how depression affects friendships and how depression affects your brain and how depression can affect a person
SELF-CARE DEPRESSION PROGRAM
epression is among the most painful and difficult of all human
experiences. It robs those who have it of energy, interest, and the
Dwill to make things better. It brings with it a profoundly negative
view of the self, the world, and the future. During depression, it seems
as though nothing can change, as though you will never get better.
But depressed people do get better and depression some of the lifestyle choices associated with reducing
does end. There are effective treatments and self-help depression are discussed in the Useful Information
skills to deal with depression. Health care professionals section at the back of the book. Although medication-
give depression treatments, but you can learn self-help based approaches are discussed briefly, most of our
skills and apply them to your own life. This guide emphasis is on these other approaches: antidepressant
teaches a set of antidepressant skills you can use to skills rather than antidepressant pills.
manage depression. Sometimes the skills can be used
on their own, when the depression isn’t too severe. We hope that the workbook will be helpful for you. But
Sometimes they have to be used along with treatments reading it will not be enough. For the approaches to
by professionals. work, you will have to put them into practice. We have
tried to present all of the strategies in a clear, step-by-
The emphasis in this book is on three steps: step format that will help you to work steadily toward
reactivating your life; changing negative thinking your goals.
habits; and solving problems as they arise. In addition,
SELF-CARE DEPRESSION PROGRAM 1 ANTIDEPRESSANT SKILLS WORKBOOKINTRODUCTION
Take a moment now to ask yourself three questions. Mark your answers on the scales below. On a scale of 0 to 100:
How much of a negative effect has low mood had on my life?
NO EFFECT EXTREMELY NEGATIVE EFFECT
How important is it to me to feel better?
NOT IMPORTANT AT ALL EXTREMELY IMPORTANT
Am I willing to make getting better a priority in my life?
NOT A PRIORITY AT ALL EXTREMELY HIGH PRIORITY
If you scored less than 50 on two or three scales, you may be considering change, but still feel uncertain.
If that’s the case, read the workbook and think it over.
If you scored 50 or more on two or three scales, you’re ready to change. You’ve had enough and you’re
prepared to dedicate some time each day to getting better.
Go to the next page and let’s get started . . .
SELF-CARE DEPRESSION PROGRAM 2 ANTIDEPRESSANT SKILLS WORKBOOKWHAT IS DEPRESSION?
ost times when you feel down, you’re not depressed. Feeling sad or low
is a big part of life and can’t be avoided. When something goes wrong in
Myour life, whether it’s an argument with your partner, conflict with your
boss, or a physical illness, your mood might drop.
Depression is not…
Most times when you feel down, you’re not depressed. If you feel especially sad or irritable because of this
Feeling sad or low is a big part of life and can’t be situation, maybe with poor sleep, not wanting to see
avoided. When something goes wrong in your life, friends or family, eating too much or not enough – then
whether it’s an argument with your partner, conflict you’re probably experiencing low mood. Low mood will
with your boss, or a physical illness, your mood typically go away in a week or two, especially if there’s
might drop. an improvement in the situation that started it.
But suppose it doesn’t go away and just gets worse. 2. if you have other problems like:
You might be depressed: ■ big changes in weight or appetite;
■ not being able to sleep enough or sleeping
1. if your mood is very low or you have almost no too much;
interest in your life almost everyday, and this ■ feeling that you are always restless or
feeling goes on for weeks; AND slowed-down;
■ thinking that you are worthless or guilty;
■ feeling really tired much of the time;
■ feeling numb or empty;
■ having a lot of trouble concentrating
or making decisions;
■ thinking about death or suicide.
SELF-CARE DEPRESSION PROGRAM 3 ANTIDEPRESSANT SKILLS WORKBOOKM
WHAT IS DEPRESSION?
The two most common types of depression are called mild depression
and major depression.
Each of these includes the same kinds of problems (the mild kind. Your family physician, a psychiatrist
ones we’ve listed above) but major depression is more or a psychologist can tell you whether you have
severe. Usually, when a person gets depressed, it’s the a depression.
SELF-CARE DEPRESSION PROGRAM 4 ANTIDEPRESSANT SKILLS WORKBOOK
.WHAT IS DEPRESSION?
A few observations about depression . . .
■ Depression is hard to diagnose on your own. time, and more than 15% of adults will be depressed
Our moods affect our judgment of ourselves. So it’s at some time in their lives.
often hard to judge whether we are really depressed.
Usually it takes a trained professional to make ■ Depression is not a sign of weakness.
the diagnosis. Many capable, intelligent, and extremely
accomplished people have been depressed.
■ If you have depression, you are not alone. Being depressed does not mean that you have
More than 4% of adults are depressed at any given a “weak personality” or a character flaw.
If you think you have depression . . .
If you think that you have depression, it is important professional. This can be your family physician, a
that you find help. The skills in this workbook are psychologist, psychiatrist or other mental health
meant to help you with your depression, but you professional. They can help you with a number of
shouldn’t have to do it alone. Getting another opinion different treatments for depression. A good thing
from someone you trust can help you understand your about these treatments is that they work well
problems or put them in perspective. If you continue alongside skills you learn from this workbook.
to feel depressed, seek the help of a health care
If you feel like hurting yourself . . .
For many people, depression makes life seem hopeless appointment, there are a number of crisis lines, staffed
and unmanageable. Most depressed people feel this way 24/7, that you should call. Go to your yellow pages and
from time to time. For a small number of individuals look under Crisis Centres to find the numbers in your
this feeling of hopelessness gets so strong that they area. You might also visit the Emergency Room at your
begin to think that life itself is not worth living. If local hospital.
this happens to you or someone you know, it’s time to
get help. Find a health care professional to help you Remember, things can get better.
get past these feelings. If you can’t wait for an
SELF-CARE DEPRESSION PROGRAM 5 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
People become depressed for a wide variety of reasons.
Research has identified a number of factors associated these areas of your life can play a role in the develop-
with causing and continuing the depressed state. The ment of depression, and depression itself can have
diagram below shows the five major factors: situation; an impact on all of them. On the following pages we
thoughts; emotion; physiology; and action. Each of consider each of these factors in more detail.
• social withdrawal
• reduced activity
• negative thinking
• poor self-care
• harsh self-criticism
• unfair & unrealistic
• altered sleep
• low energy
• changes in brain
SELF-CARE DEPRESSION PROGRAM 6 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Depression is often triggered by very stressful life situa- ■ Stress related to your physical health. This is
tions. If your attempts to cope with these situations by especially true for health problems that are chronic,
improving or accepting them have not been successful, cause a lot of pain or disability, and only get partly
you may begin to feel overwhelmed and hopeless. Then better with treatment. Some physical illnesses or
the risk of a depressive episode increases. Some situa- their treatments can trigger depression by their
tions that can be associated with depression include: effects on the body. For example, hypothyroidism
(a condition in which the thyroid gland secretes
■ Major life events, particularly involving loss. Events too little thyroid hormone) is often associated
such as the death of a loved one, moving, divorce, with fatigue and depression.
financial setbacks, or job loss are major disruptions
in one’s life. That doesn’t mean people only get depressed when
things are going badly. Some people get depressed
■ Lack of contact with other people. Social isolation when their life has been going smoothly: depression
is a significant risk factor for depression. just seems to come out of nowhere Antidepressant
skills like the ones taught in this book are just as
■ Relationship conflict. Times of conflict in useful for these people.
personal relationships, whether marital or family,
are extremely stressful and can contribute to the
onset of depression.
■ Stress related to your job. This can take
the form of employment uncertainty (not
knowing whether your job will continue),
friction with supervisors and co-workers,
or overwork (human beings were never
designed to work 16 hours a day,
either in an occupation or
SELF-CARE DEPRESSION PROGRAM 7 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Each of us is affected differently by outside events, anticipates feeling miserable, and sees the other people
depending on how we think about those events. as judgmental and rejecting. Each person’s thoughts
Imagine two people walking into a party. One person determine how the event is experienced. Research
is naturally outgoing, anticipates enjoying herself a evidence has shown that depressed individuals often
great deal, and sees the group of partygoers as friendly have distorted ways of thinking about the world that
and receptive. The other dreads social gatherings, can trigger or worsen the experience of depression.
SELF-CARE DEPRESSION PROGRAM 8 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Distorted ways of thinking
These ways of thinking often start in childhood. Some
Unrealistic, negative thoughts
people grew up in families where only negative and
about the situation.
critical comments were made. In other families,
You see the situation in an unrealistically pessimistic
children were discouraged from saying positive things
way, emphasizing its negative or threatening aspects
about themselves and rewarded for being self-critical.
and ignoring more positive or promising aspects.
Whether these negative thinking styles are caused by
the depression or started in childhood, they have
Unfair, negative thoughts about yourself.
enormous influence on your experience of the world.
You think about yourself in a very critical fashion,
judging yourself in a harsh and unfair manner.
Not surprisingly, these ways of thinking about the
world increase the negative impact of difficult life
Unrealistic, negative thoughts
situations and predispose people to emotional pain.
about the future.
A person with depressive thinking can become
You anticipate a future that is bleak and disappointing,
discouraged or hopeless even when things are
exaggerating the likelihood of very negative outcomes.
Taken together, we call this the Negative Triad: thinking
in an unfair and unrealistic, negative way about your
current situation, yourself, and your future.
SELF-CARE DEPRESSION PROGRAM 9 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Depression often begins with feelings of discouragement Remember that depressed people interpret the world in
and sadness after unsuccessful attempts to deal with an unrealistically pessimistic way and judge themselves
a difficult life situation. However, as the depression in a harsh and unfair manner. The emotions they feel
continues, these feelings of unhappiness give way to are based in large part on this negative way of inter-
more severe and painful kinds of emotional experience. preting their lives. If their thoughts about the world
The depressed individual is overcome by a sense of are unrealistic and negative, then their emotions will
despair, a pervasive mood of hopeless misery. A feeling also be unrealistic and negative.
of intense anxiety (physical tension, worry, and a
sense of impending doom) often accompanies these It may be hard to think about emotions as unrealistic.
depressed feelings. But imagine a person who firmly believes that airplane
travel is extremely dangerous and that planes are falling
Some depressed people experience a general sense of out of the sky frequently. That person will feel very
emotional numbness, an inability to feel anything. It frightened when flying. This fear, however, is based
is as though the psychological pain has become so on a false belief about airplane safety and is, therefore,
intense that your mind simply switches off your unrealistic and inappropriate to the situation. Similarly,
emotions, like a circuit breaker. depressed individuals often have beliefs about the
world and themselves that are unrealistic and lead
to unrealistic, negative emotions.
SELF-CARE DEPRESSION PROGRAM 10 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Depression is accompanied by a variety of physical One theory of depression is that it is caused by changes
symptoms. One of the most powerful physical changes in brain function, a “chemical imbalance”. There is
accompanying depression is impaired sleep. Usually, research showing that, for some depressed people,
this involves an inability to get enough sleep, whether certain neurochemicals in the brain are less active.
because the person has difficulty falling asleep, repeat- It is unclear, however, whether these changes in brain
edly wakes during the night, or awakens much too early. chemistry commonly cause depression. All we know is
Sometimes the person may sleep too much, caused by that depression is often associated with changes in
a desire simply to hide away in sleep or a fatigue so brain chemistry.
pervasive that there never seems to be enough sleep.
When sleep is “non-restorative” – that is, the person The physiological changes of depression make it harder
does not awake feeling refreshed and rested – it to cope with life problems or even to follow the steps
becomes harder to face the day and deal with problems. of a depression management program like this one.
Depressed people often feel that they lack energy and Antidepressant medication can often be quite helpful
are exhausted by everyday activities. in restoring sleep and regaining your sense of physical
energy. It can allow you to actively learn and try out
the new skills needed to overcome depression.
SELF-CARE DEPRESSION PROGRAM 11 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Depression usually has a significant impact on a person’s behaviour. Here are some of the main areas affected:
Not doing rewarding activities.
Hobbies, crafts, sports, reading, and travel may all suffer. Depressed people often feel too tired or unmotivated to
pursue these activities, and the less they participate in them, the less they feel able to do so. Most depressed
people suffer from anhedonia, reduced ability to have fun or get enjoyment from things. Why would you go
to the movies, engage in hobbies, or do the things you used to enjoy if you didn’t think you would enjoy
them? Inactivity becomes a habit. As a result, the depressed person no longer receives the personal
satisfaction provided by these activities, further contributing to the sense of discouragement.
Not taking care of yourself.
Activities designed to maintain one’s body and appearance are frequently neglected. Depressed individuals
may take less care in personal grooming or dress than usual. In addition, exercise is often reduced, whether
this involves formal fitness activities such as jogging or simply walking around the neighbourhood. Eliminating
exercise contributes to depression by removing a powerful source of physical well-being and increased self-
esteem. As well, the depressed person often has disrupted eating habits, whether this means inadequate intake
(“forgetting to eat”) related to a lack of appetite, or overeating as a form of self comfort.
SELF-CARE DEPRESSION PROGRAM 12 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION?
Not doing small duties.
A depressed person often neglects or procrastinates doing small, necessary duties, like running errands, taking
out the garbage, cleaning house, or caring for the garden. Failing to complete these chores adds to the depressed
person’s sense of inadequacy and lack of control over life. It also creates friction with others and places further
stress on relationships.
Withdrawing from family and friends.
Social invitations are refused, phone calls are ignored, and habitual get-togethers with family or friends somehow
just don’t happen. Social isolation is a strong contributor to depressed mood, taking you away from the warmth
and sense of connection to others, basic to all of us. Depressed people often believe that others have no interest
in their company, given how miserable or emotionally flat they are feeling.
SELF-CARE DEPRESSION PROGRAM 13 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAN YOU DO ABOUT DEPRESSION?
■ Talking to family and trusted friends about how ■ Speak to a family physician, psychiatrist or psycholo-
you’ve been feeling is usually a good thing to do. gist. A professional can help you figure out what’s
They can help you figure out solutions to some of the been going on and can make useful suggestions.
problems you’ve been dealing with; besides, just ■ In some cases, antidepressant medications can be
knowing that people care about you is helpful. helpful in overcoming Mild Depression. But for most
■ Write about problems you’re facing, your feelings and individuals with Mild Depression, the answer does not
thoughts, and possible solutions. This can help you lie in medication.
understand what you’re going through and what
choices you have.
Learning and practicing the antidepressant skills in this guide is likely
to be very helpful in overcoming Mild Depression.
SELF-CARE DEPRESSION PROGRAM 14 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAN YOU DO ABOUT DEPRESSION?
In addition to the actions described previously… (CBT). CBT is a talking therapy that teaches new skills
for thinking and acting more effectively. This guide is
■ Definitely see your family physician if you think based on CBT methods.
you might be this depressed. Major Depression is a ■ Yet another effective treatment is interpersonal
serious problem and should be diagnosed by a family therapy (IPT), a talking therapy that teaches new
physician, psychiatrist or psychologist. skills for dealing with partners, friends and family.
■ Antidepressant medications are the most commonly ■ For long-lasting or recurrent depression, the most
prescribed treatments for Major Depression and are powerful approach is to combine antidepressant
usually effective. medication with one of these kinds of talking
■ An equally effective treatment for most cases of therapy.
Major Depression is Cognitive Behavioural Therapy
Learning and practicing the antidepressant skills in this guide is likely to help in overcoming
Major Depression. BUT remember that the skills taught in this guide will not be enough by
themselves to fix something this serious. If you have a Major Depression, you should seek
SELF-CARE DEPRESSION PROGRAM 15 ANTIDEPRESSANT SKILLS WORKBOOKMORE ABOUT MEDICATION
edication is quite helpful in a number of cases. Many of those
who take antidepressant medication experience a lift in mood
and a reduction in other symptoms (such as loss of appetite or
But medication is seldom a complete treatment for can give you the energy and mood lift you need to
mood problems: it is also important to make changes make changes (such as starting a regular exercise
in how you think about and handle your life. Don’t use program, learning assertiveness skills, or defining
medication as a way of allowing you to keep living an and working toward your life goals).
unhealthy or unfulfilling lifestyle. Instead, medication
SELF-CARE DEPRESSION PROGRAM 16 ANTIDEPRESSANT SKILLS WORKBOOKMORE ABOUT MEDICATION
Here are some additional points about medication:
Different medications work Certain people benefit from taking
for different people. medication for a long time.
It can take time to find a medication (or a combination For some people, antidepressant medication continues
of medications) that works well for a person without to have beneficial effects over the long term. Most
too many side effects. Side effects may include sleep people take medication for a while in order to get
difficulty, change in appetite and loss of sexual desire. the strength to make positive changes, then gradually
stop using it.
Never stop taking medication suddenly.
Some people have unpleasant reactions to discontinuing It can be tempting to stop taking a
antidepressant medications. If you wish to stop a medication as soon as you get the
medication, consult with your prescribing physician. level of improvement you want.
Usually you will stop in stages by gradually taking The result is often a rapid return of the problem. It
less over time. is generally best to stay on the medication until your
mood has been steady for a while. Reductions in
medication may then be done gradually while your
mood is monitored.
SELF-CARE DEPRESSION PROGRAM 17 ANTIDEPRESSANT SKILLS WORKBOOKANTIDEPRESSANT SKILLS
n this section, you will learn three skills that can stop your mood from
sliding down, lessen your depression and help prevent it from happening
Iagain. The skills are:
Reactivating Your Life Thinking Realistically Solving Problems
We will explain how each of these skills helps fight Depression involves all areas of your life: your
depression and show you in a step-by-step way how emotions, thoughts, actions, physical functioning, and
to use the skill. It’s best to think about these skills life situation (including social support, family relation-
the way you would if you were learning a new job or a ships, employment, finances, and so on). Each of
new sport: practice is very important. Some people find these areas is connected to all the others. As a result,
it helpful to share this guide with a spouse, trusted changes in one area produce changes in the others.
friend, counsellor or family member – this person can When depression first develops, negative changes in
help you keep practicing even when you feel low energy one cause the others to get worse as well. But when
or unmotivated. If there’s no one like that, then keep you are working on getting better, changing one area
practicing the antidepressant skills. As you work through leads to improvements in the others. The goal of treat-
the skills, it will gradually get easier and the result is ment is to get all areas of your life spiraling upward,
worth it. each producing positive change that improves the others.
SELF-CARE DEPRESSION PROGRAM 18 ANTIDEPRESSANT SKILLS WORKBOOKREACTIVATING YOUR LIFE
uring depression, most people don’t
do the things that normally keep
Dtheir mood positive.
But if you stop taking care of yourself or doing the Depression leads to inactivity, but inactivity makes
things you normally like, your life becomes more dull depression worse. What seems like a good coping strategy
and depressing. Although it can feel as though you actually tends to maintain or intensify depression. The
are comforting yourself by being less active, in fact solution: don’t wait until you feel like doing more.
you are probably helping the depression get worse. Waiting actually makes it less likely that you will get
In other words: better. And don’t wait until you feel motivated – as
you get better, you will regain a sense of motivation.
Action starts first, motivation kicks in later. Setting
goals to increase your activity level is a powerful
method for managing depression.
The aim is to gradually get yourself moving even
though you might not feel like it. These are the
steps to gradually reactivating your life.
SELF-CARE DEPRESSION PROGRAM 19 ANTIDEPRESSANT SKILLS WORKBOOK