The Many Factors that Trigger Depression

Depression is a debilitating, devastating illness. In Darkness Visible: A Memoir of Madness,author William Styron perfectly captures the pain of depression:

“The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come — not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying — or from discomfort to relative comfort, or from boredom to activity — but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes.”

Depression is caused by a combination of nature and nurture, according to Deborah Serani, PsyD, a clinical psychologist who specializes in treating people with mood disorders. “[N]eurobiology sets the stage for some to have depressive symptoms.”

Nurture is how you grow up, she said. This may include “the experiences that shape you, and moments along the way that can either help protect you from your genetic leanings or worsen them.”

Serani, who’s also experienced clinical depression, has a long lineage of loved ones with the illness. “I was genetically wired for it and experienced a chronic sadness and fatigue as a child and teenager. My personal journeys in life pressed negatively on me and weakened my resolve to fight my depressive symptoms.”

(This piece from Harvard Health Publications has additional insights into the complex causes of depression, including the brain, hypothyroidism and medication.)

Depression triggers “are usually very personal,” said Serani, author of two books on depression. But there are common types of factors that spark depression.

Clinical psychologist Shannon Kolakowski, PsyD, named these triggers:

  • The end of a relationship, such as a breakup or divorce.
  • The death of a loved one.
  • Unhealthy or stressful environment or event. “About 80 percent of people who experience depression have a recent stressful life event.”
  • High conflict with your partner.
  • Major life transitions, such as retiring, starting a new job or moving to a new city.
  • Painful negative feelings, such as hopelessness, rejection or loneliness.
  • A partner with depression. Because they’re struggling with depression, your partner may be “showing less interest or compassion toward you, being more critical or negative, or withdrawing from you. This also causes arguments and can lead to feeling isolated, hopeless, lonely, experiencing self-doubt, and ultimately can lead to depression.”

Serani noted that “calendar dates are the biggest triggers.” These include birthdays, anniversaries and holidays, she said. “Dates become benchmarks for moments in our lives, and these are often filled with deep [and possibly difficult] emotions.” This is why it’s vital for people who have depression to pay attention to the calendar, she said.

Another big trigger is the news, she said. If you live with depression, Serani suggested not watching or listening to the news. Instead, learn “about the day’s events from just gleaning the home page on the Internet.”

“Knowing your personal triggers [and responding to them adequately] can really help you prevent a depressive relapse,” said Kolakowski, author of the book When Depression Hurts Your Relationship. For instance, if one of your triggers is being sensitive to rejection, the next time you’re in a situation where rejection is possible, such as not getting a promotion, ask for support in advance.

Serani has structured some parts of her life to prevent potential triggers – both big and small. For instance, she limits certain people from her life, and doesn’t watch sad movies. Once you know your triggers, she said, it’s also important for others to respect them. “Don’t let [people] minimize your needs or boundaries.”

Depression is a serious, complex illness. But it’s also treatable. Learn more in our section on depression.

A Zen Approach to Depression

In his book, Going to Pieces Without Falling Apart, psychiatrist Mark Epstein, M.D. tells the famous Buddhist story of Kisagotami and the mustard seed:

A young woman named Kisagotami lost her only child to illness around the time of his first birthday. Bereft, she went from house to house in her village, clasping the dead child to her breast and pleading for medicine to revive him. Her neighbors, thinking her mad, were frightened and did their best to avoid her entreaties. However, one man sought to help her by directing her to the Buddha, telling her that he had the medicine she was seeking. Kisagotami went to the Buddha, as we go to our psychotherapists, and begged him for the medicine.

“I know of some,” he promised, “but I will need a handful of mustard seed from a house where no child, husband, parent, or servant has died.”

Making her rounds in the village, Kisogotami slowly came to realize that such a house was not to be found. Putting the body of her child down in the forest, she made her way back to where the Buddha was camped.

“Have you procured the handful of mustard seed?” he asked.

“I have not,” she replied. “The people of the village told me, ‘The living are few, but the dead are many.’”

“You thought that you alone had lost a son,” said the Buddha. “The law of death is that among all living creatures there is no permanence.”

I lie awake last night thinking of that story. Like the young woman, I have been to so many houses looking for a cure for mydepression. I’ve been to seven psychiatrists and have tried over 50 medication combinations. I’ve worked with countless therapists, sitting on couches for well over 15 years.

I’ve spent thousands on acupuncturists, nutritionists, and holistic doctors. I’ve experimented with all kinds of herbs, hormones, vitamins, and other supplements. I’ve made drastic changes to my diet and spent my monthly salary on a Vitamix. I’ve tried to lose myself in running, swimming, and in hot yoga.

I’ve participated in meditation classes, inpatient programs, outpatient programs, and twelve-step groups. I own the self-help aisle at Barnes & Noble.

All of them have helped a little.

But I left each house disappointed.

I wasn’t cured.

Epstein says that the Buddhist story illustrates how we can use the experience of emptiness to cultivate spiritual maturity. “Emptiness can never be eliminated,” he explains, “although the experience of it can be transformed. Like sparks flying off of the blacksmith’s anvil, experiences of emptiness are part of the fabric of being. … Only when we stop fighting with our personal emptiness can we begin to appreciate the transformation that is possible.”

I remembered these words last night, as I lie awake at 12:02, 1:10, 2:30, 4:15, 5:05, and the minutes between. I knew the more I tried to ignore the anxiety, the louder it would get, like the irritating tapping of my dog’s toenails on the wooden floor when I’m trying to nod off.

“I’m okay with my emptiness,” I said to myself.

“I’m really okay with my emptiness.”

“I’m so going to feel like crap tomorrow because of this emptiness.”

I clutched the rosary in my hand and concentrated on my breath.

In…Two…Three…Four.

Out…Two…Three…Four.

I tried to quit thinking, but my gut held memories of my psychiatrist appointment earlier that day. I used to leave her office with hope that another medication or a higher dose of an existing medication would be enough to quiet my symptoms and take away my discomfort — that she’d have the Tylenol that I needed for my blistering headache. While I haven’t stopped trying new medicationsand therapies and supplements, I no longer attach any expectations to them.

I’m not so sure there exists a mustard seed, after all.

The story of Kisagotami has a hopeful conclusion:

Some time later, when Kisagotami had become a renunciate and follower of the Buddha, she was standing on a hillside engaged in a task when she looked out toward the village in the distance and saw the lights in the houses shining.

“My state is like those lamps,” she reflected, and the Buddha is said to have sent her a vision of himself at that moment confirming her vision.

“All living beings resemble the flame of these lamps,” he told her, “one moment lighted, the next extinguished; those only who have arrived at Nirvana are at rest.”

Her breakthrough, according to Epstein, happened when she was able to look past her own trauma to a universal vision of suffering.

For a few hours last night, while the whole house was asleep, I stopped fighting the emptiness. I thought about the angst and frustration and suffering of the fellow depressives I have met online in Group Beyond Blue, a support group I set up on Facebook a month or so ago. I saw their heroic efforts to achieve serenity in their lives as glowing lamps across the Internet.

They, too, have been to shrinks and hypnotists and herbalists and therapists. Some of them drink kale smoothies in the morning like I do, hoping for some green healing power. They’ve searched far and wide for the mustard seed, as well.

We are learning, together, a kind of Zen way to manage our depression: how to relax into our emptiness; how to run toward, not away from the anxiety; and how to breathe in the middle of the night, knowing that, although there exists no magic mustard seed, there are plenty of us awake … struggling in thought … and there will always be lights in the village to remind us that we aren’t alone, that all of humanity is united in suffering and impermanence.

5 Facts Many People Don’t Know About Depression

Depression is one of the most common conditions in the world. It affects all segments of society and virtually all cultures, said Constance Hammen, Ph.D, a Distinguished Professor in the Department of Psychology and the Department of Psychiatry and Biobehavioral Sciences at the University of California.

And yet many people don’t know much about depression or tend to misunderstand it. Some misconceptions “persist because depression has tended to be stigmatizing and people don’t learn about it, discuss it, or recognize it.”

But it’s key to become well informed. Depression may affect you or your family. It may affect your friends or colleagues. Even if it doesn’t touch you personally in any way, learning about the reality of depression helps you be compassionate to the people who are struggling, because depression is a debilitating illness (which is, thankfully, very treatable). Below are five revealing facts.

1. Depression isn’t weakness.

We often believe that people can control their moods, said Hammen, also co-editor of the third edition of the Handbook of Depression.So when someone can’t seem to manage their mood, they may be seen as somehow inadequate or flawed.

“It is very common for people to believe that feeling down and bad is a weakness of will or lack of effort to just get over it, or even a willful resistance to fighting it,” Hammen said.

A stressful event or stressful conditions trigger most depression, which makes it seem like people should promptly bounce back. If they don’t, they may be viewed as “weak-willed.” Even people with depression might see themselves as weak if they don’t recover right away.

Some people don’t even realize they (or someone else) are struggling with depression. “They may think of it as ‘just stressed out’ and expect them to get over it more quickly.” (These people also “are unlikely to seek professional help for being ‘stressed.’”)

Clinical depression is an illness. It can’t be willed away. The symptoms of depression — such as hopelessness, helplessness, fatigue, and difficulty concentrating — make it harder for people to take the steps to get better, she said.

Others’ perceptions (e.g., “get over it”) only make them feel worse about themselves and more alone, she added.

2. Irritability may be a prominent factor.

People are well aware that persistent sadness is a symptom of depression. But irritability is a key sign as well. In fact, irritability may even indicate a more severe depression, said clinical psychologist Shannon Kolakowski, PsyD. Irritability also is associated with a greater chance of having other mental illness, such as anxiety, she said. (Learn more about the research here.)

Other emotions tend to underlie irritability, such as sadness, shame and overwhelm, she said. But irritability shows up on the surface. “This happens when people are less aware of their internal states, where there’s trouble recognizing, labeling and processing their emotions.” (Therapy helps with this, she added.)

3. Depression affects the entire family.

“People tend to think of depression as an individual condition,” said Kolakowski, also author of the book When Depression Hurts Your RelationshipHowever, it’s a systemic condition that affects couples and families, she explained.

For instance, depression can affect everything from a couple’s communication and connection to their sex life to how they handle conflict to their ability to empathize with each other and enjoy time together, she said.

When someone is struggling with depression, it’s hard to foster warm, supportive relationships, Hammen said. This isn’t “because one is a ‘bad’ parent or spouse, but because they cannot will away the irritability, withdrawal, oversensitivity, lack of interest [and] low energy that are needed to sustain healthy relationships.”

Consequently, when someone has recurrent or chronic depression, their partner and kids may need treatment, as well, she said. (Learn more about how depression damages relationships and tips for rebuilding your bond here.)

4. Adolescents and young adults are particularly at risk.

A complex combination of factors causes depression. These factors include the environment, genetics, biology and personality traits. Many risk factors may predispose teens and young adults, who are “particularly at risk for first onset of clinically significant depression,” to the illness, Hammen said. She shared these examples:

  • A mother who has depression or is impaired in another way.
  • Difficult childhood, which, for example, led to attachment insecurities.
  • Anxiety and fearfulness.
  • Unrealistic expectations (for yourself or others).
  • Poor role models for resolving relationship conflict or disappointments.
  • “Brain circuits that reflect dysfunctions in processing and resolving negative emotions.”
  • Poverty, which exposes individuals to stressors from an early age.

These factors increase the likelihood of recurrent depression, so it’s important to identify and treat teens and young adults who are at risk, she said.

5. Cultural views perpetuate depression.

“There are many self-perpetuating aspects of depression, within the person and within families and within cultures [and] communities,” Hammen said.

For instance, some cultures believe that because life is hard, it’s normal to be miserable, while other cultures regard happiness as a life goal (“the antidote to feeling low is to pursue the things the culture think should make one happy [such as] intimacy, fame, fortune”).

Some societies also believe that if you have certain things, you shouldn’t be depressed, she said. “If you are [it’s considered] a flaw of character.” (Again, it is not.)

Depression is a serious illness. “The more people are aware of depression and how debilitating it is, the hope is that they will demand more resources to be devoted to the problem,” Hammen said.

Nothing

I really hate when there’s something in my life that stresses me out or upsets me or makes me angry and all I want to do is well….DO SOMETHING ABOUT IT; problem is: there’s absolutely NOTHING I can do about it. It happens quite often. It’s like being in a boxing match with your hands and feet tied behind your back, you just have to sit back and take the punches, the punches and the pain. I’m in a time right now that something has happened and I can’t do anything to fix it. I’m a fixer, that’s just part of my personality and when I can’t fix something it eats at me, and it makes my stress level go up a thousand notches and stress does bad things to me. I literally go insane. Usually when the stress gets to a certain point that it’s controlling my every move I end up get put in the psych ward.

Now I’ve been taught about staying in the moment and I try to practice it as much as I am able to but when the stress gets extreme I can’t do it because my mind is cluttered with memories from the past, stresses of the present, and worries about the future. It jumps from one to the next and back again. They spin round and round to a point that it gets so fast that I can only catch little glimpses of them. I always think that I’m not strong enough to be able to stop this whirlwind. People tell me I can do anything I put my mind to, I disagree. I really didn’t want to make this a negative post but I think I woke up on the wrong side of the bed this morning because I am in no mood to do thought stopping and mindfulness. I’m caught between what I should do and what I want to do. I want to go back to bed and stay there all day but I should stay up and find some peace with this. It’s funny though, nowadays I don’t go straight for the negative behavior, I actually think first of what I should do, for what is good for me. So after I write this I shall go meditate. What’s funny also is that I just did a total 180 in a matter of minutes.

I know I jumped around a lot in this post but the morals of these stories is first and foremost: sometimes there’s nothing you can do in a situation but let it play out. Secondly, even when you wake up on the wrong side of the bed there is still hope that you can change your mood. It’s not easy, but totally worth it.

The Curse

I feel numb. The curse is slowly taking over my mind and soon after that, my body. I know this curse as well as I know myself. It’s like the mirror in the Matrix, once it touches you, slowly but surely it envelopes you. What you once thought life was has become a lie. The people around you look at you like you’re a monster. Either that or they just plain pity you. You feel like your lungs are filled with sludge making it increasingly hard to breathe. In your mind is a separate demon that comes along with the curse. It creates a thick fog and it captures your thoughts and muddles them into shear nonsense. When you try to sleep, it runs those pointless thoughts in circles and it doesn’t stop keeping you up until total exhaustion takes over. You want to feel something, anything. Your body has become the host to the curse, you have no control over it anymore.

But, as much as it seems there is no hope of coming out of this alive, alas, there is hope!! I used to think that I could be depressed for the rest of my life, and I will say that I still get depressed sometimes but the difference now is that with each depression episode I was faced with when I was younger, I became stronger and more wise. I learned ways to deal with being depressed, distractions, always taking my meds as prescribed, calling someone when things get too bad, writing (or any source of outlet), and as hard as it may sound, just riding it out. It will not last forever, nothing lasts forever, it’s called impermanence. These, along with a list of over 100 things that I can do to make myself feel better are what helps me make it through the trenches of depression.

Understanding Quasi Depression

Depression rears its ugly head in all shapes and sizes. Sometimes our depression isn’t obvious. You don’t have to be stuck in bed for days to be considered depressed. Unfortunately we don’t always know we are in a quasi depression until it’s over, and we look back and recall the signs that we might have missed. Hind sight is always 20/20 but if you pay attention to slight changes in your behavior you might be able to better manage your mental health.

I was quasi depressed about a year ago. The quasi depression was written all over my body. I found myself wearing the same clothes everyday: torn jeans with a rotation of the same shirt just in different colors. I stopped keeping up with personal maintenance like waxing my eyebrows or plucking unwanted hairs. I was still getting out of bed and going to work every morning but I was miserable. I became isolative at work cause I didn’t want to deal with anyone and quite frankly, I felt like my poor co-workers were putting up with me cause they knew I suffered from depression, and just assumed eventually I would get out of it. Something as small as not washing your car or being anxious about picking up your phone are all signs of being in a quasi depression. I’d watch the same stupid shows over and over that I didn’t realize was a sign of depression until I got out of it and stopped watching them. I’m embarassed to admit I was hooked on junk food reality television and would never watch some of the shows that I repeatedly watched during that period of time in my life. You don’t have to stay in bed all day to be considered depressed. And in my experience being quasi depressed is almost worse cause, like I said, you don’t realize it occurred until you’re out of it and you can look back and say wow, that was a form of depression. In my experience quasi depression is worse than a full blown one, primarily cause when it is not blatantly obvious, we might not know how to treat it properly.

Be mindful of the little signs of being slightly depressed. Depression hurts but it can hurt more if you don’t even know you are in it, and looking back is no fun bu,t at the very least, you’ll know to watch for signs should you find yourself in a quasi depression sometime down the line.

7 Myths of Depression

Depression is often viewed as the “common cold” of mental disorders, because it is so prevalent in our lives. The lifetime prevalence of depression suggests that more than 1 in 9 people could be diagnosed with the disorder at one point in their lives. And unlike some other mental disorders, depression affects virtually every aspect of what you do and how you interact with others. Every year, it wreaks havoc in millions of Americans’ lives, especially amongst those who believe it is something you should just “get over” on your own.

Here are seven common myths about depression, and the facts that answer them.

1. Depression means I’m really “crazy” or just weak.

While depression is indeed a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life. Depression can strike anyone, at any time — whether you’re “weak” or strong, it knows no bounds. Some of the strongest people I’ve met are people who’ve coped with depression in their lives.

2. Depression is a medical disease, just like diabetes.

While some pharmaceutical-influenced marketing propaganda might simplify depression into a medical disease, depression isnot — according to our knowledge and science at this time — simply a pure medical disease. It is a complex disorder (called amental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots. While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure. Get to know the risk factors for depression.

3. Depression is just an extreme form of sadness or grief.

In most cases, depression is not just ordinary sadness or grief over a loss. If it were ordinary sadness or grief, most people would feel better just over time. In depression, time alone doesn’t help, nor does willpower (“Pull yourself up and stop feeling so sorry for yourself!”). Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever. Most people with depression have little or no motivation, nor energy and have serious problems sleeping. And it’s just not for one day — it’s for weeks or months on end, with no end in sight.

4. Depression just affects old people, losers and women.

Depression — like all mental disorders — does not discriminate based upon age, gender, or personality. While generally more women than men are diagnosed with depression, men suffer for it all the more since many people in society believe that men shouldn’t show signs of weakness (even a man’s own upbringing may reinforce such messages). And while aging brings many changes in our life, depression is not a normal part of the aging process. In fact, teenagers and young adults grapple with depression just as much as seniors do. Some of the world’s most successful people have also had to deal with depression, people such as Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan and Michelangelo. So being a loser is not a prerequisite to being depressed.

5. I’ll have to be on medications or in treatment for the rest of my life.

While some doctors and even some mental health professionals believe that medications may be a long-term solution for people with depression, the truth is that most people with depression receive treatment for it for a specific period of time in their lives, and then end that treatment. While the exact amount of time will vary from person to person based upon the severity of the disorder and how well the various treatments may work for each individual, most people who have depression do not need to be on medications for the rest of their lives (or be in treatment for the rest of their lives). In fact, a lot of research suggests that most people can be treated for depression successfully in as little as 24 weeks with a combination of psychotherapy, and if needed, medications.

6. All I need is an antidepressant to treat depression effectively.

Sorry, no, it’s not as easy as popping a pill. While certainly you can have an antidepressant medication quickly prescribed to you by your primary care physician, you’re unlikely to feel any beneficial effects from that medication for 6 or more weeks in most cases. In two-thirds of patients, that first medication won’t even work! Combined psychotherapy treatment with medication is the recommended gold standard for the treatment of depression. Anything else is going to be significantly less effective, meaning most people will suffer with their depressive symptoms longer than they need to.

7. I’m doomed! My parents (or grandparents or great uncle) had depression, and isn’t it inherited?

While in the past there’s been research to suggest the heritability of depression, more recent studies have called into question how much of depression really is genetic. The upshot? While researchers continue to explore the neurobiology of mental disorders like depression, having a relative with depression only marginally increases your risk for getting depression (10 to 15%). Remember, too, that relatives impart a lot of their own coping strategies upon us in our childhood development — strategies that may not always be the most effective when dealing with things like depression (making one more vulnerable to it).

To hell and hopefully…eventually back??

It’s been one HELL of a month, and what I mean by hell is I have felt like hell, my life has been hell, my mood has been hell, and everything went to hell. I’ve been in a deep depression since the beginning of March about. I’ve barely done anything but lay in bed, sleep, and sit on the couch in the living room staring at the wall. My depression has been so bad that suicide has become an issue again. On top of the depression, my anxiety has been atrocious, some days I have up to 3 full blown panic attacks, I take my Ativan but sometimes that’s not even enough so I have learned that using my Cpap helps with managing my breathing which means more time in bed but if it works I don’t care. Now even on top of that my hallucinations have been wreaking havoc on my life as well. The usual 7 people, 6 voices, and now I’ve acquired a lion, a snake, an elephant, and a little monkey. So imagine all this going on at one time. That is my definition of hell. There are some days that all I can think about is killing myself but the one thing that stops me is not wanting to hurting anyone. 2 weeks ago I went to the ER because I was suicidal and they turned me away because, “she seemed fine” but they obviously don’t get it. I go to see my therapist this morning to see what we should do now, I’m running out of options and I’m running out of patience. I want to get better, get back to feeling good but I’m beginning to think that’s never going to happen. It’s extremely hard having an illness that you know you will have to live with and deal with for the rest of your life, it makes things seem a little less hopeful that I will ever have the “normalcy” that I’ve always yearned for. 

5 Essential Remedies for Treating Depression: Coming Back from the Brink

Graeme Cowan suffered through a five-year episode of depression that his psychiatrist described as the worst he has ever treated.

Part of his recovery involves helping people build their resilience and mental fitness as the Director of R U OK? In his book, Back From the Brink: True Stories and Practical Help for Overcoming Depression andBipolar Disorder, he offers advice gleaned from interviews with 4,064 people who live with mood disorders.

He asked the respondents to rate the treatments they had tried and how much each had contributed to their recovery. Here’s what he found.

The following were the top eleven most effective treatments:

  • Supportive psychiatrist
  • Supportive psychologist
  • Support group, emotional support of family and friends
  • Vigorous exercise
  • Psychotherapy
  • Fulfilling work, paid or voluntary
  • Sleep
  • Cognitive-behavioral therapy (CBT)
  • Electroconvulsive therapy (ECT)
  • Reducing intake of alcohol and other non-prescription drugs
  • Belief in God, spirituality, religion

Other helpful treatments include:

  • Mindfulness-based cognitive therapy (MBCT)
  • Acceptance and commitment therapy (ACT)
  • Hobbies, such as gardening, pets, or music
  • Massage
  • Yoga/meditation
  • Medication
  • Relaxation
  • Good nutrition
  • Keeping a gratitude journal
  • Acupuncture

Cowan then categorizes the effective approaches into five major themes:

1. Emotional Support

We are social creatures who crave empathy and connection. That’s why emotional support, reassurance, and compassion from psychiatrists, psychologists, support groups, and family and friends dominate the top ten effective strategies. Cowan’s findings indicate that the emotional support and reassurance provided by psychiatrists and psychologists is judged more important than their treatments, which concurs with previous studies that have shown that the quality of the relationship between a clinician and patient is the best predictor of a successful outcome.

2. Psychological Treatments

Some psychological treatments that were listed as effective: psychoanalysis, counseling, cognitive behavioral therapy, mindfulness-based cognitive therapy, interpersonal therapy, acceptance and commitment therapy, and letting go of unrealistic goals.

3. Lifestyle Strategies

Both vigorous exercise (equivalent of running for 30 minutes 4-6 days per week) and moderate exercise (equivalent of walking for 30 minutes 4–6 times per week) were rated as very effective. Other helpful lifestyle approaches include: getting a good night’s sleep, being able to relax, doing meditation or yoga, engaging in hobbies, getting massages, and reducing intake of alcohol and recreational drugs.

4. Fulfilling Work

Cowan credits his fulfilling work — offering hope to persons stuck in depression — as one of the most powerful tools he uses to stay well. “I experienced personally the benefits of doing voluntary work in my own recovery,” he writes. “My voluntary work involved placing discouraged people (new migrants or people rehabilitating from physical or mental illness) into volunteer positions with charities. I saw how the work lifted their self-esteem and confidence.”

Fulfilling work was rated more highly than cognitive-behavioral therapy, which is often considered a highly effective depression treatment. Cowan cites the Gallup poll that found that only 20 percent of employees like what they do, but that people with a high career well-being were more than twice as likely to succeed in life overall. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, and many other positive psychologists believe that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression.

5. Prescription Medications

The results of Cowan’s surveys found that, while prescriptionmedications can play a vital role to recovery from depression and bipolar disorder, they should not be relied on as the sole strategy. Pharmacology is still in its infancy. A drug that works wonders for one person might not do anything for another except give her a dry mouth and nausea. Cowan writes: “This stresses the importance of working with a doctor who’s highly experienced in successfully treating mood disorders.”

6 Famous People with Depression Who Inspire Me

When a famous actor/actress, politician, or prominent figure of any kind risks ridicule to discuss their mood disorder, the world stops to listen.

For as long as his or her face graces the cover of a glossy magazine or the TV interview runs, folks seem to appreciate the sweat and suffering that those with depression andbipolar disorder endure as part of their illness.

I know that for me, I certainly listen to their stories, empathize with them, and take away lessons that I can use in my own recovery from depression and anxiety. Celebrities, for better or worse, can inspire us.

Here are just six of those celebrities that inspire me.

1. Rosie O’Donnell

What’s not to love about a celebrity who hangs herself upside down for 15 to 30 minutes a day to jumpstart her neurotransmitters (along with yoga and antidepressants) using inversion therapy? Seeing Rosie demonstrate it on “The View,” reading a teleprompter from a swing, made me laugh out loud at all the ways –some quite creative – we depressives use to treat our mood disorders.

2. Art Buchwald

Art Buchwald was unsure if he should go on Larry King Live in the early ’90s to discuss depression; the Pulitzer Prize-winning columnist didn’t want to become a poster boy for mental health. But he did it because the author William Styron had been a role model for him, and because he realized celebrities can play a role in helping depressed people. After that show (which received the most viewer reaction of any Larry King episode ever), Buchwald decided to speak about his depression whenever he received an invitation because it helped him as much as it did the millions of people listening to him.

3. Zach Braff

Actor and director Zach Braff loves it when people tell him that they relate to Andrew Largeman, the depressed character he played in the 2004 movie “Garden State” (which Braff wrote and directed), because in that role, he didn’t have to do much acting. Like his character — an actor confronting his demons when he heads home after his mother dies — Braff doesn’t hide under any celebrity image and isn’t afraid to be himself, he says, even if that self is very emotional and wears sweatpants all day.

4. Marie Osmond

Marie Osmond is one of the most sympathetic entertainers to speak about mental illness. “All I know is that anybody who goes through [depression], I have such incredible empathy,” the actress and singer said on “Larry King Live” in 2003. “I’m telling you that depression is…a very scary, dark place…you see no light.”

5. Brooke Shields

Brooke Shields had just released her book “Down Came the Rain” when I plunged into my most severe depression. My agent sent the book to me as a gift, wrapped in a ribbon. I read the title and wept. I read the back cover and cried some more, feeling as though this actress-model was giving me permission to bawl my eyes out. “Sitting on my bed, I let out a deep, slow, guttural wail,” she writes. “I wasn’t simply emotional or weepy …. This was something quite different. This was sadness of a shockingly different magnitude. It felt as if it would never go away.”

6. Kay Redfield Jamison

As a healer and a patient, Kay Redfield Jamison understands depression and bipolar disorder from every possible angle. Compassionate, wise, and articulate, she speaks from someone who has experienced the sheer terror and heartbreak of a mood disorder firsthand and as a knowledgeable clinical psychologist. My two favorite lines about depression come from her classic book, “An Unquiet Mind”: “tumultuousness, if coupled with discipline and a cool mind, is not such a bad sort of thing. That unless one wants to live a stunningly boring life, one ought to be on good terms with one’s darker side and one’s darker energies.”