Coping with Depression is a Catch-22

Depressed people often know what to do to help with their depression, but the illness hinders their ability to follow through.

"To recover from depression you should eat well, sleep well, be active and think realistically," says Jon Allen, PhD, senior staff psychologist at The Menninger Clinic and Professor of Psychiatry in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. "Yet the typical symptoms of depression include poor appetite, insomnia, lethargy and negative thinking. Above all, you should maintain hope, but depression can bring hopelessness."

Since depression runs in families, many people who are depressed may attribute their illness to a "chemical imbalance," and discount their active role in treatment. While depression has biological origins, Dr. Allen says, the illness develops from a pileup of psychological and interpersonal stress over the patient's lifetime.

Dr. Allen writes about stress pileup and how to overcome the catch-22s of depression in his latest book, Coping with Depression: From Catch-22 to Hope, published this month by American Psychiatric Publishing, Inc. He draws upon decades of experience at The Menninger Clinic treating patients with depression and teaching them about managing their illness.

"In teaching depressed patients about depression, I quickly learned that merely talking about all the things that they needed to do to recover was futile," Dr. Allen says. "I realized that we needed to start with the obstacles to recovery. I started using the concept of catch-22, from the Joseph Heller book."

Common catch-22s

· Thinking positively: Advice to "look on the bright side," or "think positively" isn't easy for a person suffering from depression, Dr. Allen says. Depression causes negative thinking and self-criticism that crowd out positive thoughts.

· Maintaining supportive relationships: When you're depressed, you need support from others, but depression leads to social withdrawal and is likely to undermine relationships.

· Having fun: Even having fun is a catch-22 for the depressed patient. Depression chips away at a person's capacity to enjoy life and experience pleasure.

Baby steps

Taking small steps is the only way around catch-22, Dr. Allen says. Persons with depression can't force themselves to sleep or feel pleasure.

They can become more active one step at a time, for example, sitting up in bed, getting out of bed and walking out of the bedroom. They can also participate in activities that provide an opportunity to rekindle pleasure such as walking around the block or going to a movie with a friend. For the seriously depressed patient, Dr. Allen recommends a combination of treatment methods, which may include psychotherapy along with medication.

"I think underestimating the difficulty of recovering from depression contributes to hopelessness," Dr. Allen says. "Understanding the seriousness and complexity of the illness prepares depressed persons to take an active role in their recovery by working on their physical health, negative thinking, emotional conflicts and relationship problems."

Rita R. Handrich, PhD
January 2006

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