Major Depressive Disorder: A Therapist’s View


By Ashley Bobo, LCSW, as told to Kara Mayer Robinson  

When you have major depressive disorder (MDD), understanding what to expect can help you manage the ups and downs. When someone I work with is newly diagnosed, I spend a lot of time educating them and explaining the trajectory of MDD.

 Life with MDD is often unpredictable. While you may only have one episode of depression in your life, most people have several episodes. Depression can ebb and flow over time, so it’s important to prepare for it and have a plan.

Managing MDD Over Time

With MDD, every day can be different. There may be some days when you have energy and motivation to do the things you enjoy, while the next day you have trouble just getting dressed.

 Starting counseling for depression can be a huge step toward healing. As you try new strategies, you may notice an improvement in how you feel. It may start small, then add up to bigger changes. Your mood may improve. You may start having better days. You may begin to have hope that you can feel better. 

It’s common to feel better and then experience a setback. You may feel discouraged, but it’s important to understand that this is normal for MDD. You may have lots of starts and stops. 

When I work with people who have MDD, I start by preparing them for ups and downs. I help them build new skills they can use not only right now, but later, when symptoms may come back.

Setbacks Are Common With MDD 

Expect setbacks and try to be patient with yourself. Feeling better can look more like a roller coaster or a twisted ball of yarn than a straight line forward. 

When you learn new ways to manage your depression, it may involve thinking about yourself and your environment in a different way. You may try new strategies, evaluate what happened, and tweak it for next time. This takes time and it’s not always a straightforward process.  

Depression can also lead to negative thinking patterns and strong, entrenched beliefs about yourself. This way of thinking can take time to understand, unwind, and relearn.

What to Do If You Feel Discouraged

Look back and remember times when you’ve had a setback and were able to recover from it. Sometimes just remembering that setbacks are part of growing and learning can shift how you think about it.

 Work with your therapist to identify times when you felt better. Try keeping a mood journal or using a mood app to track your ups and downs. It may help you remember upward trends in your mood and remind you that they’ll come again.

 Watch out for negative thinking. Do you ask yourself things like “What’s wrong with me?” or “Why can’t I feel better?” This is common with MDD, but it’s important not to blame yourself for not feeling better. A downward spiral of negative thinking only makes the situation worse. Try to remember that a setback isn’t a personal failure.

What to Do If You Don’t Feel Better

While your progress may not be linear, it’s still important to see a trend toward improved symptoms over time.

 If your treatment stalls or stops working, talk to your therapist. 

When this happens with people I’m working with, I look at what worked in the past, what’s working now, and what’s not working. 

We may decide to try something different, like adding or switching medication, trying a different type of therapy, or adding social support like group therapy. We’ll also explore other levels of care that may help. I may consult with other care providers to make sure we’re all working together on the same plan.

Tips for Managing the Ups and Downs of MDD

There’s a lot you can do to feel better and manage the ups and downs of MDD: 

Talk it out. Let your therapist know if you feel discouraged. Sharing feedback can keep your recovery on track.

Seek out support. Join a support group or connect with other people who have MDD. Spend time with people in your life who are encouraging.

Reset your expectations. Each moment, second, minute, hour, or day is a new opportunity to do, think, or say something different. You may be having a bad day today, but tomorrow may be better.

Identify your red flags. Be aware of symptoms of a setback. They may include:

  • Binge eating or drinking more often
  • Getting back into bed after getting up
  • Increased rumination or anxiety
  • No desire to do your usual activities, like exercise or favorite hobbies
  • Turning down social invitations

Have a self-care plan. Have a plan to take specific actions when you or a loved one notices these signs. What will you do? Call a friend? See your counselor? Go outside? Put the plan into action as soon as you see signs.


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