empirically studied. In a 2018 study, researchers asked participants to complete a verbal fear-conditioning experiment in either their native or a foreign language to explore whether simply changing language reduced emotional reactivity, as measured by pupil dilation and electrodermal response (e.g., sweat gland activity). In the fear-conditioning condition, participants were told they might receive a mild electric shock when certain colored squares appeared on the screen while they were saying numbers aloud (no actual shock was delivered). The study showed that, regardless of the language used in the interactions, hearing the possibility of a threat increased participant’s psychophysical response compared to non-threat conditions. However, both pupil dilation and skin conductance activity increased to a greater degree when participants heard the threat in their native language. As well, initial psychophysical response decreased more rapidly when a foreign language was used. All of this suggests that hearing a threat in a foreign language may indeed decrease a person’s fear-conditioned reaction. Changing our perception of fear The fact that how we talk about fear changes how we react to it certainly suggests there may be some value to trying to disrupt the language or associated meanings we use when talking about what frightens us. As well, some work (Argaman 2010) has suggested that fear increases the tendency for self-focused language such as the use of “I” and “we” pronouns and a greater tendency to put emotions into words by using affect-language (e.g., happy, sad, scared). All of this may indicate that talking about what one is experiencing in fear-inducing situations helps to regulate that emotion – as might gaining distance from fearful situations by using a second language, if available. As well, how our language categorizes an emotion (in relation to other emotion concepts) seems to impact whether we perceive those emotions negatively or positively. Unfortunately, there has not been a lot of research on clinical applications for language and emotion linkages, but it does tell us that fear is something that can be altered by cultural and linguistic experience, opening the door to potential avenues to change how we talk about and react to it. Perhaps Roosevelt was right when he infamously said, “The only thing we have to fear is fear itself.” Valerie Fridland, Ph.D., - Website - References Argaman, O. (2010). Linguistic markers and emotional intensity. Journal of Psycholinguistic Research, 39, 89-99. Chamberlain, Alex. (1899). On the Words for “Fear” in Certain Languages. A Study in Linguistic Psychology. The American Journal of Psychology, 10(2), 302–305. Jackson, J. C. et al. (2019). Emotion semantics show both cultural variation and universal structure.Science 366,1517-1522. Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S., Pfeifer, J. H., & Way, B. M., (2007). Putting feelings into words: Affect labeling disrupts amygdala activity to affective stimuli. Psychological Science, 18, 421-428. Lindquist KA, Satpute AB, Gendron M. (2015). Does language do more than communicate emotion? Curr Dir Psychol Sci. Apr 1;24(2):99-108. Oxford English Dictionary, s.v. “fear, n.”, September 2023.

Children and animals are natural teachers of mindfulness. The lessons we can learn from children and pets include gratitude, mindfulness, communication, and wonder. Engaging in simple, joyful, mindful activities can help to reduce feelings of anxiety . Gratitude allows a cognitive shift from thoughts of worry and dread to thoughts of comfort and contentment. When we are anxious and worried, we lose sight of the present moment as our minds fixate on possible future outcomes and worst-case scenarios. If we pay attention, children and animals can serve as guides back to the present moment. These small yet inspirational beings can remind us of the importance of play, presence, wonder, gratitude, and communication. Here, we will explore some of the ways in which kids and pets can educate us about how to be mindful when we are experiencing anxiety , worry, and stress. Presence and Mindfulness If you’ve ever been walking your dog and felt irritation that she was taking too long or sniffing and exploring too much, you may have missed an important lesson from your companion: The present moment is all that there is right now. Dogs, cats, and other animals have a way of focusing intensely on what is happening in the now. They simply do not possess the cognitive ability to fixate on potentialities or future outcomes. While we humans do have that ability for better or worse, we can take a lesson from the animal kingdom and work to refocus our attention on the present when we are feeling overcome and overwhelmed by future thoughts. Recently, during a rain shower, I looked out the window and observed three deer simply lying on the grass, seeming to contentedly allow the raindrops to shower them. It made me wonder, how often do we simply stop and experience what is happening? Through an anxiety lens, probably not often enough, as we constantly get hung up on the next task, the next “what if,” and the next thing on our to-do list. Mindfulness is a proven, timeless antidote to anxious and catastrophic thinking. Just watch the way animals soak in every moment of whatever they are doing with complete, uninterrupted focus. Wonder and Play The next time you are feeling a “joy deficit” because you are overstressed, stretched too thin, or fatigued by “adulting,” think about how a young child plays and experiences the world with a sense of wonder. In Virginia Axline’s psychology classic, Play Therapy, she writes that the only need of a child at play is “the need to be unshackled, to be freed, to be permitted to be expanded into a complete self without a frustrating and warping struggle.” When kids play, they experience freedom, autonomy, and a sense of endless possibility. If we are able to tap into this mentality when we are stressed, it can free us from the chains and constraints of anxious thinking. Echoing Axline’s concept, the psychologist Ernst Kris wrote of the value of “regression in service of the ego.” In simple terms, Kris means healthily “regressing” at times to simple, joyful, childlike activities as a way to rebalance our stress levels and live more mindfully and less anxiously. Children can teach us the benefits of wonder and play, and the freedom that comes from a joyful, playful view of the world and of our lives. Gratitude When you pet your cat, the purr you hear is an expression of comfort and gratitude. Animals and children alike have a way of showing us how to be thankful for positive, soothing moments. We, too, can work to incorporate gratitude into our often-stressful lives. A simple act like pausing to look around and feeling grateful for our surroundings can help us to soothe ourselves during moments of overwhelm. Gratitude allows for a cognitive shift from thoughts of worry and dread to thoughts of comfort and contentment. These types of mental reframes, which come so naturally to children and animals, can help us to refocus our emotional attention and reduce and soothe feelings of anxiety and worry. Asking for Help Though a young child crying can be jarring, it does the important work of communicating the child’s needs. As adults, we often choose to suffer in silence. Though we experience intense feelings of worry at times, we are hesitant to share those feelings, concerned that we will burden others or that we are being “weak.” What we can learn from children is that we can only receive the soothing we need if we communicate that we are experiencing that need. Obviously, we are more mature and sophisticated than an infant or toddler, which means we possess more adaptive means of expressing our needs. Whether this means letting a loved one know we are struggling or seeking assistance through therapy, the power of expression, which kids naturally have, is a vital part of our ability to cope with anxiety and overwhelm. Phil Lane, MSW, LCSW, - Website - References Axline, V. (1974). Play Therapy. Ballantine Books. Kris, Ernst. (1952). Psychoanalytic Expressions in Art. International University Press.

The Link to Child Abuse Self-harm refers to inflicting injury to one’s own body. There is a high incidence of self-mutilation among survivors of child sexual abuse (CSA), who may resort to inflicting self-harm when memories or feelings of despair and self-loathing emerge. Some of my clients use self-mutilation as a way of managing flashbacks and see self-harm as an act that can convert emotional pain to physical pain. When a flashback occurs, it can last minutes or even hours, and for some clients, self-mutilation is a way of gaining control of the memory by placing their attention and focus on hurting themselves. When memories of abuse and their corresponding feelings emerged, my client Jessie often resorted to a pattern of self-mutilation as an act to gain control and to decrease the tension and the anxiety associated with the memories that were surfacing. Rather than unwillingly re-experience the traumatic event, Jessie would take control by inflicting pain on herself. For her, self-mutilation was a way of staying in the present and managing the flashbacks, which she says “can feel like an intrusive surge of pain.” Rather than be overcome and flooded with feelings and memories of an event that was horrific and terrifying, Jessie took control by cutting. Jessie exclaimed, “It’s just me and the cutting, and the cutting and me, and nothing else exists.” I asked Jessie what would happen if she did not cut. She said she thought she would detach from her body and never be able to find her way back. She believed she would permanently disconnect from reality. Cutting was her attempt to stay sane, and to her, the self-inflicted pain kept her connected to herself. Self-mutilation can take on many forms. The parts of the body that were involved in the abuse are usually the parts that are targeted for self-mutilation, and many times the self-mutilation is related to the emerging traumatic memory or flashback. One client would take hot baths to clean her genitals and would also cut her breasts and vagina with a razor. Another client with visual memories of abuse would very slowly cut her eye lids, making small and consistent slash marks with a razor to avoid re-experiencing the trauma via a flashback. She was meticulous and took great pride in her ability to hide the marks from her partner and her children. Some of my clients have expressed that when they feel guilt and/or a deep sense of shame they may engage in self-injury as a way of punishing themselves for their sense of inadequacy and self-contempt. It is important to realize that self-mutilation does not indicate suicidal ideation; rather, it is a measure taken to reaffirm the self and to take control using pain, this time inflicted by the hands of the abused. Women who have experienced sexual trauma as children often feel hopeless, powerless, and angry , unprotected, confused, and hold negative beliefs about themselves and the world. Survivors may resort to self-harm and like my client Jessie, who self-mutilated and cut her body with a razor when she became overwhelmed with flashbacks related to her early CSA. Although there are many differences in the stories of women with CSA histories, the one commonality many share is their abuse is linked to their present pain and limited capacity to function because of unhealed child abuse. Self-harm is a temporary coping strategy to deal with overwhelming feelings. It is important the survivor understands what prompts the triggers and find alternative coping strategies and techniques. Teresa Gil, Ph.D., References Excerpt From: Gil, T. (2018). Women Who Were Sexually Abused as Children: Mothering. Resilience, and Protecting the Next Generation. New York, NY: Rowman & Littlefield.

Use these 4 tips to avoid financial disaster in your relationship. Talk about money early, openly, and often (even if it's uncomfortable). Make a plan for if the relationship ends. Figure out the best way to split expenses, but also use money to make each other happy. Ah, money. It can feel like a silver bullet for happiness if used effectively. Or it can feel like a loaded gun pointed in your direction if it's a source of constant tension in your relationship . Fighting and bickering about money is the number one source of tension and stress in romantic relationships. Winning the lottery with a scratch ticket or hitting the jackpot in Las Vegas might alleviate money problems in your relationship, but then again, I wouldn't bet on it (no pun intended). So, what are some realistic strategies to avoid being like the average couple who bickers about money? 1. Talk Early, Openly, and Often About Money (Even if It's Uncomfortable). Some say talk is cheap. But talking about money with your partner will pay dividends. Money is naturally a taboo topic, but that doesn't mean you can ignore it. Establish a rapport surrounding the topic of money within the first year of your relationship. Ideally, you can broach the subject within your first six months together, even if it's more general at first, in an attempt to open a dialogue if you see the relationship going somewhere. You'll want to have this conversation before moving in together and certainly before getting engaged or married. Plan for this conversation, starting and ending with an open mind. During this conversation, ask each other questions such as: Would you consider yourself a saver or a spender? Do you hold any debts? Are you satisfied with your income and career projection? How were your parents with money when you were growing up? What are your best and worst financial habits? What kind of wedding do you envision having (if any)? How many kids do you want (if any)? Do you prioritize travel and new experiences, or are you more of a homebody? Actively listen and learn from your partner as you work through this conversation. 2. Make a Plan if the Relationship Ends This is the least fun tip of them all but it's also potentially the most important, especially for couples that are engaged. Nobody wants or plans for their relationship or marriage to end. Yet about 50 percent of marriages in the United States end in divorce . Consider talking through what would happen if, God forbid, the marriage ends in divorce. What would happen with the house? The car? If one partner has substantially more assets than the other, it's worth considering a prenup agreement for protection. During this conversation, let your partner know that you love them and the relationship ending is the last thing you want. Frame it as a fire drill. Having a blueprint is important, even though we never realistically expect it to happen. 3. Figure Out the Best Way to Split Expenses Note that 50-50 is not a no-brainer here. Having the higher earner cover most expenses might not be the answer either. This point is where you can use some creativity. For example, let's say one partner earns roughly double the other. You might decide to split the rent or mortgage such that the higher earner pays two-thirds, whereas the lower earner pays one-third. Or maybe you agree that the higher earner pays the mortgage in full, and the lower earner covers groceries, the car payment, and the phone bill. There is no one-size-fits-all solution for this point. But again, talking about the optimal way to share expenses so that both people are authentically happy is a good starting point. 4. Use Money to Make Each Other Happy Let's end on a positive note, shall we? Money is a tool that can increase happiness. Research finds that spending on others has surprisingly powerful effects on our well-being (Dunn, Aknin & Norton 2008). And, of course, everyone likes a gift. Take advantage of this finding and treat your significant other as often as you can. Pick up their favorite wine bottle next time you make a store run. Get them a knick-knack from the airport when you're headed home from a work trip. For a big birthday or anniversary, plan the surprise trip you know your partner has been wanting to go on if it's within your budget. This point will add compassion and excitement to your relationship. So don't hold back. Max Alberhasky, Ph.D., - Website - References Dunn, E. W., Aknin, L. B., & Norton, M. I. (2008). Spending money on others promotes happiness. Science, 319(5870), 1687-168

Understanding the connection could promote greater resilience. Stress is correlated with depression. Correlation does not equal causation. How can we really know whether stress makes us depressed? Stress gets blamed for a lot of things. Did you gain a few pounds? Blame stress. Say something you regret. Blame stress. But what about something more serious like major depressive disorder? Stress often gets the blame for serious mental illness, but we know that our genetics play a role as well. Depression afflicts an estimated 280 million people worldwide, many of whom would point to stress as a contributing factor to their depression. Is it possible to tease apart the complex causes of disorders like major depressive disorder? Researchers have tried to do so, with limited success. Let's highlight some research that has benefited our understanding of this. Do stressful life events cause major depression? Answering this question comes with several challenges. One of them is the chicken-or-egg question: how do we know that stress causes depression? Or whether someone’s depressive mood and behavior caused them stress? One way to address this is through a prospective, longitudinal study in which stress and depression are measured in the same people over the years. This allows us to determine which came first, the stress or the depression. To address this, researchers asked over 2,000 female twins about their stressful life experiences and symptoms of depression at three different times over about five years. Stressful life events included divorce , the death of a loved one, and job loss, among other events. The researchers took note of the timing of both the stressful event and the onset of the depression symptoms. Their findings should come as no surprise: Stressful events often lead to the onset of depressive symptoms. When those who reported depression were asked whether something stressful happened to cause the depression or whether it came out of the blue, 85 percent said that the stressful event came first. None of them reported that depression came before the stressful experience. Next, the researchers looked at the characteristics of the stressful events. At the risk of blaming the victim, events such as divorce could be partly due to the depressive nature of the individual. By contrast, events such as the death of a loved one should be independent of the depressive nature of the individual. Researchers found that even these independent stressful events, in which the individual had no role, led to the onset of depressive symptoms. The researchers next took advantage of the fact that their participants were twins. This allows for the assessment of the impact of genetics on the stress-depression relationship. Monozygotic (identical) twins share 100 percent of their genes. Examining the relationship between stress and depression in these twins effectively controlled for the effects of genetics on the development of depression. Within these monozygotic twin pairs, researchers found that stressful life events predicted the onset of depressive symptoms. These findings provide strong support for the idea that stressful life events—even those we have no control over—can lead to the onset of major depression regardless of our genetic makeup. It's not all doom and gloom, however. The good news is that of the over 2,000 women tested in the study over five years, only about 300 (7 percent) of them developed major depressive disorder. What are the characteristics of these 1,700 women who did not develop depression? The answer to this question may allow us to promote resilience to lessen the negative effects of depression. Tony W. Buchanan, Ph.D. - Website - References Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837–841.

The battle is to engage outwardly while fighting depression's implosive force. KEY POINTS There are two opposing energies in the fight against depression and rediscovering your vitality. Three hurdles are waiting for motivation, discounting small changes, and giving up too soon. Engagement is what's important—with life, with others, and with nature, which will bring vitality and hope. Healing from a depressive episode involves what can seem like a battle between two opposing forces. Andrew Solomon wrote in his book The Noonday Demon, "The opposite of depression isn't happiness, it's vitality." It requires determination and energy that's focused on getting reconnected with life. But there's an innate problem. Depression itself can feel as if your known world is collapsing. So healing, confronting that implosion, is tough. The fight is taking place on two opposing battlefields. You're fighting to become engaged outwardly while struggling to break free of depression's implosive force. "I know I should exercise. It's hard to make myself want to do it." "I don't like to journal. I do it, but nothing changes." "Therapy doesn't work. And it's too expensive." Or "I took pills one time and they made me sick." All of these statements are common to hear. Here are the hurdles they reflect—and what you can do about them. 3 Hurdles to Taming Depression 1. Waiting to feel motivated If you're actively trying to confront your depression but are waiting to be magically motivated to change, nothing will happen. You have to make yourself do the things that are likely to help, even when you don't have a lot of energy or even hope. It's tough. But putting motivation before action is putting the cart before the horse. Afterward, you'll be enjoying the benefits of walking a mile, swimming a lap, or making yourself get out of bed. Whether it's getting dressed for the day or calling an old friend whose friendship you've let slip, action creates motivation. Kate fought me tooth and nail over the importance of exercise in managing her depression. Then one day, after a couple of years of struggling with suicidal thoughts, she came in: Well, I made myself put on a bathing suit and get into the pool. And it really helped. I've always loved to swim and, suddenly, I found myself energized. I have to get up really early to get it done, and I still have to make myself go sometimes, but after it's over, I feel so much better. Getting regular physical exercise didn't "cure" Kate, but it helped a lot. Just as importantly, it gave her a sense of control and a sense of hope—when her depression seemed unmanageable. 2. Discounting small changes Healing comes from the cumulative effect of many small changes. I wish I had a nickel for every time a patient had said, "This isn't really a big deal, but yesterday I...." Any change, any risk is a big deal, because you're confronting your depression or anxiety in small ways. Those changes add up. What can seem unimportant—what you tell yourself is no big deal—can be a very big deal. A patient who came into therapy after reading about perfectly hidden depression said, The other day, I actually told my husband I didn't have the same perspective he did, and I couldn't go along with what he was saying. We talked and it went pretty well. He told me later that he couldn't believe I actually said what I was feeling. He doesn't think he knows me. And, actually, he's right. Because I don't let him know me. I've always avoided any kind of conflict. Maybe this sounds easy for some. But it's not for someone who's been hiding what they really feel for years. 3. Giving up because you had one experience that wasn't helpful Depression can create tunnel vision. a tunnel where you only see the negative. For example, deciding that nothing will work because your first attempt wasn't effective is problematic and paralyzing. You wouldn't say to a child you cared about, "If one idea doesn't work, don’t bother trying anymore.” Or, “If you can’t do it easily the first time, give up.” Nope. Persistence can pay off. Sometimes this is an excuse because it can be hard to admit there's something wrong. You did it once, and you don't want to face another so-called failure. It takes courage to not give up. If one therapist doesn't help, ask around and find one with a different style or treatment regimen. If you found yoga boring, take a Zumba class. If you're nervous about prescription medications, then look for homeopathic alternatives. Sometimes you'll be surprised at what actually helps. Sitting in the sunshine, walking around the block, striking up a conversation with the 6-year-old next door, striking up any conversation, in fact. Engagement is what's important. Engaging with life, with others, with nature—which will bring with it vitality...and hope. Margaret Rutherford, Ph.D. - website - books

... and what you can do to fight back. Depression can alter how we see the world, ourselves, and others. "Depressive realism" is the hypothesis that depression can enhance our perceptions. Yet evidence also suggests that depression can distort our perceptions in a negative direction. With practice, these distortions can be countered. The concept of depressive realism is a hypothesis that individuals with depression may see life more accurately than those without. I remember learning of this in college, mentioned as an aside in a course, “depressed people actually see things more realistically.” As a person who has experienced depression, this dispirited me. Depression is an expert at overshadowing me with sad perspectives on myself, others, and the world. It also led me to ask: In treating this condition are mental health professionals seeking to teach people how to delude themselves? Are people who are not depressed out of touch with reality? Is depression the most reasonable response to our times? Research into depressive realism is drenched in mixed results. How do you measure a person’s sense of reality? A meta-analysis of the topic found a small trend in favor of depressive realism. This said, the authors illuminated difficulties in the measurements used in the study as well as in external validity (Moore and Fresco, 2012). A more recent (2019) study investigated this notion of how depression affected future expectations (and whether those future expectations were correct) by asking depressed and healthy participants to gauge how they would feel in four days and then looking into how participants would rate their mood at that time (Zetsche et al). Unsurprisingly, depressed participants imagined themselves feeling lower in four days than healthy controls. Depressed participants also had a trend of feeling better than they imagined they would after the four days ended as well, healthy controls more accurately estimated how they would feel supporting a concept that cognitive behavioral therapists have preached for decades: Depression lies. While the jury may still be out on depressive realism, the cognitive distortions that accompany depression are well-founded. For a small number (Gaudiano et al, 2016), this change can reach a level of psychosis leading a person to experience depressive-congruent delusions and/or hallucinations. Although not always to this extreme, in almost all cases depression brings with it some changes in thinking. Depression’s deception is insidious. What follows are five guideposts that point to its trickery. 1. When Depression Makes Sweeping Statements Depression loves generalizations. It thrives on thoughts like “no one likes you,” “you can’t do anything right” and “everything is bad.” This lie breathes words like “always,” “never,” “everything,” and “nothing.” Depression can convince you that an entire lot is ruined before you’ve even had the chance to look through it. What You Can Do About It: Look for exceptions. Even one exception will start to untie the web that depression has woven. So, for example, if depression says “no one likes you” ask yourself if you can think of anyone who has ever liked you in the history of your life. Chances are you can think of at least one. Rarely are generalizations true. 2. When Depression Tries to Predict the Future Depression can’t tell the future. Of course not, right? Well, depression is quite good at convincing us that it can. With murmurs like “You will never learn to cook” or “Don’t ask her out, she will definitely say no” depression can push us to believe we have failed before we have even taken the shot. What You Can Do About It: Ask yourself about the topic at hand. Depression is probably telling you the worst possible scenario. Write that down. Now, try to think of two other possibilities. You might look for the best possible scenario or a middle-ground scenario. Remind yourself that only time will tell which (if any) are correct. 3. When Depression Harps on You About What You "Should" Have Done If there is anything depression likes more than sketching you a terrible, horror-filled fate, it’s looking back at the past and telling you about all you’ve done wrong. Depression tends to act like it knows what would have happened if you would have made any choice other than what you did, and it will usually tell you that whatever would have happened is better than what occurred. Truth is, depression has no idea what would have happened if you took a different turn. What You Can Do About It: Remember these two words: hindsight bias. Just like we can’t tell the future, we don’t know the future while we are in the past. Depression might like to have you judge yourself for what there was no way for you to have known. 4. When Depression Tells You It Can Read Minds Depression loves to tell you what other people are thinking. Usually, the message is that people are thinking negatively about you. What You Can Do About It: How much time do you spend thinking about any given person? Chances are, it’s just a fraction. If you are worried that someone might have something on their mind about you, consider asking. That’s the only way we can read minds. 5. When Depression Says That Everything Will Be Bad Forever Depression’s preferred environment is a sort of fatalistic landscape full of awful predictions and negativity to absurdity. This can feel totally deflating. What You Can Do About It: Practice flexibility. Rarely do all things fall into such a fixed space, so look for a middle ground. Depression might tell you it plans to set up camp and stick around, but many people recover. In sum, depression can place itself like a fun house mirror. Yet no one is their depression. With practice, you can catch depressive thinking in its tracks and see through its illusions. Jennifer Gerlach, LCSW - website References Gaudiano, B. A., Weinstock, L. M., Epstein-Lubow, G., Uebelacker, L. A., & Miller, I. W. (2016). Clinical characteristics and medication use patterns among hospitalized patients admitted with psychotic vs nonpsychotic major depressive disorder. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 28(1), 56-63. Moore, M. T., & Fresco, D. M. (2012). Depressive realism: A meta-analytic review. Clinical psychology review, 32(6), 496-509. Venkatesh, S., Moulds, M. L., & Mitchell, C. J. (2018). Testing for depressive realism in a clinically depressed sample. Behaviour Change, 35(2), 108-122. Zetsche, U., Bürkner, P. C., & Renneberg, B. (2019). Future expectations in clinical depression: Biased or realistic?. Journal of Abnormal Psychology, 128(7), 678.

Which type of talking treatment is right for you? Key points Psychological treatments for depression are safe and effective. These talking treatments should be first-in-line in the management of depression. The right talking treatment for a given individual depends on a number of factors. Depression is, to varying degrees, self-remitting, but formal interventions can help to speed things up and ensure a more complete and durable recovery—and, in the meanwhile, help to keep you safe. Psychological interventions ought to be first in line in the management of depression. Very often, they offer a safer, more effective, more empowering, more individualized, and more dignified alternative to antidepressant medication. Many people with depression prefer these “talking treatments” on the grounds that they seek to address underlying problems, rather than merely masking superficial symptoms or providing a crutch. Of course, psychological treatments and antidepressant medication are not mutually exclusive, and in some cases, as with depressive psychosis, drugs can be an essential part of recovery. The type of talking treatment that is chosen, if any, depends on your symptoms and their origins, on your personal preferences, and, all too often, regrettably, on the available funding and human resources. If you are struggling to find a therapist or have to wait to access one, there are a growing number of apps out there that offer some of the benefits of therapy. Supportive therapy and counseling At its most basic, psychological treatment involves simple explanation, reassurance, and encouragement. In milder cases of depression, such “supportive therapy” is often the only intervention that is either necessary or appropriate. Counseling is similar to supportive therapy in that it involves explanation, reassurance, and encouragement. But counseling also aims at addressing life problems and is more goal-oriented than supportive therapy. Psychodynamic psychotherapy Exploratory psychotherapy, as the name suggests, aims to delve more deeply into your thoughts and feelings. Two important yet very different forms of exploratory psychotherapy are psychodynamic psychotherapy and cognitive behavioral therapy (CBT). Psychodynamic psychotherapy is built on the psychoanalytic theories pioneered by Sigmund Freud and others. It is similar to traditional psychoanalysis but brief (a few months rather than several years) and less intensive (once a week rather than twice or thrice). Like psychoanalysis, psychodynamic psychotherapy aims at bringing unconscious feelings out into the open, where they can be acknowledged, experienced, and understood and thereby “dealt with.” Unlike CBT (see below), which is based on learning and cognitive theories, psychodynamic psychotherapy normally involves careful consideration of your personal history and can be particularly helpful if your problems appear to be rooted in your distant or not-so-distant past. Cognitive-behavioral therapy (CBT) Developed by psychiatrist Aaron Beck in the 1960s, CBT has become a mainstream treatment for non-severe depression and a number of other mental disorders. In the short term, it is at least as effective as an antidepressant treatment, and in the longer term may be more effective at preventing relapses. CBT is most often carried out on a one-to-one basis but can also be offered in small groups or online. It involves a defined number of sessions, typically between 10 and 20, although much of your progress occurs outside of sessions through “homework.” You and a trained therapist (who may be a doctor, psychologist, nurse, or counselor) develop a shared perspective on your current problems and try to understand them in terms of your thoughts (cognitions), emotions, and behaviors and how these relate to one another. This leads to the identification of realistic, time-limited goals and of cognitive and behavioral strategies for achieving them. In depression, the main focus of CBT is usually on modifying automatic and self-perpetuating negative thoughts. These cognitive biases or “thinking errors” are considered hypotheses, which, through gentle questioning and guided discovery, can be examined, tested, and modified. Behavioral tasks might include self-monitoring, activity scheduling, graded task assignments, and assertiveness training. CBT has garnered a great deal of institutional support on the basis that it is both cheap and effective. But critics question the robustness of the research into CBT for depression and claim that it is, in fact, no more effective than other forms of talking treatment. A more profound criticism of CBT is that, by leaning so heavily on patterns of cognition, it may be mistaking the symptoms of depression for its causes while pretending that depression has little or nothing to do with real-life issues. More introspective or philosophical people can experience this rather superficial, mechanical approach as frustrating and alienating—helping to account for the high drop-out rates from CBT for depression. Mindfulness Some of the concerns with traditional CBT are addressed by mindfulness-based cognitive therapy (MBCT), which combines traditional CBT methods with “newer” psychological strategies, such as mindfulness and mindfulness meditation. In essence, mindfulness, which derives from Buddhist spiritual practice, aims at increasing our awareness and acceptance of incoming thoughts and feelings, and so the flexibility and fluidity of our responses, which become less like unconscious reactions and more like conscious reflections. Mindfulness can be channeled for the treatment of recurrent depression, stress, anxiety, and addiction, among others, but it can also be used more broadly to improve our quality of life by decentring us and shifting our focus from doing to being. Family therapy and interpersonal therapy Family therapy involves the identification and resolution of negative aspects of couple or family dynamics that may be contributing to depression, for example, deep-seated conflict, misunderstanding, or avoidance. It usually calls upon the direct participation, and so the commitment, of each of the major actors. Another talking treatment used in depression is interpersonal therapy (IPT), which involves a systematic and standardized treatment approach to personal relationships and life problems contributing to depression. If you feel that your personal relationships are contributing to your distress, then you might consider the possibility of counseling, family therapy, or IPT. Neel Burton, MD, Website , Book

Stimulation-seeking and missed diagnoses. Depression is deflating, but some sufferers learn to feel energized with risky thrills. The onset of theft, fighting, infidelity, and/or excessive gambling can signal depression. Evaluating for and treating depression could dissolve the problematic activity. Thrills and depression are seemingly unlikely bedfellows, but they're more collegial than one might think. At first, readers might think this refers to depression arousing creative expressive energy. After all, centuries of musicians and writers, for example, have discovered silver linings to their affective plight when it engendered well-crafted songs or prose. While indeed having created these works could buoy the spirits of the artists, there is another variety of more habituated, immediate thrills that become embedded in some patients that may make them seem more characterologically disturbed than depressed. Not the Usual Suspects It's not unusual for teens to be referred for intervention or become court-involved for theft, perhaps even kleptomaniacal activity, or fighting. Relationship therapists encounter infidelity, while family therapists may see parents concerned about their child sneaking out. While all of these scenarios could be accounted for by things like misplaced anger, cluster B personality disorders , stimulation-seeking in severe ADHD , or even, to some degree, age-appropriate rebellion, it must be recognized that these concerning actions do not always occur within such expected confines. Consider the case of Aiden and Jenna (names disguised), a young, married couple I worked with early on. Jenna called for an appointment because she was concerned about recently discovering Aiden’s online gambling and flirtation on pornographic chat rooms. Upon getting to know Aiden, it became clear the onset of these activities coincided with months-long worsening depression spurred by various unfortunate events. His guilt and shame about engaging in these were palpable, and discussing the matters initially lowered his spirits even further. Jenna knew this "wasn't him" and remained understanding as we navigated the fallout of trust issues. What Aiden explained was that the risk-taking of gambling made him "feel alive," while gaining the attention of several women, albeit superficial, made him feel desirable amidst a horribly-low self-image. As I matured in my career, similar scenarios played out across couples, families, genders, and ages. Mason (name disguised) was a college-aged male, referred for plunging academic performance at a prestigious institution. Mason presented and described a classic dysthymic, or chronic, mild-moderate depressive, experience. In the second session, he offered, "I fight a lot." Given many depressed males' dysphoria is irritability instead of sadness, which can cause squabbling in relationships, I was ready to hear about a penchant for argumentativeness. It was surprising to hear he meant he was essentially looking for fist fights. Mason confessed that after a sports event one weekend, an inadvertent brawl seemed to have been an outlet for his frustrated state of affairs. However, he described coming to chase "a charge" that came with the activity. The fighting, which Mason discovered he had a knack for, sustained a sense of superiority and provided stimulation in an otherwise deflated existence. He realized it could eventually lead to legal problems and removal from school, which would create an existential crisis. First Glance It's easy to focus on the problematic activity, given that it led to the referral. However, jumping straight to pointedly trying to eliminate the gambling, stealing, etc. may only bring frustration to the patient and practitioner. Realizing these activities tend not to exist in a vacuum is an important part of treatment. Not unusually, the impetus stems from a bigger clinical complication; essentially, remove the fuel, and the fire subsides. In 2002, Lejoyeux noted that patients with kleptomania and pyromania had significant numbers of depressive episodes. In fact, there's a body of research concerning gambling (e.g., Edgerton et al., 2018; Rogier et al., 2019), stealing (e.g., Fishbain,1987; McElroy et al.,1991; Talih, 2011), and fighting (e.g., Dutton & Karakanta, 2013; Krakowski & Nolan, 2017) being highly correlated with, and even encouraged by, depression. Relationship experts such as David Ley, Ph.D., (2010) have written about how infidelity, for some, evolves as a remedy for depression. Like Aiden, the people Dr. Ley has dealt with reported excitement and higher self-esteem. Ley also explained how someone pursuing an affair is more apt to take care of themselves for appearance’s sake, and may take to exercise and better self-care, which in themselves may be antidotes to depression. Evaluating If Depression is the Root Problem People can, of course, have baseline habits of stealing, fighting, infidelity, fire-setting, or gambling, and experience superimposed depressive episodes. Perhaps the depression is even due to the pickles they find themselves in because of their unsavory activity. In those cases, it will be important to manage the activity of choice in order to curb the depression. It must be evaluated if the reverse is true, however, like in the aforementioned scenarios, as that will dictate a focus on depression to help dissolve the concerning behaviors. The following considerations can help understand the nature of the relationship to depression in evaluating people presenting for impulse control matters, fighting, or infidelity. Make sure the behavior does not coincide with a head injury or other physical complication or initiating a medication. Some SSRIs, for example, have been correlated to cases of onset of impulse control disorders (e.g., Kindler et al., 1997; Gupta, 2014). Is this an occasional burst of behavior, or a long-standing, baseline problematic activity? If sporadic, that may be indicative of occurrence only during mood episodes. If the latter, it is more likely related to things like obtaining drugs or personality disorders. After the above, evaluating for the presence of depression is the foremost consideration. If depression is extant, it is essential to survey if the periods of concerning activity coincide within the confines of the episode(s). If depression is present, is it part of a mixed mood state, as written about in The Spinning World of Major Depression with Mixed Features? If so, referral to psychiatry for a mood stabilizer medication as used in bipolar illnesses may be helpful in controlling the matter, as the hypomanic or manic components would be the culprit. Anthony D. Smith LMHC References Edgerton, J.D., Keough, M.T. & Roberts, L.W. (2018). Co-development of problem gambling and depression symptoms in emerging adults: A parallel-process latent class growth model. Journal of Gambling Studies, 34, 949–968. Fishbain, D. (1987). Kleptomania as risk-taking behavior in response to depression. The American Journal of Psychotherapy, 41 (4), 598-603. Dutton, D., and Karaktan, C. (2013). Depression as a risk marker for aggression: A critical review. Aggression and Violent Behavior, 18 (2), 310-319. Gupta, P.R. (2014). Emergence of kleptomania during treatment for obsessive compulsive disorder with fluvoxamine. Indian Journal of Psychiatry, 56, 100‑101. Kindler, S., Dannon P.N., Iancu I., Sasson. Y., & Zohar, J. (1997). Emergence of kleptomania during treatment for depression with serotonin selective reuptake inhibitors. Clinical Neuropharmacology, 20, 126‑129. Krakowski, M. & Nolan, K. (2017, February 27). Depressive symptoms associated with aggression. Psychiatric Times, 34 (2). Lejoyeux, M., Arbaretaz, M., McLoughlin,M., & Ades, J. (2002). Impulse control disorders and depression. The Journal of Nervous and Mental Disease, 190 (5), 310-314. Ley, D. (2010, October 10). Can infidelity cure depression? Can extramartial sex self-medicate against the effects of depression? Psychology Today. https://bit.ly/3NCPNG7 McElroy, S., Hudson, J., Pope, H., & Keck, P. (1991). Kleptomania: Clinical characteristics and associated psychopathology. Psychological Medicine, 21 (1), 93-108. doi:10.1017/S0033291700014690 Rogier, G., Picci, G. & Velotti, P. (2019). Struggling with happiness: A pathway leading depression to gambling disorder. Journal of Gambling Studies 35, 293–305. Talih F. R. (2011). Kleptomania and potential exacerbating factors: a review and case report. Innovations in Clinical Neuroscience, 8 (10), 35–39.

What stops us from completing the work of sorrow and getting rid of depression? Sadness often accompanies depression, but they are not the same thing. Depression has also been linked to repressed anger and fear. Addressing the many possible components of depression can help people recover from it. I often hear my clients say, "I don't want to discuss this subject—I don't want to be sad and get depressed." Depression is indeed accompanied by sadness, so connecting depression with sadness is common. But so is confusing these two conditions. Sadness vs. Depression Sadness is a normal reaction to adverse situations. It develops when expected gratification is unavailable because of a separation from or loss of something important. We process sadness by means of sorrow and letting go. Depression is a more complex condition. In addition to unremitting sadness, depression is defined by low mood, apathy, lack of joy (anhedonia), and inability to concentrate and stay focused. Corpus Hippocraticum, the classic work published between 500 and 400 BC and attributed to Hippocrates, among other authors, includes one of the first attempts to describe depression as a medical condition. It places fear above sadness as a psychotic symptom of depression, thus postulating that fear can be a more significant factor in depression than sadness (9). Researchers such as John Bowlby, the creator of attachment theory, have concluded that sadness often appears as a reaction to some forms of loss "of a loved person or else of familiar and loved places, or of social roles" (Bowlby, 1980). Depression is also closely related to loss and to fear that this loss will recur. Bowlby described depression as a "real or feared loss of the parent figure, either temporary or permanent," and believed vulnerability to depression derived from these early insecure attachments and experiences of early loss or abandonment. We process sadness by means of sorrow and grieving to accept and let go of the things we cannot change. Grief tends to come in waves. In contrast, depression is unyielding. In this way, depression can be seen as the antithesis of grief. Nancy McWilliams says, "People who grieve normally tend not to get depressed, even though they can be overwhelmingly sad during the period that follows bereavement or loss" (7). The major role of anger in depression has been long known to psychoanalytic researchers and clinicians. In his classic work, Mourning and Melancholia, Sigmund Freud, the founding father of psychoanalysis, a precursor to all modern therapies, viewed depression "as hate turned upon the self after the loss of an important love object" (1). His close associate Karl Abraham noted a propensity towards hatred in patients with depression based on temperament or early experience. The authors speculated two things: 1) the experience of premature loss creates vulnerability to depression, and 2) depression results from anger turned inward in response to loss. The melancholic state that Freud was exploring exhibited lost connections to something important to the extent that the depressed individuals became so identified with this lost object that they kept it firmly within themselves. They were unable to establish a meaningful connection or part from it and grieve its loss. Sadness became inseparable from their condition. In sadness, one knows what they have lost, but in depression, the loss is often indiscernible and can't be addressed consciously. It is often interpreted by the individual as a sign of their own inadequacy, unlovability, or damage. They feel rejected, abandoned, and angry toward themselves in the form of shame, self-criticism, and guilt that their "badness" might have driven this thing away from their life. Thus, they feel inherently corrupt. There Is a Lot of Further Research Connecting Depression With Anger. Friedman, A. S. (1970) found that individuals diagnosed with depression scaled higher on the Resentment subscale of the Buss-Durkee Inventory than non-depressed people. Resentment is defined here as "repressing the experience of the hostile affect from consciousness" (4). Subjects reported significantly less verbal open hostility but significantly more resentment. Becker & Lesiak (1977) found that in clinic outpatients, the severity of depression correlated with covert hostility, including guilt, resentment, irritability, and suspicion, but not with overt hostility. In earlier research by Friedman et al. (10), people were asked if it is ever right to be angry. Hospitalized depressed patients answered "yes" significantly less often than non-depressed control subjects. This suggests difficulty with acceptance and expression of anger or aggression at the time of depression. Riley et al. (1989) concluded in their study that "the results […] generally support the hypothesis that depression is related to an inhibition in anger expression. The depressed group reported higher levels of anger suppression than either the normal or PTSD groups" (11). In another study by Kellner, R., Hernandez, J., & Pathak, D. (1992), 100 participants diagnosed with depression were given an extensive questionnaire about their condition. In all four groups, depression predicted inhibited anger for both sexes. Improvement in all domains of inwardly directed hostility has been reported with the alleviation of depression (Blackburn et al. 1979; Mayo 1978; Friedman 1970). Goldman & Haaga (1995) connected both anger and fear in depression. In comparison to non-depressed subjects, depressed subjects express more anger toward close family members than to others. This finding seems plausible considering the high rates of marital conflicts in couples that include a depressed partner (Schmaling and Jacobson, 1990). The fear of expressing anger to other people was highly correlated with anger suppression because of the fear of the consequences of such expression. Brody et al. (1999) demonstrated that, in comparison to the never-depressed control group, recovered depressed patients reported suppressing their anger and being afraid of expressing it because they viewed it as damaging toward other people. The authors hypothesized that anger inhibition may play a causal role in the recurrence of depression. These findings link both anger and the fear of expressing it, causing depressed individuals to suppress their anger out of fear. Thus, the role of inhibited anger in depressive conditions seems to be crucial. There might also be confusion when we describe sadness as opposed to anger. Castel, P.-H. (2016) indicates confusion between these notions: The very fact of saying "You make me sad" to somebody often expresses not so much sadness as anger and resentment. From a more psychological standpoint, sadness is often consciously experienced as an inward rage barred from public display; anger, similarly, when not fully acted out, commonly reverts to grief and feelings of helplessness. The opposition of inward vs. outward feelings will often reflect socially coded constraints on the legitimacy of the public exhibition of affective states. Agitated and violent children may actually be sad, while passive or submissive women are internally consummated with rage. (2). Researchers such as Arieti, Bemporad, and Bowlby view depression as a sadness that cannot be "metabolized," so the work of sorrow cannot be completed. Inhibited anger, fear of expressing it, and lack of knowledge or positive previous experience on how to express anger constructively might play a crucial role in hindering the process of sorrow to eventually be rid of sadness and the symptoms of depression. When dealing with depression both on a personal and therapeutic level, we need to take into account the possible presence of suppressed anger and equip ourselves and our clients with tools to deal with and express it constructively. Nancy McWilliams (2011) suggests that depressed individuals be in long-term or open-ended therapy instead of a pre-set number of sessions. If they have sufficient time to recognize their anger in a therapeutic environment, they will be able to address it. McWilliams states: Treatments that are arbitrarily limited to a certain number of sessions may provide welcome comfort during a painful episode of clinical depression, but the time-limited experience may be ultimately assimilated unconsciously by the depressive person as another relationship that was traumatically cut short—further evidence that the patient is a failure in maintaining attachments (7). Recognizing inhibited anger in a depressive state, learning to express it constructively in a therapeutic environment, and addressing the fear of losing important relationships due to anger can be salubrious strategies in helping one alleviate the symptoms of depression. Boris Herzberg - Website - References 1. Freud S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916). 2. Castel, P.-H. (2016). Loss, Bereavement, Mourning, and Melancholia: A Conceptual Sketch, in Defence of Some Psychoanalytic Views. In Sadness or Depression? (pp. 109-119). 3. Painuly, N., Sharan, P., & Mattoo, S. K. (2004). Relationship of anger and anger attacks with depression. European Archives of Psychiatry and Clinical Neuroscience, 255(4), 215–222. 4. Friedman, A. S. (1970). Hostility Factors and Clinical Improvement in Depressed Patients. Archives of General Psychiatry, 23(6), 524. 5. GOLDMAN, L., & HAAGA, D. A. F. (1995). Depression and the Experience and Expression of Anger in Marital and Other Relationships. The Journal of Nervous and Mental Disease, 183 (8), 505-509. 6. Busch FN (2009). Anger and depression. Advances in Psychiatric Treatment, 15(4):271-278. 7. McWilliams, Nancy. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). ISBN 978-1-60918-494-0. 8. Kellner, R., Hernandez, J., & Pathak, D. (1992). Self-Rated Inhibited Anger, Somatization and Depression. Psychotherapy and Psychosomatics, 57(3), 102–107. 9. Azzone, Paolo. Depression as a Psychoanalytic Problem. University Press of America, 2012. 10. Friedman AS, Granick S: A note on anger and aggression in old age. J Geront 18:283-285, 1963. 11. RILEY, W. T., TREIBER, F. A., & WOODS, M. G. (1989). Anger and Hostility in Depression. The Journal of Nervous and Mental Disease, 177(11), 668–674. 12. Allan, S., & Gilbert, P. (2002). Anger and anger expression in relation to perceptions of social rank, entrapment and depressive symptoms. Personality and Individual Differences, 32(3), 551–565.

What you tell yourself matters. Feeling depressed for two weeks or longer may reflect a disorder, which you should disclose to a professional. Self-talk refers to one’s running inner dialogue, and one can engage in either positive or negative self-talk. Flexible, fluid thinking may be helpful if one’s depressed thoughts have become too intense or rigid. The term “depressed” is often used loosely but has clear clinical implications when it refers to clinical depression , or what is known in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) as major depressive disorder. For individuals who have depressed mood for two or more weeks to the point that it interferes with daily functioning, it’s important to embark on a healthy action plan to do what is possible to reduce the depressive feelings . Positive self-talk, or mantras, you can say to yourself, can help a depressed person to feel a little more in control of what they think and how they feel. Consider each of the self-talk reminders below and ask yourself which ones resonate the most with you. “What I say to myself about my depression can make a difference.” If you were to choose only one quote to tell yourself, make it this one. Saying this to yourself is helpful because it reminds you that you have choices and that the choices you make matter. While it can often feel as if there is no choice when you feel depressed, the reality is that one always has choices—even if they are not quickly apparent. “I am teachable through this process.” Feeling depressed is complicated by much of the distorted thinking that presents with it. Feelings often get misinterpreted as facts to the degree that the depressed person becomes certain that their thoughts and feelings are not only true, but will also last forever. Telling yourself that you remain teachable while going through a depressed period can reduce much of the all-or-nothing, rigid thinking that often goes along with depression. Remaining teachable means that you will consider the coping advice of trusted, emotionally stable individuals and that you will seek out a variety of healthy techniques to help combat depression, including reading articles like this one. “I have gotten through difficult times before.” Because depression impacts one’s thinking, it makes sense that the rush of thoughts and feelings swimming around in the mind while depressed can be overwhelming. When you feel overwhelmed , you’re less likely to look rationally at your present circumstances and to make sense of them with a positive or even neutral perspective. One specific technique that can be helpful is to make a list of other difficult periods you have experienced in the past, and to estimate the length of time that difficult period lasted. For example, if you lost a job and had to find a new one, did your difficult period last a few weeks or perhaps a couple of months? Remember that you survived each of these periods, even though you probably were afraid that you couldn’t get through it at the time. “I can sometimes pleasantly surprise myself.” Nothing can help a person get unstuck like flexible thinking, which allows for the changeable, fluid nature of everyday life. And while individuals come with their own set of personality traits , people can also surprise themselves occasionally. If you are someone who defaults to a pessimistic mindset, at times, try to express an optimistic thought with someone the next time your automatic thought is to say something negative. If you’re talking to someone who knows you well, you may get some positive feedback for surprising them with your rosy perspective. What’s most important is that you can also surprise yourself and that the best way to do so is to catch yourself from slipping into easy, old behavior and to engage in the opposite, more positive behavior option instead. “I’m striking a balance between patience with my depression and taking action to deal with it.” This final reminder captures why telling yourself positive things when you’re depressed is so important. The goal is to accept that you are experiencing difficult circumstances but to simultaneously take healthy action to do what you can to make the experience more bearable. In other words, you can still feel low in energy and have a depressed mood while also reminding yourself that these feelings will pass eventually and that you may as well use today to try one or two behaviors you enjoy doing anyhow. Conclusion While confiding in a health professional and sharing your depressed feelings is important and helpful, it’s also important to practice mental discipline yourself by engaging in positive self-talk and reminding yourself of healthy, positive messages. Feeling depressed doesn’t have to take complete control over your life, so adjusting some of the intensity of depression with self-compassion and flexible thinking can help make the experience of feeling depressed less overwhelming. Seth Meyers Psy.D. - Website - Book