Recovering from depression

Last year I wrote about how and why I started taking antidepressants to better manage depression and anxiety. My commitment to normalize talking about mental health issues has not changed, so here's an update on where I am right now.

At the time of writing, I no longer take antidepressants and have been somehow managing. One of the reasons I started taking them was because both my physical and mental feelings were going wild and I was unable to control them into something positive. I needed to be a bit insensitive. Not much, but just enough.

Last December I started a new job, and despite me liking it, it's still work and work makes tires you by design. The combination of long hours and antidepressants shifted the balance go on the opposite side. I was getting too desensitized, and wondering what I should do about it.

That's when I encountered a conference talk on depression by Michael Yapko. It's called How to recover from depression and it's available on Youtube and in text format. Yapko identifies risk factors ("anything that increases the likelihood of somebody suffering a particular disease or condition") that increase your chances to have depression. For example, children of depressed parents have three to six times more chance to be depressed, making depression a contagious social disease.

Learning about those risks factors was a huge help in stopping antidepressants and I wanted, both as a reminder for myself and for others, to write them down.

Please be aware that again, this is not a medical advice and that if you need one, you should seek help form a professional.

Depression risk factors

Risk factors can be extremely personal, or quite the opposite, shared by a lot of people. And that's those more common ones that Yapko describe in his talk.

He explains five of them:

  1. Internal orientation
  2. Stress generation
  3. Rumination
  4. Global thinking
  5. Unrealistic expectations

Internal orientation

Internal orientation is the act of using yourself as the reference point. It's using feelings to make decisions, and using feelings to interpret what you are interpreting.

The internal orientation drives people inwardly. It's a narcissistic self-absorption attitude driven by the "Trust your feelings" advice (which according to Yapko is a very very bad advice). The problem is, feelings are deceiving and can make things look way worse, or way better, than what they really are.

If you look at the times that people get in the most trouble, it's when they get wrapped up inside in whatever they happen to believe that may have next to nothing to do with what's actually going on out there. Clinicians call this cognitive rigidity.
— Michael Yapko, How to recover from depression

Depressed people think things and then make the mistake of actually believing themselves. To try to get out of this subjective mindset, they have to learn to reality test. Going outside of themselves to better understand what's really happening and generate multiple explanations to an event that is triggering depression.

Stress generation

Internal orientation, among other things, can lead to bad decision making. And bad decision making complicates and exacerbates depression by creating stress. Yapko takes the simple example of exercising. It has the same success rate as a treatment as antidepressants. But someone listening to their feelings won't do it. Same for going to the doctor, or a therapist, or stopping alcohol.

What stress generation speaks to is how people make decisions that complicate their depression, exacerbate their depression. They don’t do it intentionally, but it speaks to the quality of their decision-making strategies, and when people don’t have good decision-making strategies, when they just follow their heart, just follow their feelings, they’re going to make mistakes.
— Michael Yapko, How to recover from depression

Feelings come and go, but consequences of our actions last. To get out of these stressing loops, depressed people need to take actions that are consistent with their personal goals, and avoid taking actions consistent with their feelings. It's particularly important to not take decisions without a balanced mood, as its state influences the perceptions and the quality of decisions.

Rumination

Rumination is the act of spinning around the same thoughts and endlessly analyzing at the expense of taking action. Rumination increases anxiety and depression by making basic things, like sleeping, difficult.

Ruminators are often trying to figure out what to do next based on what happened before. They use the past to predict the future, an habit called past orientation.

So they say things like, “I'll never be happy.” Prediction for the future. “Why not?” “Because I never have been.” “I'll never get a good job.” “Why not?” “Because I've never had one.” ” I'll never have a good relationship.” “Why not?” “Because I've never had one.” [...] For as long as somebody gets caught up in that loop, they're not going anywhere, why it becomes so incredibly important to convert to action.
— Michael Yapko, How to recover from depression

To get out of this loop, it's important to not define itself by the unchangeable history. For survivors of a traumatic event, it's important to recognize it, but not let it orientate the future as it will close the field of possibilities.

One of the cures of rumination taking action in a timely and effective manner. Another one is to learn the difference between useful analysis and useless rumination.

Global cognition or thinking

Global cognition is the act of generalizing instead of problem solving. It's the unfamous "Men/Women are all the same" after a breakup.

Being a global thinker prevents from achieving goals by forbidding going into specifics. It doesn't mean that people are globally thinking every aspect of their life. They can be very good at problem solving specific things, and unable to do the same into other areas without even acknowledging it.

They say to me, “Well, all I want is to be happy. Is that too much to ask? All I want is a good relationship. Is that too much to ask?” Then I'll ask the specifics. “So, what do you think it takes to build a good relationship?” And the person comes back with an equally global response when they say, “Chemistry”. If you think in those global terms, metaphorically you see the forest, but you don't see the trees, then you can't be an effective problem solver.
— Michael Yapko, How to recover from depression

Global thinking takes time to fix as it requires exercising with a therapist to sequence the steps needed to achieve a desired goal. It's basically learning to flow chart and micro-analyzing life.

Unrealistic expectations

Having unrealistic expectations is a recipe for hurt and disappointment. The main problem is, do people know that they have unrealistic expectations?

You've got to know who you're dealing with and whether the expectations are realistic before you walk into a situation that's charged, before you walk into a job interview, before anything. Lay it out. What are your expectations? How do you know whether this is realistic or not? If you get good at doing that, you will save yourself a lot of disappointment.
— Michael Yapko, How to recover from depression

Basic examples could be expecting repeated signs of affection from a partner that has never been very demonstrative to begin with. It can also be not expecting unrealistic things from others when they don't have any control on those things, like winning the lottery. It's not that expecting things is bad, just that those things have to be in line with reality.

Taking a step back to reality check expectations is also a skill that can be learned.

Working against those risk factors

Reading about those risk factors and how it can be socially contagious was eye opening. Rumination and unrealistic expectations are common in my family and were transmitted to my siblings and I. The generated stress often leads to a destructive attitude that is shared by several members. Fortunately, most of us in the family identified those patterns pretty early in adult life and worked to mitigate them.

I'm a bit inclined to internal orientation and I ruminate a lot instead of taking action. What surprised me was that my previous therapist did not thought about rumination as something dangerous. She said that sometimes, it's good to imagine how things could have turn out or fantasize to relieve stress, so I never interpreted it as something negative.

After watching the video and thinking it through, I stopped taking my antidepressants. Despite being at a very, very low dosage, withdrawal symptoms were brutal for two weeks. But having read about them and remembering to not listen to myself too much, I passed through it and came out clean.

But I quickly realized that I had other habits feeding my depression that I needed to eliminate. Among them, I stopped bringing my phone inside my bedroom, and bought a sunlight alarm clock. Removing my phone was actually the biggest and quickest benefit I felt. It significantly reduced my ruminations. It also leveled up my mood in the morning because, shocked-pikachu.jpg, getting up and opening shutters before seeing a screen is good for humans.

Still, there was last one thing. I got used to drink alcohol, even in small quantities, as was a way to relieve stress after work.

Why do I say stop drinking? If you are depressed, if you are vulnerable to depression, your alcohol intake should be zero. Alcohol is a bad drug for people who are depressed or prone to depression. It has been shown to aggravate the same neuro pathways as depression. If you are a depressed person, your alcohol consumption should be zero. [...] When I say alcohol's a bad drug, I am understating it.
— Michael Yapko, How to recover from depression

Seeing how Yapko insisted alcohol was a terrible mistake, I packed all the bottles of my house into bags and dropped them to a friend's, to its delight. I didn't drink for a month, then relaxed my rules to allow myself a beer under conditions: no alcohol in the house, no alcohol outside the house during working days.

I compensate the lack of alcohol with two things, ginger ale and sport. I registered to a gym two months ago and am now trying to go two times a week. It's expensive and I dislike the place, the effort and the overall experience so much it turns into a battle against internal orientation every time. But I try to remember it's a mean that aligns to my goals, and the dopamine rush during the after workout shower is real.

Overall it's been working well for those last two months. I still ruminate, I still listen to myself a little bit too much, but I'm starting to identify those moments and mentally push them away. It's probably going to take months, if not years, before I can say I recovered from depression and anxiety, but I'm happy to finally having this goal in my life, and taking action to achieve it.

Take care.