Overcoming Unexplained Depression: Practical Strategies Beyond Medication

I find it strange that I'm experiencing such feelings of depression and low mood. What methods can help break this cycle?

Hello Dr.
Ding,
I used to be a very happy and sunny person, always enthusiastic and positive about most things.
People often referred to me as a "happy pill" because I brought joy to others.
However, I now find myself trapped in an uncontrollable cycle of low mood and depression, lacking enthusiasm for many things, and feeling more pessimistic and negative—completely opposite to my former optimistic self.
Here's how my story unfolded...
In April of this year, I traveled abroad to spread the gospel as I am a Christian.
On the last three days of my trip, I began experiencing sleep issues.
I woke up very early on the first day and couldn't fall back asleep.
This continued for two more nights, making it difficult for me to sleep.
I had always been a good sleeper with a regular routine and enjoyed participating in church activities, so this sleep disturbance made me anxious.
I had never experienced insomnia before and felt something was wrong with me.
I researched insomnia online and learned that it could be caused by various factors, including depression.
I found it hard to believe that someone as happy as I was could develop depression and insomnia.
But why was I experiencing insomnia?
On the day I flew back to Taiwan, I was exhausted and managed to sleep well that night, thinking I had recovered.
The first week back, my sleep was normal, but after a week, insomnia returned, this time more persistently.
It worsened over time, and I desperately wanted to resolve my sleep issues.
I researched more and found that some people become anxious about their insomnia, which exacerbates the problem.
I wondered if I was one of those people.
I consulted many doctors, including traditional Chinese medicine, family medicine, psychosomatic medicine, and psychiatry, seeking solutions, but nothing seemed to work.
During April, May, and June, I struggled with poor sleep and low mood, and my daily routine became irregular.
Although my physical health was fine (I had a health check-up), I found myself eating more to alleviate my worries and anxiety, and I struggled to make choices.
I began to suspect I might be developing depression, but I couldn't identify any specific reasons or pressures that would lead me to that conclusion.
My trip abroad didn't involve any significant stress that could cause insomnia or depression, which felt strange to me.
I thought it was unusual for someone like me to experience insomnia.
I knew I shouldn't dwell on it or overthink, and that I would gradually feel better, but it seemed impossible.
I felt I should be happy, yet I couldn't understand why I had changed so much.
I even felt it was unfair.
My enthusiasm for church activities diminished, but I was grateful for my brothers and sisters who prayed for me.
After graduating from university, which wasn't a joyful experience, I regretted my decision to attend a summer church event in the U.S.
I already had sleep issues, and the time difference further disrupted my sleep.
During the two weeks in the U.S., my mood fluctuated, and I often felt dissatisfied, regretting the memories of April, May, and June, which I wished to forget but couldn't escape.
In late July, I moved to Taipei for graduate school.
After arriving, my sleep improved significantly, and I could sleep through the night.
I was thankful to Jesus that my insomnia seemed to have resolved, but since April, I could no longer take naps or sleep at my desk.
I found this odd, but my mood still hadn't improved.
I felt stuck and lacked interest in many things.
In August, I started attending classes, and my research advisor required us to enroll in a month-long summer course.
I felt a lack of interest and motivation compared to before.
I used to be serious about learning new things, but now I struggled to concentrate and felt inferior to others.
My motivation to write reports diminished, and I didn't want to do it.
These feelings were beyond my control, and I noticed I was becoming quieter and less inclined to engage in conversations, worrying about not having topics to discuss.
I didn't want to be this way; I wanted to return to my former enthusiastic self.
I initially thought everything would end, but my mood has not improved, and I still feel somewhat down and frustrated.
I began to question my interest in graduate school and whether I would be able to continue, as my aspirations were never very clear.
When asked about my passions and interests, I couldn't provide an answer.
I used to be able to do anything, and whether I was interested didn't matter much, but now I feel low and stuck in a cycle of self-doubt.
I started to genuinely ponder what I am best suited for and wished I could find my passion.
A sister from my church, who works in counseling, had me take the Beck Depression Inventory.
I took it seriously, and the results indicated I had moderate depression.
This led me to question myself again, wondering if I still had tendencies toward anxiety or if I was merely exploring my aspirations.
This line of thought kept me awake one night on August 27.
I decided to accept the situation and seek treatment.
If depression could be treated like a cold, I would go see a doctor.
I visited a psychosomatic clinic near my residence, where the doctor was very kind and listened to my situation.
The doctor prescribed MOCALM S.C.
TA for seven days, once a day.
I felt it improved my condition significantly.
However, I wondered if I could rely on this medication just to maintain a good mood.
The doctor mentioned that I might have an imbalance in neurotransmitters in my brain, but I questioned whether my body couldn't adjust itself.
Is there a mechanism in place to improve this through lifestyle changes? If medication can help, how long should I take MOCALM S.C.? Will I become dependent on it? What are the long-term effects of taking it?
Today, I finished my medication.
Should I see the doctor again? Should I continue taking this medication? It has helped a lot! But if a person is trapped in a cycle of low mood and frequent irritability, thinking about issues they never considered before, and feeling somewhat negative, can this cycle only be improved through medication? I don't want to remain in this negative cycle.
Are there practical methods to help myself without relying on medication? Are there other effective or more practical approaches besides medication?
I know my story is lengthy and lacks significant turmoil or events, which may seem unreasonable.
I apologize for that, but I feel helpless about my sudden change and sometimes truly don't want to feel this way.
It is quite painful and exhausting.
I believe I have the potential to return to my original self, but I don't know what methods I can use to gradually adjust.
Will it be okay to continue living each day like this? If you have patiently read through this, I sincerely thank you.
Thank you, Dr.
Ding.

Niming, 20~29 year old female. Ask Date: 2015/09/04

Dr. Ding Shuyan reply Psychiatry

Hello, there are indeed some cases of depression that seem unrelated to life stressors, which are more associated with inherent factors.
In such situations, I would recommend medication treatment.
Non-pharmacological treatments, such as psychotherapy, can still play a role in alleviating the impact of depressive symptoms on daily life, but relying solely on these therapies without medication may yield limited results.

If you reflect on your experiences before and after the onset of depressive symptoms, you will find that the concerns you have after experiencing depression are almost entirely related to the symptoms themselves.
To be more specific, you are worried about how you have changed and become worse than before.
This is a reality, as depressive symptoms can affect our abilities in various aspects, rather than improving them.
Therefore, it is a normal reaction to be concerned about what is happening to you.
However, these worries do not truly resolve the issue, as the depressive symptoms and the decline in your condition do not stem from external factors (in your case).
Thus, the enemy we need to confront is not external; we cannot pinpoint a manageable cause for all of this.
Yet, human instinct compels us to search for answers within ourselves.
Clearly, something is not right, and we turn our attention inward, ruminating on why this is happening.
This compulsive introspection only reinforces a negative self-image, worsening our mood, and then we desperately ponder why we haven't improved and have instead gotten worse, creating a vicious cycle that spirals down into emotional despair.
My suggestion is this: if there are external problems, face them courageously.
However, do not treat the internal depressive emotions as a problem to be despised and quickly resolved.
We should approach depression as we would a cold, patiently waiting for symptoms like coughing, fever, and sneezing to improve, without blaming ourselves for not being able to do this or that because of the cold.
Accept that depressive symptoms are temporarily with us, but shift your focus to the daily activities that need to be done outside.

If conditions are poor and performance is lacking, there is no need to be harsh on yourself; it is simply a result of being unwell.
Depression will eventually improve, and at that time, we will naturally return to our original state.

Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2015/09/04

More Info

Overcoming unexplained depression can be a challenging journey, especially when it feels like you’ve lost touch with the joyful and optimistic person you once were. Your experience of sudden changes in mood and sleep patterns, particularly after a seemingly positive experience abroad, is not uncommon. It’s important to recognize that depression can manifest without a clear trigger, and it can be exacerbated by stressors that may not seem significant at first glance.

Firstly, it’s crucial to understand that depression is often linked to biochemical changes in the brain, particularly involving neurotransmitters like serotonin and dopamine. These changes can occur due to various factors, including stress, lifestyle changes, or even a lack of sleep, which you have experienced. Your initial insomnia may have triggered a cycle of anxiety and depression, leading to a further decline in your mood and motivation.

While medication can be an effective part of treatment, it’s not the only solution. Here are some practical strategies you can consider to help manage your depression beyond medication:
1. Establish a Routine: Creating a daily schedule can provide structure and a sense of normalcy. Try to wake up and go to bed at the same time each day, even on weekends. Incorporate regular meal times and set aside time for activities you enjoy, even if they feel less appealing right now.

2. Physical Activity: Exercise is a powerful tool against depression. It releases endorphins, which can improve your mood. Aim for at least 30 minutes of moderate exercise most days of the week. This could be a brisk walk, yoga, or any activity that gets your heart rate up.

3. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or yoga can help reduce anxiety and improve your mood. Mindfulness encourages you to focus on the present moment, which can help break the cycle of negative thoughts.

4. Social Support: Stay connected with friends and family. Share your feelings with those you trust. Sometimes, just talking about what you’re going through can provide relief. Consider joining support groups, either in-person or online, where you can connect with others who understand what you’re experiencing.

5. Limit Stressors: Identify sources of stress in your life and see if there are ways to reduce or manage them. This might involve setting boundaries, saying no to additional responsibilities, or seeking help with tasks that feel overwhelming.

6. Healthy Lifestyle Choices: Pay attention to your diet, sleep, and substance use. Eating a balanced diet, avoiding excessive alcohol and caffeine, and ensuring you get enough sleep can all contribute to better mental health.

7. Professional Help: Continue to seek support from mental health professionals. Therapy, particularly cognitive-behavioral therapy (CBT), can be very effective for depression. A therapist can help you develop coping strategies and work through the underlying issues contributing to your feelings.

8. Journaling: Writing down your thoughts and feelings can be a therapeutic way to process what you’re experiencing. It can also help you identify patterns in your mood and triggers for your depression.

9. Set Small Goals: When motivation is low, setting small, achievable goals can help you regain a sense of accomplishment. Celebrate these small victories, no matter how minor they may seem.

10. Explore New Interests: Sometimes, engaging in new activities or hobbies can reignite your passion for life. This could be anything from taking a class, volunteering, or exploring creative outlets like art or music.

It’s understandable to feel frustrated and confused about your current state, especially when you’ve always been a positive person. Remember that healing takes time, and it’s okay to seek help and take small steps toward recovery. You are not alone in this journey, and with the right support and strategies, you can find your way back to a more balanced and joyful life.

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