If you are one of the seventeen million American adults who struggles with major depression, you might wonder if there are steps you can take to climb out a depressive episode once the descent begins.

The downward spiral into depression often feels like a free fall into an abyss.  We don’t know how we got there, forget what life looked like before depression, and feel immobilized from the plummet.  Despite our best intentions, we can’t simply snap out of depression.  We can, however, start to climb our way out and get better at preventing future relapses.

What Causes Depression?

Depression can be caused by our biology, the environment, or a combination of factors.  We might have a genetic predisposition for depression, a difficult childhood, or both.  We can also have one or more major life stressors that trigger depression.  For example, trauma, unemployment, reproductive or parenting issues, health problems, hormonal issues, and relationship difficulties can all potentially trigger depression.  In addition to genes and experiences, inflammatory models of depression suggest that depression might even be caused by inflammation in our bodies.

How Do We Treat Depression?   

Although depression is often rooted in biology, that doesn’t mean it isn’t open to change.  Depression is actually very treatable and it’s possible to prevent relapses.  We can use behavioral changes to turn down the influence of our genes, trauma-informed therapeutic modalities to heal emotional wounds, mindfulness-based techniques to change our relationship to our thoughts, emotion regulation skills to have a better relationship with our emotions, improved nutrition to address inflammation, and medication when it’s needed.

Here is a comprehensive list of steps to help you climb out of depression.

Steps for Climbing Out of Depression

Step 1: Start Therapy

Climbing out of depression begins with seeking professional treatment.  Therapy can provide support and teach you skills that reduce depressive symptoms.  Once some symptoms are relieved, therapy is also a great place to explore and heal emotional wounds that may be contributing to depression.  If needed, a therapist can also refer you to a psychiatrist for a medication consultation.

Step 2: Get Moving

Ample studies show that strength training and even small amounts of aerobic exercise can reduce depression.  Unfortunately, when we’re depressed, we usually feel too fatigued and unmotivated to exercise.  This type of fatigue can be tricky to manage.  Unlike the fatigue we feel when we aren’t well rested, fatigue in depression is more about our nervous system being in a state of low arousal.  That means we have to gradually mobilize our nervous system with a gentle or slow exercise and get moving even before we feel motivated to do so.  Although it may be difficult, we have resist thinking about whether we should exercise.  Instead, we need to remind ourselves that we always feel better after exercising, put our sneakers on, and just do it.  If you’re interested in learning more about overcoming low motivation in depression, the book Activating Happiness: A Jump-Start Guide to Overcoming Low Motivation, Depression, or Just Feeling Stuck by psychologist Dr. Rachel Hershenberg is a great resource. 

Step 3: Remember That Thoughts are Just Thoughts

When it comes to depression, most people have very similar thoughts.  They seem so real and personal at the time, but can feel alien to us once we climb out of depression.  That’s because low moods affect thought processes and trigger common negative thought patterns.  Rather than viewing such thoughts as deep insights into who we are, we’re better off seeing them as just a symptom of depression.  Negative thoughts come with depression, just as a fever comes with the flu.  A mindfulness approach to depression involves not identifying with our thoughts.  See if you can start seeing thoughts as just clouds in the sky.  Observe them coming and going.  To make it easier, start saying, “I’m having the thought that…” or “I’m noticing that I’m having the thought that…”  The book The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn is helpful if this approach appeals to you.

Step 4: Befriend Feelings

Emotions are meant to be temporary, but we tend to prolong them by reacting to them in unhealthy ways.  For example, occasional feelings of sadness are normal and healthy, but our emotional reaction to sadness might not be healthy.  Rather than fearing and avoiding feelings, learning how to respond to them with mindfulness, self-compassion, and self-soothing helps us regulate and release them.  Start by labeling your emotions since studies show that labeling our emotions helps us regulate them.  To learn more about befriending emotions, see my previous post.  Books such as Uncovering Happiness: Overcoming Depression with Mindfulness and Self-Compassion by psychologist Dr. Elisha Goldstein and The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions by psychologist Dr. Christopher Germer are also helpful if you’re interested in exploring a mindful and self-compassionate approach to depression.

Step 5: Nourish Your Body

Your gut is considered your second brain and its health directly impacts your mood.  In a previous post on probiotics, I presented some of the newest research citing the possible benefits of adding probiotics and fermented foods to your diet.  If you’re already getting enough good bacteria, are you also getting enough water and nutrients?  Are you eating enough healthy fats and whole foods?  Are you monitoring how inflammatory foods are affecting your mood?  Some of the most common foods that can cause inflammation include: sugar, refined carbohydrates, flour, gluten, soy, corn, and dairy.  See how you feel after eating these types of foods and discuss the possible benefits of an elimination diet with your doctor.

Step 6: Cultivate a “Resting Relaxed Face”

According to The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time by neuroscientist Dr. Alex Korb, negative facial expressions enhance negative moods.  To improve your mood, he recommends relaxing your facial muscles.  This might involve wearing sunglasses to reduce squinting, which studies show is related to feelings of irritability and anger.  It might also mean smiling (or half-smiling) if you feel up to it.  If smiling feels inauthentic, however, start with cultivating a resting relaxed facial expression.

Step 7: Heal Yourself with Heat

You might have heard about the recent cold shower wellness craze for stress and wondered if it helps with depression too.  Actually, since depression is a low arousal state, it’s heat, not cold that helps.  Increasing our body temperature stimulates the part of the brain that produces serotonin and helps us warm up our low arousal state.  One study showed that raising body temperature slightly can improve the symptoms of depression for days. According to The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation by Dana Deb, physical warmth is almost as helpful as social warmth for warming up a low arousal state and a hot shower or bath can reduce feelings of social exclusion.  Perhaps this is why so many stories of people coming out of a depressive episode begin with a nice hot shower after days of not showering.  Here are some simple things you can try to warm yourself up: a hot shower (check with your doctor first to see if this is an issue); warm clothes; blankets; exercise; a hot beverage; and even sitting by a fire.

Step 8: Become Selective About Entertainment

Do you listen to too many sad love songs?  Do you spend an excessive amount of time on social media?  Are you watching the news or shows that leave you feeling agitated or sad?  Do you read books written by authors who clearly believe that life is meaningless?  Take note of how you feel after engaging in these types of activities and start limiting or eliminating ones that contribute to negative moods.  Consider replacing unhelpful activities with the following mood-enhancing options: relaxing instrumental music; upbeat music; uplifting podcasts; meaningful books; petting or playing with a pet; funny movies; art, dance, exercise, music, improv, or cooking classes; time in nature; and sports.

Step 9: Change Your View

Depression causes us to constrict our perception.  We become inwardly focused and have limiting thoughts about ourselves, the world, and the future.  This loss of perspective is easily facilitated by our modern world, where we literally lose sight of the big picture because we are so busy looking down at screens that are just inches from our faces.  One of the easiest ways to expand our perspective is to go out in nature and look at an expansive view.  According to How the Body Knows Its Mind: The Surprising Power of the Physical Environment to Influence How You Think and Feel by Sian Beilock, having a view of nature reduces depressive symptoms.  Interestingly, even the act of looking up rather than down might reduce depressive symptoms.  So, as often as possible, pick your head up from screens and expand your perspective in nature.

Step 10: Engage with the World

This might be the hardest step, but it’s also one of the best and that’s why it’s last.  Meaningful connections are a powerful antidote to the natural urge to isolate and hide during depression.  When we feel depressed, our nervous systems usually cause us to withdraw.  Even if we don’t withdraw, we know that we aren’t feeling like our best selves and so we hide our private pain from our public appearance, which only makes us feel more alienated.  Being seen, accepted, and supported in our depression is potent medicine.  Are there safe and supportive people you can turn to?  Perhaps it’s a therapist, friend, family member, or support group.  These people can help remind you that while depression affects your self-esteem and perception negatively, others can still see you for who you really are and enjoy your company.

Your turn: I’d love to hear from you.  Is there a step for climbing out of depression (either on the list or not) that really speaks to you?

(If you are experiencing a mental health crisis, the number for the National Suicide Prevention Lifeline is 1-800-273-8255)