Depression and recovery, one year on

A green journal with a pen on top of it sitting next to a cup of tea on a wooden table

Morning journaling

Almost a year after my earlier post about my experience of depression in grad school, I wanted to discuss some of what I’ve learned about recovering from depression.  I expected that recovery would be nonlinear, with good days and bad, and that’s been accurate.  I also expected that at some point, I would pass an obvious milestone labeled “fully recovered,” and would go on feeling happy and engaged with the world without needing to consciously work towards that goal.  This doesn’t actually seem to be the way that recovery functions.  I’ve come to find that preventing relapses of depressive symptoms requires consistent and active work on my part, and I suspect that it always will.  I wanted to share this in case it might be useful for anyone else in a similar position.

The Half-Life of Depression

One thing that really surprised me during the earlier stages of my recovery was that even after I’d dealt with some of the underlying problems which were leaving me depressed, I would still have days when I felt inexplicably sad or unable to focus.  I suppose I’d assumed that I would bounce right back to my usual self once my stress levels had gone down.  However, I’ve noticed three ways in which the effects of depression can persist beyond an immediately stressful situation.

First, untreated depression changes your brain.  In the short run, it shrinks the hippocampus and makes it more difficult to form new memories, although these effects appear to be reversible once the depression improves.  In the long run, it increases inflammation in various parts of the brain, including the prefrontal cortex, which helps to govern executive function and reasoning skills.  I’ve found that while I can still produce high quality work, I can’t maintain intensive focus for quite as long, and I need to take breaks more consistently.

Second, depression can lead to shifts in your habits which require some effort to undo.  At my worst, I was ignoring my email, letting all the dishes go unwashed for days, and so forth because I couldn’t get out of bed.  I’ve had to consciously work to re-develop all my previous good habits of time management and organization.  This has also led to some interesting new challenges.  For example, if I’m consistently washing the dishes and keeping on top of my email, this helps me to focus on my other work.  If I let the dishes pile up a bit, however, I’ve found that this sets off an anxiety klaxon in my brain saying “Look at this mess!  You’re getting depressed again!  You’ll never recover!”  Over time I’ve learned to acknowledge that klaxon and then think about all the ways that I am recovering, rather panicking over it, but that was another totally new habit to develop.

Third, the process of recovering from depression might also bring up other mental health challenges that you hadn’t previously dealt with.  For me, a big part of my recovery was journaling about my emotions, and trying to figure out why I was feeling sad or stressed rather than just ignoring those feelings.  In the process, I realized that I’ve probably had a mild-to-moderate anxiety disorder for most of my life.  It’s ultimately been good to address this more openly, but at the time it felt like a big setback as I tried to reach my goal of Being Mentally Healthy, and led to a relapse of depressive symptoms for a while.  (As it turns out, most of the steps for dealing with depression also work on anxiety, at least for me.)

Rethinking Recovery and Productivity

The other thing that’s struck me about recovery is how much more sensitive my moods are to my general level of self-care.  If I’m getting enough sleep, exercise, and time to journal, then I can bounce back from stressful events pretty quickly.  If I’m not, stressful events can quickly lead me to feel depressed again.  I’ve come to think about self-care not as something indulgent, but as a process of investing in resilience.

This has required some fundamental shifts in how I think about my productivity.  There are strong narratives within American academia and American culture more broadly about how productivity can only be achieved at the expense of one’s physical and emotional health.  When I was younger, before my period of severe depression, I absolutely lived into this.  I was regularly overcommitting myself at school and at work, and skipping sleep and social events so that I could finish my projects.

In some ways, that mindset has been the biggest reason why I don’t think I’ll ever arrive at “fully recovered” — because my idea of what being fully recovered looks like is actually an unhealthy one.  I’ve held on to the perception that “recovery” means being able to work extremely long hours without ever having to take care of myself, and without suffering ill effects.  Uprooting this deeply held belief is still a work in progress for me.  In particular, I’ve had to really work to not compare my current rate of productivity to the unsustainably high rates I could produce in my teens and twenties.

One thing I’ve found helpful here is trying to focus more on process than on outputs.  If I get too focused on how soon I’m going to finish a report or an article, I end up falling back into unsustainable habits, like working late or skipping the gym.  I can do this for a few days, but I’ve found that I inevitably crash after that, and will then lose the next few days to another wave of depressive symptoms.  Conversely, when I prioritize meeting my standards for self-care, this leaves me feeling rested and focused for the rest of the day.  I’m trying to remind myself that working consistently is more sustainable in the long run than working intensely, if the latter pattern forces me to alternate between working intensely and not working at all.

Self-Care Suggestions

Here are the aspects of self-care which I’ve found most helpful during my recovery.  Everyone’s experience is different, and I don’t mean to claim that this is the royal road to mental health — simply things that have worked for me.  Also, I’ll note that I haven’t to deal with very inflexible work or caregiving responsibilities, which would definitely have made this more challenging.

  • Getting enough sleep.  I cut down on caffeine and stopped using an alarm clock if I didn’t have any early meetings, both of which help me to get the amount of sleep my body actually needs.  (The tea in the photo is caffeine free!)
  • Regular exercise.  Doing some moderate cardio every other day helps me to feel much more focused.  Being outside for a workout also seems to help, although if I’m working out indoors I’ll try to spend a bit of time outside at another point during the day.
  • Journaling.  If I wake up with something on my mind, I’ll write about it right away, so that I’m not worrying about it for the rest of the day.  I try to use the journal for immediate problem solving during the week (like “how should I handle this challenging conversation I’ve got coming up?”), and take time to write about bigger issues on the weekends.
  • Solving small problems right away.  If I notice a small issue that I need to resolve, I try to handle it promptly, so it’s not distracting me.  This seems trivial, but I’ve found that I otherwise get stuck in a cycle of being distracted, then blaming myself for being distracted about something small, then being even more distracted.  Something about the experience with depression means that I have a hard time snapping out of these cycles if I get into them, so I try to just avoid them.
  • No mind-reading.  Lots of people hesitate to bring up difficult topics with their partners or colleagues.  When I do this, I find that I often end up trying to guess at how the other person feels, or imagining worst-case scenarios for the conversation, and that’s a definite trigger for depressive symptoms for me.  Raising difficult topics directly and trying to resolve them helps me avoid that outcome.

Also, lots of other things haven’t worked for me!  Among them are giving up alcohol, cutting back on screen time, and meditating, none of which seemed to have any correlation with my mood.  I also haven’t tried any medication, although I’m open to that in the future if my current set of self-care practices no longer seems to be enough to keep depression at bay.  Recovery is definitely a trial and error process.

Here’s what academic departments, faculty, and graduate students can do to support mental health

Infographic reading Infographic via the Berkeley Science Review

Almost six months ago, I published a post on my experience with depression in academia.  I was really blown away by the thoughtful and supportive responses that I received from so many people both within and outside of the academy.  Since then, I’ve had a number of really good conversations about what departments, faculty, and grad students can do to better support students’ mental health.  Here are some of the suggestions that really stood out to me.

What everyone can do

The first step for staff, faculty, and students is to familiarize themselves with the facts about mental health on campus.  Nearly 40% of grad students across multiple countries say they’ve recently experienced moderate to severe depression.  However, with appropriate support, people facing mental health challenges can still do excellent research and finish their doctoral programs in a timely manner.  It’s important to challenge the narrative that grad students with mental health problems aren’t suited for academia, which is an ableist view that shuts a lot of smart people out from the system.

Second, check out the mental health resources that are available at your campus.  These may include counseling provided through your university health center; mental health advocacy groups; or online resources, like Berkeley’s free, downloadable guide on Promoting Student Mental Health.

Third, I can’t overemphasize how important it is to remove some of the stigma from mental health issues by discussing them openly.  Before and during the time I experienced depression, I knew very little about mental health on campus.  I thought I was the only person in my department who was struggling, and I was afraid to admit that things seemed to be going deeply wrong.  But once I began opening up to people about it, I found that a significant proportion of my PhD classmates had experienced similar issues, and had often significantly benefited from therapy or medication.  I might have pursued treatment much earlier if I’d had any idea how typical my experience was, and how many options were available to help me feel better.  Starting the conversation early, even if you and all the people you know seem to feel all right at the moment, is a really important step.

What departments can do

Departmental staff are already the unsung heroes of academia: the people who help you navigate your class schedule, submit your grant applications, and answer all your questions about graduate requirements.  They also have an important role to play in connecting students and faculty to mental health resources.

It’s really important to begin discussing mental health issues openly from the beginning of grad students’ careers.  Doing a module on common mental health challenges, and the resources available on campus, during orientation for new students would be a great way to start this conversation.  This information could also be shared with current students every year, since everyone could use the occasional reminder that mental health issues are normal and there are lots of ways to seek support.

If you find that you’re struggling with your mental health as a grad student, but you’re concerned about discussing this with your faculty advisor, you can reach out in confidentiality to the graduate student advisor on staff in your department.  They can help you connect to mental health resources on campus, change a challenging workload, or think through funding options if you need some time away from campus.

What faculty can do

One of the comments I got on my depression post aptly pointed out that graduate students aren’t the only people dealing with mental health problems.  The demanding teaching, research, and administrative responsibilities of academia — not to mention structural problems like racism and sexism — mean that faculty are also vulnerable to depression and anxiety.  I’ve since updated the earlier post to acknowledge this important point.  If you’re a faculty member concerned about your own mental health, definitely check out the suggestions for graduate students below.

The heavy workload of  a professor, not to mention the additional toll of family responsibilities and one’s own potential mental health challenges, may leave faculty feeling that they don’t have the time to follow up on students’ mental health.  However, there are some fairly quick things that faculty can do to support their students.

First, it’s useful for faculty to introduce mental health as an acceptable topic of discussion.  During a meeting with a new student, you could say something like this: “I know that grad school puts people under a lot of pressure, and many students end up dealing with challenges like depression or anxiety.  That’s pretty common, and doesn’t mean that you’re failing as a student.  If you’re ever feeling like that, you can always talk to me about it.  I can help you connect to other mental health resources around campus.”  Most students probably won’t take faculty up on this, but it’s important to let them know that if they do end up facing mental health challenges, they don’t need to fear being punished for discussing it.

Second, take the time to briefly check in with students about their work-life balance during the course of the academic year.  If you notice that a student seems to be struggling to complete their work or meet their deadlines, send them a quick email emphasizing that they’re not in trouble, and asking them if they’re doing all right or would like to talk.  Again, a faculty member’s role here isn’t to serve as a therapist.  But reaching out to them in this way and offering to connect them to other mental health resources on campus could be an easy way to encourage someone to seek the help they need.

Third, advocate for policies that reduce some of the structural stresses faced by graduate students.  Many of these are financial: you can ask your department to index stipends for inflation or the cost of housing, or ask them to pay out conference travel grants up front,  rather than requiring students to pay out of pocket and get reimbursed.  Other issues are related to discrimination: you can support the creation of working groups for women or people of color in the department, or encourage the department to name an equality chair who can support students and faculty who have faced discrimination.  Students who are less stressed about money or discrimination have more bandwidth to do excellent academic work.

What graduate students can do

Let’s say you’re a first year grad student.  You’re feeling excited about your proposed research idea, but also a bit overwhelmed by the amount of work you’ve got ahead of you.  What are some steps you can take to support your own mental health and that of your classmates during the years of study ahead?

Start by taking the time to do periodic check-ins with yourself about your mental health.  Almost everyone feels stressed by work and deadlines and career prospects at various points during grad school, and that’s not inherently problematic.  However, it is important to be aware of whether you’re feeling manageable stress, or whether you’re experiencing a more persistent mental health problem.

I’ve found that the most reliable way for me to figure out if I’m having a bad period of mental health is to look at patterns in my behavior.  If you look at how you feel, you might just brush it off: “I’m stressed and miserable, but everyone in my cohort sounds stressed and miserable about exams right now, so I shouldn’t complain about it.”  If you look at other circumstances in your life, things might seem all right: “I’m in a great program and have a nice place to live, and that means that I don’t have any reason to feel sad.”  But it’s harder to deny what’s happening if you’re looking at repeated patterns of behavior: “That’s the second time this week that I’ve skipped class because I couldn’t get out of bed.  I don’t remember myself acting like this before.”

You can use the same strategies to engage with your classmates about their mental health.  If you notice that someone is acting out of the ordinary — say, missing class or ignoring deadlines — it’s worth sending them a quick message about it.  You can note that you’ve seen a pattern of behavior that concerned you a bit, and ask if there’s anything they’re feeling stressed about, or would like to talk about.  Of course, your classmate may say that everything is fine.  But in my experience, it’s easy to brush off an email that says, “Hey, where were you in class today?”  It’s not so easy to ignore an email saying, “Hey, I’ve noticed that you’ve been away from class a lot this month and didn’t turn in that last paper.  Is everything all right?”   No student is responsible for someone else’s mental health, of course.  But it’s worth taking the time to check in on each other — you never know when it may give someone the opening that they need to start thinking seriously about their mental health.

If you do notice these types of patterns in your behavior or that of a classmate, that’s a good sign that you or the classmate might need additional support.  This could take a variety of forms.  Walking up to a counselor at the university health center and declaring that you feel depressed might feel liberating, or it might feel like it’s a bridge too far at first.  You don’t have to do this right away (or ever) if you don’t feel comfortable doing so.  A good place to start is simply by taking stock.  Talk with a friend, or write a journal entry, or do something else that lets you think about how you’ve been behaving recently.  What patterns do you notice?  Do they seem to be correlated with something else in your life, like financial stresses, or struggling in a class?

Sometimes you can figure out the proximate source of anxiety or depression on your own, and try to make the necessary changes in your life, like dropping a class.  For other issues, like financial challenges or systemic discrimination, you might not be able to solve the underlying problems by yourself.  Or you may feel that you’re miserable even though everything else seems fine.  Those are good moments to seek outside help.  Talk to a counselor at your health center, and tell them about the behavior changes that you’ve noticed.  It’s totally normal to admit to feeling confused and scared, and to feel like you don’t know what to do next.  Counselors are around to help you work through these feelings and figure out possible solutions.

If you’re concerned about the cost of therapy, even with insurance, there are several options you could pursue.  Many therapists will offer a sliding scale of fees for clients in financial distress.  If your university has a psychology department, you may be able to get free counseling provided by graduate students as part of their clinical experience.  This article has more suggestions for accessing therapy when you can’t afford to pay much.  Also, if you’re struggling to figure out what types of therapy your US insurance covers, which may feel opaque at the best of times and nearly impossible if you’re depressed, ask a friend or family member if they can support you in this.  You don’t have to do everything on your own.

If you are feeling depressed or anxious to the point where you have a difficult time carrying out daily responsibilities or meeting your professional obligations, you should seriously consider discussing this with your faculty advisor.  Advisors vary, of course, and not all of them will be supportive, so you will have to make this decision on your own.  But if the alternative is falling behind on your work with no explanation, that may also have lasting reputational costs.  In general, it’s better to be transparent about the fact that you’re facing health issues.  This is the #1 thing that I wish I had done differently when I was depressed.  Once I did speak with my advisor about my health after almost three years of serious depression, he responded with understanding and support, and worked with me to shift my dissertation project to something that I could complete given the constraints I was facing.

Depending on how seriously your mental health challenges are affecting your life, you may find it useful to take a medical leave of absence, so that you can pursue treatment and not have to worry about your work for a while. Talk to the graduate student advisor in your department about how this might work.  It may feel really hard to take this step, but mental health problems are real health problems, and there’s absolutely no shame about needing time away from work to deal with them.

The good news is that depression and anxiety aren’t permanent.  Therapy and antidepressants have both been shown to be effective at helping people cope with these issues.  I’ve found regular journaling to be incredibly useful.  Recovery does take time — anywhere from weeks to years, depending on your situation — but it’s absolutely possible to become more healthy and get yourself professionally back on track.

My experience with depression in academia

A painting that is almost entirely a deep turquoise blue, divided by a horizontal line of lighter blue in the middle

Mark Rothko, Untitled (Blue Divided by Blue)

And now for a post on a more personal matter.  I haven’t said much about this publicly, but for the last several years of my PhD studies, I’ve been dealing with a severe case of depression.  I missed major deadlines, failed in my teaching obligations, and thought seriously about dropping out at various points.  For most of that time, I didn’t really understand that I was ill, or that treatment was an option.  Once I did understand that and opened up about how I was feeling, I made enormous progress towards feeling happy and productive again.  I’d like to talk about this experience, and how some common narratives about academic success can make it particularly difficult for graduate students to identify when they’re depressed and get help.  Depression is a very common experience for graduate students, with nearly 40% of students in a number of countries reporting that they feel moderately to severely depressed.  If you’re reading this and it resonates with something in your experience, some treatment resources are discussed at the bottom of the post.  [ETA, 9 April 2019: I’ve since written two other posts about how to improve mental health support in academia, and what it feels like to recover from depression.  Do check those out as well.]

Depression from the Inside

Depression really caught me unawares.  Other members of my family have a history of depression, but I hadn’t been affected by it when I was young, so I always believed that I’d gotten lucky and wasn’t susceptible to this.  I never learned much about the importance of emotional health, and of being open with your feelings.  For most of my life, if I felt sad or stressed, the only coping mechanism I had was to ignore the problem and pretend that I was fine.  This worked well enough for a while.  However, by my late 20s I was facing a series of problems that were difficult to ignore, including a marriage to a lovely man which regardless wasn’t working out well, and some serious doubts about whether the PhD I had embarked upon was actually the right career path for me.  I felt trapped, and ashamed of admitting that I was unhappy, and I grew steadily more depressed over time.

I got through the first and second years of my PhD well enough.  By the third year, however, I was barely getting out of bed unless I had to go to class or teach — and sometimes not even then.  I hardly engaged with the class I was teaching second semester and cried in front of them more than once.  I started skipping my own classes and on-campus presentations that I really wanted to attend.  My committee had to reschedule my prospectus defense date after I missed the deadline for submitting the prospectus with no warning.  I scraped through the defense and went off to Ghana to start my dissertation research in my fourth year, only to spend most of my time there moored up in my room by myself.  It took me a solid year of this before I finally thought, I have to tell someone about how I’m feeling.  (I’ll write more about treatment and recovery below.)

In retrospect, it is unbelievably obvious that I had depression.  Any one of the incidents above would have been enough to signal that something was wrong; all of them together could not be any more clear.  So why didn’t I understand what was happening to me?  And why didn’t anyone else call me out on it either?

I spent that entire period blaming myself for being lazy and stupid.  I understood that I felt depressed, but I didn’t think I had depression, because that was something that happened to other people.  I thought that I just needed to work harder on ignoring my problems and forcing myself out of bed, even though it felt like someone had replaced all my bones with lead when I wasn’t looking.  I was also convinced that if I didn’t pretend that I was fine — if anyone realized I was struggling — they would judge me and dislike me and perhaps kick me out of the PhD for being an incompetent scholar, and then I would be both sad and unemployed, which would be even worse.  The idea of going to therapy never crossed my mind, because I thought you should only go to therapy if you had a real problem, and not if you were simply lazy and stupid.

I now know that this is one of the cognitive effects of depression.  It’s easy to end up in these spirals of negative thoughts.  It’s also very tempting to just try to ignore the underlying problems, because they’re always on your mind and you’re tired of thinking about them.  I so badly wanted to just snap my fingers and be all right, and I spent years thinking, “today is the day that I get my act together,” even though the same statement hadn’t worked on the previous day or week or month.

Depression in Academia

Academia can be an especially difficult place to contend with the idea that depression is your own fault.  I was struck by how my feelings of shame and guilt around depression were reinforced by narratives about the determinants of academic success in the American academy.  Throughout my time at in grad school, I received the message that success in the PhD was the product of intelligence and discipline.  If you weren’t doing well in the program, it was because you lacked those attributes, and consequently didn’t deserve other scholars’ time or attention.  There is little room in this narrative for the idea that mental health problems — or structural problems like racism or sexism — could also affect students’ work, for reasons unrelated to intelligence or effort.  Fortunately, there is now growing awareness that graduate students’ personal lives and mental health have an impact on their academic performance, but there remains a lot of work to be done to really dislodge these ideas.

This narrative of personal effort was communicated to me in various ways. For example, it was common to hear that people who left my program before they finished, because it wasn’t a good fit or because they wanted other employment, simply “couldn’t hack it.”  I thought seriously about dropping out at some points, but the idea of being known as someone who couldn’t hack it was horrifying.  When I started regularly missing classes and subfield colloquia, one senior professor commented that I was failing to signal my commitment to the department, and implied that I had been a bad investment for them, which made me feel even more panicked and depressed.  Later, when I had trouble finishing a prospectus draft, and eventually missed my defense date entirely, I got a number of comments from faculty about how I needed to stop flaking out on selecting a topic and just do the work — but no one ever asked if there was a reason that a previously high-performing student was now badly struggling. (To my classmates’ credit, several of them did ask if I was all right during this period.  I wasn’t in a position to give them an honest answer at the time, but it means a great deal to me now that they noticed and cared enough to ask.)

I don’t think any of these messages or actions were badly intended.  Some of them seemed to be born of a type of congratulatory self-regard among certain professors, who tend to emphasize the role of intelligence and effort in their own success, without always acknowledging the role of privilege and luck.  (And to be very clear, I’m a Berkeley student because of privilege and luck as well as hard work.) These ideas are also the product of a fairly decentralized PhD system in the social sciences in the US.  Students are responsible for selecting their own topics and keeping up their own progress.  Advisors are expected to support their students, but don’t tend to closely monitor their work, in part because faculty members are also generally overworked — and often have their own struggles with depression as well.  All of this meant that when depression hit, my own deep sense of shame about it was compounded by this academic narrative of personal effort, and no one was in a position to consistently observe that I was struggling and ask if I needed help.  That’s not unique to academia, but I do think it can be especially pronounced there.

Treatment and Recovery

I ended up climbing out of the well of depression with support from my family and friends.  After a full year of being miserable, I finally decided that telling people about how I was feeling couldn’t really be worse than what I was already feeling.  I went in concentric circles, starting with my partner, then my family, then close friends.  After much discussion with them, I made some decisions that helped me have more control over the underlying problems in my life.  My partner and I reevaluated whether our relationship was working, and ended up getting the world’s friendliest divorce.  I moved back to East Africa and launched the Mawazo Institute with a good friend, which put me back on track towards the type of career that I really wanted — research-focused, but not within academia.  I took my fifth PhD year off from dissertation work, mostly by accident as I was busy with the move and Mawazo, but also ended up finding that it was useful to have some time away from research in order to regain my enthusiasm for it.  I also started doing a lot of journaling to address some of my continuing mental health issues.  Even after I resolved some of the major problems that had been stressing me out, I still had a lot of negative thought patterns that I’d developed during years of depression, and journaling helped me to identify those and work to reduce them.

It’s now been about a year and a half since I began opening up about my experience of depression.  There have been many points when I felt that I was just complaining without feeling better, or when I did start to feel better, only to get totally knocked out when some new source of stress came up.  But the average trend of my feelings has been decidedly upwards, towards a place of much greater self-understanding and much less fear and shame.  Talking about my emotions has deepened many of my friendships, as I found that people tended to respond to my admissions about mental health not with derision, but by sharing stories about their own challenges.  It’s helped me to have a calmer, happier, and more trusting relationship with my current partner, knowing that I can now communicate openly about any problems that might arise.  It’s improved my performance at work, as it let me address some productivity issues which I hadn’t even realized were related to depression, like what used to be a horrible habit of procrastinating on email.  And it’s allowed me to feel curious about the world again, which, as someone who still hopes to finish her PhD research some day, is very reassuring!

All of this is to say, if any of this post resonates with you: there is nothing wrong with you.  Depression is such a normal experience, and there’s no shame in having it.  Trying to hide how you feel often seems tempting, but it’s usually only delaying an inevitable reckoning.  It can feel pretty vulnerable to open up about your feelings at first.  However, if you can do that with a friend or a therapist who will support you — or with a journal, or in prayer, or in some other way if you’d rather do it privately — then there’s a high likelihood that you’ll start to feel better.  There’s some really interesting research about how identifying your emotions actually reduces the activation of your amygdala (which is one of the places the brain processes fear) and helps people feel better when confronted with stressful situations.  Simply talking about your feelings can help you to feel calmer and more in control of your life, even if it doesn’t immediately fix an underlying problem.

There are a number of different approaches to treating depression.  You might try several of them, alone or in combination, before you figure out what’s most useful for you.  For me, journaling has been incredibly effective.  I’ve had to invest a lot of time in it — anywhere from 10 minutes to several hours per day, over many months — but it’s ultimately helped me develop a great deal of insight into my own feelings, and identify solutions to a range of problems.  Here are some tips on how to get started with journaling.  Speaking to a therapist has also been shown to be highly effective at reducing depression in many people.  I didn’t do this last year because I was traveling a great deal at the time, but I know many of my friends have found therapy very useful.  The American Psychological Association has a good overview of what to expect from therapy, and why some common myths about therapy aren’t true. Medication is also an option, and you can work with a psychiatrist to figure out if it seems helpful for you.  Here’s a useful overview of antidepressants.  There’s no shame in using medication to treat depression, and there’s also nothing wrong with deciding that you’d rather not use medication.  It’s really important to pay attention to your own experience and preferences when you’re seeking treatment.  It can feel really difficult to find the energy for this when you’re already depressed, but I promise it’s worth the effort.