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Jan Marsh recently retired after 40 years’ experience as a clinical psychologist. During her career she worked in a variety of settings, including rehabilitation, mental health services, child protection, tutoring and court work. Most recently, she worked in private practice, focusing on adults who presented with anxiety, depression and challenging life issues.

The case studies in this book do not represent particular individuals but are composites from the author’s years of clinical experience. Any resemblance to actual people is coincidental. This book is a general guide only and should never be a substitute for the skill, knowledge and experience of a qualified professional dealing with the facts, circumstances and symptoms of a particular case. The nutritional, medical and health information presented in this book is based on the research, training and professional experience of the author, and is true and complete to the best of their knowledge. However, this book is intended only as an informative guide; it is not intended to replace or countermand the advice given by the reader’s personal physician. Because each person and situation is unique, the author and the publisher urge the reader to check with a qualified healthcare professional before using any procedure where there is a question as to its appropriateness. The author, publisher and their distributors are not responsible for any adverse effects or consequences resulting from the use of the information in this book. It is the responsibility of the reader to consult a physician or other qualified healthcare professional regarding their personal care. This book contains references to products that may not be available everywhere. The intent of the information provided is to be helpful; however, there is no guarantee of results associated with the information provided. Use of drug brand names is for educational purposes only and does not imply endorsement.

From birth we are primed for growth and mastery. Watch a baby gain the most basic skills of survival and you will see the strength of that drive: to learn, to explore, to develop even the simplest skills, such as feeding from a bottle or a spoon or grasping an object. As the child grows, so does the drive to develop increasingly complex skills such as playing a sport, doing mathematics or learning a musical instrument. Children show us the pleasure of mastering a new skill and often, if they have some control over the process, they will persist for long periods of time. With every step of every skill the child asserts, ‘This is my life and I can be effective in it.’ We are designed for this: to learn and grow, and feel some sense of control in our lives.

When the fog of depression settles in, your familiar, capable way of life seems lost to you. It becomes hard to feel at all effective. But through good self-care and patience you can take back your life.

For those suffering from depression and those who are close to them, this book offers practical steps for a way forward.

Throughout this book I share some simple ideas to help you regain control of your life and push back depression. Most of these suggestions can be done at home or in your community at little financial cost. Some will deepen your relationships and help you find joy in daily life. That might sound like a bold claim, but when you take control you can improve your life.

Throughout my many years of work as a psychologist, I have noticed that when people are bogged down in how bad they feel and how badly they feel they are being treated — by life, their family, their workplace — they lose sight of simple things like a healthy diet, exercise, fun. When talking with clients I often found myself covering the basics of good self-care that form a strong foundation for wellbeing, no matter what issues or symptoms the client might bring. There is also the mental side of wellbeing. So many of us get around feeling not good enough, failing to notice all the day-to-day gifts life has to offer and unable to make meaningful contact with others for fear of being judged. Often those judgments are in our own minds. I believe that your mind, given the right conditions — including good self-care and supportive relationships — knows how to heal itself. By deciding to tune in to what you need and committing to some practical steps, you can make a difference to how you feel.

There are two parts to this book. In Part 1, I give some background to depression, so that you can understand it and know what you’re dealing with. My intention in this section is to demystify depression and remove any sense of shame attached to it. Depression is a process that follows the laws of nature and is no more shameful than catching the flu. I show how depression is diagnosed and how the symptoms affect body, mind and emotions. I also describe some causes of depression as well as some ways in which it may serve a purpose, for example, by highlighting the need for love in our lives or indicating when it’s time to give up a course of action that’s not paying off.

In Part 2, I share specific tips to improve your wellbeing in body, mind and spirit. It is a prescription for physical, mental and spiritual fitness that can go a long way towards both preventing and managing depression. I look at how you can take care of yourself and your connection to the world and to other people, and also how to cultivate attitudes that improve your resilience to the ups and downs of life.

If you are someone who likes to really understand a subject, read through Part 1 and get to know what depression is about. It will make the subject more approachable and give a rationale for the suggestions that follow in Part 2. I hope you will be able to see how the theory and practice are linked. Understanding how it all works will help you to find the motivation to do something to improve the way you are feeling.

If you are suffering and feel impatient to get on with doing something about it, you could turn straight to Part 2. You won’t need to tackle all the tips, but I suggest you look at something from each of the three areas: body, mind and spirit. Pick one or two from each section and start with something that seems approachable. Depression eats away at motivation or immobilizes you with indecision, so make it as easy for yourself as you can. The important thing is to do something.

To counter depression you need to regain control of your life and a few successes, however small, will help you to feel effective. You will need whatever determination you can gather in order to make a start, but once you get into a routine and start to feel the benefits, motivation will follow. If you can do nothing else, go for a short walk, breathe deeply and slowly, emphasizing your exhalations, and look at your surroundings with open attention.

If you are not sure where to start, turn to ‘Key points to remember’ on page 161, glance down the list of tips and pick one action. Commit to it daily for a week and see what happens. The key points also offer a quick reference if you are having a dark day and need a tip to ease the pain. Look through the lists and choose something that is easy to implement in the present moment.

What I have written might seem very simple, in fact I hope it does. It might seem as though you know all this already — and you probably do, because deep down we know what we need. I want to refresh your memory and encourage you to commit to good practices that will give you back your life.

If you are supporting someone through depression, many of these suggestions, such as getting some exercise or healthy eating, can be implemented together and the tips are useful for a healthy life, whatever your circumstances.

When fog hides the blue sky, we know that the sky is still there, the fog will pass. Depression is like the fog and hope tells us there will be blue-sky days again.

You wake at four in the morning and stare into the darkness, thinking of all the things that are wrong with your life and the world. You feel certain that it has always been so and the times you thought otherwise you were fooling yourself.

Just as it starts to get light you doze off and when the alarm rings you surface with difficulty from a blank, unrefreshing sleep.

•Pull the blankets over your head and stay in bed until midday, when you get up, watch the soaps without remembering anything about them and forget to eat.

•Drag yourself out to face the day, put on a brave face at work and hope no one notices how often you go to the toilets to cry.

•Appear in the kitchen in your pyjamas, shout at the family and, when everyone is upset, throw on some clothes and storm off.

•Get up and drive around until the pub opens, then settle in to drink yourself numb.

You ask: What’s the matter with me? Is it just me?

This could be depression and, no, it’s not just you.

Depression is not something that happens to people who are weak or crazy. It is everywhere and it can affect anyone.

Scientists talk about a worldwide epidemic of depression. Often referred to as ‘the common cold of emotional problems’, depression is the subject of much study and concern. One in seven people will suffer from an episode of depression in their lifetime, and for women the rate is higher, up to one in five, although accurate figures are hard to establish due to variations in different cultures and age groups. Rates of depression are calculated by interviewing people from large random samples and establishing the level of their mood by using standard questions.

The reason for the gender difference in depression rates reported to such interviewers is not clear. Perhaps women are more ready to acknowledge feelings of hopelessness and self-criticism, while men mask their depression with other problems such as alcohol abuse and anger. Only about half of those who experience depression seek help, even though after an initial episode the chance of a recurrence is high.

The cost to society in terms of loss of productive work, damage to relationships and the effect on families is considerable. Depression is the leading cause of suicide, which is why it is so important to recognize and treat it promptly.

Let’s meet some people who have come to terms with depression. We will get to know them throughout the book as they make changes in order to manage their low mood and improve their lives.

I was brought up in a strict, religious family. We went to church every Sunday and had Bible study during the week. I was a timid child and I was sure that God was watching and finding fault with me all the time. My mother certainly was. She had a terrible temper and would beat my brother and me with a wooden paddle for the slightest offence. As well, she would say that we made God unhappy. I tried very hard but I could never please her. I loved my father, but he seemed scared of her too and didn’t stand up for us.

I was a nerdy teenager who wore dowdy clothes and wasn’t allowed to go to parties or dances. I had friends at school but because I couldn’t socialize with them after school they weren’t close friends.

When I left home to go to university I was a fish out of water. I had no idea how to mix with the other students, so I studied all the time. I think my first period of depression was caused by loneliness and overwork. I went to the Student Health doctor complaining of tiredness and she seemed to pick up that I was depressed, and she just advised me not to stay in bed and to have a routine for my study. I made a timetable that involved even more study, and I soldiered on.

Around that time I lost my faith and started drinking quite a lot. At first that helped a bit because I took time off from my books and I learnt to let my hair down. But the alcohol had a bad effect on me and some days I felt very black. In the end I seemed to get things into balance for myself. I finished my studies, though my grades weren’t as good as they might have been, and I got a job that I enjoyed. I made friends through work and had more free time, so things were good for a few years.

Then I met Dave. We went out for a couple of years, and we got married when I was 26. I was happy when I became pregnant with Josh but the birth was a difficult one, and looking back I think I was quite traumatized. I knew I loved Josh but I just couldn’t feel any pleasure in looking after him and I was so tired all the time.

It came to a head when I couldn’t face any of the chores around the house and I was often still in my pyjamas at three in the afternoon. I took care of Josh, but that was all I could do. Dave would come home and cook the evening meal and put the washing on. I’d be back in bed by eight o’clock, often crying myself to sleep.

I never felt as good as other boys, even my brother. Especially my brother. He was such a star — good grades at school, captain of the winning football team, and he went out with the most beautiful girl.

High school became a real pressure because teachers expected me to be like him. It got worse as my mates became really keen to find girls to date and talked a lot about who they liked and how to ask them out. It wasn’t so bad in my junior years but it did make me feel a dork not really having anything to say. I hung out for a while with the misfits but I hated the way they were so down on everyone, making really nasty comments and calling people ‘gay’ to put them down. I wondered what they said about me behind my back.

By Year 12 I worried a lot about what people thought of me, so I kept to myself. I started going to the library in the school breaks. After a while even the misfits stopped asking me to do things after school and nobody messaged me on the weekends, so I felt even worse.

My brother went to uni, so I was home on my own a lot for the last two years of school. Mum and Dad were working long hours and they went out together for bike rides and dinner on the weekends. They liked to have a drink, so there was quite a stash of alcohol in the kitchen cupboard. I picked a bottle of vodka because I could top it up with water and I had a few drinks when I was feeling down. It really helped. Soon I finished that one and used my pocket money to buy another one, and another one. I used my brother’s ID, so it was easy. I left a half-finished bottle of mainly water in the cupboard and kept mine in my desk drawer. I’d have to smuggle the empties out in my school bag and down the road to someone’s recycling bin on a Tuesday morning.

Funny, after a while the vodka didn’t help any more. In fact, it made me miserable. I’d drink a bit and sit on my bed, looking at Facebook where my ex-friends were having a great time and I admit I’d cry.

I went through a bad time when my parents split up when I was thirteen. I was angry with everyone and spent a lot of time in my room. My mum was sad all the time because it wasn’t her idea to split and my dad was tied up with his new girlfriend and her four-year-old son, so no one really noticed me.

One of my friends told me it helped to cut yourself. I found a craft knife in the drawer and tried it on the top of my arm where it wouldn’t show.

Somehow, when I was sad and hated my family for what they were doing, it helped to see the blood and afterwards I’d feel calm and kind of purified. Eventually my mother found out and she was horrified.

I had a pretty successful engineering business that I built up from my dad’s backyard operation. I worked long hours and probably didn’t see as much of the family as I should have, but I really enjoyed the work and I was happy with the way I grew the business. I hadn’t been university material or anything like that, but I had a knack and it went well.

My wife Sally was at me to slow down a bit and that seemed fair enough. Some of my mates had heart problems and they were only my age, so I saw it as a bit of a warning. When a bigger company made me an offer for the business I thought, why not? We could invest the money and live comfortably off it. The house was paid off, even the renovations, and we had new cars and the holiday house (which I hardly ever got to use) and the boat. I thought, Great, I’ll retire early, do some fishing, visit the kids and spend time with the grandchildren.

So I sold the business for a good price, and they kept me on for a week or so to train the new manager. Then one day I woke up and didn’t have to go to work. It was fine for the first week but then I started getting under Sally’s feet. I’d had no idea what a busy life she led. I thought she would be around for company, but it was Monday painting class, Tuesday coffee morning, Wednesday gym and so on. She let me come to the gym with her but the other things were her time.

I can’t say I even went through a stage of being bored. I just fell right into this black hole where I felt my life was over, no one needed me and somehow I’d got it all wrong. I started dwelling on all the things I wished I’d done differently. I wished I’d gone backpacking through South America. I thought of my first girlfriend and wondered whether I should have married her instead of Sally — I even looked her up online but I didn’t contact her. I spent my days mulling over regrets and started planning how to do away with myself so that it would look like an accident. I even went down to the holiday house and took the boat out. I thought I could just slip over the side, but I was too scared to do it.

Then I was on the phone to my daughter and burst into tears.

I always felt that my parents treated me differently from my brothers and sisters. It seemed that there was never enough to go round and it was always me who missed out. I was quiet and tried not to be a nuisance but it didn’t get me any better liked.

I went through life like that and was often the victim at work. I’d get dumped on and end up doing someone else’s job or I’d be bullied and criticized by the boss. I changed jobs a lot but it always seemed to happen. My first husband was a bully too, but I took the children and left him; he seemed to respect me more after that and we got on okay as we raised the children.

My second husband is lovely, very generous and sensitive, and I could tell right away that we were meant for each other. It was fine for a while, but he lost his job and got very down and somehow the two of us got more and more depressed together. I thought I had some kind of illness and I kept going back to my doctor for tests but nothing ever showed up.

Each of these people has come to experience depression in a different way: Laura has been overwhelmed by becoming a mother, Jackson is in the shadow of his successful older brother and is unsure of his identity, Josie feels abandoned because her parents have separated, Tom has lost his role in life through retiring and Kathy has a long-standing feeling of malaise. The next few chapters will throw some light on how these different experiences can lead to depression.

Everyone feels ‘down’ or miserable at times, especially in the face of disappointment or loss. It may be because a relationship breaks up, or when someone we care about dies or moves away. It may be that we didn’t get the job we hoped for or the situation we find ourselves in has become overwhelming and too hard to cope with. Most times, these feelings pass and we move on in some way. Gradually we take pleasure in the enjoyable aspects of our life again and the bad feelings fade.

However, if it’s impossible to shake off the feelings of gloom and misery, even when something good happens, this might be the beginning of depression. People talk about the world looking grey and colourless, about the long dark night of the soul, about a black cloud or a black dog. Feelings of despair, helplessness and lack of hope are part of it.

Both Josie and Tom experienced major losses, which triggered their depression. In Josie’s case the way in which her parents split up meant that she felt she had lost them both. Her mother was preoccupied with her grief and her father with his new family. Unable to get either of them to listen to how she felt, Josie resorted to non-verbal communication; cutting herself not only relieved the pain for a while, it became a message to her mother.

Tom never imagined that his retirement would feel like a loss. After all, he had done well, he chose the right time to sell the business and he had the fruits of his hard work — the holiday house, the boat — right there to enjoy. But when it came down to it, his view of himself as a worker and an achiever took a severe blow and he needed help to adjust to the change in his life. This is a case where something that is mainly a positive change can still be experienced as loss and can lead to depression. Loss of self-image is a particularly hard thing to adjust to.

For Laura and Kathy, their family backgrounds contributed to their tendency to experience depression. In Laura’s case, she found ways to cope with her emotions until the extra stresses and changes of having a baby triggered a full-blown postnatal depression. Kathy struggled with a long-term depression that seemed biological in nature and in spite of her best efforts was only lifted by medication.

As depression worsens, you might find it so hard to get motivated that even getting out of bed is a major effort. When you reach your limit, mind and body shut down and the simplest action becomes a major challenge.

Depression is not a sign of weakness. It is a common condition that can become serious. It can occur at any age and can be preceded by periods of anxiety and fear.

The good news is that depressive episodes can be treated, and even if they remain untreated most depressions are self-limiting; that is, they improve in time, usually in a matter of months.

With treatment, you can expect to make a full recovery. About half of those who have one episode of depression have another at some point in their lives, but often the second episode is recognized more quickly and help is found before it becomes too entrenched. By developing a good understanding of yourself and the particular triggers for depression that affect you, you can use a range of skills to lift yourself out of a down period before it becomes entrenched. With good self-care, depression can be prevented.

No one can give a full explanation of the causes of depression. There is no definitive test for it, such as a blood test or scan, but a familiar pattern does emerge, and there are four levels at which depression occurs.

•inability to make decisions

•slower thinking

•lack of concentration

•poor memory

•thoughts of death or suicide plans

•expecting the worst.

•lack of appetite or increased comfort eating leading to weight change

•sleep disturbances, especially waking early or sleeping too much

•loss of interest in sex

•lack of energy.

•feelings of sadness or emptiness

•feelings of hopelessness and despair

•feelings of worthlessness or guilt

•crying more than usual, or becoming too numb to cry

•loss of pleasure in the things that used to be enjoyable.

•avoidance — of other people, or of situations that might cause stress

•avoidance of formerly enjoyable activities

•passivity, lack of initiative or motivation

•loss of the usual range of behaviour in many areas of life.

Depression is identified first by its timeframe — has the depressed mood or loss of interest in the usual details of life lasted for at least two weeks and for most of each day? Secondly, there is a checklist of symptoms based on the pattern described above:

•depressed mood

•loss of interest and pleasure

•disturbance in appetite

•changes in sleep

•changes in activity level

•fatigue

•continual feelings of guilt

•difficulty in concentration

•thoughts or plans of suicide.

If five or more of these are present, depression is diagnosed. You can take a test online at cesd-r.com or www.depression.org.nz. These are only guidelines to give you an idea of where to start. If you have concerns, see your family doctor or another health professional to talk about your situation and get a more accurate diagnosis.