I have been taking antidepressants more or less continuously for the past decade. During that period, I’ve had five episodes of moderate to severe depression, ranging from two months to three years in duration. But now I’m coming off medication completely in order to start fertility treatment. It’s a daunting prospect, and with my mood becoming a little more labile, my GP has suggested I think about non-medication strategies I can use to keep myself well and manage any mental health symptoms that occur.
What follows is a list of pretty much everything other than medication that has helped me in the past and that I think could be useful now. I haven’t limited myself to depression, firstly because mirtazapine has done more than just lift my mood (it’s also reduced my anxiety and helped me sleep), and secondly because I think everything has a knock-on effect when it comes to my mental health. It’s not unusual for prolonged stress and high anxiety levels to trigger an episode of depression, for example.
I hope this post will be useful to others who, for whatever reason, need or want to manage similar mental health problems without meds. It comes with some caveats, though: 1) What works for me may not work for you. 2) Always seek appropriate medical advice. And feel free to make suggestions or share what’s helped you in the comments.
Baths: A hot bath (preferably with Lush products) is great for calming me down and reducing the generalised aches I sometimes get when depressed or fatigued.
Books: This could be a whole post in its own right! My favourite fiction and cartoon books are real comfort reads when I’m feeling a bit rubbish, but some mental-health-related ones I think will be especially useful are ADD-Friendly Ways to Organize Your Life (concentration), When Things Fall Apart (mindfulness), Radical Acceptance (ditto) and the psalms in the Bible.
Blogging: When there are too many distressing thoughts swirling around in my head, blogging or journalling gets them out onto the screen and helps me make sense of them so I can figure out a way forwards.
Breaks: It’s important to take regular breaks when I’m working, especially if I’m finding it hard to focus.
Choral music: Listening to choral music is one of the best and fastest ways to calm me down. Singing is also very cathartic and making it to choir rehearsals is usually one of my top priorities!
Church: Going to church regularly helps me feel closer to God and makes it easier to separate what’s really important in life from what’s not. I need to make more of an effort to get to church on weeks when I’m not required to sing. Attending a different church from usual can also be helpful (great to get a different perspective on things).
Compassion: Beating myself up for not being perfect and pushing myself too hard are surefire routes to stress and depression. Being compassionate doesn’t mean that I can’t acknowledge when I’ve genuinely done something wrong and make amends.
Counselling / psychotherapy: In the near future I’ll be able to afford to see someone privately. I think this would be a good idea, though I don’t want to get into anything too deep and heavy while I’m adjusting to life without meds. Someone who could help me with more practical coping strategies and provide ongoing support would be good.
Fun relaxation: Activities that are both restful and enjoyable (like reading Harry Potter) seem to be much better for my energy levels than doing something fun and energetic followed by a boring rest.
Humour: My sense of humour has been my lifeline at times, and laughter helps whether I’m depressed or just struggling a little. This can include funny books and cartoons, comedy programmes, being silly with my partner and of course The Real Energizer Bunny.
Mindfulness: I try to practise mindfulness by regularly taking a moment to connect with what I’m really feeling and what my needs are in this moment. Mindfulness helps ground me – counterintuitively, really focusing on how anxious I feel actually makes me feel less anxious! It also has an important role to play in preventing depression. I have a tendency to stick rigidly to goals, rules and plans that made perfect sense when I created them, but might no longer be the best way forwards, and I think this is often a key factor in relapses of depression.
Never put things off: Nothing drains me more than putting off doing something that’s very important but scary or challenging. I need to get these things out of the way if I want to maintain good mental health.
Reaching out: Letting other people know what I’m feeling and how they can help me is something I really struggle with. This ties into my longer-term work on learning to trust people more – which I still plan to write about in depth, but which has somewhat taken a back seat as I figure out how to cope without meds. It’s something I will keep chipping away at, though, because having good support really does help.
Reducing responsibilities: When I’m depressed or really struggling with my mental health, I try to reduce my responsibilities to a level that feels manageable.
Relaxation CDs: I particularly like Experience Yoga Nidra.
Rest: It’s important that I get enough of this.
Pacing: When I’m depressed or fatigued, I try to start with a level of activity that feels comfortable to me (which often means doing very little!) Then I gradually start to stretch myself by adding activities, but always remaining mindful to how that makes me feel.
Prayer: For me this ties in closely with mindfulness. Asking God to calm my mind and help me focus on what’s important really helps.
Prioritising: I resisted this for years. I’ve finally come to accept it’s essential for avoiding stress, exhaustion and overwhelmed-ness! For work stuff, I use the ABCDE method.
Professional help: Although I’ve been asked to try coping without mirtazapine, it’s important that I stay in touch with my healthcare professionals and let them know how I’m doing. Medication in pregnancy is always a balancing act between the risks to the mother and baby from the drugs, and the risks from the mental health problems themselves. If I become too depressed, my GP or psychiatrist might recommend I start taking antidepressants again, or they might be able to offer other treatment. I’ve also bookmarked some local charities on Delicious.
RET for freak-outs: I find this exercise helpful when something has happened that’s really triggered me. It’s supposed to be for anger, but I find it helpful for any intense, overwhelming negative emotion. That said, sometimes when I’m very upset I don’t want to do anything constructive about it, because it feels somehow invalidating. The best thing to do when I feel like this is just get into bed and let myself grieve – I might be grieving something “trivial” but allowing myself to feel whatever I feel is important.
Step away from the smartphone: The second most draining thing I know, after putting off important tasks, is circling around Twitter, Facebook and my RSS reader mindlessly checking for updates. Of course, these two things often go hand in hand.
Showers: I find taking a shower calms me down, helps me think more clearly and can “reset” me.
Small goals: When I’m depressed or otherwise struggling, I find it helpful to set a few small and achievable goals, breaking larger tasks into lots of baby steps. This helps give me a sense of achievement and by combining it with prioritising, I can stop an episode from derailing my life completely.
Small treats: Likewise, when I’m depressed lots of small treats are better than one big treat – because there’s less pressure and disappointment if I can’t enjoy something. I try to focus on what I really feel like doing in the moment, as long as it’s not totally self-destructive. Even if I’m not capable of enjoying anything, there are usually things I can draw some comfort or relief from.
Staying hydrated: This doesn’t apply to full-blown depression, but it’s amazing how often problems concentrating or focusing go away when I have a drink of water.
Sunshine (or light therapy): Getting out in the sunshine helps lift my mood whether I’m depressed or not. Unfortunately, it’s been pissing it down solidly for about a month, so I might have to reclaim my lightbox from the friend I lent it to and see whether that helps.
Supplements: I’m currently taking evening primrose oil (which stops me from aching) and omega-3 fatty acids (which are supposed to help with mood and concentration). I need to double-check whether these are safe in pregnancy. Update: I’ve just been advised that EPO is best avoided in pregnancy as it hasn’t been proven to be safe. However, most omega 3 supplements are fine (not cod liver oil; check with a pharmacist, or get one that’s specifically formulated for pregnancy).
Thought records: Irrational thoughts aren’t as big a feature of my depression as they used to be, and I’ve become a little wary of (NHS style) CBT-based self-help, because I got sick of being given a sticking plaster and told it would cure me. Nonetheless, when I am being tortured by thoughts I suspect aren’t accurate, listing the evidence for and against them does help me cope in the moment.
Walking: Walking helps ground me. It’s been part of my daily routine since January and I intend to keep it that way. (I’ve never found exercise effective as a treatment for depression, however.)
More will probably be added as I think of them…
Edited to add: Compassion (11/05/12).
Things feel a little scary at the moment. I’m coming off my mirtazapine in preparation for getting pregnant, and I’ve left my therapy group. Intellectually I have no qualms about these decisions – after all, I can always go back on ‘safer’ antidepressants or find alternative therapy if I need to – and emotionally it feels good to be saying, “I am normal enough. I am well enough. I have my issues, but I have the strength to deal with them within me.” But emotionally there’s also the fear that comes with any venture into the unknown.
Meds-wise, things are easy enough to explain. My GP has agreed it would be better to start reducing the dose sooner and take longer coming off the drugs, than do it all in a month as my psychiatrist had suggested. So I’ve spent three weeks at 45 mg with no ill effects on my mental health, and I’m now enjoying some lovely withdrawal symptoms, having dropped to 30 mg two days ago. Dr Right has also emphasised that no one will expect me to go without antidepressants if it turns out I need them, but it would probably be a different drug. Unfortunately, the main ones used in pregnancy – sertraline and Prozac – are SSRIs, but we’ll cross that bridge if and when we come to it. She thinks SSRIs are more likely to work for me than they did ten years ago, because I’m in such a different place now, and I think that at least if they do Bad Things to my brain I will recognise the early warning signs and know what to do about it.
Therapy-wise… I’ve previously written a lot about what I learned from therapy, and why I don’t think Group Therapist’s approach was right for me, even if I haven’t been able to sum it all up neatly. I am very grateful for the things GT taught me. I definitely don’t agree with all his opinions and beliefs about my issues and about mental health in general, but even where he ‘got it wrong’, it’s been helpful to bump up against a different perspective and that’s been a chance for me to clarify and reconsider what I do believe.
At the same time I’m 100% certain that walking away was the right thing to do. It’s funny, but I don’t think the ‘official’ reason I gave for leaving the group – that therapy in a group setting didn’t work for me – had much to do with it in the end. Once I’d committed to my decision, a lot of that fear seemed to melt away and I was able to participate fully and connect with people in my last few weeks. I left with the sense that actually, this was a group of people with whom I could have worked on learning to trust – but that my problem was with Group Therapist and perhaps psychoanalysis in general. It’s a shame I didn’t feel able to articulate this in the group to him, but I need an approach where practical stuff can be incorporated and where the good as well as the bad in me is understood as important.
I’ve spent most of the past decade struggling to get mental health professionals to take me seriously, and having to fight to get any help. GT was the total opposite, which lured me in at first. But having someone ignore your achievements, dismiss the things that have helped you, and assume you must be feeling really depressed and worthless when actually you’re fine – my issues are cyclical – is no better. And that last sentence sounds very critical, but in fact one of the best things GT did for me was get me to recognise that and push me to a place where it’s no longer about communicating how much I’ve suffered, but refocusing on what I need to do to continue my recovery. I think I’ve finally come to terms with how badly the NHS let me down in the past and I feel ready to move on from this. Was that GT’s intention? If so, he played his cards very close to his chest.
What am I focusing on now? Two main things, really – one is depression relapse prevention, which ties in a lot of threads from other issues I’ve been writing about (perfectionism, mindfulness), and the other is learning to trust people and reach out to them more. I will write more about both of these things at a later date.