How to cure yourself of depression

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That’s a big claim to catch your eyes and score highly on the search engines. I hope.
To be honest I don’t think you can cure yourself without help from others or drugs or both. I didn’t. And in fact I don’t think you can be cured of depression: I’m not. In fact this blog has been delayed because I’ve had a relapse, and have been feeling extremely depressed this past few days. At the moment (who knows in the future?) depression is a life sentence without a cure; the best we can do is keep it in abeyance for as long as we can, and if we’re very fortunate, that might be for the rest of our lives.
But there are many things we can do to help to help ourselves, and I’m going to talk about some of the things that have helped me. I think everyone might find them helpful; if you’re not suffering from depression, then maybe these will help you to live just a little better life.
And apologies if they seem blindingly obvious to you; they weren’t to me. I’ve learned them the hard way.

Drugs.
If you are really depressed, and if it has been going on for any period of time, you almost certainly need them, and you have to see a medical practitioner to get them. In the UK that means your GP or a psychiatrist, who then writes to your GP. They will almost certainly start you off with an SSRI. Do some research: there are many anti-depressants out there, and they work in slightly different (and mysterious) ways. They take time – weeks, months – to take effect though, so don’t be too dismayed if nothing has happened the next day. You should hopefully start to see an improvement within a few weeks. If the first one doesn’t work, then you will need to try another. It’s preferable that you have someone to monitor your mental state and behaviour, because you are often not the best person to judge if you are getting any better. Different drugs have different side-effects on different people, and if you find yours unbearable, again you should discuss changing drugs with your medical advisor. There are alternatives you can get without prescriptions (e.g. St John’s Wort, SAM-e), but these had no discernible effect on me. If you’re interested, after many years and changes of medication I have settled on Duloxetine (Cymbalta) for depression and Quetiapine for anxiety.

Other people.
You cannot fight severe depression alone. You hopefully have already seen your doctor, but probably should be seeing a psychiatrist as well. I have tried different sorts of clinical psychology and therapy, and have eventually found a cognitive-based therapy system that looks at your childhood, attitudes, and relationships to be a revelation. Different things though seem to work for different people. You will need your friends too, and need to be open with them that you are depressed. Fight that stigma!

Changes.
There are many changes I have made that I think have contributed to my shift towards wellness.

Work.
For want a better name – that thing that someone else pays you to spend your time doing. In the first instance you might need a period of time off work – look into your sick leave entitlement. Contact your HR department.
I took a long hard look at my academic job and decided I had had enough. There are many things I liked about it, but an increasing number of things I no longer enjoyed and that seemed to me to be pointless. On the other hand I love writing and journalism, so I decided to “retire” and become a full-time writer. It’s a financial risk. It might not work out. I might be poor for the rest of my life. But at least I feel that I am in control, and doing only what I think is worthwhile.
You might say I’m lucky being in the position to retire and become self-employed, and you’re probably right. But what is your health worth? What big changes can you afford to make? Is the big house and fast car really worth what you’re having to endure? And big changes don’t apply just to work either: is that toxic relationship really worth staying in?

Exercise.
I think you have to be starting to get well to make some of these changes, or at least not in the pits, but I decided I had to lose weight and get fit. I, like many depressed people, am pretty useless at self-discipline. So I joined a gym and signed up with a personal trainer. It’s one of the best calls I’ve ever made. I’ve lost over 25 pounds so far and my weight is still going down. I feel so much better; I have more energy and after each exercise session my mood is lifted. There’s plenty of evidence for the positive effects of exercise so get to it. And no, I still don’t really enjoy doing exercise, particularly cardio, which I find painful and boring.

Fresh air and light.
Many of us who are depressed really benefit from more light. I try and maximise my exposure to sunshine, even sitting outside when it’s sunny but in the cold depths of winter. I have a light box that I use even in summer when it’s dull. I try and get as much fresh air and to get outside as much as I can even when I’m busy working at home.

Diet.
I have tried many diets (in the sense of modes of eating) and as I have blogged before find the science complicated, confusing, and contradictory. One certainty is that you have to cut sugar and refined and processed food right out of your diet. I have also greatly decreased the amount of carbohydrates I consume. My breakfast will be something like prawns, berries, another piece of fruit, and nuts; my lunch fish, sweet potato, and home-made baked beans; dinner lean white meat or fish, lots of vegetable, and nuts. It’s a bit boring and expensive, as I don’t like spending large amounts of time cooking for myself, but I see no alternative. I also take good quality fish oil supplements. I have cut back on the amount of wine I drink but still find some each evening calms me down; fairly harmless self-medication in moderation.

Mindfulness and meditation.
I find meditation difficult – sometimes it hurts my mind too much to sit still with nothing but my thoughts, even for as little as ten minutes – but I try. And I do gain a great deal from being mindful – trying to live in the moment and be present. The evidence suggests that mindfulness training might be as effective as medication. There are many good books and resources on mindfulness training, so give it a try.

Thoughts.
I have tried to change my cognitive structure – saying “I am not my illness”, working out what the really important things are in my life and changing those things, trying to be honest with myself, and trying to be kind. I accept responsibility for things I do wrong and acknowledge the role of others when things go well. Or rather at least I am trying to do these things!

Routine.
I have written about my search for a perfect routine so many times before (blogs ad nauseam). How can the writer find a perfect day when they can write something good every day and yet fit everything else in? But a routine of some sorts is essential if you are or have been depressed. It’s boring and others might mock you for it, but you’re the one that’s ill or have been ill.

Sleep.
My problem, particularly under medication, is staying awake at night and waking up in the morning. However I used to have terrible trouble getting to sleep. The most important thing is to choose regular times and stick to them, come what may. I have a particular problem with waking in the morning, so I set my alarm for 7.20 and get up at 7.30. Occasionally I really struggle, but I will always be out of bed by 7.55.

Gratitude diary.
My friend Ian Jay swears by a gratitude diary – somewhere towards the end of each day you list three things that day for which you’re grateful.
It’s important to do the things you have decided help you, particularly if you feel yourself becoming ill again. If you’re getting a bit down and start skipping your exercise you’re going to be in trouble. So write out a list and tick the things off every day.
I hope you find some of these ideas useful. Good luck with the fight regardless.

True grit

Cheviots from Carter BarIt is easy to get out of the habit of writing. In spite of my blog a few weeks ago (Nulla dies sine linea – not a day without a line, first said by the painter Apelles of Kos, but which applies just as much to writing as painting), quite a few of my recent days have sadly passed without a line.

I can attribute this failure in part to what remains of the day job (especially marking, a task that I particularly detest but which is one of the most important things that academics do, and which requires time and concentration), but I know thats a feeble excuse. I should have had plenty of time. I have just found it difficult to find an independent working routine that suits me.
All the data shows that we work best when we follow a routine. Depressed people function better when they follow a routine that imposes some structure on our lives. Finding a good routine is good. In fact to be creative you might need one. If you look at the lives of highly creative people they all have very highly structured periods when they’re working – routines bordering on rituals (hence the title of one my favourite books on the subject, Mason Currey’s Daily rituals, a book I’ve talked about before in this blog). One of the most popular rituals is to get up early and start writing, stopping around lunchtime, and then taking the rest of the day “easy” (including do those low-value, distracting tasks such as email). I can see the advantages of such a schedule: you get your words under your belt first thing. I always feel better about the day after I’ve written at least a thousand words. But life is not so simple for a depressed writer: my medication (even though I’ve really cut back) really interferes with my morning. I feel tired on waking around 7.30, and it takes me a few hours to get going properly. Maybe one day I’ll be able to cut out that final Quetiapine, but I still can’t really imagine waking at 5 am, because I can’t imagine going to bed at 9 pm. I love midnight too much. And in any case I’ve talked to a few depressed people who say they can’t really get going until 10.30 or 11.00 am.
Let me take yesterday as an example. I woke at 7.15, and rushed to get out before my preferred two hours easing in time, leaving before 9 for gym at 9.30. At least exercise makes me feel better overall, and has the advantage of waking me up. Then I had a few errands to run, and back for coffee at 10.45. I did some useful reading while drinking coffee. Then as rain was forecast for later in the day, I did a few garden jobs I’d been putting off. Then I had my Primal living lunch (yet another type of diet, or rather lifestyle, I’m trying out). After that there were some “real work”-related things I had to do, and particularly several pressing emails to answer. That left me pretty tired, so I had a short nap. Then it was 4.45. I had a few work things to do again, and some washing to sort out, which took me to 6. That left me two hours of creative time, by which time I felt horribly guilty about not doing enough earlier.
Sound familiar? That’s how my life often goes. I can’t point to anything and say I shouldn’t have done it, so what else could I have done? Now you unlucky souls in a 9-5 job are probably thinking “lazy f*cker, he should have my job to see what can be done in a day”. But I “work” after 5, and all weekend, and most holidays too. And as I’ve talked about before in this blog, if you look at how much real work can be done in an hour, it’s surprisingly little. My own measurements suggest I cant do more than 35 minutes an hour over 8 hours without hitting the wall. This figure of 3-5 hours of real work – deep work – a day is consistent with what Cal Newport says in Deep work, with how highly creative people schedule their time in Daily Rituals, and how much deep practice can be sustained in one day (a discussion of which can be found in Duckworth’s superb book Grit, which I’ve just finished reading). Passion and perseverance are tiring.
So I am still searching for the perfect routine, the perfect ritual, the perfect day. And of course every day is different: some days I don’t go to the gym, some days there are other things to deal with, and some days it’s Christmas. Nulla dies sine linea says nothing about stopping writing just because it’s Christmas (but I have).
So one reason why we don’t we stick at what we want to do is finding the time to do real work. It’s difficult enough for the best of people with the best of intentions. Those of us with mental health problems suffer additional burdens that eat into our time in addition to the time-killing side-effects of medication.
Being mad really does steal your life.

Mens sana in corpore sano

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It’s under a hundred days to go now before my official “retirement” date and when my life as a full-time writer begins. I’ve made the big change – or at least the decision to make the big change – that I hope will lead to a more satisfying and mentally healthier life, and now it’s time to look at smaller changes I can make. I’ve already taken up exercise in a big way and been going to the gym regularly for some months now; I’m pleased – and surprised by myself – that I’ve stuck to it. I’ve reduced my medication gradually without too many ill effects. I have now sorted out my life, to some extent, and my depression is in abeyance, at least for now. I have identified a purpose – writing, in the first instance on consciousness. I now need to go further and tweak my mental and physical well-being. I also face many years (I hope) “post-work”, and I want them to be healthy, happy years. I can already feel a bit of arthritis in the fingers of my left hand, and I still feel more tired than I would like. I am at last doing enough exercise, so what else can I change for a better life?The obvious answer is diet.
Now I don’t think my diet is too bad – as I have coeliac (celiac) disease (I don’t like the phrase “I am celiac”, identifying myself with the disease), I already avoid gluten and wheat and too much dairy. I am fortunate in not particularly liking the taste of sugar, and avoid processed food. What else can be done for a better diet and hence better life? We are after all what we eat Note that I am using the word “diet” in a loose sense to refer to everything we eat, not specifically a means of calorie restriction.
Unfortunately the world of improving your health through diet is a nightmare. It used to be so straightforward: eat with the pyramid of a little fat, lots of complex starches, fruits, and vegetables, and avoid saturated fat, while doing moderate or more exercise three to five times a week.We can say with some certainty what is bad: smoking, too much alcohol, no exercise at all, processed food, sugar, modified sugars, trans and hydrogenated fats, and too many calories. But then things get very confusing. It’s pretty much agreed that leafy green vegetables are good for us (although opinion is divided on whether they are better lightly cooked or raw). But here is the list of some of the disputed foods:

– carbohydrates: much loved by “official” dieticians, treated with great suspicion by many food movements (e.g. Paleo, Primal, to a lesser extent South Beach). I’m assuming we’re talking about good carbs (no crisps, no cakes) that you get directly from vegetables. Sweet potato seems to be the healthiest.
– grains: many are a no-no already when you cut out gluten, but things like rice are disputed. I don’t like them much anyway.
– fruit: you thought you were on safe ground, but many are very high in sugars, particularly fructose, and Paleo and Primal limit their intake. Best fruit: berries.
– nuts: high in calories and oils and many have the wrong Omega 3:6 ratio.
– oily fish: generally agreed to be good, but some worry that they’re a source of contaminants, heavy metals, and colourings: wild or organic are best (if you can get them!).
– meat: disliked by many diets, but preferred in Paleo and Primal, particularly grass-fed and organic (again if you can get it).- saturated fat: despised in the traditional diet, but desired as a major source of calories in Paleo and Primal.
-mushrooms: full of fibre and vitamins – but argued by some to aggravate intestinal yeast infections. Is this anything more than superstitious thinking?
– garlic: how can garlic be evil? The Bulletproof diet says avoid because of its mind-altering properties.
– omega 3 oils (fish oil): as long as they’re heavy metal free, although the extent to which they are beneficial to adults remains disputed by some scientists.
– organic or not: surely it’s got to be better to eat stuff that’s free from pesticides and herbicides? Some scientists have argued it makes no difference.
– alcohol: preferably as red wine, a little is generally thought to be good by many.

What is most problematic is whether most of our calories should be coming from carbohydrates, or from fat, oils, and protein. Will fat kill us, or stave off the heart attack? It’s a high-stakes game.
But in the end, as my finger hurts and my back hurts and I decide to skip that glass of wine and measure out a nice, I sometimes just despair at the confusion. It’s difficult being an anti-ageing biohacker.

Nulla dies sine linea

 

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I have to finish the first draft of my book on consciousness by the start of November. I want to leave about two months for rewriting, clarifying, and improving the style. That means. 1339 words a day every day before 1 September to reach my target 160,000 words. (My writing software of choice, Scrivener, will automatically calculate the daily target based on your deadline and target length, and keep track of your daily writing total against the daily target.) There are probably going to be some days when something goes wrong and I can’t write, so I should be aiming for about 1500 words a day. I don’t know whether that sounds a lot or little to you; most days I have to read and think to be able to write those words, and I have to keep track of citations (not included in the total) as I go.

It would be easier if I didn’t have a day job too. Fitting writing in spare moments is difficult and stressful. Whoever thought that a writer has an easy life? At the very least it requires great discipline and great dedication.

When writing like this it is difficult to fit much else in to life. The mundane tasks are piling up. I really should wash the car, clear the vegetable patch, and change my energy suppliers, but such things always come last.

But the end is in sight. I finish the day job on 31 July. As of today that’s exactly 100 days.

Hopefully then things will be easier. But then there are these things called “holidays”. No wonder holidays can be among the most stressful of life events! Holidays for the writer and depressed person are interesting things. Words don’t get written unless you’re at the computer (or typewriter, or even with a notepad and pencil), and totals don’t wait for holidays. I suppose all self-employed people have the same problem – can we afford to take a break? It is though I think more challenging for writers facing a deadline. My current plan is never to stop writing, and write even in holidays and on Christmas day.

I suppose there is with every task a point at which it sometime becomes a chore, no matter how important the job and no matter how enjoyable it usually is. We just have to push on through.

A long time ago, Apelles the painter said:

Nulla dies sine linea.

Not a day without a line. The same applies to writers too. Even depressed writers. And setting some task for the day ahead, however small, and if possible doing it is of great help to depressed people in general.

Removing the stigma of mental illness

 

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My planned post can wait: last week was UK Depression Awareness Week.

I used to be sceptical about these special days and weeks, but now I think there is a great deal of benefit to having a concerted surge of activity because at the very least it generates publicity.

There used to be a great deal of stigma and shame associated with any kind of mental illness. People felt forced to hide their suffering. They were discriminated against, made fun of, and even bullied – things that of course just made people even worse. At our school, many years ago, boys who were slightly odd were given nicknames based on the local mental hospital. People found it more difficult to get and keep jobs. I remember an employee, a long time ago and in a place far away from here, feeling forced to tell me that he had been off work for some weeks with a “very bad cold in the head” – whereas there were rumours that he had had a “nervous breakdown”. There was very little advice available in the NHS, and there was a much more restricted choice of drugs. Prozac only became widely available in 1988.

Things are by no means perfect even now, but every time a celebrity “comes out” as mad, there’s another step forward. Every time someone is honest at work or with their friends all of us are a little more liberated. Those of us who can owe it to the others to stand up and say we’re GLAD TO BE MAD. Well, maybe not glad, but we are, and there’s nothing to be ashamed of. Stop the stigma now.

 

Making big changes the small way

NW Scotland

 

If you want to change yourself for ever, make the change in tiny steps. We’re all familiar with people who make big resolutions at New Year (I’m just as guilty as anyone else), who then take out gym membership on 1 January but who have stopped going by the 10th. When I reflect I’m ashamed by the number of times I have resolved to eat less, drink less, exercise more, work more, travel more, go out more, and so on, and so on, and so on.
A few years ago the book Nudge by Cass Sunstein and Richard Thaler (2009) was very popular; apparently politicians were taking it on holiday as beach reading. I see that there is a forthcoming book (2015) by David Halpern called Inside the Nudge Unit; its Amazon description starts:

“Behavioural scientist Dr David Halpern heads up Number 10’s ‘Nudge Unit’, the world’s first government institution that uses behavioural economics to examine and influence human behaviour, to ‘nudge’ us into making better decisions. Seemingly small and subtle solutions have led to huge improvements across tax, healthcare, pensions, employment, crime reduction, energy conservation and economic growth.”
The much debated “sugar tax” is presumably a recent application of the nudge principle: a small increase in the price of sugar-containing goods will (or might) change behaviour by stopping some people eating quite as much sugar as they have, leading to a reduction in obesity levels. With millions of people you don’t need to make a big change to make a big difference.

Nudging means changing behaviour by making small changes. We know dramatic diets are often ineffective; indeed people often end up weighing more than they before dieting. When people fall off the diet wagon they think “what the heck”, and binge. Small changes to lifestyles are more likely to persist and have long-lasting effects than dramatic resolutions.

So I am reducing my medication, and doing it gradually. (A caveat: always discuss it with your healthcare professional before you change medication in any way. I did with mine, and they’re monitoring me in case I go downhill without appreciating it.) I’ve cut quetiapine from four to one a day, very gradually. I don’t feel so good after going down to just one but I’m hoping it’s just a blip.

And of course only change one thing at once, and give that change a chance to bed in and observe its effects. There are still many more things I want to change about my life so that I can find more time for writing, reading, and thinking, but this change is the big one for now. It will mean I need to sleep less and am more alert in the day.

This technique should work for everyone – including depressed non-writers and non-depressed writers and even non-depressed non-writers. Look at your life. Decide what is the most important thing you have to change. Decide upon a small step towards that change. Implement the change. Give it time until what you’ve changed is now habit, then repeat. The technique is good for diet, exercise, working more, working less, and so on.

One thing I am not so sure about is whether gradual change is better for making a permanent change in areas such as smoking and alcohol and drug addiction. In these areas many people appear to have success with going cold turkey. Whether nudging would be even more successful for these sorts of things I don’t know, and I don’t know of any figures either way.

So vow to make one small change today.

 

 

The daily schedule of a depressed writer

 

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It’s not easy being depressed, and it’s not easy being a writer. Being a depressed writer is worse than the sum of the parts. I often wonder why I bother; why not just go for the easy life of staying in bed all day long, which is often what I most often most want to do? Instead I struggle to make time for my writing.
It does mean that for depressed writers there is the question of how can we best arrange our time to facilitate writing? Of course it’s a problem all writers and creative people share. One of the best books I have read recently is Daily Rituals: How Great Minds Make Time, Find Inspiration, and Get to Work by Mason Currey (2013). Unusual creativity comes from unusual people living unusual lives. It is quite difficult to discern a pattern in the most creative lives. Have a look at this nice graphical representation of the daily routines of a sample of creative people (including creative scientists):

https://podio.com/site/creative-routines

With all sorts of caveats, and with many exceptions, the pattern seems to be get started early, exercise, relax. I’m not being prescriptive: until I cut down my quetiapine medication I was incapable of getting started early. And when I was Dean I had countless 8.30 and 9.00 am meetings, which really got in the way of getting deep work done (see my earlier blog on “Deep work”). There is robust evidence that some people are morning types and some evening, and if I were going to be prescriptive about anything, it would be to work out when you have most energy and feel best, and do your most creative work then. So of course there are many exceptions to this general pattern of writing first thing: some writers can only really get going at night after a few martinis. (Amazingly though Ernest Hemingway always started writing at six in the morning, even if he had been up late the night before with hard drinking, and worked until about noon.)
For me it ‘s good though to get the writing out of the way. I can never relax until I’ve completed my writing goal for the day. Another problem with starting late is that I never know how a writing task is going to take until I’ve done it. I’m writing a book on consciousness at the moment and I’ve set myself the target of a thousand words a day. It preys on my mind until the target bar in Scrivener (my currently preferred book writing software) reaches 100% for the day.
It is worth spending time on working out what is the perfect day for living the perfect life, in the sense of maximising quality time to get what we want to get done, done. It’s obvious that routine is important; routine crystallised to the point of ritual in many cases, as the title of Currey’s book suggests. Routine does bring its own problems for living – routine is the enemy of spontaneity, unless we schedule some hours in which to be spontaneous, which almost defies the purpose. But when on a creative burst, writing a book with a deadline, I need routine. A rigid routine or else I will not get it done. This routine means being tough on myself as well as other people. No exceptions.
I do wonder how some people manage to get so much more than me. I struggle at the moment with work, let alone writing. I try and free up as much quality time (for reading, writing, and thinking) as possible by outsourcing things like cleaning and mowing the lawn. I’m lucky that I can. How do people with children manage? But there are some days when I am so depressed that I just want to sit and cry and stare into space. Fortunately these days are much rarer when I’m writing; perhaps the sense of purpose writing provides helps us lift my mood. But one of the most depressing things about being depressed is how much time is lost to being ill. It is tragic.