One day, somewhere in my early teens, I found out my mom was in the hospital. I didn’t understand why she had to go to the hospital for being sad, but at least she looked fine when we visited. She returned home soon after, and life went on as usual.

That was more than two decades ago. During that time, I learned more about depression and my mom learned a lot more about living with it. All that learning paid off. Today, she enjoys an excellent quality of life, despite her depression always lurking in the background. That’s why I decided to ask her some questions about how she managed to pull it off.

Let’s start at the beginning. What exactly is depression?

There are many definitions by professionals, but for me, it basically comes down to feeling utterly miserable when you have no reason even to feel bad. And it goes on and on and on. Naturally, hardship and loss can worsen depression, but it’s not necessarily the source. Feeling like you have nothing to live for when you KNOW you have lots of things to be grateful for adds a layer of guilt, only making the situation worse.

This is different from feeling blue for a day or two or grieving for a loss or being sad about something that happened. These feelings can be terrible, but they dissolve over time and usually don’t rob the person involved of his ability to experience joy.

That’s depression for me: a thief trying to steal all the joy from your life.

Depression is quite common, right? Do you think it’s increasing, or are people just becoming more open about it?

I think both. People are more open and that’s great. In our Afrikaans community in South Africa, I also try to do my part to lessen the stigma. But there is a troubling increase in mental illness, especially now with the pandemic just going on and on (particularly in countries with a low vaccination rate).

Could you share with us your journey down to rock bottom — that proverbial point where it is darkest before dawn?

It took me nearly a decade to reach rock bottom for the first time. I fought long and hard but without real knowledge or support.

One will never know, but the starting point could have been the failed miscarriage (yes, there is such a thing!) of twins that I experienced between my two children. It left me with a huge sense of failure and loss, and there was absolutely no support and very little sympathy for women who had lost an early pregnancy at the time.

The next step was postpartum depression after the birth of my second son (who is now one of the greatest joys in my life). I now realize that I tried too hard to be the perfect mom, the perfect wife, the perfect daughter, the perfect friend. Perfectionism is a close ally of depression.

Starting a new career when I had the opportunity, while I would have preferred to remain a stay-at-home-mom who wrote romantic fiction in her (very little) spare time, was not the best decision. I was very good at my job, but I compromised a great deal to be accepted after a previous experience of severe bullying (which I only recognized years later for what it was). The pressure of doing everything perfectly while handling my job, two sons in different schools, and a dear husband who did not realize how hard I struggled, brought me to the point where I spent many weekends crying in bed. Finally, I surrendered to being admitted to the hospital.

Nearly twenty years later, after many years of ups and downs, but mostly ups, I reached rock bottom again. Over about five years, a series of deaths in my extended family, the emigration of both my children (although I’m extremely proud of them both), plus some disillusionment in my writing career took their toll. I actually considered suicide, but after a brief Google search realized that is not for me. I phoned my psychiatrist and uttered the most important words in my life: “I need help.”

What’s it like to be trapped in such a deep depression?

Depression distorts your sense of reality. Everything is wrong. Nothing seems good or right or joyful. You feel you’re worth nothing — that nobody loves you or has any reason to love you.

You have no sense of self-worth and lose the ability to enjoy the things you used to love.

You may lose your appetite, or you cannot stop eating (that’s me), which leads to body issues and an even worse image of yourself.

You either sleep too little or too much.

You know you must reach out to people, but you don’t have the energy.

The worst-case scenario is where you don’t see any reason to keep living. It’s not necessarily that you want to die — you just can’t live anymore.

Now for the comeback story! First off, what triggered the turning point in your battle with depression?

My first hospitalization many years ago (they basically just kept dangerous objects like scissors out of reach and gave me an injection to sleep). After that, my secret was out. Most people had no idea what to say to me, and vice versa. I experienced it as a huge humiliation, but over the following years, a slow learning process began to emerge.

My second hospitalization two decades later was a much more positive experience because a wonderful clinic for mental illnesses had been established in our town. They followed a holistic program, creating a safe space when the world becomes too much. I could also openly share my experience with family, friends, and contacts on social media.

Another pleasant surprise was that people were much more willing to talk about it than all those years ago. Other people shared that they also spent some time in a clinic. Thus, I can see clearly that the stigma has weakened during those two decades, although it’s far from completely gone.

That second hospitalization was four years ago. How has life changed since then?

What I learned over the years (and really experienced during and after my week-long stay at the clinic) is that many people respect me for fighting depression and being open about it. But I must stress that I try to keep my communication with them as positive as possible. People find it hard to cope with someone who complains all the time. Most people cannot understand depression completely (not even me after thirty years of intense study!). And being confronted with a depressed person’s lament makes them feel helpless and prompts them to give unsolicited advice.

The tremendous support I received during this time helped make it a very positive experience. It also helped that I had the insight to take part in ALL the activities the clinic offered, especially when I didn’t feel like it. This experience cemented many lessons I learned over the years, but the thing that changed is actually something very small: Learning to fill empty spaces of time with craftlike activities, which lessens the urge to go and lay down on my bed (the biggest danger of all for a depressed person). I’ve always done some knitting and crocheting, but I came home and added things like coloring for adults, building puzzles, and doing crossword puzzles to my repertoire. These are stationed at strategic places in my home, ready to be used when necessary.

The pandemic also served to cement some well-known truths in my life: that life is short and unpredictable, that deliberate gratefulness can actually lead to a real sense of gratefulness, that the world is a wonderful and interesting place with millions of secrets waiting to be discovered.

I developed a real sense of how precious life is and that it can end at any moment. This helps me live to the fullest while I have the opportunity.

I’m particularly interested in lifestyle solutions for controlling depression. What would you say is the relative importance of medication and lifestyle? Do they complement each other?

I believe one cannot stand without the other. Medication can give you the lift to be able to make lifestyle changes. Therapy is also a must — at the very least a few sessions when you’re in a really bad spot.

Sadly, both are very expensive and, at least here in South Africa, not accessible to most people. I’m one of the lucky ones, but even I find it very costly. Another problem is that many doctors still freely dish out antidepressants with no therapy or lifestyle change advice. This can lead (as it did for me years ago) to the patient believing everything would be fine after taking medication, which is often not.

Lifestyle change did not allow me to reduce my medication, but it helped me reach the point where I can live a really good life despite my depression.

What permanent lifestyle changes did you implement? Which ones do you think make the biggest difference?

My lifestyle developed over many years, and often I did not even realize I’m doing the right thing concerning my depression.

The most important thing that got me through many bad patches (and without which I cannot survive) is walking every day. For the last 27 years, I have walked 5 km at least five times a week.

Developing a morning routine also helped me a lot. I’ve known for many years that if I really want a successful day, I must do the important stuff as early in my day as possible. It’s only quite recently that I learned a morning routine is actually a thing.

Nature, reading, traveling, music (very important), and yoga have all helped me over the years. Nurturing relationships are of the utmost importance.

Later, I added a set of breathing exercises and meditation to my routine.

Each of these elements helps me keep my head above water. It basically comes down to filling your life with as many meaningful (for you) experiences as possible.

What I find impossible to conquer is my addiction to comfort food. Too many carbs can bring me down very effectively, so I do my best to control my intake of refined sugary products. But I cannot cut sugar completely (especially not when presented as carrot cake in a nice coffee shop that needs my support to recover from the Covid-slump).

I imagine that depression is not exactly the best mental state for making these types of lifestyle changes. How did you get it done despite the challenges?

I’ve always been interested in lifestyle design and living a meaningful life. Reaching my sixties and thinking about the inevitable challenges of aging enhanced my need to live my life as well as possible.

Having a son interested in these things with whom I can share my experience also played a big role in formalizing my development.

You mentioned the importance of nurturing relationships. Which relationships help the most with your depression?

My female friends are a great source of strength and hope, but what really can make or break me are my relationships with my close family: my husband, two sons, and one daughter-in-law. I simply cannot live without meaningful interaction with each of them.

I work very hard to maintain communication with each of them on their terms. They all have unique lifestyles and preferences I try to respect. That includes trying not to intrude too much on their time (but also not pulling back because of the fear of intruding).

A great joy in my life, prompted by my second hospitalization, is the daily early-morning video calls with my two emigrated children. With these short chats, we keep each other accountable to be up bright and early. This is especially important for me when my husband is traveling since I work from home and, in his absence, there’s nobody who sees or cares whether I get up and do things or just stay in bed and mope all day.

I savor these conversations and make sure I’m available at the decided time, respect our schedule, and keep the tone as positive and fun as possible, but also authentic and free of toxic positivity. For example, I don’t ignore the dire situation in my country, but I avoid feeding sad stories to my children all the time.

How would you describe your current relationship with depression?

We live together in a tense but respectful relationship. There is no winner or loser — we’re stuck with each other, and both of us accept that.

I’ve accepted that I will never be “cured” of my depression. I’m no longer looking for quick fixes or to be saved by anyone (doctors, religion, my dear husband). I’ve taken full responsibility for my quality of life.

I take care to complete all my daily tasks. Ticking off things I have done gives me a sense of control. That includes my daily tasks, but especially my little list of MUST DO’S for every day: exercise, healthy eating, being creative, meaningful contact with people I care about, doing something for other people. These things are most important when they feel the hardest.

What do you do nowadays when that somber feeling comes over you?

The very best thing I learned to do is just to put one foot in front of the other, even when I feel totally overwhelmed or incredibly sad. Quite often (but not always!) I succeed in stopping negative thoughts by taking a few deep breaths and letting the thought pass. It’s amazing how quickly a thought can dissolve when you don’t dwell on it.

At sixty-five, I have finally accepted that life is not meant to be a picnic and that all is not lost when one (or quite a few) things are bad or sad or wrong. During the pandemic, I recognized that this is a hard time, but not nearly as hard as many of the wars, famines, and natural disasters that millions of people have had to cope with over the centuries.

Did the pandemic present a particularly tough challenge?

At the beginning of the pandemic during total lockdown, I was inspired (and full of adrenalin) and literally did everything right. Sixteen months later, it is much more difficult.

Living with the loss and suffering in my country (South Africa) is never easy, but now it sometimes gets unbearable. I find solace in the many stories of real goodwill and people standing together in adversity. Doing small things for others (like lending my books to fellow readers while libraries are closed due to lockdown) and talking about my experience with a few special friends carry me through.

Oh, and crying. I’ve always been ashamed when I cried. Not anymore. Crying brings huge emotional relief. You must just stop again. 😊

A few years ago, I learned about Highly Sensitive Persons — a rather large percentage of the population wired to experience emotions and physical stimuli much more intensely than other people. Learning and accepting that I belong to this group eased my guilt about my more intense reactions to things other people wouldn’t think twice about. I’ve also learned that being a Highly Sensitive Person has its advantages, like finding natural empathy with other people’s ordeals.

If you could go back and give your younger self advice about living with depression, what would it be? Would the advice look different at different stages of life?

My advice would be the same at every age: Do not carry it alone. Seek help. Take responsibility. Look after yourself. If you cannot love yourself, at least respect yourself and treat yourself like a good friend, not as an enemy you try to bring down all the time. You deserve the best.

What would you say to your younger self when she was at her lowest point?

You are not alone. You are good enough.

Any final words of wisdom for readers who are struggling with depression?

Like the above: You are not alone. You are good enough.

Also: You deserve a good life. Use medication and therapy to help yourself, but do not stop there. Take responsibility for your lifestyle. Lifestyle changes cannot magically heal depression, but they can dramatically enhance your quality of life.

Life is precious. Savor it.