How to treat clinical depression

Clinical depression is not merely about having a 'problem' or occasionally feeling down. It refers to being diagnosed with depression at a clinical level, meaning that you have a recognized mental health condition. Several diagnoses fall under clinical depression, such as Major Depressive Disorder, Mood Dysregulation Disorder, Persistent Depressive Disorder, and Premenstrual Dysphoric Disorder. Additionally, some depressive disorders are triggered by substance use, medication, or underlying medical conditions. Regardless of the type of disorder, you can overcome depressive symptoms through support, coping strategies, and altering negative thought patterns.

Ensure your safety if experiencing suicidal thoughts. If you have thoughts of harming yourself or attempting suicide, it is crucial to get help immediately. If you're unable to control suicidal impulses, it is important to go outside and find support right away.

• Call a local emergency number like 115.
• Contact suicide prevention hotlines such as 0923457788 or 0962237788 (in Vietnam), or seek online support.
• Go to the nearest emergency room and express your feelings to the medical staff. Inform them that you are contemplating suicide.

Consult with a specialist. When seeking help from a specialist, you should choose someone experienced in treating patients with depression and someone you feel comfortable with. A suitable specialist may not solve all of your issues immediately but can help guide you in self-help, refer you to a psychologist if necessary (for medical treatment), and assist you through tough times.

• Contact your health insurance company to find a list of licensed clinics in your area. Be sure to ask about the services covered by your insurance.
• If you don't have insurance, you can search online for affordable or free mental health clinics locally. Alternatively, you can call local social services or government organizations for assistance or financial programs for low-income families.
• If you find a suitable specialist, you can continue treatment if it proves effective. Find out if you can contact them after hours in case of emergencies.
• Look for or ask for a referral to a treatment group. For example, Cognitive Behavioral Therapy (CBT) is an effective treatment method that helps alleviate the depression you may be experiencing.

Consider using medication. Medications like SSRI antidepressants are effective in treating severe depression. You should consult with a specialist to see if the medication works for you. Ask your specialist about the names of psychologists who have successfully treated patients with similar issues.

• Even when taking prescription medication, don't assume it's a simple fix for your problem. There are other methods to treat depression that you should consider trying.
• Accept that not all psychologists have the same level of expertise. You should ask your psychologist how they treat patients with situations similar to yours. Learn about commonly prescribed medications, whether they prescribe multiple medications, and their dosage protocols. If it doesn't feel right, you should seek a different doctor.
• If you choose to take medication for depression, each type has a different effect. Some may worsen your depression for a time or even trigger suicidal thoughts before they begin to work. If this happens, you should contact your doctor or specialist immediately.
• Don't stop treatment abruptly. This can lead to negative side effects (shaking, chills, etc.) and worsen your depression. You should only change or stop medication under the supervision of your psychologist.

Seek support from family. Social support is one of the most valuable resources when facing depression. It can boost feelings of worth and love, as well as provide you with people ready to help and care for you.

• Depression is a hereditary mental illness. You should review your family's medical history. Do any other family members suffer from depression? Observe what they do to cope with it.
• If certain family members show more support, you should reach out to them. If it's uncomfortable to seek help from immediate relatives (parents, siblings), try reaching out to grandparents, aunts, uncles, or cousins. If support is still lacking, consider contacting a close friend.
• If you can only rely on a specialist, that's okay too. They can connect you to group therapy which provides social support if you can't rely on friends or family.

Share your feelings with others. Emotional support is a common solution for those dealing with depression. This approach helps release emotions when someone is there to listen, rather than letting them build up, which could lead to an emotional outburst or breakdown.

• Talk to friends. If you're feeling down, try finding a friend to listen and support you, even if just their presence is enough to make a difference. Opening up may feel harder when you're depressed, but don't be ashamed to share your feelings with your friends.
• Crying in front of friends or family can ease your mood.
• If you're in a better mood, you can invite your friends to join you in something fun.

Develop healthy relationships. Research has shown that the quality of relationships with your partner, family, and friends is a major factor contributing to clinical depression. Those who have poor relationships or lack support are twice as likely to experience depression compared to those with healthy relationships. Identifying and ending unhealthy relationships can help improve this situation.

• A healthy relationship is built on mutual respect, trust, collaboration, and acceptance. Such relationships often involve physical closeness, open communication, and honesty.
• Unhealthy relationships typically involve fear, humiliation, threats, domination, judgment, and blame. These relationships may also include various forms of abuse (verbal, physical, sexual) and possessiveness.
• Evaluate your current friendships and relationships. Are there individuals who constantly bring you down or criticize you? Perhaps they do more harm than good. Consider distancing yourself from unhealthy relationships or building new ones.

Self-educate. One of the best ways to begin addressing your depression is by educating yourself. Knowledge is power, and understanding the causes of your depression can get you halfway toward overcoming it. Information support can assist those struggling with depression in dealing with challenging situations.

• Psychological education refers to thoroughly learning about your disorder. You can ask your specialist for educational resources related to your specific condition and create a treatment plan.
• Gather books, research papers, watch documentaries, and conduct online research to find information about your condition.

Set goals. Setting goals is an essential step in any treatment plan for reducing depression symptoms. To effectively treat depression, you need a plan.

• Ask yourself what you want to achieve through your treatment. How do you want to overcome your depression? Do you want to reduce its severity? Do you want to find new coping strategies? Be specific and set time limits (e.g., one week, one month, six months) and realistic, achievable goals. For example, curing depression within a month might not be realistic, but reducing the severity of depression on a scale from 1 to 10 (with 10 being severe and 1 being no depression) from 9 to 7 is more achievable.
• Outline a plan to reduce your depression. Use the coping strategies listed below to set specific goals. For example, you can aim to research mood disorders at least once a week.
• Evaluate the effectiveness of your plan. Modify the plan if necessary to incorporate new strategies you haven't tried yet.

Engage in activities that bring you joy. How you choose to cope with depression depends on the underlying stressors, culture, personal resources, and unique social situations.

• Healthy activities include: reading, watching movies, writing (journals or short stories), painting, sculpting, playing with pets, cooking, playing music, knitting, and crocheting.
• Incorporate these healthy activities into your daily routine.
• Spiritual and religious practices have been shown to reduce depression, especially in older adults. If it feels right for you, consider incorporating this into your approach.

Focus on solving problems. Life events or stressful situations may sometimes lead to feelings of depression. It's important to find solutions to your problems to reduce stress. Focus on what you can control in this situation (your reactions or thoughts about it), rather than worrying about things you cannot control (such as others' actions).

• Personal conflicts can sometimes make depression worse. It's helpful to address any issues when they arise. For example, you could express your feelings openly without aggression, using 'I' statements, like 'I feel upset when you forget to call me back.'
• Avoid seeking information as a way of procrastinating, which is common among those with depression. Understand that to change your circumstances, you need to take action. Gather the information you need to make decisions, but eventually, you must take the step to act on that decision, whether it’s ending an unhealthy friendship or trying a new treatment option.
• Focus on what’s within your control. Redirect your attention toward plans and solutions that you can change, rather than obsessing over others’ mistakes or external circumstances like traffic or noisy neighbors.

Exercise. Physical activity is proven to be an effective way to alleviate depression. Regular exercise can even help you overcome depression, whether it's related to physical health issues or life challenges.

• You could try activities like walking, jogging, cycling, using fitness machines, hiking, or weightlifting.
• You might also enjoy trying new activities like Zumba, dance classes, yoga, strength training, or rowing.

Practice mindfulness or meditation. Mindfulness meditation can increase awareness and reduce stress. Mindfulness is about being fully present in the moment, here and now. It involves focusing on the present, rather than dwelling on the past or worrying about the future.

• For beginners, you can practice mindfulness by paying close attention as you eat a piece of fruit (apple, banana, strawberry, or your favorite fruit). Start by observing its color and shape. Then touch the fruit. How does it feel? Soft, smooth, or rough? Be mindful of its texture and structure. Next, inhale its fragrance and enjoy the aroma. Take a bite and notice the flavor. Is it sour or sweet? How does it feel as you chew it? Eat slowly, focusing on the experience. Be aware of any distracting thoughts and gently let them go without judgment.
• Another mindfulness exercise is taking a mindful walk. You can walk to a neighbor's house (if it's safe) or to a nearby park. As with the fruit exercise, observe everything you encounter—sights, smells, sounds, tastes, and sensations on your skin and body.

Restrain yourself. Restraint exercises, or distraction techniques, are especially helpful when you need a break from temporary emotional pain. These techniques can help you redirect your attention away from depressive thoughts and focus on something else for a period of time.

• Try a mental restraint technique like listing cities, colors, or animals (from A to Y).
• Engage in physical restraint exercises like splashing cold water on your hands, taking a bubble bath, or cuddling with a pet.
• You can find more restraint exercises online.

Avoid using negative coping strategies. These only worsen depression. Negative ways of dealing with depression include isolating yourself socially, engaging in aggressive behaviors (like yelling, violence, or harming others), or abusing alcohol or drugs.

• Avoid using substances like drugs and alcohol to cope with feelings of sadness or other depressive symptoms.

Unconscious Cognitive Restructuring. The way we perceive ourselves, others, and the world around us shapes our unique reality. Thoughts are directly connected to emotions. If thoughts are negative, it becomes easier to feel down. Cognitive restructuring involves replacing negative and unhelpful thoughts that contribute to depression with more realistic ones. By consciously changing your thinking, you can reduce depression significantly.

Resisting Black-and-White Thinking. This means you believe something is either completely bad or completely good. Try to adopt a more neutral perspective. If you think something or someone is entirely bad, try listing a few positive aspects and focus on those instead.

Minimizing Self-Blame. This is similar to thinking, 'Everything is my fault. No one loves me because I am a bad person.' Such thoughts are inaccurate because not every mistake is solely yours, and there are always multiple factors at play.

• However, you should avoid blaming others too. Take responsibility and strive to assess the situation realistically.

Avoid Catastrophizing. This means you anticipate the worst possible outcome and try to predict the future.

• Try to think about how things might turn out differently. For example, if you think you won't get the job after an interview, you could consider that the interviewer liked you and you still have a chance.
• Try to predict the worst-case scenario. If your thinking is logical, the chances of a negative outcome are low.
• Another method is to consider the worst possible scenario and decide that you can still manage. For instance, if the worst-case scenario is failing a crucial exam, you can survive and move on to try again. Perhaps the situation isn't as dire as you think.

Reduce Perfectionistic Thinking. Perfectionism, or the belief that everything must go according to plan, can lead to depression. This happens because you set unrealistic expectations for yourself, others, or your environment, which leads to disappointment. Prolonged frustration inevitably leads to feelings of sadness and other depressive symptoms (such as difficulty sleeping, weight loss or gain, etc.).

• Set realistic goals and expectations for yourself. If you want to lose 5 kg in three days, you're likely to fail. This is difficult to achieve and unhealthy for your body. However, if you set a more reasonable goal, such as losing 4 kg in a month, it becomes more manageable and reduces perfectionistic thoughts.
• Shift your perspective by adding positive achievements, rather than focusing solely on what you didn’t accomplish or feel you could have done better. Instead of nitpicking, link your attention to things you have done right or well.
• Allow yourself to rest. Remind yourself, 'I don't always need to give 100%. Sometimes I feel tired or worn out. I can take time to rest and recharge.'
• Set project limits and stick to them. If you plan to spend one to two hours completing a small task, allocate that time and stop afterward. This prevents you from endlessly analyzing or revising your work, which is common among perfectionists. Just set a reasonable time frame for yourself (e.g., don’t just allocate one hour for writing an essay).

Believe in Yourself. You should have confidence in your ability to cope with situations and negative emotions. Positive thinking about your ability to tackle depression can actually improve the condition comprehensively.

• If you experience negative thoughts like 'I can't handle this. It's too much for me. I can't cope,' try shifting to a more positive and realistic mindset, such as 'This is really tough, and I feel discouraged, but I’ve overcome challenges before, and I can succeed again. I know I can manage this emotion.'

Accept Feelings of Sadness and Discouragement. People suffering from depression often struggle to accept that certain feelings need to be acknowledged. However, many situations can be addressed simply by accepting them. For instance, when experiencing negative emotions (like sadness or discouragement), accepting them as normal and reasonable allows you to address them in a healthy way. Sometimes, resisting negative emotions can hinder your ability to soothe yourself. If you don't allow yourself to process your emotions, the sadness or discouragement can persist.

• Try accepting your emotions by saying or thinking to yourself, 'I accept the fact that I'm feeling down. This isn't pleasant, but the emotion is signaling that something needs to change. I will find a solution to feel better.'