How to manage anxiety and depression in 10 easy* steps

*not really

Anxiety and depression are deeply inter-related and both are among the most terrible things I have ever experienced.

This is in no way to say that they are worse than other things. It's not a competition and one of the many terrible things anxiety and depression do is make you feel guilty about feeling bad because so many people have it worse off than you, because of disaster or illness or poverty or circumstance, which just makes the whole thing worse.

Anxiety often starts with a specific concern, something you are worried about, either personal [aggh money, agggh relationships, aggg jobs, aggg illness] or public [agggh run around screaming the whole world is on fire and no one seems to be able to do anything oh dear god I can never look at the news again did that really say nuclear war why won't it stop and gosh isn't it getting hot recently].

At some point, it metastasizes, spreading from a particular thing you have been over-thinking about and becomes a persistent feeling of dread and discomfort that will then alter your perception of anything that you think about.

Or sometimes it just turns up for no fucking reason at all.

Dread and discomfort do not do it justice, however.

It makes getting out of bed sort of…terrifying. In fact, it makes anything you have to do at all sort of…terrifying. Even the thought of doing something is terrifying. The sensation is like when you get frightened and there is this clenching in your chest but it never alleviates and turns into a rat that is constantly gnawing at your insides, a thin ribbon of indescribable panic that sits under your ribcage and pulls your focus away from the world.

You desperately don't want to talk to people or see anyone or do anything. Then you notice that a quick sip of alcohol burns out the thin ribbon of fear, stops the rat gnawing for a second. This is self-medication and it works in the short term and makes things worse in the long term, which gives you a whole new thing to worry about.

This is the generalized kind of anxiety. This feeling of extreme panic, all the time, is extremely tiring. It's a bit like being on a roller-coaster on the way up to the biggest drop but it just keeps going up all the time and you have a fear of heights and hate roller coasters and would do anything to get off the ride but you can't.

There is also a kind where sometimes all the anxiety builds up into an explosion called a panic attack, which your body tells you is a heart attack or that you are dying. You get very dizzy and nauseous and your head and chest get really tight and you are desperate to not let anyone know what is happening, which makes it worse.

Depression is the calmer but equally destructive other side. Your body gets exhausted, sometimes from all that anxiety, and you lose hope that you will feel better ever again.

Yes, it is a bit like feeling sad, but as though you were wrapped inside an impenetrable cocoon of sad. Your mind wants you to give up. Everything loses flavor, nothing seems fun or exciting. It makes getting out of bed sort of… really, really hard. You can just lie in bed all day, occasionally worrying, mostly just thinking about being depressed, and you never get bored. You just stare and think about how terrible it is that you are sitting there staring at nothing.

You burrow further and further inside your own head. You stop washing, eating properly, wanting anything. The other scary thing about it is that it feels sort of… comforting. It's hard to explain because it feels really bad, but also like you are out of the world and it no longer concerns you anyway and there's something weirdly seductive about it. You can feel halfway bad, on a precipice, could go either way and trying seems so hard and just giving in seems so easy…

Now, there are of course various chemical and therapeutic treatments that address these issues, symptomatically and systemically. Anxiolytics will calm you down short term but are very habit forming. With regular use anti-depressants work to alleviate symptoms for a lot of people [how they work isn't really clear, at all, and no one understands why it takes a few weeks for them to kick in. Also, when you start taking them a thing happens where you get much worse. You know the fair balance guidance on the TV ads about them on TV in America where it says it may cause suicidal thoughts? And you  —  a smart viewer — think that's stupid — "why would antidepressants make you have those and if they do why take them?" Well, gosh, every time you start taking them a few days or weeks in something super weird happens and you get much, much more depressed and your brain starts spontaneously generating thoughts about killing yourself. It's so common it's considered the norm but no one really tells you about it. It usually lasts a week or so once it kicks in but that week is hell. It's called persistent suicidal ideation and it's…not fun]. I'm obviously not a doctor, I'm not giving medical advice, and I don't want to get into the complex psycho-social and chemical drivers of these conditions.

Treating the symptoms lets people get to a place where they can get by, get through a day, get back out of the pit they've fallen into inside their own minds. But re-building resilience and getting from OK to AWESOME takes what I've started to call "going through the motions."

To explain.

Depression and anxiety are, if you'll forgive the metaphor, cognitive parasites. This isn't a helpful metaphor for some people, but it is for me. They grow opportunistically, in niches that open up because of tragedy or trauma, or simply through unhealthy thoughts and behaviors repeated enough to become illnesses. Your mind is very powerful and the more you think about something the more your brain changes shape to reinforce that thing: neurons that fire together, wire together. So if you think bad thoughts frequently enough for long enough they will eventually re-architect your brain.

Because they are organisms, they will do anything to survive. This is why they are so insidious, so difficult to manage, so hard to get rid of once they start to grow. They change what your brain tells you what to do, in ways that are specifically engendered to keep them alive and are extremely deleterious to your health.

Now, to caveat the annoying headline I wrote to catch your click, the 10 steps are super easy but doing them is not, because they are ALL THE THINGS depression and anxiety make you not want to do. In fact, the not doing of them are basically the external symptoms of anxiety and depression. None of these things will alleviate the symptoms, but they do attack the cause, the monster growing inside your mind.

Essentially, in this state, everything you want to do makes you worse, and everything you don't want to do makes it better.

I know, it sucks, I'm sorry. It makes you feel like your own brain is trying to kill you. It's not. It's the anxiety/depression creature, a neural parasite made of emotions, chemicals and thought patterns that came to life and is now exerting control over your behavior for its own ends. This is what parasites do.

The extremely hard thing is that you won't want to do them again until you have already been doing them for some time.

You have to find ways to force yourself, bribe yourself, cajole and encourage, have someone make you, push you, encourage or scare you, get handcuffed and get help to just go through the motions. Because that's what it feels like.

It's like life is pointless and the world is on fire and your soul is empty and everything is dire so why the fuck brush your teeth? When you do manage to pull yourself out of bed and do anything it feels empty and so there's no rewarding brain juice to make you want to do it again. Fucking dopamine.

Here is a song from the musical episode of Buffy the Vampire Slayer that explains this feeling: "Going Through The Motions"

So, taking inspiration from Buffy, we can reframe going through the motions. Here are the ten steps.


If these all sound easy to you — congratulations! You don't have anxiety and or depression.

Anxiety and depression make everything hard and seem pointless. Some situations [anything outside of bed] make anxiety especially seem much worse, especially if you are in public, because anxiety begs to remain hidden, makes you pretend you are fine until you no longer can.

But since everything feels like you are going through the motions anyway, every smile seems forced, every email unopened feels dangerous, every email sent feels like a problem you have created for yourself in the future, here's something to consider — since everything seems equally terrible, why not do some things that will help?

Some things you do, even though they feel the same terrible, help the creatures grow and some strike blows and make them weaker. Since you feel terrible either way, try to focus on things you don't want to do from the list above.

Remember, it's not you, it's a monster that is feeding off you, a psychic vampire, and you need to fight it off.

It's like yoga — you still get the benefit even if you are only going through the motions. [That's sort of a joke.]

Start by trying to do just one of them. That's one attack — good job for fighting back! The more attacks you can manage, the more strikes you can get in each day, give yourself a point for each. Celebrate each of these seemingly small things.

Do NOT blame yourself when you don't do them. This will happen. The vampire is very seductive, it whispers in your ear, it will do anything to keep feeding on you — it wants to live!

You will have some mornings that defeat you. Mornings are hard. Mornings are usually the worst, actually. You will look for succor and find it in a vodka bottle. Doesn't matter. It's not a failing, it's an attack. You have been hit. Lick your wounds. Kiss yourself. Whisper sweet reassuring nothings to yourself. Stroke yourself [I didn't mean like that, but yes, that way too if it helps and you can manage it. Often that's really hard too].

Forget each day as it finishes, then wake up and try again. Every day.

Just keep trying to get more points. I promise, once you are doing all these things and it doesn't feel like going through the motions, you will have beaten back the demon.

I can't promise you will be well or that it won't come back, but if you are doing all these things and it feels fine, you are no longer depressed, so it must have worked.

And always, always be kind to yourself. Because you love you, certainly a lot more than the thing that is feeding on you. Even when you don't think you do.

[Faris' creative firm, Genius/Steals, has an awesome newsletter I subscribe to. — Mark]

Image: NYS/Shutterstock