When living with depression how do you regain your sense of self? I don’t know who I am anymore.

Hi Ruthie, that's a great question. And let me start by saying that I hope I get to work with you personally on these issues. But as for this written answer to your question, maybe I'll start with self-esteem since that is what you started off with in your question. I think self-esteem is made up of various factors, from our self-talk to learned helplessness versus self-efficacy to certain innate personality traits to the way our parents treated us as children and maybe many others. But knowing about the factors influencing self-esteem can only take us so far. What can we do about it? Well, if we go down the list of those factors we could identify some interventions to change self-esteem. First, we could increase our awareness of how we're talking to ourselves, monitoring and journaling about it. Then, we could begin to practice positive affirmations and self-compassion more. We could increase our self-efficacy and avoid learned helplessness by setting small achievable goals and accomplishing them daily. We could study our personality traits through self reflection, observation and feedback from family and friends, and maybe even professional assessment. With that increased insight into our personality, we could begin the process of learning about the strengths and weaknesses of our personality traits, and ultimately work toward self-acceptance and appreciation of how our personality contributes to the betterment of society. Finally, we could reflect on our childhood experiences and how the way we were raised might have shaped the way we think and feel about ourselves. We can seek professional help to increase our awareness and insight into the ways our childhood may have shaped our self-esteem.

The next reaction I had to your question is that what you're describing about your situation appears to be a depressive episode. Depression is directly related to self-esteem, weight gain, marital discord, loss of interest in previously enjoyable activities, fatigue, decreased motivation, and really everything you're describing. So what can we do about depression? There are a lot of options for treatment of depression that have been scientifically studied and shown to be effective. Some of the interventions I mentioned above would be applicable here too. One of the most evidence-based treatments for depression is called cognitive-behavioral therapy. This therapy examines how our thoughts lead to feelings and behaviors, as well as the other way around. As mentioned above, if we can become more aware of our thoughts and self-talk and start to challenge them and change them to be more positive, we'll begin to feel better and behave better. Then, we can try to focus on our strengths and practice affirming self-talk and positive thinking. Another effective treatment for depression is something called behavioral activation. This is in some ways the inverse of CBT in that we can start by behaving better in hopes that this improves our feelings and eventually our thinking. An example of this might be getting up and going for a walk in the park when we feel depressed without really thinking about it, and then we start to feel better and our thinking gets more positive. Another twist on this behavioral activation that can help even more is the idea of not doing just anything, but doing something that is social and altruistic or helpful. You seem to be touching on this intervention already, maybe without even knowing it, when you mention that you do get pleasure from volunteering to hold babies in the NICU and spending time with your sons and grandchildren. One last type of treatment for depression that is newer but gaining a lot of scientific support is something called acceptance and commitment therapy. This treatment says that one practice that can bring satisfaction to our life is clarifying our values and bringing our thoughts and actions into consistency with our values.

Now, as for the specific problems you bring up in your question, I would say that if you can heal the inside, then the outside will follow. If you effectively treat your depression and self-esteem, I think you will live a healthier lifestyle, feel motivated to exercise, and not only lose weight but feel better about your body. If you treat your depression, I believe your marriage will improve, or at least you'll have a better chance of working on making it better. If you treat your depression, you'll probably want to return to your hobbies of gardening, baking, and decorating, and maybe you'll even pick up some new hobbies. Your volunteer service to the NICU babies will probably be even more satisfying, and you might decide to give service in other ways as well. You'll continue to enjoy spending time with your sons and grandsons, and they'll probably enjoy spending time with you even more.