What helps you deal with depression?

Noasu suggested that I share the techniques and strategies I use which help me to fight depression.

Background: I now believe I've had depression intermittently for most of my adult life. I'm now 36. But until about 18 months ago, I managed to deal with it myself and I didn't really think I could be clinically depressed. Since then, I have been severely depressed 3 times, coming close to suicide each time. Each "episode" lasted approximately 2-3 months. I also have a substance misuse problem, which tends to give me very short highs but usually just makes the depression even worse.

Caveat:This is just what helps me personally. Depression seems to affect everyone differently and you will probably find different results in your own life.

I'll list the things that help me in roughly the order of importance.

1) Medication. (currently 40mgFluoxetine per day). There are lots of great techniques for helping depression, but I found that I needed to reach a minimum level of happiness before most of the other techniques would have any effect. The Fluoxetinehelped raise my baseline happiness so that I had the energy and motivation to implement the other ideas. Note: some people have bad side effects to Fluoxetine. I'm fortunate that the side-effects are trivial for me.

2) Lots of good quality sleep. And I mean a lot! I can easily sleep 10 hours most nights. At first I felt guilty about this, but then I realisedhow important sleep is for me. After those 10 hours, I usually wake up feeling great. Conversely, it only takes 1 or 2 nights of disturbed or short sleep for my mental health to decline rapidly. Sleep is hugely important for me. I even wear an eye mask now (how camp!) to ensure I sleep deeply enough.

3) Daily exercise. Well, I aim for 6 days per week. If I really feel sore or unwell, I either have a day off or exercise more lightly. I very rarely actually *want* to exercise. If I waited until I felt like exercising, I would probably never do it! But I keep reminding myself how good I feel afterwards. I use Jillian Michaels' "30 Day Shred" workout DVD. It is *very* intense (especially on the 3rd of the 3 levels), but the good news is it delivers results pretty fast and only takes 25 mins per session. It's basically like circuit training with almost zero breaks. Importantly, afterwards I always take the time to congratulate myself for doing the workout, despite not wanting to do it. I think that "feel good" factor is really important psychologically. On days when I exercise, I notice a huge difference to my mood. I am more alert, more energetic, more motivated and happier. I also sleep better.

4) Mindfulness Meditation. It's no longer for hippies, it is scientifically proven to help anxiety and depression. It's easy to get discouraged with meditation, but a chap called Andy Puddicombeat www.headspace.com has put together some excellent guided audio meditations, starting at just 10 mins per day. You get the first 10 days free too. I have to admit, I don't meditate as often as I would like. But I do try to practice mindfulness in my day-to-day life. Basically, it just means slowing down and really noticing what's around us and how we're feeling.

5) Hypnosis CD. I like to think of myself as quite scientific, so I am hesitant to recommend this. But most nights just before sleep I listen to the "Change Your Life in 7 Days" CD from Paul McKenna's book of thesame name. You can probably find it on YouTube too. I don't really know exactly how much this CD helps me. But I do know that it leaves me feeling relaxed, happy and peaceful immediately before sleep, which is a fantastic way to end the day.

6) Gratitude. Every day I try to notice at least 10 new things to be grateful for. It's important that I actually feel grateful too, not just list things intellectually in my head. The Dalai Lama says that if we can want what we already have, rather than grasping after what we don't have, we'll be much happier. It's surprising how much of a difference it can make when you regularly feel gratitude, especially for the little things in life.

7) Compassion.This starts with compassion for myself. I forgive myself for my mistakes and I try not to beat myself up. We tend to talk to ourselves incredibly harshly - if a friend spoke to us that way then they wouldn't be our friends for very long! So, I try to catch myself saying unhelpful things to myself, and replace those with more helpful thoughts. Again, I try to conjure up the feeling of compassion, which canbe described as a feeling oflovingkindness. It's about realising that essentially all of us are the same - we are human beings, all doing our best in this crazy life. I noticed something really unexpected when I started practising compassion - my social anxiety almost totally evaporated overnight. I no longer was worried about what other people thought of me - my mind was pre-occupied with curiosity and compassion for other people instead.

7.5) No comparisons. As part of compassion, I try to never compare myself to other people whoI might think are "better" than me in some way. It just makes me feel rubbish, so I no longerdo it. I quit Facebook (and use email or phone calls instead). I don't envy my contacts on LinkedIn. I barely watch any TV (to avoid the toxic negative effects of advertising). I avoid newspapers and magazines like Mens Health which just seem to make us feel more insecure. Whenever I see a newspaper these days, it shocks me just how incredibly negative they are! So, rather than compare myself to others, I remind myself that I am unique. I have my own unique look and personality. I assume that most people will like me just for being me. Caveat: Sometimes I compare myself to people who areworse off than me. For example, refugees or people without access to clean water. This helps me to have perspective and feel gratitude for everything good in my life.

8) CBT and REBT. Cognitive Behavioural Therapy and its cousin,Rational Emotive BehaviouralTherapy, both teach us how to weed out overly negative thoughts and replace them with better ones that help us to feel better. In my opinion, both therapies are useful, though I think you do need to be mostly well already to have enough energy to use them consistently. They make you think really hard, and it can be quite difficult. I've read several books on each therapy and also had CBT sessions myself. The main problem with these therapies is that they focus a little too myopically on thoughts and tend to ignore feelings. This means that sometimes you can be treating symptoms and not causes, so it can feel a little futile. By contrast, counsellors from the Humanistic school tend to be concerned with you as a whole person, not just your thoughts. For that reason, I personally find Humanistic counselling more useful than CBT.

9) Supportive friends and family.I probably should have listed this higher up. Early on, I found that keeping secrets ate me alive. Yeah, I was scared that telling the truth about everything might cause problems, but I'm so glad I did. My friends and family know everything about my depression. It's far less stressful for me that way. Note: I do not recommend this for everyone. Some people can be super judgemental. You need to have a good idea of your friends and family's attitudes to mental health problems before you spill the beans to them. Anyway, without my wife (who works in mental health), I probably wouldn't be here now.

10) Structure & Routine.Last but not least, I try to have some routine and structure in my life. This is hard for me because I work from home and set my own hours, and I've never been good at discipline. But, as a bare minimum, I try to make sure I get enough sleep, and try to I set myself at least one small task each day, so I have something to look forward to. Otherwise I can quickly start to feel that my life has no meaning, and I risk going downhill again.

There are probably some other factors I have not included. Some I have omitted intentionally for specific reasons, but PM me if you're interested in those secret ideas ;)

So, that's what helps me. What helps you?