I know that my loneliness is a major cause of my depression, but the depression makes it much harder to reach out. Similarly, I know my unworkable job contributes to my depression, but I am in survival mode and can't organize myself well enough to change my situation. It seems like a vicious circle, and none of the innumerable medications I have tried over my 60 years has helped so far. How do I break out of the cycle?

Answered by: David Hellerstein

People with chronic depression often find themselves becoming socially isolated and demoralized, and may lack the energy to make various changes in their lives. Being stuck can be both a result of depression and a cause of further discouragement, and therefore can contribute to further depression. There are various ways to address this type of situation, which should be discussed with one's doctor or therapist. For one thing, it is important to review one's medication regimen. Sometimes an adjustment of medication type or dosage, or use of a second medication, may alleviate what we call 'residual' symptoms of depression, such as low energy, poor concentration, a lack of initiative, and so on. Once these symptoms decrease it can be easier to make necessary life changes. Additionally, psychotherapy approaches may be helpful. Various forms of therapy have been shown to help depression, including cognitive behavioral therapy, interpersonal therapy, and less-well-known approaches such as 'behavioral activation.' In general, psychotherapy approaches encourage people to examine cycles of thoughts, feeling, and behaviors, and to start making small manageable changes over time. Decreasing isolation may be particularly helpful, by joining community activities or self-help organizations such as the Mood Disorders Support Group ( It is also worth pointing out that regular exercise has significant antidepressant effects, and should be considered as an additional type of 'therapy' for many people with chronic depression.

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David J. Hellerstein, MD
Director of Medical Communications, Columbia U. Department of Psychiatry 

Dr. David J. Hellerstein is Director of Medical Communications at the Columbia University Department of Psychiatry. He is a research psychiatrist at the New York State Psychiatric Institute, New York, NY, and Professor of Clinical Psychiatry at Columbia University.

He was formerly the Clinical Director of the Institute. He specializes in the treatment of mood and anxiety disorders, with a particular focus on the medication treatment of persistent depressive disorder, or chronic depression.

Dr. Hellerstein is also Director of the >>> Read more info

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