Synopsis: While some people can change their habits through sheer willpower, many people need a source of motivation or energy to make meaningful change. This is especially true for people who experience depression. This article discusses depressive habits and strategies for changing them so that treatment for depression can be more effective and durable.

BY LEN LANTZ, MD / 3.19.22; No. 56 / 9 min read

Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post might also contain affiliate links. Please click this LINK for the full disclaimer.

We don’t talk enough about this issue

Something happens in depression that isn’t talked about very much. It involves negative habits that show up after depression begins. You might engage in these negative/depressive habits occasionally before becoming depressed, but once depression kicks in, these behaviors can dominate your life and feed your depression. Here are some examples of depressive habits:

• Maintaining poor sleep: staying up late, sleeping or napping excessively

• Eating poorly: skipping meals, binge eating, or eating junk food

• Isolating from others: spending time alone, ignoring others, or refusing to leave your home

• Stopping exercise: not even going for a walk or walking your dog

• Avoiding structured activities: repeatedly calling in sick to work or school

• Engaging in mindless activities: doomscrolling media, endlessly watching TV/videos, or playing videogames alone

• Avoiding brain-healthy activities: not reading books/magazines, creating art, singing or playing music, or going out into nature

• Ignoring basic tasks: not taking care of hygiene, cleaning your home, opening mail, doing laundry, paying bills, or grocery shopping

Do you see yourself engaging in any of the above depressive habits? While nearly everyone—depressed or not—has struggled at times with depressive habits, it would be a mistake to deny the power that those habits have in causing and maintaining depression. Some people can just gut it out and force themselves to do healthy behaviors to keep their depression at bay. However, many people with depression feel incredibly stuck in their depressive habits. They are waiting for their energy, enjoyment, and motivation to improve before doing the activities that help their mood. And sometimes, even after their depression improves, they forget to change depressive habits. What happens then? Usually, the depressive habits create a slippery slope, and the person slides back into depression.

The opposite of depressive habits

Many treatments, which I will mention later in this article, work for depression, and one of the most effective strategies is called behavioral activation or self-activation. This approach involves putting yourself on a schedule, staying busy, and changing up activities throughout each day. This is an incredibly powerful and effective treatment for depression (Mazzucchelli, et al. Clinical Psychology: Science and Practice. 2009). Behavioral activation is not simply doing fun activities all day—it is doing activities that are in alignment with your values throughout each day. Some of the activities are fun and some are necessary.

The activities themselves place a significant demand on a depressed person’s brain, and this helps depression. It is thought that the positive effects of the activities (social interaction, body movement, cognitive activation, and a sense of purpose/accomplishment) are responsible for changing brain function and lifting depression. Behavioral activation is essentially the polar opposite of depressive habits. For more information on behavioral activation, please read my article, “Behavioral Activation for Depression.”

Why don’t people utilize behavioral activation strategies more?

Avoidance.

I am not judging or criticizing people with depression. Avoidance is a frequent behavior or response among people stuck in depression. When you are depressed, it can feel hard to do anything. There are numerous reasons why people have a hard time doing the things that would be best for their mood. Here are some of the most common reasons why people with depression have a hard time increasing their positive activity level:

• Having no energy or motivation (waiting for energy to show up before taking action)

• Experiencing anxiety over change or fearing failure

• Taking antidepressant medication irregularly (even when consistent medication use is associated with consistent improvement of mood)

• Seeing variability in improvement (good days fluctuating with bad days)

• Wasting good days and fueling bad days with depressive activities

• Being afraid of improvement because the future looks impossibly difficult

When you are depressed, you might desire, fear, or loathe the idea of increasing your activity. One of the best ways of working your way past avoidance is to honestly acknowledge that it is there, show yourself some kindness and compassion over it, come up with a plan for dealing with it, and when you start to see improvement in your depression, seize the opportunity to change.

Some people need a quick win to begin changing depressive habits

Many people need a quick win to overpower or overcome avoidance. The quick win can feel like walking or running with the wind at your back. It’s just easier. This experience of having more motivation, energy, or hope that change is possible usually occurs when your depression starts to improve. That boost that you experience can become the tipping point to start behavioral activation strategies and change your depressive habits. Life events that can give you a quick win are:

• The spark that comes with changing jobs

• The beginning of a romantic relationship

• Connecting with a positive therapist

• Finding some benefit from an antidepressant

• Beginning a new exercise program or dietary change

• Going on vacation or to a retreat

• Starting TMS (transcranial magnetic stimulation), ECT electroconvulsive therapy), or ketamine treatment for mood

• Experiencing some other victory in life or another positive life event

Many people take a moment and breath a sigh of relief when they start to see improvement in their depression. If you finally start to feel better, you might as well relax and enjoy it, right? It’s only human to feel that way, but if you want your improvement to last, you need to start changing your depressive habits as soon as you have the energy and motivation to do it.

What to do you when you start to see progress in your depression

Just because you feel better does not mean you can do everything at once. Once your depression starts to lift and your motivation and energy improve, you can begin adding in the healthy things that are absent and changing the habits that cause you the greatest problems. Here are some guidelines for implementing behavioral activation strategies:

• Keep things simple: break larger goals into smaller, achievable tasks

• Be realistic with your goals: plan and schedule goals/tasks with which you are most likely to succeed

• Don’t multitask: do one activity at a time and work to minimize distractions

• Change your environment: consider moving to a different room or working on an activity in a public place to help you focus on a task

• Have a plan for setbacks: know in advance how you will handle missing a goal or not completing a task

• Reward yourself: reinforce the behaviors you want to be doing by giving yourself a little reward

• Practice self-compassion: be nice to yourself and go easier on yourself in the same way that you would encourage a close friend

• Enlist a friend: get friends to help you with accountability and problem-solving if your strategy is not working

• Schedule things: set timers and alarms to not get stuck on a task if things are not going as well as planned, and keep activities short in the beginning (follow the schedule instead of how you “feel” each day)

• List the long-term benefits: remind yourself why you are doing your day-to-day tasks, as this can help you talk yourself into doing the things you need to do

Even people who are not depressed struggle to implement positive behavioral change. Make sure to pace yourself, be forgiving of yourself, and receive help from others to get started until you have the momentum to continue the positive change on your own.

A story about changing depressive habits

Jill was a 37-year-old woman who had a history of setbacks with depression. It was so frustrating! She experienced her first depressive episode in the 10th grade, and ever since then, she would try a medication or switch therapists when her depression worsened. It was such a relief when she would start to feel better, but not long after she got better, the improvement would wear off, and she would fall back into her depression again.

She decided to try transcranial magnetic stimulation (TMS) therapy for her depression. She was very hopeful but also worried about whether or not the treatment would work and if the improvement would last. She shared her concerns with the psychiatrist as she explained the variety of treatments that seemed to help in the beginning and then failed. The psychiatrist listened patiently and then shared her perspective.

The psychiatrist said, “Well, most people do get significantly better with TMS therapy for their depression. It’s a really effective treatment, and we have seen a lot of people get to remission—full freedom from depression. We still check in with our past TMS patients every few months to see how they are doing. Many of them have maintained their improvement—sometimes for years!”

Jill interrupted the psychiatrist at this point. She said, “Look—no offense—but I need this treatment to work. I just want you to tell me flat-out what I can do to improve my chances and get this treatment to work and the improvement to stick.”

The psychiatrist paused for a few seconds and reflected on what to say next. She then said, “Thank you for sharing that. We do use several strategies to improve TMS outcomes at our office. We want everyone to exercise daily—even if that just means going for a walk around the block—and to maintain a healthy sleep schedule. Keep meeting with your therapist during treatment and after TMS therapy ends. I’ll take over prescribing your meds during treatment to see if we need to optimize them, and I’ll also share with you some thought-balancing activities I want you to do before and during your TMS treatment sessions. All of this will help you to optimize your chances of improving and, hopefully, getting to remission. But there is something you need to know. You’ve had depression for a long time, and it sounds like you have developed some depressive habits. I want you to work with your therapist on changing these depressive habits during treatment. You can change these habits through an approach called behavioral activation or self-activation. It might feel impossible now, but when your mood, energy, and motivation improve, you will need to fix these depressive habits.”

Jill shook her head and said, “People have been telling me this forever. Change your activity level. Stay busy and this will help your depression. I’ve tried! It just leaves me feeling exhausted and demoralized.”

“That’s a great point, Jill,” the psychiatrist replied. “Here’s the deal. There are excellent odds that TMS therapy will give you a break from your depression. We are hoping that it will put the wind in your sails. When your motivation and energy improve—when you start feeling your mood lift, I want you to work with your therapist and me to set up and implement your plan of behavioral activation activities. You can work to eliminate your depressive habits and replace them with ones that will sustain the improvement of your mood. If we improve your mood but your habits don’t change, eventually those depressive habits will drag you back into depression. That, unfortunately, is a pattern I have seen for some people who relapse back into depression after treatment.”

“Okay,” Jill said, “I can see that. It makes sense, and I can actually see that pattern for myself. I like the idea of changing depressive habits once I start to feel better. I just don’t feel like I have ever been able to do that while I’m in the middle of feeling so depressed and miserable. I think I want to move ahead with TMS.”

As her depression lifted with TMS, Jill found she had the motivation and energy to do the hard work of establishing “non-depressed” habits. She reached remission of her depression and was able to truly thrive, which enabled her to remain free of depression over time.

You can change depressive habits

Do you believe that depressive habits can steal your progress in improving your mood and pull you back into depression? I certainly do. While it can sometimes feel impossible to change your habits, imagine taking advantage of any treatment or life event that lifts your mood and energy and amplifying your improvement by changing depressive habits. Spend some time determining what you are going to do to get some relief from depression. Your solution might be therapy, medications, or an intervention, such as TMS or ECT. You can leverage the improvement you see in your mood and energy by strategically changing your habits and, hopefully, the trajectory of your mental health and life!

For further reading, check out:

• Len’s Article, “Behavioral Activation for Depression”

• Len’s Article, “A Plan for Stubborn Depression”

• Len’s Article, “A New Kind of TMS for Depression: SAINT Becomes Stanford Neuromodulation Therapy (SNT)”

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