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Healing from a depressive episode involves what can seem like a battle between two opposing forces. Andrew Solomon wrote in his book The Noonday Demon, "The opposite of depression isn't happiness, it's vitality." It requires determination and energy that's focused on getting reconnected with life.

But there's an innate problem.

Depression itself can feel as if your known world is collapsing.

So healing, confronting that implosion, is tough. The fight is taking place on two opposing battlefields. You're fighting to become engaged outwardly while struggling to break free of depression's implosive force.

• "I know I should exercise. It's hard to make myself want to do it."
• "I don't like to journal. I do it, but nothing changes."
• "Therapy doesn't work. And it's too expensive." Or "I took pills one time and they made me sick."

All of these statements are common to hear. Here are the hurdles they reflect—and what you can do about them.

3 Hurdles to Taming Depression

1. Waiting to feel motivated

If you're actively trying to confront your depression but are waiting to be magically motivated to change, nothing will happen. You have to make yourself do the things that are likely to help, even when you don't have a lot of energy or even hope. It's tough. But putting motivation before action is putting the cart before the horse.

Afterward, you'll be enjoying the benefits of walking a mile, swimming a lap, or making yourself get out of bed. Whether it's getting dressed for the day or calling an old friend whose friendship you've let slip, action creates motivation.

Kate fought me tooth and nail over the importance of exercise in managing her depression. Then one day, after a couple of years of struggling with suicidal thoughts, she came in:

Well, I made myself put on a bathing suit and get into the pool. And it really helped. I've always loved to swim and, suddenly, I found myself energized. I have to get up really early to get it done, and I still have to make myself go sometimes, but after it's over, I feel so much better.

Getting regular physical exercise didn't "cure" Kate, but it helped a lot. Just as importantly, it gave her a sense of control and a sense of hope—when her depression seemed unmanageable.

2. Discounting small changes

Healing comes from the cumulative effect of many small changes. I wish I had a nickel for every time a patient had said, "This isn't really a big deal, but yesterday I...." Any change, any risk is a big deal, because you're confronting your depression or anxiety in small ways. Those changes add up.

What can seem unimportant—what you tell yourself is no big deal—can be a very big deal. A patient who came into therapy after reading about perfectly hidden depression said,

The other day, I actually told my husband I didn't have the same perspective he did, and I couldn't go along with what he was saying. We talked and it went pretty well. He told me later that he couldn't believe I actually said what I was feeling. He doesn't think he knows me. And, actually, he's right. Because I don't let him know me. I've always avoided any kind of conflict.

Maybe this sounds easy for some. But it's not for someone who's been hiding what they really feel for years.

3. Giving up because you had one experience that wasn't helpful

Depression can create tunnel vision. a tunnel where you only see the negative. For example, deciding that nothing will work because your first attempt wasn't effective is problematic and paralyzing. You wouldn't say to a child you cared about, "If one idea doesn't work, don’t bother trying anymore.” Or, “If you can’t do it easily the first time, give up.”

Nope. Persistence can pay off.

Sometimes this is an excuse because it can be hard to admit there's something wrong. You did it once, and you don't want to face another so-called failure.

It takes courage to not give up.

If one therapist doesn't help, ask around and find one with a different style or treatment regimen. If you found yoga boring, take a Zumba class. If you're nervous about prescription medications, then look for homeopathic alternatives. Sometimes you'll be surprised at what actually helps. Sitting in the sunshine, walking around the block, striking up a conversation with the 6-year-old next door, striking up any conversation, in fact. Engagement is what's important.

Engaging with life, with others, with nature—which will bring with it vitality...and hope.