Common Pitfalls That Worsen Major Depressive Disorder

There may be some subtle things you’re doing that are working against you and making your symptoms worse. In this Everyday Health article, Zishan Khan, MD, explains six pitfalls that worsen MDD and how to correct them. 

If you’re one of the estimated 21 million U.S. adults who have experienced major depressive disorder (MDD) in the past year, you’re probably aware that talk therapy, medication, and similar strategies can make your symptoms better. 

You may be less privy, however, to the subtle things you’re doing that are working against you and making your symptoms worse, despite treatment. 

Pitfall #1: Believing Depression Is a Personal or Moral Failure

A major myth about MDD is that people have any control over whether they develop this condition. Oftentimes people with MDD may fault themselves for the way they’re feeling. 

Rather, an assortment of factors that aren’t within your control are thought to play a role in causing depression:  

• Brain chemistry 
• Hormones 
• Stressful or traumatic life events 
• Having a chronic or acute illness 
• For marginalized communities, the effects of systemic oppression, including racism, sexism, transphobia, ableism, etc.  

Pitfall #2: Not Taking Care of Your Body 

Fatigue and lack of energy are common symptoms of MDD, and if you have this condition, you may find it difficult to even get out of bed, let alone attend to your body’s needs like personal hygiene, nutrition, and exercise. But paying attention to those very things, while not a cure for depression, can help you feel a lot better. 

“One of the most crucial mistakes is not taking care of yourself or practicing proper self-care,” says Zishan Khan, MD , a psychiatrist with Mindpath Health. “If you are not sensitive to what your body needs and push it past its limits, it can very well worsen your depressive symptoms.” 

Several self-care strategies could help, adds Dr. Khan: 

• Try to eat more fruits, vegetables, whole grains, and lean proteins. People with depression who adhered to a brief dietary intervention rich in these foods experienced significantly lower depressive symptoms than those who did not, according to a study published in 2019 in PLOS One. 
• Aim to exercise on most days of the week. Breaking a sweat for at least 30 minutes a day, three to five days a week, could substantially improve symptoms, say Mayo Clinic experts.  
• Practice good sleep hygiene. This includes going to bed and waking up at the same times each day, keeping your bedroom cool, quiet, and dark, and not drinking alcohol before bed.  

Pitfall #3: Judging Yourself for How You’re Feeling

It’s not uncommon for people with MDD to be hard on themselves for how their depression affects them and their ability to function. But judging yourself for having depression or struggling with your symptoms can make life with the condition even harder. 

It might help to reflect on any self-critical thoughts you’re having and reframe them in a more helpful way, suggests Hua. 

Pitfall #4: Isolating Yourself from Loved Ones

Social withdrawal is a hallmark sign of MDD. While trying to be present with others can be challenging, it’s still important to stay in touch with people around you, even if only in a limited capacity such as a text or Zoom call. 

Social interaction with loved ones has beneficial effects on the brain. “When we spend time with loved ones and friends, our posterior pituitary gland releases stored oxytocin,” says Khan. “This oxytocin in turn supports the secretion of serotonin, which is a neurotransmitter primarily responsible for regulating behavior and mood.” 

Pitfall #5: Trying to Avoid Your Feelings

People with MDD often struggle with feelings of guilt, unworthiness, loneliness, and sadness. While these feelings can be hard to sit with, trying to push them away can make things worse.  

Hua suggests you spend some time reflecting on these feelings, as long as they don’t totally consume you, or unpacking them with your mental health provider, who can suggest strategies for coping with them. 

Pitfall #6: Turning to Alcohol or Drugs for Relief

One thing people often do to avoid tough feelings is misuse substances like drugs and alcohol. In fact, it’s very common for people with MDD to also have a substance use disorder, according to a systematic review and meta-analysis published in 2020 in the Journal of Affective Disorders. 

If you struggle with substance use as a means of coping with your mental health, it’s very important to let your doctor know, especially if you take antidepressants, as this could lead to negative drug interactions. And if you think you may have a substance use disorder, your doctor may be able to suggest dual-diagnosis treatment programs that could help you learn to manage both MDD and your substance use disorder. 

The symptoms of a substance use disorder, according to the Mayo Clinic, are: 

• Intense urges to use drugs or alcohol every day or multiple times a day, to the point it’s hard to think about anything else 
• Needing more drugs or alcohol over time to achieve the same effect, or using more drugs or alcohol over a longer amount of time than you meant to 
• Always making sure to have enough drugs or alcohol 
• Spending money you don’t have on drugs or alcohol 
• Prioritizing drugs or alcohol over work, school, relationships, or other responsibilities 
• Continuing to use drugs or alcohol even though you’re aware of the negative effects they’ve had on your life 
• Doing things that are usually out of character for you, just to get drugs or alcohol 
• Driving under the influence 
• Not being able to stop using drugs or alcohol, despite prior attempts 
• Having withdrawal symptoms if you try to stop using drugs or alcohol 

Read the full Everyday Health article with sources.