Self-Help Sabotage: 11 Things You Can Do to Help Depression, and Why You Shouldn’t Care if You Do Them
If you have Bipolar II Disorder, you probably spend more time depressed than hypomanic, and more time depressed than well. It would be amazing if there were simple things you could do to get better – things under your control that aren’t medical treatments, drugs or therapy… in other words, self-help.
Self-help books, the internet, your therapist, and well-meaning family members are full of suggestions for things you can do to help your depression. Here’s the problem – when you’re depressed, considering taking even one of these steps can seem absolutely impossible – let alone looking at a list of them. Incorporating changes into your life can have a good effect on your mood. The quality of suggestions that you get is going to vary quite a bit. Many of them have one very important thing wrong with them – they set you up for failure.
How Can Self-Help Set You Up For Failure?
- The suggestions can be too difficult for someone who is severely depressed, and this isn’t usually addressed or acknowledged.
- The responsibility is 100% on you. If everyone is saying that 10 minutes of exercise a day will help lift your depression, and it doesn’t help, it’s easy to fall into a spiral of negativity, thinking it’s your fault that it isn’t working. The fact is that if a treatment didn’t work, even if it’s just a self-help strategy, it’s not your fault.
- Bipolar disorder isn’t something that can be magically cured through self-help strategies. It requires medication. Despite this, people have lots of happy suggestions for how you can ward off depression. Enter the concept of toxic positivity – the idea that if you would just eat healthy and exercise (or whatever else), you’d be well. I can’t take any credit for the concept, but I love it (the concept – toxic positivity itself sucks).
- Some suggestions can actually worsen your symptoms, or trigger hypomania.
Exercise is one of the most magical, important activities you can do with and for your body and mind. You get endorphins out of the deal, better sleep, a healthier body, and you might even socialize during the process. Definitely do it if you can, even if it’s just a ten minute walk.
In my experience, I notice the benefits of exercise – typically moderate to high intensity – while I’m doing it, and for up to an hour afterwards. But when I’m acutely depressed, the benefit just disappears. The exercise is good for me, but it’s hard to say whether I end up back where I started or even more depressed during those times.
It’s Not Always Easy to Trick Yourself Into Exercising
My favorite memory of someone pushing the benefits of exercise was a blog post where a woman said she puts her sneakers in front of the door and forced herself to take a walk. I can easily picture myself staring at the shoes, maybe hating myself for being lazy, and going back to bed to read a book. That’s not laziness, though – it’s a sign that your symptoms are really, really bad.
Some Treatments Make Exercising Problematic
Quite a few medications used to treat bipolar II disorder could make it difficult or even dangerous to exercise – for example, lithium can increase your need for water, and if you don’t replenish yourself your blood levels of lithium could become dangerous. At best this raises the difficulty threshold for someone to get into the activity, but if they’ve been told not to exercise, I can easily imagine that they would feel disheartened by this suggestion – “another path to getting better that’s closed to me.”
Should you exercise? Of course it’s good for you. If you can’t exercise though, or if you do and it doesn’t help your symptoms, that’s OK too.
2) Take Omega-3 Supplements (Emphasis on EPA)
This has been shown to have a lot of health benefits, and as long as you do it without expecting to see a benefit, do it. Make sure you get around 1500mg of EPA every day. Do your own research if you like, but keep in mind that labeling may not be accurate, and there may be mercury lurking in some products. Check here and here to see the results of actual testing. Consumerlab.com isn’t free, but they do very extensive testing, will help you figure out what product is the best deal, and are worth a subscription if you use a lot of supplements.
So is it a good idea to take Omega-3s? Probably. On the other hand, there are accounts of Omega-3 supplements triggering hypomania in some people. Just remember – if you take them and they don’t help, no big deal. There are plenty of other things to try.
3) Establish a Routine
This should be on everyone’s list for maintaining mood stability. It’s a core component of Interpersonal and Social Rhythm Therapy (IPSRT), can help diminish both depression and hypomania, and can help prevent episodes too.
One problem here is that when you’re severely depressed, it can be very difficult to follow a routine. You can end up blaming yourself for not being able to stick to your schedule, and this is not going to help resolve your depression. When this happens, it’s better to look at trying other treatment strategies, and revisit the idea of keeping a routine when you’re able to.
The first time that I tried to meditate and felt darkness closing in from all sides, I was very alarmed. In the past, the thoughts I’d notice while meditating were about my grocery list or something. But of course it makes sense – if you take away all of your distractions in a state of deep depression, there’s nothing but darkness. Meditation may not be the best idea.
Try “Maximum Distraction” Instead
At my worst, reading books almost constantly was the only thing that helped – clearing my mind through maximum distraction, sort of the opposite of meditation.
5) Social Contact
Social contact has been shown to reduce depression – but that doesn’t mean any social contact, and it doesn’t mean it always does.
Countless times when I was very depressed, I have dragged myself to social events out of a sense of obligation, and found afterwards that there was a short-term positive effect on my mood – so short term that only lasted a few hours. Other times, being at a party felt horrible, and it got worse the longer I stayed.
Socializing Can Be Hard Work
With most people in my life, I’m going to put on a good face almost no matter how bad I’m feeling, and this is exhausting work. Social interactions can also spawn comparative thoughts, like about how much better the other person’s life is.
Sometimes, You Might Not Be Fit For “Human Consumption”
Other times your irritability might be so bad that being around other people is really hard – and frankly they might not want you around either in that state.
What’s the Bottom Line on Socializing?
Don’t force yourself to socialize if it isn’t something that helps you – it’s OK to be isolated sometimes. That said, if you’re isolated all of the time, that’s not a good thing.
6) Do Things You (Used To?) Enjoy
When I’ve attempted this, the most likely outcome is that I feel horrible remembering the things I used to enjoy, the ways I used to feel, and the facilities I’ve lost. It’s excruciating, and certainly doesn’t leave me feeling positive about myself, let alone improve my depression.
- Doesn’t make you feel despair at your loss of function and well-being.
- Isn’t frustrating.
- Passes time in a way that allows you some respite from your symptoms.
7) Set Small Goals
When I read the quote above, I almost laughed out loud, thinking back to, among many other things, months spent in bed reading books, subsisting on candy, yogurt, and applesauce. I think a “small goal” at that point would have been changing my shirt every day – getting dressed every day would be too much – but then I would have been faced with the need to do laundry when I ran out of shirts.
The thinking behind this advice is that you will feel accomplishment when you meet your small goals, and this will bump your mood up a little. It’s absolutely true. And when you fail to meet even the teensiest of goals? You will feel that you can’t accomplish anything ever again.
While this advice works in theory, it sounds to me like advice written by someone who hasn’t experienced serious depression, and it’s full of landmines. Even if you do set a small goal and you meet it, it’s a short hop to “is this all I can accomplish? I’m pathetic.” You need to be a very self-aware and insightful morbidly depressed person to try this one.
8) Go to Sleep and Wake Up at the Same Time Every Day
While this is great advice, I would not be surprised if you find it impossible to follow. I know that I do during episodes of major depression or hypomania.
What if you go to bed at the same time every night, but don’t fall asleep for hours – an hour one night, three hours another? Aside from opening you up to self-criticism for failing, you’re going to crash right into the next piece of advice…
9) Get Enough Sleep
What’s enough sleep? 7-9 hours. It’s great advice. What’s the problem? Maybe you can’t get enough – insomnia paired with having somewhere to be in there morning, or hypomania.
We’re supposed to stick to a schedule and get enough sleep, but if you can’t do both, should you choose to get enough sleep or to stick to a schedule?
My answer to this is to choose “get enough sleep” over “stick to a schedule.” “Enough sleep” is just one of those bedrock things.
10) Don’t Get Too Much Sleep
Yes, I know I just said to get enough sleep, but there is such a thing as too much. The thinking behind this advice is that getting too much sleep can cause depression to worsen, or cause it outright. There is rock solid evidence that sleep problems are tightly linked to depression. Don’t think, however, that if you’re sleeping 12 hours a day, you can reduce your sleep to 9 hours, and see an improvement in your symptoms. If only it were so simple. This is another instance of advice that can just end up making your depression worse – “I tried that, and I couldn’t do it. Other people could. Maybe I’m not trying hard enough, or I’m broken somehow.”
It’s easy to plunk “don’t get too much sleep” onto a list of things people can do to help their depression and call it a day, but if I did, this would be a garbage article.
What If You Can’t Control Getting Too Much Sleep?
There have been times during bad episodes of depression when I’ve slept 12-14 hours a day. I think that the only thing that could have gotten me to sleep less would have been someone bodily tossing me out of bed and injecting me with amphetamines. I needed that sleep, and sleeping less would have done nothing to improve the level of my depression.
A few paragraphs into this article, the author quotes Dr. Michael Irwin saying that people who sleep more than 8 hours a night are actually staying in bed longer – essentially, they’re getting low quality sleep, so they need more hours of it. Strangely, the author completely misses the point and concludes that too much sleep is bad for your health, failing to notice that people are sleeping too much because of an underlying condition.
Medications that are commonly used to treat Bipolar Disorder – particularly atypical antipsychotics – often cause a marked increase in the amount of time people sleep. This can make the advice to not get too much sleep impossible to follow.
What’s the Bottom Line on Sleep?
Getting too much sleep will probably worsen your depression. On the other hand, depression can also cause you to need more sleep, or at least to sleep more. If you can, limit yourself to nine hours a night, and if you find you need more, get checked out for conditions that might be impairing your sleep.
11) Try Sleep Deprivation
This definitely does work, but don’t try it – and not just because it flies in the face of the other advice about sleep. The biggest reason not to try it is that for people with bipolar disorder, messing around with sleep duration can worsen an episode or trigger a switch to hypomania. Sleep deprivation is also bad for your health, and long-term sleep deprivation can cause depression. Let’s leave it to the researchers to figure it out and develop new drugs instead.
Short-term sleep deprivation has a 60-70% efficacy rate (that’s huge) for treating depression – treating it for a small amount of time anyways. In my extensive experience, the effect lasts just for the day following the night of low sleep. Total sleep deprivation does not work, and neither does losing just a couple hours.
Simply put – don’t try sleep deprivation. Please.
What Are The Two Things You Absolutely Have to Do?
So, ten out of eleven of these things can be really helpful (remember: don’t try sleep deprivation). However, you’d be doing yourself a disservice if you don’t prioritize these two things:
- Find a good therapist.
- Find a good psychiatrist.
Check out this post for advice on how to find good ones.