Let's say that these conditions sound reasonable. The key question is how to avoid getting depressed—that's number one—and how to reverse depression once it sets in. We can approach the whole question of prevention and getting better with the same three categories.

1. Outside events: People will say: "Did you see the evening news? I'm so depressed about the state of the world." Or, "I was depressed during the whole Bush era." This implies that outside events make us depressed, but in fact this ingredient is the least powerful in causing depression. Losing your job, for example, can be depressing if you are prone to the depressed response, but it can spur you to rise even higher if you don't turn to the depressed response.

Bad things are unavoidable, but some factors make them worse:
  • If the stress is repeated
  • If the stress is unpredictable
  • If you have no control over the stress.
These points are easily proved with mice given mild electric shocks. If you space the shocks at random intervals, give them over and over and provide no way for the mice to turn off the shocks, it doesn't matter that the shocks are harmless. The mice will soon give up, act lethargic and helpless and, in time, die. In other words, you have induced extreme depression to the point that the will to live is destroyed.

What does this mean for someone who wants to avoid or alleviate depression?

  • Stop exposing yourself to stresses that occur over and over. This could mean a bad boss, an abusive husband, a boring job or any other stress that is reinforced every day.
  • Avoid unpredictability and uncertainty. They say life is uncertain, but there's a limit to what is acceptable. A boss who unpredictably flies into a rage isn't acceptable. For many people, a sales job, where any customer might lash out or walk away, is too uncertain to bear. A spouse who may or may not cheat is unpredictable in the wrong way. Regular habits, including a good night's sleep, regular exercise, a steady relationship and a job you can count on, are necessary for everyone. They aren't just good for you. They help avoid depression.
As a doctor, I know that someone isn't depressed if they can answer a simple question about a bad situation: Is this something I can fix, something I should put up with or something I need to walk away from? Depressed people deny themselves those key decisions. They almost always put up with bad situations. When depression isn't present, you know what to fix, what to put up with and what to walk away from. Learn how to make such decisions now, and you won't be saddled with future situations that create depression.

How to respond differently to difficult situations


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