Planning for Depression

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By Bruce Campbell

(Second in a four-part series on the use of planning to manage ME/CFS and FM.)

Many situations we face can be anticipated and the negative consequences reduced or eliminated if we give them some advance thought. In this and three companion articles, we look at different ways that planning can diminish suffering and increase quality of life if you have ME/CFS or FM.

Depression in ME/CFS & FM

Depression is very common in people with ME/CFS and fibromyalgia. It may be triggered by a sense of helplessness, by fear, frustration and anxiety, by loss, or by uncertainty about the future. Signs of depression include feelings of unhappiness or sadness, lack of interest in friends or activities, isolation, suicidal thoughts, and loss of self-esteem.

There are two types of depression associated with ME/CFS and fibromyalgia. One type is called situational depression, which means depression that occurs as a response to a particular set of circumstances, in this case having your life turned upside down by long-term illness. Self-management strategies such as those described below are usually helpful in response to this type of depression.

Depression may be biochemical as well, created by changes in the functioning of the brain. Prolonged stress may alter our biochemistry, causing depression. Self-management strategies may also be useful for this type of depression, but treatment normally includes medication as well. Serious or long-term depression or thoughts of suicide call for immediate help from a doctor, therapist or suicide-prevention service.

Planning for Depression

Everyone has times when they feel unhappy or sad. We can recognize that these feelings are likely to occur from time to time and plan how to respond, so we’ll know what do when a time of low spirits comes.

Here are six strategies used by people in our program.

Be Active: Depression produces hopelessness, an attitude that becomes a self-fulfilling prophecy. Counteract those feelings by being as active as your situation allows. Being active changes mood; also, successes promote hope. For more, see Two Special Anti-Depression Strategies (below).

Stay Connected: Supportive human contact is very soothing. Calling a friend or getting together to talk, share a meal or see a movie counteracts isolation, preoccupation with problems and the low mood often associated with chronic illness. Just explaining yourself can give you perspective.

Consider Medications: If your depression is biochemical in origin, you may be helped by an anti-depressant medication. On the other hand, tranquilizers and narcotic painkillers intensify depression, so if you are depressed, it may be due partially to medication side effects.

If you suspect this, check with your doctor about a change of medication or a reduced dosage.

Use Positive Self-Talk: If you have a tendency to think of the worst that might happen, you can retrain yourself to speak soothingly and realistically when you're worried or depressed.

For example, you might say something like “Feeling blue didn’t last in the past, so it probably won’t this time either” or you can change your mental climate by noticing what's going well and congratulating yourself on your accomplishments.

Maintain a Schedule: Keeping to a daily routine regardless of how you feel can help counteract depression. Your daily round of activities will depend on the severity of your illness, and might include things like getting dressed, making the bed, cooking meals, taking a walk and watching a favorite TV program. Forcing yourself to do things, even if you don't want to, counteracts the inertia of depression.

Do Something Pleasant: Pleasurable activities offer a distraction from symptoms and help create a good mood. The key is to find things that absorb your attention. Such activities might include reading, listening to music, sitting in the sun, taking a walk, doing crafts, solving puzzles, watching a movie and spending time with friends.

Two Special Anti-Depression Strategies

One person in our program, recognizing that depression is likely to recur, has created two special anti-depression strategies that she uses when she's feeling blue.

She calls the first “The Treasure Box of Pleasantries.” It’s a notebook containing compliments she has received, photos of places she has visited or would like to see, plus treasured notes, photos and cards. When her spirits are down, she picks them up by going through the box.

The second strategy, which she calls “The 100 Hours Program,” is a way to stay active and give herself a sense of purpose when her spirits are especially low. She scripts a period of up to 100 hours with "every special, pleasant and meaningful activity I can think of."

Depending on her functional level, she might schedule hair and massage appointments or lunch with friends. In addition, she has a list of 50 activities she can do on her own. They include catching up on unread magazines, watching uplifting or interesting movies, perusing picture books and preparing easy-to-fix meals.

Everything is worked into a schedule, which she keeps in a binder. She says that usually by the end of the time she is back to normal. The most important part is that "I don't have to think ‘what do I do now'. I've planned it all out beforehand."

Letter to Myself

Another person in our program has responded to the likelihood that depression will recur and temporarily cloud her judgment by writing a “letter to myself,” which she can read when depression hits in response to a relapse. It begins:

I am writing to you from a peaceful place of acceptance, but I remember very clearly what it was like to be gripped by fear and desolation. Now, on the back of the insights that lifted me up again, I want to reach out to you and help you to avoid spiraling even further downwards. I am writing this in the hope that I can inspire you to retain (or regain) a clear connection to the insights and tools which can help you to avoid being sucked down into the swamp again.

She goes on to challenge herself not to give in to self-pity and she reminds herself in detail of what has helped her through difficult periods in the past. (The letter is seven pages long.) She concludes:

I hope you will choose faith and hope and life. I hope you will choose to reach deep inside yourself to access all of those decades of growth and learning. I hope you remember that you are loved and appreciated and that your writing has affected hundreds or maybe thousands of people that you have never met. You have so much more to give. Reach into your heart and find a way to survive and thrive again. You can do it, no matter what. I believe in you and I am always here with you, even when you can't find me.

With love from the tranquil, serene, accepting, creative, meditating Mary.