My Depression Management Plan

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By Terence T. Gorski
Author

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it: https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-simple/

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here: https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.

3 Responses to My Depression Management Plan

  1. Thank you so much for the blog about depression. I must say i can relate to much of it Terry. I´m going through a mild to severe depression with anxiety symptoms now. It has been like this for a month now. Sometimes i cant think clear, my head is “Another” place, but still i feel like im here…. It has been a couple of times where my depression kept me in bed and i felt like i didnt want to life this way anymore!! I felt really powerless and chaotic inside…. Now when im sitting here posting, i feel a little anxiety, but i manage my life pretty well nowadays. What is most important for me is that i continue my participation in my Fellowship, where i can share about it, and be with friends that knows me, and care for me. Another thing is that i talk much about my feeling and status QUO with my loving wife (Witch handles my things in a good NOT co-dependent way), and really understands and have a optimistic view on in it my worst days. Then i also try to get in to selfdispline to practice meditation, but its hard sometimes, but still i do it. I also go out for walks and try to listen to every sounds, and let my heart open for the beauty of my surroundings. I just need to keep on going, and don´t let my negative thoughts or dialogue in my head control me. Im a Alchol and Drug Counsler working as a Treatment Manager in Norway. I have come to understand that helping others, isn´t the same as trying to help my self, it can be harder to manage my own things then helping others with their problems, still i always try to do the best i can to search for solutions rather then living in the problem, but again sometimes it can be hard, but for me i think thats part of my own process….

    Take a look at my homesite: http://www.addiktolog.no and my linkedin profile: https://www.linkedin.com/profile/view?id=158110823&trk=nav_responsive_tab_profile

    Best Regards
    Ove Andre Remme ( Norway)

    • Terry Gorski says:

      Ave Andre Remme,

      Depression and anxiety can be very difficult to manage. Difficult, but not impossible. My depression comes and goes in waves. I found self-monitoring the severity of my depression symptoms to very helpful.

      Knowing what symptoms I tend to experience is also very helpful in setting up a symptom management plan.

      I made a symptom checklist from the symptoms listed in DSM IV. I added that to my four-times per day self-monitoring and found my general label of “depression” was composed of three key symptoms and related to periods of high stress.

      I found stress management (meditation, exercise, outside walks) were effective if I could do them early in a depression symptom episode. If I waited until the depression was severe (7 plus on my 10 point scale) it was more difficult, sometimes impossible, to get started, and the management techniques I used were not nearly as effective.

      This too will pass. Pay special attention to work-related stress. You have a very stressful job.

      • Thank you so much for your advice Terry 🙂 I know that my job is can be really stressful at times, so now i´m home taking some time of, just to find my self again and to try to manage my self and my time to time depression 🙂 Can you please share your symptoms list listed in DSM IV for me?

        Thanks again Terry 🙂

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