It has many ways that it can be created — years of abuse, a debilitating illness, a child with a drug problem, divorce, the death of someone you love, neglect, bullying, discrimination, never feeling adequate. The list goes on and on.

It has many faces. Agitation, anxiety, anger, not caring, giving up, sadness, melancholy, needing to look perfect, not feeling anything at all.

It has many ways you can try to avoid it. Drugs, alcohol, working all the time, never sitting still, distracting yourself with social media, denial, discounting, labeling it “weak,” or going back to bed after you take the kids to school.

It has many ways it can get your attention. Becoming suicidal, having a panic attack, wondering what it would be like to simply drive away. Gaining weight, losing weight, never sleeping, always wanting to sleep. Not being able to focus. Not getting things done that normally you’d have no trouble accomplishing. Not caring what happens to the people you love. Hating your life. Feeling a tremendous but secret loneliness.

And yet, you can heal. It’s hard work. And it becomes more complicated when the depression you experience is recurrent or happens in a cycle.

But there are many paths to recovery — to healing.

Watch this wonderful tale of the black dog of depression by Mathew Johnstone and published by the World Health Organization.

Many experts detail, as does this video, how to gradually but persistently confront the depression that can haunt you. But people struggle to do it. Or they count far too much on antidepressants or anti anxiety meds — when studies show that medications may be helpful, but for what reason, we really don’t know. And in more moderate depressions, they may not be helpful at all.

To fight depression, you’re supposed to exercise, to move, to get enough rest, to journal, to go into therapy, to consider medications, to grieve, to recognize trauma, and to reach out to friends. You know these things. But maybe you can’t make yourself do it. Or do it consistently.

It’s the difficult thing about depression. You’re fighting to become engaged outwardly, while struggling to break free of depression’s internal grip — a hold that can keep you paralyzed.

“I know I should exercise. It’s hard to make myself want to do it.”

“I don’t like to journal. I do it, but nothing changes.”

“Therapy doesn’t work. And it’s too expensive.” Or, “I took pills one time and they made me sick.”

Three Hurdles to Taming Depression… 

All of these statements are common to hear. Here are the hurdles they reflect — and what you can do about them.

1. Waiting to feel motivated.

If you are actively trying to confront your depression but are waiting to somehow be magically motivated to change, nothing will happen. You have to make yourself do the things that are likely to help. You have to discipline yourself — when you don’t have a lot of energy or even hope. It’s tough. But putting motivation before action is putting the cart before the horse.

Motivation follows risking a new behavior. Because afterwards, you’ll be enjoying the benefits of walking a mile, swimming a lap, or making yourself get out of bed. You can’t wait to be motivated — or that change is very likely not to happen. Whether it’s exercise, going for a yearly check-up, or calling an old friend whose friendship you’ve let slip, action creates motivation. Not the other way around.

An example comes to mind. Kate fought me tooth and nail over the importance of exercise in managing her depression. Then one day, after a couple of years struggling with suicidal thoughts, she came in. “Well, I made myself get into the pool. And it really helped. I’ve always loved to swim and suddenly, I found myself energized. I have to get up really early to get it done and I still have to make myself go sometimes, but after it’s over, I feel so much better.”

Getting regular physical exercise didn’t “cure” Kate, but it helped a lot. Just as importantly, it gave her a sense of control and a sense of hope-– when her depression seemed so unmanageable.

Kate got to experience herself as being able to change. For someone who’s depressed, that can feel like a miracle.

2. Discounting small changes.

Healing usually involves a cumulative effect of many small changes. I wish I had a nickel for every time a patient had said, “This isn’t really a big deal, but yesterday I….”. Any change, any risk is a big deal. Because you’re confronting your depression or anxiety in small ways. Those changes add up.

What can seem unimportant — what you tell yourself is no big deal — can be a very big deal. Here’s an example. Jennifer, who came into therapy after reading about PHD said, “This may not sound important, but the other day, I actually told my husband I didn’t have the same perspective he did, and I couldn’t go along with what he was saying. We talked and it went pretty well. He told me later that he couldn’t believe I actually said what I was feeling. He doesn’t think he knows me. And actually, he’s right. Because I don’t let him know me.”

Maybe this sounds easy for some. But it’s not for someone who’s been hiding what they really feel for years.

It was a huge deal.

3. Giving up because you had one experience that wasn’t helpful.

Part of depression can look like tunnel vision — only seeing the negative. But this mistake — when you decide that nothing will work because one attempt wasn’t effective — is a common problem — and one that’s paralyzing. I don’t think any of you would parent in this way. You wouldn’t say to a child you cared about, “If one idea doesn’t work, give up.”

Nope. Persistence can pay off.

Sometimes this is an excuse because it’s so hard to admit there’s something wrong. You did it once. You don’t want to reveal it all over again.

So it takes courage to continue — to not give up.

If one therapist doesn’t help, ask around and find one with a different style or treatment regimen. If you found yoga boring, take a Zumba class. If you’re nervous about prescription medications, then look for homeopathic alternatives. Sometimes you’ll be surprised at what actually helps. Sitting in the sunshine, writing a note to someone who’s in the hospital, striking up a conversation with the 6 year-old next door, striking up any conversation… engagement is what’s important.

Engaging with life, with others, with nature.

Andrew Solomon, in his book The Noonday Demon, “The opposite of depression isn’t happiness, it’s vitality.”

Engagement brings with it vitality. And it brings hope.

We’re headed into the holiday season! Please consider Dr. Margaret’s book as a fun stocking stuffer for the person you love! Click here for “Marriage Is Not For Chickens.”

You can hear more about depression and many other topics by listening to Dr. Margaret’s podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to this website and receive her weekly posts as well as her podcasts, plus Dr. Margaret’s eBook, “Seven Commandments of Good Therapy.”