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Synopsis: Some people have severe depression despite having a relatively good life. Others know exactly why they are depressed and can identify the specific cause or situation that is worsening their mood. This article focuses on depressive symptoms caused by maladaptive patterns and life toxicities and what to do about them.
BY LEN LANTZ, MD, author of unJoy / 9.25.20; No. 35 / 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 also contains affiliate links. Please click this LINK for the full disclaimer.
When you feel depressed for a reason
While some people have depression for no clear reason, others know exactly why they are depressed. If you know why you are depressed, it is important to address it. Inaction can cause misery by itself and often makes depression worse.
I believe that the first step in addressing your depression is to identify the actual causes. Once you do that, you will be able to determine if you need to change your situation or hang on and cope until the situation changes on its own.
What in your life is contributing to your depression?
I work with both kids and adults in my clinical practice. When I inquire about depressive symptoms, most of my time is spent asking about life issues, not the depression. The actual symptoms of depression are easy to track. It’s a person’s life circumstances that help me determine the context of the depressive symptoms to figure out if the depressive symptoms are a natural response to a life situation or a biologically-driven depression.
I spend a substantial amount of time in clinical interactions helping patients see for themselves which of their mood and anxiety symptoms are normal emotional responses to difficult situations and which are driven by a poorly controlled mood or anxiety disorder. There are common situations in life that lead to depression, such as:
Work toxicity: Coworkers, managers, customers, and unrealistic expectations at work can contribute to depression whether or not the work environment is hostile. For example, some people have a reasonably nice work environment, but they hate their job or feel trapped.
Unresolved marital, family or other relationship strife: Unhealthy relationships with a significant other, relative, neighbor or friend can lead to a person feeling depressed. The situation may be severe, such as physical, sexual, verbal and/or emotional abuse. Maybe the person you are at odds with has an addiction or attempts to control you.
Religious or philosophical issue: Some people are not allowed to express themselves or are rejected for other reasons based on the religious views of their family or their community. For example, in some families, people are told that anger and sadness are a sin. That’s crazy! If a person believes in God the Creator, then they will accept that God created all emotions. All emotions are acceptable. What you do with your emotions is a different story. On a philosophical note, some people struggle with a chronic existential crisis that is usually driven by overwhelming anxiety and thoughts such as, “What’s the point of life or living if _________ [specific situation] exists?”
Medical illness and physical pain: Taking care of your health is an important part of life. If your body is not right, your brain and emotions won’t be either.
Identity-based persecution: Being persecuted and discriminated against based on race, gender, political beliefs and/or sexual orientation is oppressive and contributes to depression. When people conclude, “How can I get ahead – or just find some peace – when this is what I have to deal with every day?” they might be suffering from depression due to a lack of acceptance of their identity.
Unresolved grief: Unresolved, complicated and traumatic grief without professional guidance can convert into major depression. The symptoms of grief mimic depression, but if it continues long enough, it becomes major depression.
Untreated or inadequately treated mental illness: There are many other mental illnesses that if severe and/or untreated eventually result in major depression. Common mental illnesses that result in depression include substance abuse, anxiety disorders and eating disorders.
Poverty and financial stresses: Feeling overwhelmed by financial stresses and trapped by poverty can cause depressive symptoms. There are effective strategies that can improve these situations. Some people need more money, while others need to control their spending. I believe the person who has helped people out of their money dilemmas most effectively is Dave Ramsey (I have no affiliations with him or his companies). He has online workshops for purchase which are designed to convince and motivate you to eliminate debt, increase income and build wealth. Following his strategies can help your financial situation.
Avoidance feeds depression
Sometimes you cannot get out of your situation for obvious reasons, however, you might be able to improve your life despite the circumstances. You can spend years or decades in a negative situation because your reaction to the situation keeps you miserable. Sometimes it is simply an unhealthy coping strategy that keeps us depressed. Other times, unhelpful habits block us from needed change. Almost all of the unhealthy coping strategies that feed depression fall under the category of avoidance. Avoidance encompasses many behaviors but boils down to hiding from your responsibilities, lying to yourself and others, making excuses and refusing activities that involve even small degrees of discomfort. Common behaviors that feed depression include:
Refusing help – Refusing help or seeking rescue rather than help. An inability to seek and receive help is probably the number one reason why people feel stuck.
Doing endless “fresh starts” – Repeatedly doing a “fresh start” rather than actually looking at and dealing with your problems.
Ignoring how you feel – Denying or stuffing your emotional responses and general feelings. That does not mean to always blurt everything out but it requires acknowledging how you really feel and not judging yourself for it.
Hiding from the world – Lying in bed all day or binge-watching Netflix in your pajamas when depressed is one of the worst strategies for confronting depression and life situations that require action and change.
Looking externally for emotional security – Getting into unhealthy, dependent relationships.
Denying your fragile narcissism – Thinking too highly of yourself and your motives and closing yourself off to feedback from people who really care.
When you have a coping strategy that ultimately feeds your depression, working with a skilled therapist can make all the difference in the world. Identifying and addressing habits that keep you stuck in your depression and block you from needed change is critical to getting and keeping your depression better.
Change can be risky
Often people refuse to make a change until the discomfort of their situation is greater than the discomfort of change. For some people, a slight difference in discomfort is sufficient to motivate change. For others, especially those who have been stuck in a negative situation for decades, the discomfort of persisting in the current situation needs to be huge in order to risk change.
Count the cost of changing your situation (if you can change it). Some risks are small and some are quite large. If you are considering a major change, make sure to obtain guidance from a wise friend or an attorney if you believe there is a risk of:
Death
Serious injury
Lawsuit
Losing your job
Homelessness
Losing your marriage or significant relationship
Losing custody of your kids
Going to jail
Does making the change you need involve a risk as great as those in the above list? If not, then what is stopping you from needed change? The reality is that you cannot eliminate risk. You can only reduce it. If the risk of change is not on the above list, then you have to ask yourself, “How big is my risk of change, really?” If you are trying to move outside your comfort zone and need a single litmus test, it might be to answer this:
“When I’m 80 years old, what choice will I regret more? Taking action or staying stuck?”
A Story About Dealing with Depressing Circumstances
“Michael” was 20 years old and living at home. He felt incredibly stuck and depressed and he knew why. His life leading up to the present wasn’t that great. He hated public school starting on his first day of middle school – what a hellhole that was! He skated through school with Cs and Ds because he didn’t turn in his homework and didn’t try. It wasn’t because he was incapable of the work, and his teachers and parents pointed out to him that they believed he was smart and had potential. He graduated high school with a GPA of 1.5, a number which he strategically left off his resume. He didn’t try very hard because he just didn’t see much of a future for himself. His parents divorced when he was 14 and they both had jobs, but they certainly weren’t going to pay for him to go to college, and honestly, he didn’t think he wanted to go. He worked 20 hours per week in the stockroom at Walmart but was starting to call off work more and more due to feeling stuck and depressed. His mother noticed this and convinced him to work in therapy with someone she heard was quite good.
Michael remembered seeing therapists on TV shows, so he expected the first thing out of the therapist’s mouth to be, “So…tell me about your mother.” Instead, he learned that his new therapist specialized in something called Acceptance and Commitment Therapy (ACT). He was going to spend time in therapy learning some skills for managing his emotions and thoughts and also looking at different areas of his life where he wanted to see positive movement. One of the things that came up repeatedly in his therapy sessions was figuring out what he actually wanted. As he spent time being honest with himself on these issues, he started to see a path forward. He began to realize that he knew things that he wanted in his life but he didn’t know the steps for reaching his goals. When his therapist asked if he knew anybody who had accomplished some of the things that he wanted, he could only think of Joe, one of his father’s buddies. Joe was really opinionated – and that was annoying – but he was also confident, happy and successful. Michael reached out to Joe and, to his surprise, Joe offered to treat him to lunch.
In their lunch meeting, Michael laid out his lackluster academic career and his current situation. He then shared with Joe what he wanted in life. He said, “Joe, I’m meeting with you today because I need to change some things in my life to start going after my goals. I don’t know where to start. I think I need to go to college, but I don’t even know what to major in. I admire you, Joe. You’ve been successful. So, I’m hoping to get some advice from you to make sure I’m not making the wrong steps or wasting my time.” Michael then explained what he wanted in life, including the meaningful aspects he hoped to see in a future job, as well as the type of house, truck and vacations he hoped to afford.
Joe smiled and said, “Well, buddy. At least you know what you want. That’s actually the first step. I did some calculations while you were laying out your goals, and you will need to make at least $50,000 each year and control your spending to get what you want. Picking a major in college is much easier at this point. You are going to have to look up what jobs pay $50k per year or more, and I can tell you that most of them require at least a 2-year college degree. There are only a limited number of jobs that pay that much, so you’ll need to line up your major with that field of work and look at how competitive the job market is in that area. I can help you with that if you like. You might also need to live in a larger city in the future to access those jobs and get paid more. Also, you looked a little freaked out about paying for college. Did you know that you don’t actually have to go into debt to get a college degree? You work for Walmart, right? They’ll reimburse you for good grades at our community college. Or, you could work at Starbucks and they’ll reimburse you for good grades at ASU online. So, you’ll need to get serious about school. Otherwise, you’re lying to yourself about what you really want.”
Michael felt relieved after meeting with Joe. No one had ever laid things out like that for him. He already felt better because he knew what he wanted and how to get there. He and Joe set up a meeting the following week and Michael continued to meet regularly with his therapist to check on his progress and keep him accountable to himself.
Change what’s changeable and improve your depression
If there are things in your life causing your depression, you might be able to change the situation entirely or change some aspect of your experience to make life better. Enacting needed change can be uncomfortable and risky, but it might be the exact thing you need to see an improvement in your mood. Looking at and dealing with areas of avoidance in your life can be incredibly liberating. Imagine getting unstuck from a toxic situation and getting one step farther along in your journey to full freedom from depression.
For further reading, check out:
Len’s article “A Plan for Stubborn Depression”
Len’s article “The Surprising Results of Exercise for Depression”
Len’s article “Acting on Anxiety – Knowing When to Confront It or Avoid It”
Len’s article “Behavioral Activation for Depression”
A Guide to Rational Living by Drs. Ellis and Harper (See Len’s Book Review)
Mind Over Mood, Second Edition: Change How You Feel by Changing the Way You Think by Drs. Dennis, Greenberger and Padesky (See Len’s Book Review)
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