“Dear Diary,
Happy World Mental Health day! Thought I should write to you on this occasion since I was lacking motivation these past few days. Although I said ‘happy’, I am actually not, but I will be honest, I am not entirely hopeless like the time I last wrote to you. I went to see a therapist, yes, I finally did it, are you proud? I was disappointed at the first visit. She just asked me a few questions and suggested a few medications and asked me to come back the following week. My guesses were true, I have moderate to severe depressive disorder resulting in chronic functional impairment. Coming back home I complained a lot to my mom that this is going to be useless. Because I read somewhere that in depressive disorder, there appears to be a pattern of symptoms that are inadequately addressed by serotonergic antidepressants — loss of pleasure, loss of interest, fatigue, and loss of energy. These symptoms are key to the maintenance of drive and motivation. Also, although medications are certainly valuable in some cases, they work for fewer than half the depressed patients who try them. But two weeks later, here I am, slightly hopeful because my therapist said after hearing my concerns that antidepressant is just a bandage to cover the wound, she will guide me to heal myself from within. I like her, she reminds me of my gran.
I do not yet have much good news to share with you, but my therapist suggested to write to you more. I have started going back to my daily routine, she suggested I progress in baby steps. She encouraged me to find something I can be myself with and spend quality time with anything I love. I tried, I couldn’t yet find anything on my own, but as I said I have slightly more motivation than before, I searched for engaging things to do. I ended up with something else, and am understanding depression better – I think that helps too. Depression is closely linked to a toxic thought process called rumination—the habit of dwelling on negative thoughts, turning them over and over in my mind. We’ve probably all ruminated at some point. It’s a perfectly natural response to upsetting events. And when rumination lasts for only a short while, it can even be useful, helping us figure out what went wrong and how we might work to correct things in the future. The problem comes when people start ruminating for long stretches of time, going over the same thoughts again and again and again. Such chronic rumination actually cranks up the intensity of our negative mood, making it unbearably painful. Unfortunately, I spend literally hours ruminating every day.
A change of lifestyle for the better greatly reduces depression, this I sort of believe, because following the below, I am feeling moderately better.

1. Engaging activity – I clean around the house, do some gardening, take care of my pets; these elevate my mood…I still want to get more out of my day, but baby steps, right?
2. Physical exercise – yoga is my zen zone, and I have restarted practicing it, I am thinking about doing some other form of exercise too. Oh, and I religiously take a walk in the morning after my yoga session, which helps me concentrate throughout the day.
3. Sunlight Exposure – at first, I was skeptical about this, but it really helps! It’s not simply going outside on a sunny day can brighten my mood, an even deeper link exists between light exposure and depression — one involving the body’s internal clock, or the circadian rhythm. Without enough light exposure, the body clock eventually gets out of sync, and when that happens, it throws off important circadian rhythms that regulate energy, sleep, appetite, and hormone levels. The disruption of these important biological rhythms can, in turn, trigger clinical depression, for example, me. A half-hour of sunlight is enough to reset the body clock and hence my walk in the morning.
4. Social Support – okay now this I am very lucky with, I have a wonderful understanding circle of friends and family who guide me gently so that I do not get lost. Once I am a bit better, I want to start a platform for those who do not have such support. Big dream? I can, don’t you think?
5. Sleep – MOST IMPORTANT! I will write later about how I am managing my troubles falling asleep later, but listen to how much better I feel by getting proper sleep! Each day now, I feel well-rested and energetic – no not like before, let’s not get ahead of ourselves because the before I am comparing to was 18 years back – but much better than the past few months. And my skin looks so fresh! I am loving it and the dark circles are fading too. Did you know the body repairs itself while sleeping? Maybe that’s the reason.
   

I reported the above to my therapists and she is happy to see my progress, but I have not given you the gravest news yet, I have other mental issues too. I am feeling tired now, must go to bed on time, so let’s put a pin on it? I will write again soon I promise.
I think I may get better.”
Series: Dear Diary
Part 2: Depressive Disorder
References:
Ilardi, S., 2009. The Depression Cure. Da Capo Press.
Nutt, D., Demyttenaere, K., Janka, Z., Aarre, T., Bourin, M., Canonico, P., Carrasco, J. and Stahl, S., 2006. The other face of depression, reduced positive affect: the role of catecholamines in causation and cure. Journal of Psychopharmacology, 21(5), pp.461-471.
Artwork by the brilliant Nishat Nailah