Discover how depression effects relationships, your sex life and how depressed people can help themselves and their relationship. Included: how to help your depressed partner.

Depression adversely affects every aspect of our lives - including our relationships - and when one partner is depressed, the relationship may suffer very badly.

This is a great shame as a good relationship is very therapeutic for somebody with depression, because when we're really low we need love, support and closeness more than ever - even if we're not very good at showing it.

What is likely to happen if your partner has depression?

Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.

This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.

Frankly, it's really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you're finding your partner's depression a real pain, try to take heart from the fact that this is natural.

Being the partner of a depressed person is very, very difficult. So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.

Sex and performance

We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.

From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.

This effect is most marked with regard to sleep, which is invariably disrupted. But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination - and that includes sex.

So many people who are depressed tend to lose interest in sex. Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives - sometimes even finding that sex is the only thing that gives them comfort and reassurance.

• In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
• In women, this diminished brain activity tends to be associated with lack of interest in sex, and very often with difficulty in reaching orgasm.

All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

It's not just the illness that affects a person's sex-life - antidepressant medicines such as Prozac can interfere with sexual function.

One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all. If this happens - and you are keen to have and enjoy sex - you should ask the doctor about changing medication.

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How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

• Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood.
• Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
• You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
• Listen to music that matters to you.
• Have faith that the depression will pass, and that you will enjoy your life again.
• Even if you don't feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don't want it, just tell your partner that you're not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.

How to help your depressed partner

• Don't keep saying that you understand what your partner is going through. You don't. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
• Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
• Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
• Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to anti-depressants. Cognitive behavior therapy (CBT), for example, is becoming much more readily available on the NHS. In fact, the government is committed to providing 10,000 extra therapists. Many GP practices can also provide CBT by means of Internet programs. These can have a good effect quite quickly in many cases.
• Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
• Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
• Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
• Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat - for example, sport or dancing - may well help you too.

About the author: Christine Webber LNCP, MNCH Dip PHTA, Dip Cognitive Approaches to Psychotherapy (London) is a popular columnist and qualified psychotherapist and life coach. She is also the author of numerous books including Get the Happiness Habit, Get the Self-Esteem Habit and How To Mend a Broken Heart.

Living with a depressed person isn't easy and can put a lot of stress on a relationship. Here are 9 rules for living or working with a depressed person.

The couple sitting opposite me in my Tampa offices look like a nice couple. They are polite to each other. They even love each other, so they say. But the marriage is ending. She wants out.

"I can't live with his depression," she says almost as soon as they've sat down. "It's his negativity, he's constant looking on the dark side of everything. And I'm always making excuses for him--he won't let me tell people the truth about his depression, so I have to lie for him!"

Living, working or having a close relationship with somebody who suffers from depression is not easy, even if they're one of the lucky 30% who is really helped by antidepressants. Often they feel guilty, or ashamed, about being depressed. Sometimes their depression will take the form of anger at you or others. Sometimes it may cause them to sabotage or harm themselves. If they're honest they will complain of the pain the illness causes, if they're less than frank they'll withdraw or blame you for their depressed state. You may well feel you're in a lose-lose situation.

The real danger in any relationship with someone who has a serious illness is that you and he or she will become codependent around the problem. This is most obviously true with alcoholism, but the same forces are at work in cases of cancer, or HIV or depression. Lying for someone, making excuses for them or pretending the problem doesn't exist is part of the codependence spectrum.

The trick to surviving in a relationship with a depressive--or an alcoholic for that matter--is to firmly maintain your boundaries, or, as we would put it, be aware of and insist on getting your needs met. Any relationship is a mutual satisfaction of needs, regardless of either party's state of health.

Establishing clear and consistent boundaries can be very hard because often our natural inclination is to try to make the sufferer feel better, to rescue. I have known people who have gone broke trying to appease the demands of the inner demons that torment their partner, trying to make it right for them, trying to make them happy.

In the book Creating Optimism: A Proven, 7-Step Program for Overcoming Depression, which I wrote with my wife and partner (and former sufferer of treatment-resistant depression) Alicia Fortinberry, I included an appendix living with a depressive. In it I laid out nine rules for living, or working, with a depressed person (these rules work for living or working with people with addictions as well).

The rules are:

1. Understand the disorder. Take time to find out what depression is and is not. So many popular misunderstandings about the illness and so much denial about its origins exist.
2. Keep in mind that he can't "snap out of it." Remember that the other person has a real illness. Like someone with cancer, they can't simply "get over it." Try not to express your frustration or anger in ways you'll regret, but don't suppress your own feelings either. You can say for example, "I know that you can't help feeling down, but I feel frustrated." If the person is an unrelenting pessimist, as so many people with depression are, try to point out the positive things that are happening. His negative childhood programming--the "inner saboteur"--will probably prevent him from seeing these for himself. The depressive illness has a vested interest in the lie that nothing will go right.
3. Ask about his feelings and his childhood programming. Encourage your friend to discuss his feelings with you. Your ability to listen non-judgmentally will be helpful in itself. It will also give you the opportunity to learn about his childhood pattering and what role you are playing in regard to it. Who do you represent to him from his early life? What actions of yours may be triggering depressive episodes?
4. Admit your own powerlessness against the disorder. Many people believe they can cure someone they love just by the sheer force of their love, as if that feeling alone should be enough to effect permanent change. It isn't. The first stage to avoiding guilt over someone else's depression is to acknowledge that you are not responsible for it. It's not your fault, and you alone can't cure it. You can offer support, you can show friendship or love, whichever is appropriate, but you are probably too close to be able to solve the problem. Step back, admit that you alone are powerless against the disorder. Seek support for yourself from friends and perhaps a psychotherapist. The first stage toward helping the other person is to get help for yourself.
5. Do not try to rescue. A person suffering from a mood disorder will probably be a slave to his depressive program. The disorder will infantilize him, and he may well put pressure on you to fix whatever he perceives to be the problem. Sometimes the program can be temporarily assuaged in this way and the depression will lift. But it will come back and the inner saboteur will make even more demands. You may be forced into trying to play the role of omnipotent parent and feel guilty when you fail to provide what is demanded of you.
6. Don't make excuses for him. Never become part of the depressed person's denial. Don't lie for him. Making excuses or covering up for a friend or colleague only prevents him from getting timely help. In the addiction field this is called "enabling." Ultimately it may do him harm and delay his recovery.
7. Encourage him to seek help. Many sufferers from depression deny that they have the disorder or try to self-medicate with alcohol (as my mother did) or overwork or shopping--all of which are depressives in the long run. Part of your self-preservation is getting the depressed person in your life to seek professional help. This is true whether you live or work with him.
8. Discover your own programming. It's important to realize that the other person's depression is playing a role in your inner saboteur's game. In clinical terms you may be getting a "secondary gain" from his disorder. His behavior may seem to give you an excuse to vent angry feelings, or an opportunity for you to play the knight in shining armor or perhaps a reason to excuse your own real or imagined shortcomings. If you find yourself having relationships with a number of people who are depressed, there's probably a reason in your own past. Seek help in dealing with those emotions and fears.
9. Tell him what you need. The depressed person in your life may be ill, but you still have needs of him. All relationships are based on the mutual meeting of needs.

If you aren't honest about what you're getting from the relationship, or what you want to get, you will make the other person feel even worse about himself. If you follow the guidelines in our book Creating Optimism you'll learn how to identify your own needs and boundaries and be true to them. You'll also know when it's OK for you to compromise and when it's not. Be honest about what you can and cannot do, and about what you will and won't do. Never promise what you can't fulfill. You may often be asked to.

On the other hand, going through the process of exchanging real, functional needs with a depressed person can be a very powerful healing tool for both of you.

Above all remember that even the worst depression is curable, even if you alone can't cure it. The turning point can come at any time, maybe without your even realizing it. If you and your friend do what we suggest, the real person you chose to live with or to work with will come back to you for good.

About the author: Dr. Bob Murray is a bestselling author, relationship expert and psychologist.

"I hate sex. It feels like invasion of myself and my body by someone else. Life would be great if no one ever expected me to be sexual again."

Tina, raped by her father as a child.

"My penis and my heart feel disconnected. I use sex as a way to blot out pain when I'm feeling down. Masturbation is a lot easier than having sex with my wife. She wants a lot of kissing and hugging and I'm uncomfortable with all that closeness."

Jack, molested by a neighbor as a young teen.

Like Tina and Jack, many survivors of sexual abuse suffer from a variety of sexual problems. And it's no wonder. Sexual abuse is not only a betrayal of human trust and affection, but it is, by definition---an attack on a person's sexuality.

Our sexuality is the most intimate, private aspect of who we are. Our sexuality has to do with how we feel about being male or female, and how comfortable we are with our body, our genitals, and our sexual thoughts, expressions, and relationships.

When you were sexually abused--- whether you suffered a gentle seduction by a loved relative or a violent rape by a stranger--- your view and experience of your sexuality were affected by what happened to you.

The good news is that a variety of effective healing techniques now exist to help survivors overcome the sexual repercussions caused by abuse.

What are the sexual problems caused by sexual abuse?

The ten most common sexual symptoms of sexual abuse are:

1. avoiding or being afraid of sex
2. approaching sex as an obligation
3. experiencing negative feelings such as anger, disgust, or guilt with touch
4. having difficulty becoming aroused or feeling sensation
5. feeling emotionally distant or not present during sex
6. experiencing intrusive or disturbing sexual thoughts and images
7. engaging in compulsive or inappropriate sexual behaviors
8. experiencing difficulty establishing or maintaining an intimate relationship
9. experiencing vaginal pain or orgasmic difficulties
10. experiencing erectile or ejaculatory difficulties

What is sexual healing?

Sexual healing is an empowering process in which you reclaim your sexuality as both positive and pleasurable. It involves using special healing strategies and techniques to actively change sexual attitudes and behaviors which resulted from the abuse. The process of sexual healing often includes: gaining a deeper understanding of what happened and how it influenced your sexuality, increasing your body and self-awareness, developing a positive sense of your sexuality, and learning new skills for experiencing touch and sexual sharing in safe, life-affirming ways.

Sexual healing can take several months to several years, or more, to accomplish. It is considered advanced recovery work and thus, best undertaken only after a survivor is in a stable and safe lifestyle and has addressed more general effects of sexual abuse, such as depression, anger, self-blame, and trust concerns.

There are different levels of sexual healing work that a survivor can pursue; from simply reading about recovery to engaging in a series of progressive exercises, called "relearning touch techniques." These exercises provide opportunities to practice a new approach to intimate touch. While some survivors are able to progress in sexual healing on their own, others find it essential to enlist the guidance and support of a trained mental health practitioner. Professional care is recommended because of the high possibility that sexual healing will stir up traumatic memories and feelings.

You don't need to be in a relationship to do sexual healing work. Some exercises are designed for single survivors. However, if you have a partner, your partner needs to become educated about the sexual repercussions of abuse and learn strategies for participating actively and effectively in the healing process.

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Here are some ideas for how to get started in sexual healing:

1. Learn about healthy sexuality
   The first step in sexual healing is to learn to distinguish abusive type sex from healthy sex. If you commonly use words like "bad" "dirty" "overwhelming" "frightening" "hurtful" and "secretive" to describe sex, you need to realize that these are descriptive of "sexual abuse." "Healthy sexuality" is something very different. It is characterized by choice, consent, equality, respect, honesty, trust, safety, intimacy, and sensual enjoyment.

   In the books that you read and the movies you watch, decrease your exposure to abusive sex images and increase your exposure to examples of sex in which partners are responsible and express love and caring for each other.

2. See yourself as separate from what was done to you
   We are all born sexually innocent. Due to sexual abuse or subsequent sexual behavior, you may erroneously believe that, sexually, you are bad, damaged goods, or merely a sexual object for someone else's use.

   Let the past be past, and give yourself a healthy sexual future. You are not strapped to the negative labels an offender may have called you or to the way you saw yourself as a result of the abuse. Now you have a choice and can assert your true self with others. Old labels will disappear as you stop believing them and stop acting in ways that reinforce them.

3. Stop sexual behaviors that are part of the problem
   You can't build a new foundation for healthy sex until you've gotten rid of sexual behaviors that could undermine healing. Sexual behaviors that need to go, typically include: having sex when you don't want to, unsafe and risky sex, extramarital affairs, promiscuous sex, violent or degrading sex, compulsive sex, and engaging in abusive sexual fantasies. If you can't do it on your own, seek help from 12-step programs and other supports. It takes time to break old habits and learn how to channel sexual energy in ways that nurture the body as well as the soul.

4. Learn to handle automatic reactions to touch
   Many survivors encounter unpleasant automatic reactions to touch and sex, such as: flashbacks of the abuse, fleeting thoughts of the offender, or strange reactions to something a sexual partner does or says during lovemaking. While these reactions are common, unavoidable, even protective, results of trauma--- years later---they can get in the way of enjoying sex. By developing understanding and patience you can learn to handle them effectively.

   When you experience an unwanted reaction to touch, stop and become more consciously aware of the reaction. Then calm your self physically with slow breathing, self-massage and relaxation techniques. As soon as you can, affirm your present reality by reminding yourself of who you are now and that you have many options. You may also want to alter the activity in some way to make it more comfortable. Automatic reactions will diminish over time you become more aware of and responsive to them.

5. Familiarize yourself with touch techniques
   You can use special touch exercises to help you relearn intimate touch in a safe and relaxed way. Different from traditional sex therapy techniques (which can be overwhelming to survivors), the "relearning touch" techniques provide a wide assortment of exercises from which to choose as you feel ready. You can do some relearning touch exercises on your own, while others require a partner.

These exercises help you develop skills such as: feeling relaxed with touch, breathing comfortably, staying present, communicating with a partner, having fun, and expressing and receiving love through physical contact. The exercises are progressive and follow a sequence from playful, non-sexual touch to sensual, pleasuring touch activities. When necessary, you can address specific sexual problems, such as orgasmic and erectile difficulties, by modifying standard sex therapy techniques using the new skills acquired in relearning touch.

You can repair the damage done to you in the past. You can look forward to a new surge of self-respect, personal contentment, emotional intimacy. When you reclaim your sexuality, you reclaim yourself.

Hand-to-heart exercise from the "Relearning Touch" video

Wendy Maltz, MSW, is an internationally recognized therapist and expert on healthy sexuality and sexual recovery. Her books include: The Sexual Healing Journey: A Guide for Survivors of Sexual Abuse, Private Thoughts: Exploring the Power of Women's Sexual Fantasies, and Incest and Sexuality: A Guide to Understanding and Healing.

What are HIV and AIDS?
How AIDS Works in the Body
HIV Treatment
Who Should be Tested for HIV?
HIV Contraction
Common Misconceptions About Contraction
The Importance of HIV Testing and Diagnosis
How Does HIV Testing Work?
Test Counseling
Conclusion

What are HIV and AIDS?

The Human Immunodeficiency Virus, which is commonly called HIV, is a virus that directly attacks certain human organs, such as the brain, heart, and kidneys, as well as the human immune system. The immune system is made up of special cells, which are involved in protecting the body from infections and some cancers. The primary cells attacked by HIV are the CD4+ lymphocytes, which help direct immune function in the body. Since CD4+ cells are required for proper immune system function, when enough CD4+ lymphocytes have been destroyed by HIV, the immune system barely works. Many of the problems experienced by people infected with HIV result from a failure of the immune system to protect them from certain opportunistic infections (OIs) and cancers.

Defining the terms

People infected with HIV are broadly classified into those with HIV disease and those with Acquired Immunodeficiency Syndrome, or AIDS. A person with HIV disease has HIV but does not yet have any symptoms or related problems, and still has a relatively intact immune system (that is, a CD4+ lymphocyte count greater than 200 cells/mm3). A person with AIDS, on the other hand, has very advanced HIV disease and his or her immune system has incurred significant damage. As a result, people with AIDS are at very high risk for a number of OIs, cancers, and other AIDS-related complications. The Centers for Disease Control have defined the conditions that mark a progression from HIV disease to AIDS. They are: certain infections, such as repetitive pneumonias, Pneumocystis carinii pneumonia (PCP), and cryptococcal meningitis certain cancers, such as cervical cancer, Kaposi's sarcoma, and central nervous system lymphoma CD4+ count less than 200 cells/mm3 or 14 percent of lymphocytes

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How AIDS Works in the Body

Before highly active antiretroviral therapy (HAART) became available, most people who contracted HIV eventually progressed to AIDS and had some AIDS-related complication, such as:

• a deterioration of immune system function and an increased risk of infections and cancers
• brain damage that may cause dementia or memory loss
• heart problems that can cause heart failure and symptoms such as shortness of breath, fatigue, and swelling of the abdomen and legs
• severe kidney damage requiring dialysis
• an inability to perform activities of daily living such as balancing a checkbook or driving a car
• metabolic changes that may cause significant weight loss or diarrhea

Due to these potential problems, a person with AIDS is at very high risk of becoming very ill, and, if some action is not taken to protect the person from these infections or reverse the damage done by HIV, he or she is at risk of dying.

The speed of progression to AIDS
The damage caused by HIV occurs more quickly in some people than in others, but generally an untreated HIV-infected person can expect that they will progress to AIDS within 10 years of their infection. During the time the person is infected with HIV, a war rages between the person's immune system and HIV, with HIV slowly wearing the immune system out.

A slow progress: A number of factors can affect how rapidly HIV progresses, some that can be controlled, and some that can't. Some people have certain genes that slow HIV progression, or they are infected with a weak strain of HIV that their immune system is more able to control. In general, taking better care of yourself and following your doctor's advice also slows the progression of HIV disease to AIDS.

A more rapid progress: Factors that may cause a more rapid progression to AIDS are: infection by a virulent strain of HIV, having a high viral load setpoint (a certain level of HIV replication that varies from person to person), older age, and the abuse of drugs or alcohol.

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HIV Treatment

In the time between initial infection and AIDS, the infected person may feel relatively normal, despite the constant attack by HIV. People living with HIV have to understand, however, that despite feeling well on the outside, significant damage can be occurring on the inside. Fortunately, over the past five years, significant progress has been made regarding the treatment of HIV and prevention of some of the infections and cancers that may be caused by it. Antiretroviral medications can directly attack HIV and stop it from reproducing and causing further damage. For most people, the biggest factor in preventing progression to AIDS is adherence to HAART, which can suppress HIV replication to very low levels and not allow it to continue to attack the body.

Prophylactic medications In addition to HAART, other steps can be taken to prevent illness in people living with HIV and AIDS. Certain antibiotics, called prophylactic medications, can effectively prevent opportunistic infections. A physician can help to assess the appropriateness of these medications in a particular treatment program, and which ones to use, but it is important that they be taken as prescribed so that infections can be prevented. With careful monitoring, OIs and certain cancers can be detected in their early stages before they have spread, and the antibiotics can work more effectively to ward off further serious complications. I recommend that every person living with HIV or AIDS see a physician for appropriate monitoring and treatment.

Who Should be Tested for HIV?

In the early 1980s, when HIV infections were first starting to appear, HIV was associated primarily with gay men. Then it became associated with intravenous drug users and hemophiliacs. During the past 20 years, however, HIV has become a disease that can affect almost anyone who is not monogamous with an uninfected person.

HIV contraction

HIV is contracted through an exchange of bodily fluids, such as blood, semen, or vaginal secretions. As a result, the most common ways of acquiring HIV are sharing needles while doing intravenous drugs, and sex, especially anal intercourse. While the highest risk of HIV transmission is associated with anal intercourse, vaginal intercourse is becoming a common means of spreading HIV. Vaginal intercourse is the most rapidly growing risk factor for acquiring HIV infection in the United States and in the developing world it is the most common method of HIV transmission. Everyone must take appropriate steps to prevent the spread of HIV: Safer sex with condoms and dental dams and not sharing needles can help prevent the spread of HIV.

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Common misconceptions about HIV contraction

People are often concerned that HIV can be contracted through common contacts with an HIV-infected person, such as shaking hands or sharing glasses or eating utensils. These are not risk factors for contracting HIV. There is no evidence that HIV can be spread through these means, and people should not be afraid to be around people who have HIV or to use a glass, eating utensils, or plate that an HIV-infected person has used, or to have other common contacts.

Those who should consider being tested for HIV include:

• people who received a blood transfusion or blood product at any time, but especially in the late 1970s or 1980s
• homosexuals and heterosexuals who have a history of unprotected sex with potentially infected persons
• people who have had multiple sex partners
• people who have had a sexually transmitted disease such as syphilis or gonorrhea
• people who are intravenous drug users
• pregnant women

The importance of testing and diagnosis

The importance of HIV testing and diagnosis has increased over the past five years. Before the improvements in antiretroviral therapies, many people believed that there was little that could be done to prevent the progression of HIV and so they did not get tested. While these people were right about the ineffectiveness of the antiretroviral therapy available at that time, they failed to recognize that medicines had been discovered that could prevent many of the common infections that afflict AIDS patients. Thus, many people were diagnosed with HIV only after they were admitted to the hospital with severe infections, especially PCP. Some died needlessly because they had not sought appropriate medical care and did not receive one of the medications that could have prevented PCP from occurring.

Now, there are even more reasons to seek HIV testing and medical care. Within the past five years, the medicines to prevent infections have been significantly improved and effective antiretroviral therapies have been developed that can not only halt the progression of HIV, but can also reverse much of the damage that has already been done. Therefore, it is important that HIV is diagnosed while the person is relatively healthy and before a major, potentially life-threatening OI occurs, such as PCP or cerebral toxoplasmosis. With HIV, what you don't know can hurt you.

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If you think you are at even slight risk of having HIV-if you have had numerous sex partners or if you have had sex with someone who might have been bisexual or had a history of intravenous drug use-you should be tested. If you test positive, you can then receive medical care necessary to keep you healthy and prevent the diseases that occur in untreated AIDS patients. If, on the other hand, you wait until you feel sick before you are tested, you may already have progressed to AIDS and your immune system may already have incurred significant damage that may not be reversible.

Pregnant women
Recent advances in therapy have also led to effective methods of preventing mother-to-child transmission of HIV. Virtually every pregnant woman, especially those who have a history of intravenous drug use, have had sex with someone in a high-risk group, or who have had numerous sexual partners, should be tested for HIV. HIV-infected mothers should consider taking antiretrovirals, which can effectively prevent transmission to the infant. Since breast-feeding can also cause transmission of HIV to the infant, HIV-infected mothers should not breast-feed their infants if there is an available alternative. Many states also require testing of the infant at birth, so that appropriate treatment can be provided.

Testing is voluntary and confidential
Under most circumstances, HIV testing is voluntary. Unless there are special circumstances, most states require a person to give specific permission, called informed consent, before he or she can be tested for HIV. Privacy and confidentiality are legitimate concerns for people who are being tested for HIV. Most people do not want other people or organizations, such as their employer, to know they are HIV-infected and most don't even want them to know that they are being tested. Most states have laws that protect the confidentiality of HIV testing and the diagnosis of infection. While accidental disclosure of a person being HIV positive can occur, in my experience it is extremely rare. It's a mistake to avoid testing because of fear of accidental disclosure.

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Also, there are other options including anonymous testing in a clinic or at home (for example, Home AccessR), where you are identified by a number, not by name, and no one but you knows your number. The cost of testing is generally between $30 and $100, and some groups, including many health departments, provide testing free of charge.

How Does HIV Testing Work?

HIV is usually diagnosed by a blood test, but newer tests can be done on saliva or urine. If you're squeamish about getting blood drawn, there are alternatives you can discuss with your doctor. Generally, the purpose of the test is to search for antibodies to the virus. The initial test is an enzyme-linked immunoabsorbent assay (ELISA) and is confirmed using a test called the Western Blot. The antibody tests are very reliable, but may not be able to detect an infection during the first six months after an exposure. There is also a test that can test for the presence of the virus itself, and this test is called an HIV PCR. HIV PCR is used to test for HIV after a potential HIV exposure, but before antibodies have developed. Because infants may have their mother's antibodies in their blood confounding the HIV antibody test, HIV PCR is also useful for them. However, HIV PCR may not be reliable in detecting HIV in all infected patients, especially those with a low viral load.

How long do the results take?

It used to take several days to a week to get test results back. Now there are rapid detection methods that allow reliable results in less than an hour. As a result, HIV testing can be completed while you are still in your doctor's office.

Test counseling

Pre-test and post-test counseling and education are important parts of HIV testing. Counseling gives people who test negative for HIV an opportunity to learn more about HIV and how to avoid becoming infected. For those who test positive for HIV, counseling gives them a chance to learn about the importance of being medically evaluated and, if appropriate, treated so as to prevent disease progression or OIs. These counseling sessions take about 15 minutes, including time for questions. They are a very valuable part of the testing process, regardless of the test results.

Conclusion

HIV disease is a chronic disease that used to be fatal for virtually everyone who got it. Now, things have changed and effective treatments are available to treat HIV and, in most cases, these treatments can prevent HIV from doing further damage and can keep the person healthy. In order to take advantage of these treatments, you must be tested and diagnosed with HIV. All persons who may have been infected with HIV and virtually all pregnant women should be tested as soon as possible.

Brian Boyle, MD, JD, is an Attending Physician at the New York Presbyterian Hospital-Weill Cornell Medical Center and Assistant Professor of Medicine in the Department of International Medicine and Infectious Diseases at Weill Medical College of Cornell University. Dr. Boyle has authored and co-authored more than 100 publications and abstracts relating to the treatment of HIV and hepatitis. In addition, he has lectured across the country on the latest advances in the treatment of HIV, Hepatitis C Virus and Hepatitis B Virus as well as many other HIV/AIDS and hepatitis related topics.

next: HIV, AIDS, and Older Adults

Self-injury is often called "cutting" because that's what most self-injurers do, but there are many ways to self-harm.

A study published this week shows 17 percent of respondents at two Ivy League schools have self-injured. And 75 percent of those have done it more than once.

The Early Show national correspondent Tracy Smith met a young woman from Peoria, Ill., who says self-injury can become a dangerous addiction.

Teens and Self-Injury

Looking at Alicia Moore, 17, it's hard to see the traces of a troubled little girl but they're there. From a young age, Alicia was exceptional — a brilliant student, a talented musician and dancer. But she hated herself for it.

"I'd get made fun of for being smart. Getting A's on tests. Stuff like that," she remembers. "It was devastating. I thought there was something wrong with me. And that it ... was always gonna be like that."

Isolated and alone, Alicia found the only way she felt better emotionally was to hurt herself physically. The first time she cut was in fifth grade.

"I ripped the soda can in half and I just cut myself right here almost on instinct," Alicia explains. "I just remember kind of looking down and be like, 'I did that.' And I just remembered just having kind of this euphoric, everything's okay."

Alicia started down a dark path, where self-mutilation became her only solace.

She says she was addicted to hurting herself. "It was, I feel, the smallest amount of anything. And it was, 'OK, I can cut myself. And it'll go away,' " Alicia says.

Alicia found plenty of ways to cut herself; some were obvious, like razor blades, safety pins and scissors. Other methods took some creativity, like using broken CDs and even ordinary buttons. All were acts of a desperate and hurting girl. She even secretly made a video, recoding her despair. "I hate being me, that's the bottom line," she said in the video.

Karen Conterio, co-author of "Bodily Harm," says there are several reasons why people self-injure. Self-loathing is typical for self-injurers. "Self-injury can be used as a punishment, it's intentional. Self-injury can be used as a way to say 'Look at how much I hate myself,' " she explains.

Alicia says she wasn't trying to kill herself. "I didn't cut myself to try to kill myself. I cut myself to release all of this emotional pain that I felt like I couldn't handle anymore," she says.

Self-Injury a Secret Activity

Alicia is not alone. In a study of more than 2,800 college students published this week in Pediatrics magazine, a little more than one in six reported having self-injured.

And of those who self-injured, nearly 40 percent said that nobody knew about their behavior.

Alicia tried to keep her cutting a secret, but her parents knew something wasn't right.

Her mom took it upon herself to investigate, trying to find out what was wrong.

The Moores found Alicia's online diary, and pages of bloodstained poetry with chilling, macabre lines. "Can't take the anger, can't take the pain. Must relieve the only way I can. Cut. Cut. Cut," she had written.

"It was just hard seeing the signs of self-injury. You want so much for your kids," Alicia's mom tearfully explains. "To have 'em go through something you have no control over is really hard."

The Moore family sought help from Amy Simpkins, a social worker with Catholic Charities. To keep Alicia safe, Amy suggested she start using alternatives to self-harm including taking out aggression on objects, like her desk, instead of herself.

Teen's Path to Self-Injury Recovery

After years of working with Amy and her family and starting antidepressants, Alicia slowly overcame her negative image of herself and stopped cutting and began to move on. Today, the self-harm scars on her skin are barely visible and the internal scars are fading, too.

"She's a great young lady. And I think she's finally starting to realize that," says her mom.

"She said to me, 'You know, it's okay bein' a bright girl,'" Alicia's dad remembers.

"I don't think that I'll ever fully be able to say I'm completely done with it," Alicia says. "It's completely over. But I'm at a point right now where I'm stable. I'm happy. I can function. So I'm pretty sure that this is where I'm gonna be."

The major warning sign for parents seems obvious, but is often missed: unexpected cuts and injuries.

If you see them, experts say it's best to confront your child about it — it's better to ask and be wrong than not ask at all.

Read and watch more self-harm stories.

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For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life

This is, at heart, a book about the female sexual response. We believe that what women and their partners learn here will eliminate much anguish and despair and help them enjoy more sexually satisfying lives. For Women Only also reflects the enormous change in the treatment of women's sexual problems in the last three years. Our book grew out of this exploding new field, and we are privileged to have played a part. Female sexual dysfunction is at last on the table a recognized and often treatable disorder, which affects the general health and quality of life of millions of women around the world.

What you read here is based directly on our work when we were co-directors of the Women's Sexual Health Clinic at Boston University Medical Center. Thanks to the help of our mentor and role model, Dr. Irwin Goldstein, the pioneer and leader in the field of male erectile dysfunction, this clinic was an enormous success.

We are sisters and started the clinic together, which was the realization of a longtime dream. We had talked for years about the possibility, particularly as Jennifer, a surgeon and anatomist and one of the few women urologists in a nearly all-male field, became convinced that women could benefit from the same medical attention to sexual problems that was given to men. Laura, a sex therapist and psychotherapist heavily schooled in anthropology, enthusiastically supported Jennifer's views.

We opened our doors in the summer of 1998 and have not caught our breath since. The clinic was among the first in the country to offer comprehensive treatment, both physiological and psychological, for women suffering from sexual dysfunction. We have made it clear from the beginning that while we could learn a tremendous amount from the treatment of male sexual dysfunction, we were not going to subscribe to the initial efforts of many physicians to define "female impotence" in masculine terms. We treat women with female sexual dysfunction in terms of four newly classified categories -- hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorders -- as well as a wide variety of other problems. We also offer sex therapy, couples therapy, educational counseling, medical treatment, and surgery. We answer frequently asked questions: What is orgasm? How can I enhance my sex life? Am I normal? How can I get my partner to fulfill my sexual needs? Our work is exciting and rewarding. With new medical technology and medications as well as existing psychotherapy treatments, women now have more options than ever before.

Clearly, help is needed for women as much as men. Studies estimate that more than half the women over age 40 in the United States have sexual complaints. In early 1, the National Health and Social Life Survey published in the Journal of the American Medical Association released a report showing sexual problems to be even more widespread: the survey found that 43 percent of American women, young and old, suffer from some sexual dysfunctions significantly higher percentage than that of men, who suffer at a rate of 31 percent.

And yet for most of this century doctors have dismissed women's sexual complaints as either psychological or emotional. In the nineteenth century, the Victorians believed that "good" women had no sexual desires at all. Even now, in our supposedly enlightened era, it is still shocking for us to hear how many doctors, female as well as male, tell their female patients that their problems are emotional, relational, or due to fatigue from child rearing or their busy jobs, and that they should take care of their problems on their own. Many doctors tell older women that these are not real problems at all, just something to accept as a normal part of aging. This is particularly true of older women, although women of all ages have reported this to us.

We hope this book will serve as an antidote to what women have heard for decades. The problem is not "just in your head." You are not crazy, or alone, or fated never to have an orgasm or feel sexual again. Of course, we don't dismiss the importance of psychological factors. But in our experience with our patients, who come from all over the United States and the world, and from all age groups and cultural backgrounds, most problems tend to have both medical and emotional roots, and feed on each other. Our goal in this comprehensive handbook on sexual health is to help the whole woman.

In our clinical work we have always worked as a team. Jennifer conducts the medical part of our patient evaluation and treatment. She is also in charge of our laboratory research, including a recently completed study funded by the American Foundation for Urologic Disease on the smooth muscle function of the vagina and clitoris. This research helped us better understand the mechanisms underlying female sexual arousal responses. Laura is the clinic's psychotherapist. She has a Ph.D. in health education and therapy, with a specialty in human sexuality. She interviews and evaluates patients both before and after Jennifer sees them, and determines if they have emotional problems or relational conflicts that require treatment on a longer basis. Laura helps them get a sense of the larger picture of their lives, and provides ongoing therapy to individuals, couples, and families if needed.

Both of us feel that women's sexual complaints are still neglected by the medical establishment, and that many of the same health problems that cause erectile dysfunction in men, such as diabetes, high blood pressure, and high cholesterol as well as many medications used to treat these conditions, can cause sexual dysfunction in women. Most women also experience diminished sexual responsiveness and loss of libido at the onset of menopause, and many have sexual complaints after hysterectomy or other pelvic surgery. Although drug companies have worked for years to treat male impotence, they are only just beginning to recognize female sexual dysfunction as a medical problem. Even female sexual anatomy is not completely known or understood. It was not until 1998 that an Australian urologist, Helen O'Connell, discovered that the clitoris is twice as large and more complex than generally described in medical texts.

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The fact remains that there has been a great deal of psychological research but almost no medical research into the sexual response of women since the groundbreaking work of William H. Masters and Virginia E. Johnson in their laboratory in St. Louis, Missouri, in 1966. Masters and Johnson were the first to describe the physical changes in the vagina during sexual arousal, which they observed and filmed in volunteers with a small vaginal probe and a camera attachment. We have begun where Masters and Johnson left off.

We have adapted the more sophisticated technology of our day: pH probes to measure lubrication; a balloon device to evaluate the ability of the vagina to relax and dilate; vibratory and heat and cold sensation measures of the external and internal genitalia; and high-frequency Doppler imaging, or ultrasound, to measure blood flow to the vagina and clitoris during arousal. Ultrasound, which has been widely available since the 1970s, has never before been used to evaluate genital blood flow when a woman is sexually aroused. Currently, even more sophisticated instruments are being developed to evaluate female sexual arousal, response, and function. These include probes to measure vaginal, clitoral, and nipple sensation and computerized equipment to measure vaginal anatomy and physiology in the office. MRI, or magnetic resonance imaging, is even being used to determine what areas of the brain are responsible for arousal and orgasm.

One of our most important findings is that a physical problem -- a decrease in blood flow to the vagina and uterus, perhaps as a result of aging, hysterectomy, or other pelvic or vascular surgery may be a cause of a diminished sexual response just as diminished blood flow may affect male sexuality. Some women have sexual complaints after hysterectomies and often are told by doctors that they are simply depressed. We believe that in some cases injury to the nerves and blood supply to the genital area may be the cause or be contributing to the problem. Jennifer is in fact developing the same nerve-sparing pelvic surgery for women as is available for men who undergo prostate surgery. Furthermore, we are beginning to realize the important role testosterone plays in female sexual function and dysfunction..

Our goal in this book is to arm women with the information they need about their bodies and sexual response and to provide them with a full spectrum of options for treatment. Our hope is that women will take this book to their doctors, give it to their partners, or share it with other women. It is written without jargon, by women, for women. Clearly, the options will continue to grow as more research is done in this field, and it is also our plan to update women with the latest information.

We are in a new era of women's sexual health -- perhaps feminism's next frontier. Sex is central to intimacy, to who we are, to our emotional well-being and quality of life. Doctors have assumed for years that as long as a woman is able to have intercourse without pain, all is well. That is simply not the case. The fact that sexual education has rarely been a part of physicians' education and training has further aggravated the problem. Most male physicians have only their personal life experiences to help them understand female sexuality. We hope that this book will also help bridge that gap and encourage early education in sexuality for physicians and health care professionals in training and help educate those currently in practice.

It is high time for women to receive the same attention as men, and to demand treatment, not only for pain but to increase their sexual pleasure.

Buy For Women Only

When you’re depressed, it can be hard to practice self-care. Self-care, though, is essential for beating depression.

Depression forces its own ways of thinking, feeling, and doing (or not doing) on people. Depression’s control is hard to resist, and giving into it comes to feel natural. Self-help for depression becomes increasingly difficult.

A decreasing ability to practice depression self-care has absolutely nothing to do with laziness. No one actually wants to remain pinned by depression. This is why self-care is so vital; self-care helps you begin to rise up out of depression. The following ideas for depression self-care will help get you started.

Depression Self-Care: WRAP It Up

Self-care is vital; unfortunately, depression can make people forget about caring for themselves or about knowing what to do for self-care. In The Depression Workbook (2001), Mary Ellen Copeland discusses the importance of having a written plan in place to provide guidance when you’re really depressed.

Copeland, along with people she’s helped, developed the idea of a Wellness and Recovery Action Plan (a WRAP). A WRAP includes such things as

• A daily maintenance list. Creating a list of depression self-care necessities makes it easier to take care of yourself. A check-list of actions such as taking care of personal hygiene, getting some exercise, eating regularly and well, and doing something enjoyable can help you break free from depression even when depression feels overpowering.
• Triggers to be aware of. Certain things tend to worsen depression. Triggers can be food-related (for example, processed foods can worsen mental health conditions like depression). Triggers can also be people-related (a well-meaning aunt who constantly tries to cheer you up by telling you to just stop being down and start enjoying life), or they can be related to situations or events. While avoiding people and things in general actually worsens depression, identifying specific triggers and creating distance from them is a powerful aspect of self-care.
• A list of steps to take when things are worsening. Having a list to turn to with people to contact, special things to do (reading a favorite book, watching a funny movie, snuggling with a pet) helps stop the downward spiral.

WRAPs are very individualized. What’s important is the concept of creating a personalized plan for depression self-care and to use it regularly.

Depression Self-Care Means Appreciating Yourself

Depression makes people extremely hard on themselves. It’s difficult to break from depression when depression tells you horrible things and causes you to describe yourself with negative labels. When depression makes you think things like, “I’m stupid,” “I’m so worthless,” “No wonder no one likes me,” “Why try because I’ll just fail,” the idea of self-care can begin to feel pointless.

Depression self-care means countering such faulty, depression-driven thoughts with real things you appreciate about yourself. Make a list and carry it with you to review it often. Tips for making a self-appreciation list:

• Start where you are. Reflect on your current self, and identify strengths and positive qualities. What things, big or small, do you do well? What kind of person are you? Caring? Helpful? Persistent?
• Be aware of your own best self. In times when your depression is better, what’s different? How do you think, feel, and act? What successes have you had?

Appreciating yourself is an important part of depression self-care because it helps you regain a healthy, accurate perspective of yourself.

More Self-Care Ideas for When You’re Really Depressed

Self-care is a broad term that includes a way of being with yourself and a way of doing in the world around you. Depression has a way of making it hard to think of ways to practice self-care. This partial list of self-care ideas just might inspire your own ideas.

• Exercise or engage in mild to moderate activity (such as housework) daily.
• Create, and stick to, a sleep routine.
• Make time for play and laughter every day.
• Pay attention to small pleasures.
• Appreciate the beauty around you and in yourself.
• Decrease the amount of time you watch television, play video games, and use social media.
• Get out into nature.
• Volunteer.
• Participate in neighborhood or community events.
• Have lunch or coffee with someone.

Create a list of depression self-care ideas and keep it handy. Then when you’re really depressed, you’ll already be prepared to practice self-care and start beating depression.

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Wondering how to pull yourself out of depression is a very common question, especially when depression has ahold of you and just won’t let go. You can pull yourself out of depression in a pleasant and empowering way.

To pull yourself out of depression implies that you are actively doing something to overcome depression (10 Things to Help with Depression). In taking an active role, you take control away from depression, and you do things intentionally to feel better and better.

When you’re living with depression, though, just the thought of being active and doing things can seem exhausting and enough to make you want to stay in bed. That’s the depression trying to control you (Depression Symptoms: What are the Symptoms of Depression?). Take a deep breath, and get ready to pull yourself out of depression.

Pull Yourself Out of Depression with Flow

Flow is a state of being fully engaged in whatever it is you’re doing in a given moment. With flow, your mind is still, and your whole being is immersed in the activity you’re doing. Flow means letting go, and it means diving in. When you are experiencing flow, even your depression is suspended.

Flow pulls people out of depression because it pulls them out of the lethargy and despair depression causes. Flow also provides successes and positive experiences, which boost self-confidence and help people begin to believe in themselves again.

Flow helps people feel better about their experiences; further, after engaging in an experience that creates flow, people feel better about themselves. After doing an activity that brings flow, people tend to describe themselves positively, stating that they feel active, motivated, creative, and strong (O’Connor, 2010).

What Causes the State of Flow that Pulls You Out of Depression?

Flow has distinct components:

• It involves being active in some way
• The activity must be one that you have willingly chosen to do, as opposed to it being assigned to you
• The activity requires skill and is challenging enough to remain engaging
• The activity is not so challenging that it becomes frustrating

Depression can zap the joy and energy away from you, so it might seem impossible to find something you want to do at all, let alone one that will engage you so completely. That’s okay. Flow isn’t something to pressure or force yourself to do.

How to pull yourself out of depression with flow starts with choosing an activity you used to enjoy and committing to do it. It’s unlikely that you’ll immediately experience flow, but you will be able to congratulate yourself for doing it, and because you’ve done it once, you’ll find it easier to do a second time. And a third. And out of that will arise flow.

How to Pull Yourself Out of Depression with Flow

Pulling yourself out of depression takes effort (How Not to Feel Depressed: What’s the Secret?). Depression makes it so that you typically don’t feel up to spontaneous bursts of energy. It’s unlikely that you’ll suddenly decide to spring out of bed, head outside, and paint a gigantic mural that decorates the entire front of your house. It is very likely, though, that you go buy some painting supplies and paper, and spend time every day painting, even if it’s just for a short amount of time.

Depression can make it hard to think of ideas. To get around this depression roadblock, create a collection of activity ideas, things you like, used to like, or would like to try. You can use a jar or a box, and you can decorate it to make it look attractive to you. This is your flow jar, so have fun making it look appealing. Using craft sticks, note cards, or anything else you can write on and that fits in your flow jar, brainstorm activities that could bring you flow. Keep these ideas in your container, and when you need activity ideas, pull one out and immerse yourself in it (Stop Being Depressed. Use These Self-Help Tools Now).

There really is no limit to flow-inducing activities, as long as they’re safe. They can be artsy, crafty, musical, athletic; they can involve nature or urban settings; they can be indoor activities or outdoor.

Actively engaging in experiences that create flow will help pull you out of depression.

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Getting out of depression can seem impossible. Depression has many negative effects. It can completely change someone’s life and rob him of the person he thought he was. Happily, that person isn’t gone. That person is smothered under the weight of depression. The following ideas for how to get out of depression can be effective strategies for overcoming depression.

• Embrace and work with your strengths
• Listen
• Operate from the perspective of gratitude

Getting Out of Depression with Your Strengths

Depression says that you’re inadequate. You aren’t, of course, but it’s hard not to believe it. Depression makes it difficult to do things both big and small, and when it prevents you from being active, it blames you for it and belittles you with name-calling. Naturally, this makes it even harder to do things. There’s a way out of this cycle, and there’s a way out of depression. One method of getting out of depression is by taking action with your strengths.

Depression makes people forget that they have any strengths at all. You do have strengths, and you can use them daily. Here’s how to get out of depression by drawing on your strengths:

• Remind yourself of all of the good things about you. Write them down in a dedicated notebook, or make a collage and hang it on your wall for a constant visual reminder. Focus on things you do well and on positive character traits you have. For example, are you caring? Do you have perseverance? Discover your talents and character strengths, and let them be your guide.
• Use your strengths to guide you to enjoyable, meaningful actions and activities.
• Record your activities (anything from making your bed to volunteering at your local elementary school) in a journal so you can see that you are doing things and that you are making a difference.

How to Get Out of Depression by Listening

A problem with depression isn’t an inability to listen in general. If you are living with depression, chances are that you’re listening very well—to your depression. Unfortunately, depression is a harsh inner critic that labels you, picks on you, and keeps you mired in its muck. The critical inner voice isn’t your true voice.

Separate your real voice from depression’s voice. When depression tells you that you can’t do something or that you’re worthless, notice it, challenge it, and then choose one of your strengths-based activities to do. It’s another way to get out of depression.

Gratitude and Getting Out of Depression

Depression zaps joy. It washes away positive feelings. It makes the world, inside of you and outside of you seem bleak and pointless. That is only a faulty perception, clouded by depression. Training yourself to notice and appreciate things in life helps pull you out of the depression perspective.

The field of positive psychology offers this exercise, often called Three Good Things (Peterson, 2006), for how to get out of depression the gratitude way:

• Set aside a time each day to reflect on things for which you are grateful, good things that you noticed during the day. Jot them down in a journal. This will help you notice the good in yourself and the world even when depression wants you to see only the bad.
• Next, reflect on this question: Why did these good things happen? You soon notice a pattern; good things aren’t arbitrary. You, and others, make good things happen. You are the one appreciating beauty. You aren’t your depression.

Depression can be so strong that it feels impossible to figure out how to get out of depression. Getting out of depression doesn’t have to be difficult or fancy. It can involve simple actions and different ways of thinking. Identifying and using your talents and strengths, learning to listen to yourself, the real you, and developing a grateful mindset all work together to help you get out of depression.

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A common question among people living with depression is just how to get over depression because it can be all-encompassing. It takes over thoughts, feelings, and behaviors, making each one feed off the others until someone living with depression feels imprisoned. Depression can interfere in relationships and make someone feel isolated and alone. Thankfully, depression isn’t someone’s identity; indeed, depression isn’t who someone is but instead is something that he or she is dealing with.

This is significant. It means that there are ways to get over depression and that depression can be overcome. These three strategies for getting over depression are tools you can start using today to reclaim yourself and your life.

How to Get Over Depression: 3 Ideas

1. Create a routine, and use schedules. When depression takes over, it makes it hard to do much of anything. The smallest task can feel like an insurmountable challenge. Sometimes even getting out of bed feels impossible. This has nothing to do with laziness but instead is caused by the illness that is depression (Depression Symptoms: What are the Symptoms of Depression). Knowing that lethargy and lack of motivation isn’t a character trait can empower you to begin to get over depression.

Inactivity deepens depression and leads to prolonged inactivity in a vicious cycle. Creating a routine and using schedules to hold yourself accountable for things you’ve planned helps motivate you to get going. Here’s how to use schedules and routines for getting over depression:

• Before going to sleep at night, set an intention for the next day. Why do you want to get up? What one thing do you want to do that is meaningful or helpful? Write it down so you can use it as a reminder the next morning.
• Set an alarm clock and get up at the same time every day. Getting into this routine will help you avoid lying in bed.
• Make your bed. It’s harder to crawl back into a bed that’s made, and making it brings a feeling of accomplishment.
• Create a small to-do list, break the tasks into smaller parts, and make a schedule for completing them. The brain, plagued by depression, needs help getting back into action. Routines and schedules are part of how to get over depression.

2. Increase activity and exercise. Being active in everyday life and exercising, even mildly, are proven ways of getting over depression. According to Cousens & Mayell (2000), exercise

• Boosts serotonin and endorphins, important biochemicals in the brain that play a role in mental health
• Improves mood both immediately and up to 24 hours afterward
• Counters symptoms of depression
• Improves the quality of sleep

Routine and schedules apply to exercise and physical activity. Making exercise and activity a part of your daily routine, and of course, making them appealing, increase the likelihood of following through with them.

3. Relaxation. Depression often causes the mind to become harsh and belittling. People living with depression often have extremely critical thoughts about themselves and judge themselves with negative labels. It’s important to have time every day dedicated to quieting the mind. Getting over depression by using relaxation involves

• Creating a quiet, peaceful space dedicated to daily relaxation time
• Making relaxation part of your daily routine
• Breathing slowly and deeply
• Concentrating on one thing, observing its properties without judging them; when your mind wanders, gently bring it back to the object

Formal meditation programs do exist. These can be beneficial, but they’re not required. The above steps are useful for daily relaxation.

Getting over depression doesn’t happen overnight. It’s a process, and it’s a process that is absolutely possible for everyone and anyone (Treating Depression Without Medication: Is Self-Help Enough?). Creating a routine and schedule, increasing activity and exercising, and relaxation are all proven ideas on how to get over depression.

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