Someone recently said to me:

“Your tips are fine for those who struggle with mild to moderate depression. But what about if you can’t get out of bed you’re so depressed? What would you say to those who are really ill?”

She’s absolutely right. Suggestions to improve one’s mood and to pursue healthy living should vary from tips on how to stop crying. I understand that merely getting through the day is an act of triumph when you are buried in the deep hole of depression.

Since I have been there, more than once — where staying alive consumes all of your energy — I thought I’d share with you what has helped me.

1. Just keep going.

My mom once told me, “You can’t wait for the storm to be over; you have to learn how to dance in the rain.” That is appropriate for a day, week, or lifetime weighted down by severe depression. Dancing in the rain demands perseverance and courage — going forward despite the evidence of difficulty and forecast of doom. It means not ending your life, even as death appears to be the only and ultimate relief. It requires the kind of courage that Mary Anne Rademacher describes when she says, “Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day that says I’ll try again tomorrow.” And it is “fear holding on a minute longer” (George Patton).

2. Breathe.

You can do this from bed. You can even do it in between crying sessions. All I do is count to five while inhaling, and count to five while exhaling. If you do this slowly, you will breathe about five times a minute, which is called coherent breathing, associated with a strong stress-response system. It stimulates the parasympathetic nervous system, which calms down the sympathetic nervous system that’s totally wigging out, responsible for a fight-or-flight response. If you spend even five minutes breathing from your diaphragm, you will feel a tad calmer. Not totally transformed. But capable of a few logical thoughts.

3. Go gentle.

Anyone who has ever been locked up in a psych ward knows the sting of the stigma attached to mental disorders. And as much as positive psychology studies and holistic philosophies can help, the person with severe depression ends up feeling that much more defeated. “If I can’t change the neuroplasticity of my brain … If I can’t remedy my depression with Omega 3 fatty acids … If yoga doesn’t make me feel calm … If mindful meditation makes me angry … then I am even that much more of a failure.”

I know. I’ve been there. Which is why I think it’s crucial to be gentle — really gentle–with yourself, and to talk to yourself as you would someone you admire and respect. My dialogue goes something like this: “You are doing great, considering you are up against this severe illness. Every day you are climbing an incredibly steep mountain, but you are doing it! Your aunt took her life because of this pain — it’s so bad that it kills people, lots of people — but you are managing to be somewhat productive. You haven’t given up yet. You haven’t taken your life today. You are strong.”

4. Stop trying.

When I was right out of the hospital, I devoured self-help books because I was in a hurry to get better. But they all made me feel worse. Finally, my doctor asked me to stop reading, that it was inhibiting my recovery. Her advice was grounded in neuroscience. Here’s the thing. Refined brain imaging shows us that when non-depressed people try to retrain their thoughts, or reframe negative emotions, they are often successful. The brain activity responsible for negative emotions in the amygdala (fear center of the brain) decreases. However, when depressed people try this, the activity increases. Their efforts backfire. The more they try, the more activation in the amygdala. So just stop trying for now.

5. Read Styron.

Hope is your lifeline. Without it, depressed people die. Almost a million of them around the world every year. Fear and hope are intertwined, says Baruch Spinoza: “Fear cannot be without hope, nor hope without fear.” Whenever I descend into the frightening black hole of depression, I read this paragraph of hope from William Styron’s classic, Darkness Visible:

If depression had no termination, then suicide would, indeed, be the only remedy. But one need not sound the false or inspirational note to stress the truth that depression is not the soul’s annihilation; men and women who have recovered from the disease — and they are countless — bear witness to what is probably its only saving grace: it is conquerable.

I also repeat this mantra to myself: “I will get better. I will get better. I will get better” until it soaks in.

6. Distract yourself.

The best therapy for the severely depressed is distraction. Engross yourself in any activity that can keep your mind off the pain, just as you would if you were healing from a hip or knee replacement. I am unable to read when I’m depressed, so I make phone calls, even as it’s hard to follow a conversation. My depressed friends do all kinds of activities to keep their brains active: scrapbooking, crossword puzzles, gardening, watching movies, purging the house of all nonessentials, rearranging the furniture, or painting the bathroom.

7. Revisit your strengths.

This is not your glory hour. But you’ve had several in the past. Remember those. If you don’t have the energy to get a piece of paper and write them down, at least recall those moments of which you are most proud. For example, the hardest thing I have ever accomplished — and the one for which I am most proud — is not taking my life in the two years of suicidal depression in 2005 and 2006. And I managed to stay sober throughout the pain. Those accomplishments continue to carry me through rough patches today. I know that I have it in me not to give up.

Originally posted on Sanity Break at Everyday Health.