Almost Depressed: Is My (or My Loved One s) Unhappiness a Problem

by Jefferson Prince, Shelley Carson

We all experience unhappiness—but for some, sadness, stress, and negative thoughts can become a regular part of our lives, no matter how good things may be going. There is a place between basic sadness and diagnosed clinical depression called almost depression.

Through engaging stories along with their professional experience, Jefferson B. Prince, MD, and Shelly Carson, PhD, outline the symptoms of depression, the role that stress plays in depression, as well as many of the physical conditions that can mimic depression. Then, based on the latest clinical research, they offer step-by-step guidance for making positive changes to help alleviate and reverse almost depression. Through this insightful and informative book, you There are many pathways that can lead you out of almost depression toward brighter days ahead. Almost Depressed will show you the way.

Genres: Nonfiction

320 pages, Paperback

First published October 1, 2013

Reviews

[Gwen · Rating 4 out of 5]

If you have to ask, you probably already know…

This book provides an excellent, thorough understanding of what it's like to be almost depressed: being in that strange gray area between "normal" and clinical depression. The authors have helpful self-understanding quizzes that are able to pinpoint your concerns and priorities; they then spend the majority of the book detailing the 4 major methods of coping: behavioral, psychological, social, and biological.

Behavioral Coping
I feel like a textbook example of the behavioral deactivation spiral (84): physical inactivity → social isolation → decreased motivation → physical inactivity → social isolation → decreased motivation → almost depression. (As I write this, I *know* that I *should* be doing yoga or going for a run, but then that's negative thinking [that I'm not doing what needs to be done] and just fuels the inactivity…)

I appreciate how the authors discuss the importance of the "Pleasurable Activities List": a friend of mine recommended this tactic when they were going through some rough times, and it seems to be a good option, especially options that involve physical activity. I like how the authors note that you might not be able to think of anything you *currently* enjoy doing--and that's okay. "Remember that one of the signs of depression-spectrum disturbances is anhedonia, the loss of pleasure in activities. One way to get around this block is to think of activities that you used to enjoy." (95) The pleasurable activities list--and then actually doing said activities--is a process.

Related to the pleasure activities list is identifying activities associated with worthy aspirations and goals. This is where I loved the authors: they note, "But there is a problem here. What if you don't have any goals and can't conceive of anything that would make your life more meaningful? The fact is that when you're depressed (or almost depressed) it may seem that nothing much has meaning. And if nothing seems worthwhile, how will you even go about setting goals that will help you feel better and make your life seem worthwhile? It's sort of a catch-22." (103) Specific, attainable goals are the most important, and even making slow progress toward a goal means you are less likely to experience negative feelings.

I liked the graphic on "The Stress Sequence" (131): stressor → appraisal (perceived inability to handle stressor) → stress response (cortisol, tense, on edge) → negative feelings. This was a simple but very clear explanation of the process, and it was nice to see the steps all lined up...in hopes that I can use the known process to change my appraisal or stress response, so that I don't have the same negative feelings resulting from the stressor. Later, the authors augment the graphic with exactly this: how to cope with the stressor (135). Coping with the first two elements (stressor and appraisal) means problem-focused coping, or directly coping with the stressor. This can be done through planning (ie, anticipating the stressor and making plans to mitigate it) and positive reframing. Coping with the second two elements (stress response and negative feelings) involves emotion-focused coping, or reducing the negative emotions associated with the stressor. You can do this through meditation or exercise. [Negative emotion-focused coping for the negative feelings could be denial or substance abuse…]

The authors share a nine-step process for dealing with stressors (137-141):
1. Recognize the signs of stress
2. Define the problem
3. Set a goal
4. Brainstorm possible ways to meet your goal
5. Evaluate possible solutions
6. Choose the best solution based on pros and cons: focus on the solution with the least cons, not the one with the most pros (140)
7. Make a plan to implement the solution and try it
8. Assess success
9. If the first solution didn't work, try another

Psychological Coping
It took me some time to appreciate this section. There was a lot about meditation, reframing thoughts, and discussion about shame that entered Brene Brown territory. (I dislike Brene Brown and find her work trite.) But the section redeemed itself the more I read.

The authors tease out the differences between "shame" and "guilt," a helpful distinction. "Guilt says, 'You made a mistake' whereas shame says, 'You are a mistake.'" (194) Shame is more closely linked to depression than guilt. Perfectionism, especially neurotic perfectionism, is related to shame: "by aspiring to meet impossible standards, neurotic perfectionists set themselves up to fail and to experience shame and feelings of worthlessness" (195).

A beautiful section on how shame can be unlearned:

If shame is part of your depressive profile, you likely feel dominated by your "inner critic," the internalized voice of those experiences that taught you to feel unworthy. If you have perfectionistic tendencies, this is the voice that punishes you for not meeting unrealistic standards and goals. Your inner critic may have gained strength over time. Because shame tends to generalize or spread, you may be devoting a large percentage of your time and resources to making sure you do not do anything that will cause further shame. You may try to avoid more and more actions that might cause shame. However, avoiding action actually leads to more areas of perceived incompetence that can strengthen your inner critic's message that you are "not enough." (196-197)

I learned about the common cognitive distortions associated with depression, like all-or-nothing thinking, overgeneralization, exaggeration, and "should" thinking. I have started recognizing these distortions with my thoughts, and it's been nice to put a name to the directions my brain went--and then how to manage once I had those thoughts. Appendix C, "Negative Thinking Patterns Associated with Depression," had more information on this, and it included more examples, like mind-reading, minimization, and emotional reasoning. This appendix (a longer version than included on page 9 here) was incredibly helpful and provided a good understanding of how your mind can react--and solutions for mitigating these thoughts. I wish the authors would have included a bit on hypervigilance, which seems to be where my mind goes a lot at work...

Social Coping
The authors are brilliant here, sharing good coping mechanisms for when you need to be social but you just can't. "Despite all the evidence pointing to the importance of social support during a depressed state, people who are depressed often begin withdrawing from friends and family or they act in ways that are off-putting to others. In effect, depressed people often undermine the very social support that they desperately need." (229)

The authors explain the "interactional model" of depression: "Initially, the depressed person elicits sympathy and concern from others. After all, no one wants to see a friend or family member feeling distressed. However, the depressed person simultaneously rebuffs the concerned efforts of others with continually seeking more reassurance from them. Eventually, others tire of offering reassurance only to have it refused. They become irritated with, or begin to avoid, the depressed person. Either way, the depressed person feels rejected and sinks further into the downward cycle of depression." (230-231)

The authors share the need to practice social skills, especially if you've not been around people for some time. And it's okay that you don't always 100% succeed. Being social (again) is a learned skill, and you can work towards improvement. It won't be like flipping a lightswitch, and skills with come with practice and time.

Biological Coping
Much like Scott Adams' emphasis on eating right and getting good sleep, the authors place similar importance on these factors. And they're right! As hard as it might be, especially if you're not in the mood to eat properly or get good sleep, those really do help.

They also explain the role/place of medication, supplements, or anti-depressants. [Talk with your doctor, of course.] They also suggest light therapy as a possible aid.

They close with the importance of increasing positive emotion: how you can flourish after being almost depressed. Being grateful. Forgiveness (of yourself and others). Savor joy. (It's okay to be happy!)

********
This was an excellent book, and I'm so thrilled that my library had a copy. Dealing with a toxic job for years had warped my thinking and sense of self-worth enough to make me seek out this book. After finally leaving that job, I was able to take some time to implement the authors' strategy: eating better, exercising more, doing more creative activities (gardening, dancing, cooking, sewing), traveling to see family, being more social (rough as it was at first...), reframing my thoughts away from neurotic perfectionism (tendencies only strengthened by a boss that wouldn't take anything less than 100% perfection...), and focusing on coping techniques. I hope that my reading of this book will help me succeed in my new job and create a roadmap for dealing with these issues, should they crop up again.

[Marcia · Rating 5 out of 5]

I thought this book was an a very helpful and informative book. I read about it in an article and I was intrigued by the premise. It was written to help people that are "almost depressed" or know someone who they feel might fit the category. There were many concrete ways to help yourself or to help others. I do not find myself a depressed person, yet some of the chapters really taught me to think about some things that I could do to help me look at some situations in a more positive light. And, how by doing so, it helps one's general happiness improve. I like reading non-fiction books. Out of those I have read on various topics, I found this one very easy to read and understand and could see where someone could really benefit from reading this book.

[Kristi Staub Radach · Rating 5 out of 5]

Incredibly easy to read, nice font and stories for emphasis. As a nurse, I understood a lot of the medical jargon but still kind of skimmed over some of that. Very practical exercises that are evidenced based and easy to incorporate into daily practice. Please read!

[Mouna · Rating 3 out of 5]

It's informative but a bit repetitive at times and too many examples. You need to take your time reading it.