By Dr. Andrea Hilborn, ND

The word 'depression' gets thrown around a lot these days; people say 'I'm depressed' to refer to feeling down. More technically, the word depression refers to persistent sadness and lack of interest.

Some experts believe that there are actually two distinct kinds of depression: one type that causes a debilitating sadness and fatigue and one type that includes sadness and lack of interest, but also anxiety. I find this to be a useful distinction.

In this article, I will address the first type- the deep depression that leaves you unable to experience enjoyment and unable to carry out your usual activities.

Depression is now considered a chronic disease, meaning that if you are affected by it, it is likely that you will be affected throughout your life. To my mind, this just means that you have to put more thought into how you will keep yourself healthy.

1. Start small and reward yourself- Setting big goals for how to get better can set you up for failure, which only makes things worse. Set small goals, and as you achieve them, you will feel competent and capable, setting you up for more successes. Also, acknowledge the things you are doing that contribute to a normal life. Did you change out of your pajamas? Great! Did you finally make that phone call? Fantastic! One technique I like is to create a daily checklist. Include some things in the checklist that you do out of habit. Also include some things that you would like to be doing more consistently. Checking off the things you are already doing sets a positive tone. The momentum from that positive tone helps you accomplish those other things.

2. Use physical and psychological methods – Studies have shown that the most effective way to treat depression is use both psychological counselling and medication. These studies usually use pharmaceuticals, but there are also herbal remedies that can help depression. One review study that compared St. John's Wort to selective serotonin reuptake inhibitors found that St. John's Wort is as effective and causes fewer side effects.

3. Seek connection- Pharmaceutical companies have undertaken a massive campaign to characterize depression as simply an imbalance of brain chemicals (neurotransmitters). This is very misleading; depression happens within a physical, mental, emotional and social context. It is not just a physical problem. One of the major contributors to depression is loneliness. I believe that loneliness is one of the biggest health problems facing our society. When you are depressed, the natural tendency is to isolate yourself. It is extremely difficult to override this impulse, but the effort is worth it. Head outside and smile at someone walking down the street. Take a book to a busy park and see if anyone strikes up a conversation. Go to the coffee shop and compliment the cashier on having a friendly smile. Fire off an e-mail to one of your contacts, asking about his or her life.

4. Never stop your medication or herbal supplements cold turkey- If you are at a noisy construction site and then you get into a car, the noise level drops suddenly and it seems quiet, even though you can still hear the muffled sounds from outside. The same principle applies when you stop taking a medication or herb that affects your neurotransmitter levels. Your body is used to a high 'volume', and even though the new level is normal, it seems low compared to what your body has become accustomed to. You may feel like you're suddenly back at square one, or worse. For this reason, it is best to taper off when discontinuing.

5. Top up your vitamins- Having optimal levels of Vitamin D and B Vitamins gives you the best chance of shaking off depression. Before supplementing with Vitamin D, it is best to have your blood level checked to determine what an appropriate level of supplementation is for you. B Vitamins are water soluble so you are unlikely to overdose, but it is still best to get the advice of a healthcare professional. To find a good quality supplement, look for B12 to be in the form of methylcobalamin, and folic acid should be in the form of methyltetrahydrofolate.

Although depression is a chronic condition, that does not mean that you have to live with it forever. Finding the right treatment may take some trial and error- the key is to keep trying.