My Depression Is Getting Worse: 6 Ways to Manage

If You Need Immediate Help

If you have feelings of hopelessness or despair that need attention right now, there are resources to help you. The Suicide and Crisis Lifeline is a 24/7 resource reachable by call or text at 988. If you are a young LGBTQ+ individual in a mental health crisis, you can call The Trevor Project at 1-866-488-7386 or text at 678-678.

If someone you love is in a mental health crisis, you have the option to call 911 and ask for a crisis intervention trained officer. This may or may not be available in your area, but you can advocate for yourself and others by asking.

Recognizing the Signs of Worsening Depression

Depression can present with mild, moderate, or severe symptoms. Recognizing signs your depression is getting worse can prevent a mental health crisis from developing. If you have recurrent depressive episodes, it can be helpful to make a list of your common depression symptoms and what makes your depression worse. You can share the list with loved ones and your treatment team.

Here are common symptoms and signs of worsening depression:

• Intense feelings of worthlessness or shame
• Feelings of emotional numbness
• Significant changes in appetite or weight loss/gain
• New or increased feelings of disconnection or dissociation
• Increased agitation with those around you
• New or worsening thoughts about suicide, death, or dying
• No hope that your situation will get better

Potential Causes of Worsening Depression

Depression can worsen with biological or environmental triggers. Understanding how your depression typically presents and the triggers for worsening depression can help you prevent a mental health crisis. Sometimes, these causes can be prevented or managed, which is why it is important to stay knowledgeable about what makes your depression worse and inform your loved ones and treatment team of any changes.

Potential triggers and causes for depression getting worse include:

Life Stressors

Stress can trigger episodes of depression because it presents a negative environment for symptoms to thrive.¹ Life stressors like financial difficulties, relationship problems, or job loss can cause worsening depression.¹ For example, single moms can be prone to depression because they may have less money, a lack of resources, and a lack of education, which prevents them from securing food and housing.

Chronic stress and depression have a bidirectional relationship, meaning that the two phenomena may exacerbate experiences.¹ For example, someone who is of lower socioeconomic status losing their job may trigger an episode of depression, but the depression may cause an inability to feel motivated to get a new job.

Changes in Medication

When making alterations to psychiatric medications, you can experience new or worsening mood changes. Since antidepressants work directly to affect the brain, any changes should be made under the guidance of your prescribing provider. Report any worsening side effects, such as new irritability, physical symptoms, or increased sad or anxious thinking patterns.

Underlying Health Conditions

Chronic pain can make a person’s depression worsen, and illnesses such as cancer or Parkinson’s can cause or worsen depressive episodes. The overlap between medical diseases and depression rates is as high as 53%.² In these instances, depression may be a reaction to the highly stressful symptoms of medical conditions.¹

Hormone Changes

Hormonal imbalances can also play a role in the development of major depressive disorder.¹ Menopause and postpartum depression are two examples of triggers for depression, which are caused by dramatically fluctuating hormone levels.¹ Since hormones play a part in mood regulation, these changes can trigger or worsen depressive symptoms.

Recent Trauma

Trauma increases the risk of development of depression.³ Individuals with trauma-related depression may have prolonged episodes and difficulty in success with antidepressants.³ Trauma can worsen depression through the person’s negative views of themselves and others, increased feelings of helplessness or hopelessness, or even heightened agitation.

Early exposure to childhood traumatic events, in particular, has links to the development of depressive episodes later in life.¹ Some evidence supports depressive episodes happening after a loss occurs, such as the loss of a relationship or sense of self.¹ These traumatic losses may hold particular significance for women and immigrant or refugee populations.¹

Substance Use & Addiction

Drug use and alcoholism frequently occur alongside depression.¹ Sometimes, the use of substances causes episodes of depression, and other times, depression causes the individual to use substances.¹ Regardless, recreational substance use, including drugs and alcohol, can exacerbate depression symptoms. Substances can cause dramatic shifts in mood, uncomfortable physical sensations, or unstable thinking patterns that can all worsen depression symptoms.

Habits That Can Make Depression Worse

Lifestyle factors can impact depression in positive or negative ways. Things that make depression worse can range from lack of sleep hygiene, poor diet, choosing the use of substances to cope, or isolation from others. Building an awareness of habits that can negatively impact your depression can help you understand warning signs and avoid pitfalls in your mental health.

Habits that can make depression worse include:

• Excessive alcohol consumption: Alcohol is a depressant, meaning that it slows down brain and body functioning. This can worsen symptoms of depression when your cognitions and physicality are already at limited capacity.
• Poor dietary choices: Lack of adequate nutrition can impact how your body and brain are functioning. Since depression can also affect appetite, sometimes this can cause issues with restricting or binging foods. Mood changes can also spur cravings for junk or processed foods that don’t give your body the nutrients it needs to help stabilize energy levels, and some foods can cause depression.
• Lack of physical activity: Depression can affect motivation and cause fatigue, so movement may be the last thing on your mind. However, it’s important to find a form of movement you enjoy, or at least tolerate, to get some physical activity.
• Sleep disturbances: Depression can cause sleep disturbances, such as sleeping too much or too little. Lack of sleep hygiene, like sleeping in a bad environment or not having a sleep routine, can also cause sleep disruptions.
• Isolation: Depression can cause you to feel like you want to isolate yourself, but this can worsen symptoms of loneliness. Feeling alone can spur episodes of rumination that will worsen negative thinking patterns.
• Over-working: Some people with depression use over-working to avoid painful symptoms like feelings of helplessness or hopelessness. Although avoidance will work in the short term, in the long term, this type of coping strategy will strain the mind and body to the point of exhaustion and make symptoms worse.

How to Stop Depression From Getting Worse

If you’re not sure why your depression is getting worse it can be difficult to know where to begin. You might wonder what is keeping your depression from getting better and feel very stuck in treatment. Always consult with your treatment team to understand what strategies might be helpful for you. These general tips are areas of exploration to help you find a pathway to remission.

Here are six strategies that can stop your depression from getting worse:

1. Talk to a Therapist or Counselor

Connecting with a therapist or counselor can prevent your symptoms from worsening and help you learn to recognize signs of any future depressive episodes. Some individuals find relief from depression symptoms with medication or psychotherapy alone, whereas others might require a combination of treatments. Since the risk of experiencing recurrent depression increases with each new depressive episode, seeking treatment early is necessary.³

Cognitive behavior therapy for depression is one of the most common evidence-based therapies.⁴ This therapy focuses on helping the individual understand the interconnection between thoughts, emotions, and behaviors. Through therapy, they learn to reframe negative thinking patterns to develop more adaptive emotions and behaviors.

Here are some questions a mental health professional may ask:

• How long have you had more severe symptoms?
• Do you notice anything that makes symptoms worse?
• What about anything that makes symptoms better?
• Did anything significant happen around the time you started to experience symptoms?
• Does anyone in your family have a history of depression or mental illness?

Establishing a treatment team can be a life-changing intervention for recurrent depression. You can talk to your insurance about therapy coverage or use an online therapist directory or online therapy for depression platform to find a therapist. Most therapists will offer a free initial consultation, so speaking with multiple professionals to determine who might be a good fit for your needs can help you find someone you feel comfortable receiving treatment from.

2. Consider (or Reconsider) Medication

If you notice signs of depression worsening, medication management through antidepressants may be an option. If you already take medication, you can meet with your psychiatrist to reconsider your choices. It is important to discuss potential benefits, side effects, and concerns with your treatment team when starting any new medications. Keeping a daily diary or using an app like the Bearable app can be a helpful way to track mood, depression symptoms,  and side effects.

If you are looking to begin taking antidepressants, you can find a psychiatrist to help with your medication management. Depression can be effectively managed through combination therapy of medication and psychotherapy. Sometimes, online psychiatrist options can be helpful if your location, times available, or mobility is an issue.

3. Implement Lifestyle Changes

Good habits are lifestyle changes that can help you prevent or mitigate depressive episodes. Feeling like your depression is getting worse can make you feel stuck and stagnant. Lack of motivation and feelings of worthlessness may keep you from establishing and keeping a routine. If you are struggling with implementing lifestyle changes, a therapist can help you find and manage a structured daily routine that works for you.

Here are some self-care strategies for depression that can help keep it from getting worse:

• Regular exercise: Movement builds an important mind-body connection that may be lacking during a depressive episode. Finding a form of movement that feels good for your body is not only psychologically soothing, but it physically releases endorphins that promote feelings of wellness. Research has long agreed that exercise can help with depression.⁵
• A balanced diet: Research has supported how a healthy diet can help with depression by affecting glycemia and immune activation.⁶ Traditionally, a Mediterranean diet has been associated with improved mental health.⁶ It is important, however, to find foods that feel good in your body, honor your taste preferences, and feel sustainable.
• Sufficient sleep: Good sleep hygiene is important for regulating mood, improving concentration, and consolidating memories. Developing a sleep routine that pays attention to your nightly habits and sleep environment can help you stabilize your rest.
• Daily meditation: Research has supported meditation, which is targeted to decreasing worry and rumination and is helpful in preventing depressive episodes.⁷ Mindfulness is a lifestyle choice of attuning to the present moment, and meditation for depression is just one way to practice it, which has beneficial effects on the quality of life. Mindful practice can be as simple as paying attention to the physical sensations of brushing your teeth in the morning or eating a meal with mindful intentions.

4. Build a Support System

Humans are relational creatures who have a primal need to feel supported by those around us. Depression may make you feel the need to isolate yourself. The nature of the disease can keep you from feeling connected to the world around you, but there are strategies to help. If it feels like too much to meet with people in person, you can try online support groups, such as Grouport.

Here are some examples of how to reach out to loved ones for emotional support:

• Commit to a weekly morning coffee date with a friend
• Ask your partner if you can have a weekly check-in about your mental health
• Dedicate one weekend day as a family day, where you focus on building supportive relationships with family members
• Ask a trusted colleague at work if you can check in with each other about work stress and the impacts it may have on mental health
• Find a group of friends who are committed to supporting one another’s mental health and host a monthly group Zoom

5. Find a Purpose & Stick With It

Depression often negatively affects a person’s sense of purpose in life. Meaning in life can come from religion or spirituality, work or creativity, or the relationships we have with others. Oftentimes, feeling a sense of purpose is a mixture of these things. Finding the things in life that make you feel connected to the world around you can help you re-focus on the larger meaning of life.

Once you know the things that give you a sense of purpose, you can connect these to the life goals you have. You may also be able to sense when a depressive episode is coming based on your feelings of disengagement with the things that normally give you a sense of purpose.

6. Educate Yourself on the Course of Depression

This may sound simple, but psychoeducation about your disorder plays a huge role in how you go about managing symptoms. It can affect your treatment and the course of the disorder. Knowing how depression typically presents can vary based on your gender, age, or even culture.

It can help to find relatable mentors who have also dealt with depression or mental health issues. These mentors can help to educate and guide you as you find your own ways of depression management. If it feels too scary to talk to people, using relevant books, podcasts, and blogs may help you feel better prepared to manage the disorder.

Coping Strategies for When Depression Worsens

Feeling like your depression is getting worse can be overwhelming, and you may believe things will never get better. These are the challenging moments where you are at a crossroads and where depression can take a turn for the better or worse. Finding coping strategies for when your depression worsens can help you avoid experiencing more painful symptoms.

Here are some coping strategies to try when depression worsens:

• Journaling: One strategy is journaling about your depression to try and combat feelings of overwhelming sadness. Journaling can be guided or non-guided, timed or untimed, and you may choose to rip up what you write or re-read it with your therapist. Journaling for depression can offer you the freedom to feel more in charge of your thought patterns and re-write challenging thinking.
• Sleep hygiene: Developing good sleep hygiene can help with sleep changes that occur because of depression. You can start by setting up a good sleep environment with ideal lighting, temperature, and limited distractions. You can also utilize sleep podcasts, meditations, or stories to help prepare your mind and body for a good night’s rest.
• Relaxation techniques: Strategies like deep breathing or progressive muscle relaxation can help with reducing negative emotionality and stress associated with depression.⁸ These techniques help to foster good mind-body connection and help you establish a calmer psychological baseline in daily life.
• Opposite action: Performing the opposite action is a DBT skill that can help reduce the consequences of engaging in negative behaviors that worsen depression. For example, depression can encourage people to isolate when feeling down, and the opposite action would encourage you to seek support during these times.
• Tidy your spaces: Tidiness looks different to everyone, but keeping your work and personal spaces in good working order can foster a sense of self-esteem to combat feelings of worthlessness. Your “tidiness” might look like having your paints and pencils out on your desk if you are an artist, but this sends a message to your depression about your daily priorities.
• Build and maintain relationships: Depression can foster feelings of loneliness. By continuing to make and keep up with important relationships, you can decrease feelings of isolation.
• Keep a sense of normalcy: Depression can make you feel foggy, disconnected, and fatigued. Continuing to keep a sense of normalcy through relationships, work produced, or hobbies enjoyed can help you continue to feel somewhat connected to life around you. This may be as simple as making your bed in the morning or making sure you still call your parents on Sunday afternoons.

The Importance of Safety Planning

Safety planning is an essential part of treatment for depression. Safety planning involves making a detailed plan for coping with a mental health crisis. You can develop a safety plan with your therapist or psychiatrist. If you are feeling suicidal, it is especially important to tell your therapist and work on a safety plan together. A good safety plan includes warning signs of a mental health crisis, coping strategies, trusted support, and crisis numbers for emergency situations.

Your therapist or psychiatrist may already have a safety plan in place for you. You can also ask for it to be updated if you feel your circumstances have changed. You can ask for a copy of your safety plan from your therapist. Making sure you and trusted individuals know your safety plan gives you the best chance at preventing or having support during a crisis.

Treatment Options for Depression

Depression treatment can look different depending on an individual’s particular needs and accessibility. Depression treatment options can include psychotherapy or medication management alone, but they often include both. Educating yourself and exploring various treatment options can help you feel comfortable with whatever approach you and your treatment team decide to take.

It can help to have a primary care provider, psychiatrist, and therapist to approach your depression management. This type of team can take care of you both physically and mentally.

Treatment options for depression include:

• Psychodynamic therapy: Psychodynamic therapy is an insight-oriented approach that can work for depression since those with depression are often concerned with what happened in the past. Psychodynamic therapy can help individuals develop new insights about their past to work toward how they want to handle their future.
• Cognitive behavioral therapy (CBT): CBT for depression helps the individual understand the interplay between thoughts, emotions, and behaviors. Through therapy, they will learn how negative thinking patterns prompt them to feel certain emotions and do specific behaviors that keep them experiencing depressive symptoms.
• Dialectical behavior therapy (DBT): DBT for depression helps the individual learn new life skills in the areas of mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. These new skills can help the person approach their depression in a different way and become better able to tolerate the distress of symptoms.
• Narrative therapy: Narrative therapy is focused on how the story you tell yourself about your depression affects your experience of symptoms. A narrative therapist can help you re-write your story in a way where your perceptions are most important to how you choose to see your life with depression.
• Family systems therapy: A family systems approach can be helpful for depression therapy, especially when there is a family history of mental illness. Family systems therapy can help you recognize intergenerational patterns, familial roles, and familial expectations that play a part in your experience of depression.
• Compassion-focused therapy: Depression often comes with painful feelings of rejection, worthlessness, and shame. Compassion-focused therapy helps you learn to engage with yourself and your perceived failures with empathy and sensitivity.