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Symptoms of Depression

  • Lack of pleasure/apathy about most things, most days for at least 2 weeks
  • Fatigue
  • Difficulty Concentrating
  • Sleeping Changes and/or Eating Changes
  • Agitation/Restlessness
  • Feelings of Worthlessness/Guilt

While these are all symptoms of depression, each of these symptoms can be caused by other things.  Depression indicates a neurotransmitter imbalance which can be caused by stress, trauma, negative thinking and/or lifestyle factors, age-related hormone changes, chronic pain or medication side effects.  However, regardless of the underlying cause, if you are waking up each day feeling exhausted and unmotivated, it is not a surprise if you also start feeling worthless, agitated, hopeless and/or helpless.  By examining each symptom in context–when it started, what things make it worse, what things make it better — you may find a variety of things you can do to start feeling better.

Neurotransmitter imbalances are often like a water leak.  If you address them only by taking medication, it is like addressing a water leak by turning up the water pressure.  The underlying “leak” or problem is still there and will likely continue to worsen until it is addressed.  The number of people who have inadequate “happiness chemicals” because that is how they were born or due to traumatic brain injury is relatively small in comparison to the number of people on antidepressants (1 in 10).  Therefore, it is beneficial to examine lifestyle and health factors which may be causing the imbalance.

If you are currently taking antidepressants and they are working for you, great.  You likely will still be able to find tips to feel even better.  If you are not on medication, or are on medication, but not feeling better, these videos might give you some things to talk with your care team/physician about.


Depression Isn't One Size Fits All

Depression, like the flu and many other issues, is diagnosed by identifying a cluster of symptoms.  Two people who have been diagnosed with depression may have very different symptoms.   It is vital to understand your symptoms, when each started, what each one worse, what makes each one better.

Let's look at two examples.  Tom's depressive symptoms started when his wife brought their new baby home.  Depression after the arrival of a new baby is not uncommon for either parent.   The lack of sleep and the additional stress of having a new life to care for can cause some men and women to start getting run down, lose motivation and interest in anything else, feel guilty and worthless and, without understanding what is causing all that, hopeless and helpless to change the situation. Many times these symptoms are ignored in men, because we generally only think of women getting depressed during the postpartum period.

Tom's wife Sally did pretty well in the immediate postpartum period, but she felt guilty when she had to go back to work and stopped nursing the baby,   (An important note is that women's hormones do another huge shift when they stop nursing) The baby was still not sleeping through the night, but Sally had to get up at 6am regardless to get to work, work all day then get up and down with the baby all night.  She began to feel exhausted, unmotivated, irritable and “depressed.”

For John, his depressive symptoms started after a significant injury that resulted in chronic pain.  The medications he was put on to manage his pain can had depressant effects.  Each time he would take a does, he would get exhausted and have to lay down.  Additionally, he lost certain abilities due to the pain which started causing feelings of anger, resentment, worthlessness, guilt and powerlessness.  To top it off, he wasn't getting quality sleep which contributed to his fatigue, sense of hopelessness and neurotransmitter imbalances.

As you can see, the causes and interventions in each of the above examples are going to be quite different. It is important to look at all of the potential contributing factors–physical, social and cognitive.

Fatigue: Causes and Interventions

  • Fatigue is different than being sleepy.  It is being very tired which can be caused by inadequate
  • Quality sleep is necessary for thee brain to balance neurotransmitters necessary for focus, motivation and happiness
  • Decent nutrition is needed for the body to make the hormones and brain chemicals required for focus, motivation and happiness
  • Hydration (drinking enough water) is needed to get out the toxins and facilitate the chemical reactions that turn food into fuel, hormones and brain chemicals.
  • Stress management will help you get quality sleep as well as prevent excess energy expenditure.  Stress impacts the body like driving with 150 pounds of dog food in the trunk of your car impacts your gas mileage.
  • Physical activity causes the brain to release happy chemicals and helps set your circadian rhythms so you can feel awake and energized during the day.
  • Pain management and good ergonomics is essential even for people who don't have chronic pain issues.  Think how much more drained you feel if you wake up and have a severe “kink” in your neck.  How much harder and more exhausting does it seem to get your daily tasks done?
  • Good health (get a physical) will also help prevent fatigue.  Hormone changes due to age, thyroid issues, diabetes and heart disease all can cause fatigue.  Make sure your body-machine is operating efficiently and effectively.


Sleep Disturbances

As you have already read, sleep is vital for health and happiness.  Deep sleep is when your body rebalances neurotransmitters and repairs damage.  Remember the acronym SHADES

  • S= Sleep Routine.  While you don't have to go to bed at exactly the same time each night, try to do the same three or 4 things each night before bed to cue your body that it is time to wind down.
  • H= Hydration.  Drink enough fluid to keep everything running smoothly, but  consider cutting back on your fluid intake about 3 hours before bed to minimize midnight bathroom trips.
  • A= Alcohol.  Stop consuming alcohol early enough so your blood alcohol is 0.00 at bedtime.  Your body processes about one ounce of alcohol per hour.
  • D= Darkness.  Your brain will not send out the right amount of sleep hormones if it senses light.  Use blue-blocker filters on your electronics and turn down the lights 90 minutes before bed.
  • E= Ergonomics.  Make sure you have a comfortable sleeping area.  A mattress that doesn't make you too hot, and a comfortable pillow are essential.
  • S= Stimulants (caffeine, nicotine) stay in your body for hours after ingesting them.  Try to cut back on caffeine after 11am and on nicotine products at least 2 hours before bed.


Apathy and Lack of Motivation

Norepinephrine and dopamine are essential for having the motivation/desire to do anything, and the ability to experience pleasure reward when you do it.

  • Find purpose.  You can help increase motivation and excitement about something if it is directly connected to something important to you.
  • Eat healthfully. Your body needs proteins and vitamins to make norepinephrine and dopamine (among other things).  No building blocks = no energy or motivation.
  • Get adequate quality sleep (yes, this again).  Sleep is involved in helping you stay healthy, regulating your appetite, libido and circadian rhythms and much more.
  • Manage your time more effectively.  When you are overwhelmed and feel like you are being pulled in 15 different directions, it is easy to lose motivation.  Identify the must-dos, delegate as many of them as possible.  Until you start feeling better, be compassionate to yourself and don't try to do it all.
  • Get at least 10 minutes of sunlight each day to help set your circadian (sleep-feed) rhythms.  If you work in an office, try to keep it bright most of the day.
  • Make sure you are getting enough rewards.  Give yourself credit each day for a job well done.  Create small weekly goals that help you keep moving toward your goals, and give yourself rewards for those.  Living things naturally do things that are the most rewarding.  Too much time between rewards or doing something really difficult without a reward can kill motivation.
  • Get up and go.  Do whatever it is for 15 minutes.  If you are still miserable you can stop.  Often getting started is the worst part.
  • Address your fears of failure.  Fear is a huge motivation killer.  How can you think about failure in terms of a learning experience or a demonstration of your courage to step out of your comfort zone?  There are many memes online about failure.  Find one that helps you embrace challenges instead of run from fear.
  • Pay attention to your personal temperament needs.  While it is not always possible to be in your ideal environment, there are often things you can do to make it less stressful by paying attention to your personal temperament and needs.
  • Address chronic stress.  If you regularly feel that nothing you do seems to make a difference, then not only are you not getting enough reward for your efforts, but you are creating a situation which might make you feel powerless (hopeless and helpless).  Most people can identify at least some stressors they can eliminate.  (Watch the video on the ACT matrix for tips)

Agitation and Restlessness

These are not necessarily signs of being grumpy or worried.  Sometimes you may feel that you just can't sit still, but don't know why.  When you have too much norepinephrine in relation to other chemicals you can feel agitated.  Although, too many stimulants, blood sugar imbalances and thyroid problems can also cause these symptoms.

  • Exercise releases serotonin which is a calming chemical.  It also helps you use “nervous energy.
  • Cut down (out) stimulants which tend to cause agitation and restlessness and make you feel like a squirrel in the middle of the road.
  • Get focused on the people, things and goals that are most important to you.  Everything else is secondary.  When you focus on things that are meaningful and make you happy, you naturally will feel less agitated.
  • Stay busy.  If you have nervous energy or cannot sit still, find a hobby or something you can put that energy into.
  • Practice mindfulness to identify thoughts which might be triggering agitation, your strengths and tools which have helped you deal with agitation in the past and vulnerabilities which may be making you more prone to agitation and restlessness.
  • Rule out any physical causes like hyperthyroid by getting a physical.
  • Pet an animal or snuggle with someone to help your body release oxytocin, which helps you feel connected and calm.
  • Examine your environment for things you can do to feel more relaxed and fulfilled.  For example, if you are spontaneous and are feeling oppressed by structure, figure out how to get a little spontaneity in your life.

The videos take more in depth about each of these interventions, but this can help you figure out where to start.