Getting "Over the Hump"

Many times my depressed patients find themselves stuck. They are at home, fatigued, sad, and filled with negative thoughts. What is often needed at times like that is to get out of the house and get some new experiences. Staying at home and watching TV is not sufficient stimulation to distract them from their internal negative thoughts. However, getting out can be difficult. It requires energy, and that is something they often don't have.

But once they are out, they usually feel better than if they had stayed at home. It would seem like a paradox. Why don't we do what is good for us?

I think that one answer is to use the example of a lawnmower. It takes initial energy to get the process started. Then once it is started, it runs on its own. A scientist patient of mine compared it to the energy of activation of a chemical reaction. It takes an external input of energy to get the reaction started; after that it is self-sustaining.

So the depressed individual needs something to get them "over the hump," to get them going. Then once they are out of the house, they often feel better than they would have felt if they just stayed at home watching TV or sleeping.

What is the solution? In therapy, I find that it works best if there is a plan. Once the patient has a plan, they are more likely to follow through. One plan is to make a commitment to get together with other people. Another type of plan is to buy tickets. People often will follow through with a concert or event because they have already put money down on the tickets. Another type of plan is to have someone come by to pick up the person and go out. It is hard to turn someone down who has made the trip over. There are probably many other types of solutions to this, but these are a few.

I think that another important type of plan is to look objectively at the consequences of staying home. Does it make the person feel better? If not, then the next time they have a chance to get out, they need to remember that staying home may be the easiest thing to do for a few minutes or an hour, but it may lead to more depression over the next several hours than getting out would.