Recovering from depression can be a catch-22

by Jon G. Allen, PhD on May 21, 2010 · 8 comments

in depression,substance abuse

Coping with Depression, one of many books written by Jon G. Allen, PhD

I have found two basic ideas to be helpful in understanding depression: stress pileup and catch-22. We know that episodes of major depression are preceded by stressful events, and these events have two main themes: loss and failure. Loss of a key relationship through death, divorce or a break-up is a common precipitant of depression. A feeling of failure could be associated with not meeting your aspirations or others’ expectations at work or in school—or with relationship problems that also involve loss.

Often, depression is preceded by a cascading pileup of stress: problems at work lead to overuse of alcohol, which further impairs work performance; drinking to cope leads to marital conflict, which further fuels alcohol use; marital conflict is stressful for children, who then have more difficulty in school—such scenarios are innumerable.

All the things you must do to recover from depression are made difficult by the symptoms of depression.

Being vulnerable

Although depression is commonly preceded by stress, many people manage a pileup of stress without becoming depressed. Why do some and not others succumb? One reason is genetic vulnerability to becoming depressed in the face of stress. In addition, general medical conditions and physical ill health can contribute to depression.

Yet another reason for vulnerability: a history of stress pileup over a person’s lifetime. Childhood trauma, such as loss, abuse and neglect—combined with genetic vulnerability—can contribute to risk for depression in adulthood. Stress and episodes of depression in adolescence also add to risk for later depression. And, as in the example given earlier, substance abuse is a catalyst for depression: if you’re headed into depression, substance abuse can speed up the process and hinder recovery.

Depression’s impact

Depression notoriously saps energy and impairs concentration and complex problem-solving ability. Thus, heading into depression, you are liable to struggle harder to stay afloat, for example, in managing demanding jobs and household responsibilities, including caring for children or aging parents. Effort increases while energy decreases. At some point, you run out of energy entirely and “crash” into severe depression. It’s as if your mind wants to keep going but your body declares, “I quit.” At the extreme, you can become bedridden.

Adding insult to injury and contributing further to the pileup is the fact that many people feel ashamed of being depressed and withdraw from relationships as a result. Because social isolation is a major contributor to depression, more stress pileup ensues. Another potential blow: the prospect of stigma can interfere with seeking professional help.

The catch-22

Paradoxically, the process of recovering from depression also is stressful in that it’s extremely challenging. I attribute this to a catch-22: all the things you must do to recover from depression are made difficult by the symptoms of depression: you should sleep well, eat well, be active, engage in pleasurable activities, think realistically, stay engaged with persons who can provide support and maintain hope.

Now consider the symptoms of depression: insomnia, poor appetite, lethargy, diminished capacity for pleasure, negative thinking, social withdrawal and hopelessness. Recovery is the norm, but the catch-22s often make this process of recovery slow—several months to recover fully from an episode of major depression is not unusual. (I talk a lot about the catch-22s of depression in my book Coping with Depression in case you’re interested in learning more about them.)

Tips on recovery

Here are some key points for recovering from depression and preventing further episodes:

  1. See if you can find a way to get out of the maelstrom of stress pileup to take stock of your situation, respecting the power of the stresses without minimizing them. Psychotherapy can be helpful in such stock-taking; sometimes patients need the asylum provided by hospitalization to get the needed respite and distance from the stressful situation.
  2. At least in the short run, do everything humanly possible to minimize stress. This is not easy: you can’t give up your children or quit your job and go to the Bahamas. Yet you might find ways to cut back some. Saying “no” is not easy but can be helpful. Ditto for seeking help.
  3. Take stress seriously and develop methods of coping more effectively. In his masterful book, The End of Stress as We Know It, stress researcher Bruce McEwen asserted that everything we know about managing stress our grandmothers could have told us. But now we have the scientific evidence to back up grandmother’s wisdom. Sleep, diet, exercise, relaxation, pleasurable activities—these are the mainstays of stress management. Yet we must be mindful of the catch-22s.
  4. Be patient with yourself regarding any difficulty you may experience in recovering from depression. Patients who have recovered refer to the “baby steps” that got them there. Catch-22: being patient with yourself can be difficult because depression spawns self-criticism.
  5. Make every effort to stay connected: the mere presence of another person can ameliorate stress, and the presence of a trusted companion with whom you have an emotional bond is the most potent antidote to stress known to man (and to many other mammals).
  6. A caution: It is little wonder that depressed persons seek potent chemical solutions. Alcohol, for example, relieves anxiety and produces pleasure—all too temporarily. In the long run, as stated earlier, substance abuse catalyzes and prolongs episodes of depression. The worst time to drink or do drugs is when you are doing so to manage psychiatric symptoms of any sort.

There is one major basis for hope: the vast majority of depressed persons recover, albeit slowly. And to drive home the importance of others in a person’s recovery,  I conclude with this anecdote: when I made the point in an educational group that it is difficult but not impossible to recover from depression, a patient rightly protested: “Doc, I can tell you that it was impossible for me to recover on my own.”

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{ 6 comments… read them below or add one }

Vickie May 7, 2017 at 6:08 pm

I struggled with depression for 21 years. Some months/years were brighter than others – but always was an underlying sense of gloom. When I was very depressed I struggled to get up, dress, shower – mostly I didn’t bother. But for much of the time I was either working or studying. However, the depression just takes the colour out of everyday and makes everything you do a major battle. You get stuff done, sure, but where’s the joy? For me, the thing which turned the tide was getting rid of a stressful job. yes, I know, not many people can just up and leave a job, but with help, an ally who is there for you, it may just be possible to start putting a plan in place which, in time, may allow you to move from or handle better, a stressful job. Note I’m talking about job stress here, not financial, relationship, ill-health or other stressors. Tiny goals, baby steps, heaps of self-compassion and allies around you can help with the elimination of stress and therefore offer hope for depression.

Yesindeadie June 30, 2016 at 5:18 pm

Jerrie….Right on!!!!
You said it perfectly.
Most shrinks and book writers have no idea what he’ll people who live with abuse and the enduring depression are going through.
The solution to depression is to solve the problems themselves and this can’t be done because in most cases they are things inflicted by others such as abuse, divorce, loss of a job and the sad fact is that some people are tested more than others with life challenges. The rest of the clueless children who basically lead charmed lives and whose biggest complaint is one or two or even three life catastrophes have no idea what CONSTANT STRESS is like.
And in fact, they will never recognize those of us who have it because we learn to hide it from the idiots around us with their pithy solutions which Jerrie so aptly points out are patently absurd. In fact many depressed people are depressed because they have a much higher IQ than average which allows them to analyze the insanity of the human government, society all norms… Etc… And like playing chess they realize it is KO, game over, you can’t fight city hall…and they are incapable of deluding themselves into believing there is indeed a pony under all that dung. The good news Jerrie and I will make it through the apocalypse before the advice slingers. Why? Because we deal with hell ever damn day.

Jerri Petrie March 27, 2016 at 7:16 am

Great to read someone who realises that all the things we are told to do to recover from depression are the very things we are unable to do because of the depression. Such advice is useless and insulting. You feel like saying, ‘What part of depresssed…?’ Along with the mental depression I have physical symptoms of extreme muscle pain, joint pain, exhaustion and weakness that make ‘exercise’ a very bad idea. As for ‘doing more things that you enjoy’ – what on earth are they talking about? You are incapable of feeling enjoyment.
I didn’t understand what you meant about it might takes ‘months’ to recover. I have been in this state for over thirty years now. Not once in all this time have I felt any pleasurable feelings or had any release from the physical pain, weakness and tiredness. My GP, grudgingly, mumbled over his shoulder that I had ‘general low mood’. Needless to say I no longer see him.
I have recently realised that I was raised by narcissistic parents – big revealation and so good to finally understand what all that was about. But such insight does nothing to change how I feel. Nor does diet, or hurting yourself exercising, or standing on a bus stop and struggling through a shopping centre (going out – doctor’s favourite advice), or writing down which room you were in ‘when you felt depressed’ – as if you were fine before you went into the kitchen with Mr.Bun the baker (CBT).
The fact is – and I speak from 30 years experience – there is no cure for depression. I never took drugs for it but look at the thousands of people who commit suicide by overdosing on anti-depressants. Anyone who claims to have ‘overcome’ depression can’t have been that badly off in the first place – or is trying to promote a book.

Jan Rice, LPC October 4, 2013 at 6:56 am

I love the reference to “catch 22” about depression’s symptoms being the problem and the solution!

I often tell my clients that the very things they don’t want to do are what they need to do to lift themselves out of depression.

The negative, irrational thoughts are not valid and only help keep them stuck. One of my favorite anecdotes to regaining lost ground with depression is “move your muscles”–which means doing what needs to be done whether you feel like it or not!

Thank you for the article. I will recommend it to my clients.

Jan Rice, LPC

Venessa September 22, 2013 at 12:52 pm

Thank you for this short article and book. Depression, however prevalent it is, is still very much a widely misunderstood condition, and if only everyone could drop their cynicism and show a little compassion, the world would be a better place. Patients suffering from depression are vulnerable and helpless.

To anyone suffering from depression out there… there will be times when the future seems bleak and to add on to this, it seems like the people around you aren’t willing to help. They may judge you, they may discount your condition. Whatever the negativity is, believe in yourself.

Whatever happens, never ever ever give up. Greater things lie ahead.

Dianne Borowski June 7, 2010 at 3:46 pm

Very good article. Have struggled with depression most of my life. Am now a senior citizen and trying to survive the diagnosis of breast cancer. Actually doing pretty well. I am determined to cope without succumbing to depression. I push myself to keep busy and try to keep a positive attitude. So far, so good. Thanks.

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