Depressive symptoms can include low mood, sadness, anhedonia (decreased pleasure/interest), fatigue, changes in weight/appetite, irritability, sleep disturbance, agitation, impaired concentration, apathy, indecision, lack of motivation, pessimism/hopelessness, and suicidal thinking. Over-sensitivity to criticism/rejection, social withdrawal, feelings of excessive worthless/guilt, feelings of loneliness or lack of belongingness, feelings of numbness or emptiness, and feelings of inferiority or excessive self-criticism are also common. Persistent aches, pains, headaches, cramps, and digestive problems that do not ease with treatment may also be related.

So what can be done about depressive symptoms? Below are some common approaches to easing symptoms of depression. Each approach is explained in the sections to follow.

Rule-out Organic Causes

It’s important to see your Primary Care Physician (PCP) at least once per year and get an annual physical. Discuss any mood symptoms with your doctor. They may want to perform examinations and run bloodwork to rule-out common medical conditions that can contribute to depressive symptoms, such as vitamin deficiencies (e.g., Vitamin B12, folate, Vitamin D), infectious diseases (e.g., mononucleosis, Lyme Disease), endocrine disorders (e.g., thyroid imbalances, Cushing disease), inflammatory conditions (e.g., lupus, multiple sclerosis), neurologic conditions (e.g., Parkinson disease, Huntington disease, traumatic brain injury), anemia, etc. They may also want to rule-out sleep-related disorders (e.g., sleep apnea, periodic limb movement disorder). And because some medications are known to contribute to depressive symptoms in some people (e.g., corticosteroids, benzodiazepines), your doctor may want to re-evaluate your current medications.

Time

For some people, depressive symptoms resolve by themselves with time. However, to prevent recurrence or to cut down on the duration of symptoms, some form of treatment may be desirable. Fortunately, 80% of people who seek treatment for depression show improvement.

Psychotherapy

Many different types of psychotherapy have been shown to be effective in the treatment of depression, including Behavioral Activation, Cognitive Therapy, Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), Problem-solving Therapy, Self-management/Self-control Therapy, Acceptance and Commitment Therapy (ACT), Behavioral Couples Therapy, Emotion-focused Therapy (EFT), Rational Emotive Behavioral Therapy (REBT), and Short-term Psychodynamic Therapy. To find a psychotherapist, use the PsychologyToday Online Therapist Directory or contact your state’s psychological association for a referral.

Medication

Medication is also an effective treatment for depression, and often works even better in combination with therapy. There are numerous classes of drugs that have demonstrated efficacy in depression treatment. The most commonly prescribed antidepressant medications are the Selective Serotonin Reuptake Inhibitors (SSRIs), which operate on the serotonin system and have a low side effect profile. Tricyclic Antidepressants (TCAs), Monoamine Oxidase Inhibitors (MAOIs), and Norepinephrine and Dopamine agonists have also been shown to be effective antidepressant agents. And atypical antipsychotics, stimulants, thyroid agents, and anxiolytics are sometimes used as adjuncts. Talk to your primary care doctor or consult with a psychiatrist or psychiatric nurse practitioner to see if you may be a good candidate for medication.

Herbal supplements

Some herbs have been shown to reduce symptoms of depression. For example, St. John’s Wort may be effective in mild to moderately severe depressive symptoms (Linde et al., 1996). Others seem to be helpful with anxiety, such as Kava (Pittler et al., 2000). Often these herbal supplements can be purchased over the counter in pill form or in teas. However, only use herbal supplements in coordination with your physicians, because they can be contraindicated for some people and can interact negatively with some medications.

Exercise

Physical exercise is associated with a variety of health benefits. Physical inactivity, on the other hand, may put people at risk for many disorders — including coronary heart disease, diabetes, certain cancers, obesity, hypertension, and anxiety and depression (Schuch et al., 2016). Fortunately, a great number of studies suggest that exercise training — aerobic and non-aerobic — may reduce depressive symptoms in both clinical and nonclinical populations (Strohle, 2009). Strohle writes: “the effects of physical activity might stimulate a complex system and trigger a cascade of events, which, for example, result in higher resilience against (stress-associated) mental disorders.”

Sleep

Good sleep hygiene is important to mood stability. Sleep deprivation has been shown to strongly impair mental functioning, especially mood (Pilcher et al., 1996). Make sure to get sufficient sleep every night. And if you snore, move often while sleeping, or wake frequently throughout the night, tell your doctor. They may wish to conduct a sleep study to rule-out sleep apnea and other sleep disorders that interrupt nighttime breathing and proper sleep cycling.

Nutrition

Poor diet may be a risk factor for depressive symptoms (Bodnar & Wisner, 2005), so eat healthy and take your vitamins. Initial evidence also suggests that a diet rich in omega-3 fatty acids may help with depression (Lin & Su, 2007). And to maintain balanced blood sugar, and thus stable mood, avoid sugars and don’t skip meals. Consider meeting with a nutritionist/dietitian if you are significantly overweight or eat poorly.

Decrease Drugs and Alcohol

Some drugs — prescription, over-the-counter, and illicit — can be depressogenic, meaning that they can cause symptoms of depression. If you take any drugs, check with a doctor to see if they may be contributing to poor mood. Alcohol is also a commonly abused depressogenic substance (Schuckit et al., 1988). Cutting back or eliminating your alcohol intake can significantly improve mood.

Light Therapy

Some people notice seasonal dips in their mood. This may be due to lack of sunlight in fall/winter months. Fortunately, light lamps with brightnesses of 10,000 lux or more have been shown to improve mood and reduce depression (Golden et al., 2005), and can be purchased for around $150$250. And getting outside on sunny days is free!

Decrease Stress

For many people, stressful life events can precipitate depressive symptoms. One study concluded that 42-67% of individuals with depression report a very serious life event in the year before the depression began. Reducing the amount of “inbound” stress that you have to contend with on a daily basis can greatly reduce depression. Work with your therapist to identify your sources of stress! Some of us have taken on way too much, leading to burnout. Re-evaluate your list of responsibilities, and consider cutting down on extra commitments.

Reduce Anxiety

Anxiety tends to run with depression. In fact, 60% of people with depressive disorders also have an anxiety disorder. Anxiety can exacerbate depression. For some people, what starts as anxiety later leads to depression. So nipping anxiety in the bud can prevent depression.

Increase Social Support

One of the most important balms for depression is social support. Interpersonal relationships prevent depression and help us heal from it more quickly.

Increase Self-care

Many of us do not take care of ourselves sufficiently. We do not engage in good proactive coping (engaging in regular self-care activities) or good reactive coping (responding to stressful events with self-care). So rethink your self-care!

Use Complementary and Alternative Medicine

There is a reason Complementary and Alternative Medicine (CAM) has been around for centuries: it helps! CAM includes healthy activities like mindfulness meditation, yoga, massage therapy, acupuncture, qi gong, martial arts, and others.

Behavioral Activation

How can you increase the amount of reinforcements you receive while reducing the amount of punishments? This is the basic question behind Behavioral Activation (BA). You can’t get positive reinforcement by just sitting around the house. Sitting around the house is not good for depression. So get up, get out! Stay active, even when you don’t feel like it. This increases the likelihood that you will access positive reinforcements, which in turn combat depression. Click here for a list of ways to stay active in and around Baltimore.

Positive Activity Scheduling

Do more of what makes you feel good. Get a calendar and add positive activities to it. Schedule a dinner with friends. Or a trip to a ballgame. Or a walk in the park. Carve out more “me” time.

Challenge Negative and Maladaptive Thinking

We all have negative thinking, but those with depression tend to suffer from it on a much larger scale. Common cognitive distortions include: all or nothing thinking, overgeneralizing, mental filter, disqualifying the positive, jumping to conclusions, magnification and minimization, emotional reasoning, shoulds and musts, labeling, and personalization. Ask your therapist about unskillful thinking styles.

Improve Your Problem-solving

Some of us need to work on our problem-solving. Our lack of effectiveness in various areas of our life causes problems, which creates stress. Becoming more effective reduces stress.

Increase Your Interpersonal Effectiveness

Some of us need to become more effective interpersonally. Experiencing constant difficulties in our relationships creates stress. And having trouble working through conflict leads to unterminated stress. To find out how to become more effective interpersonally, consult your therapist. And consider joining a therapy group!

Be Kind to Yourself

Few of us are as kind to ourselves as we are to others. We need to work on this. The following books may be helpful in facilitating healthy self-love: Self-compassion (Kristin Neff), The Mindful Self-Compassion Workbook (Kristin Neff), Radical Compassion (Tara Brach), and Lovingkindness (Sharon Salzburg).

Find Meaning

It is important that we take time to create a life worth living. Meaningful endeavors — inside or outside of work — give life importance and direction, and make it easier to bear difficulties. For some people this is related to service work and volunteering to help others in need. For others, this may be related to Religion and Spirituality. If you are wrestling with existential issues — such as death, meaning, freedom, and isolation — make sure to bring this up with your therapist or clergy member.

Grieving

Many people who encounter grief bounce back in time. The same is true for people who encounter trauma. However, some people do not bounce back as quickly and need extra help to work through these experiences. If you fall into this latter category, consider seeing a therapist or joining a grief/trauma group.

Bibliotherapy

For some people, information is helpful. Reading more about depression can help to normalize what you are going through and facilitate healing. The following may be particularly helpful: The How of Happiness (Lyubomirsky), Learned Optimism (Seligman), Authentic Happiness (Seligman), The Mindful Way Through Depression (Williams), Radical Acceptance (Brach), and When Things Fall Apart (Chodron).

Use Apps

Applications have been developed to help you monitor your mood over time and improve it throughout the day. For example, Moodivator helps track mood over time so that patterns can be identified. It also helps motivate you to set and reach achievable goals.

Relapse Prevention

Once you have achieved remission from depression, it is important to maintain it. Ask your therapist about how to maintain remission through therapies like Mindfulness-based Cognitive Therapy.

Options for very severe depression

For some people with VERY severe depression, interventions like Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) can be helpful. There are also new biological-based intervention being explored, such as Vagal Nerve Stimulation (VNS) and neuroelectrode implantation. Ketamine has also shown promise for treatment-resistant depression. And new options are being discovered and investigated every day!