• While depression will often require more extensive support and treatment, self-care exercises can still help alleviate some of your distress

  • Dr Greg Smith shares three breathing techniques to help you manage depression and its symptoms

  • Don't struggle with depression alone – our therapists and counsellors are here to help – find yours here

Depression is one word with many meanings, an umbrella term covering everything from ‘feeling a bit flat’, to ‘a bad case of the blues’, through to a complete immobilisation requiring hospitalisation. The extreme end of major clinical depression will require much more than simple breathing and has recently been found to have a range of very physical factors involved, often including inflammation of the brain.

Breathing techniques can, however, be very beneficial in helping someone to be more energised, happier, ‘get out of the slump’  and also as part of a broader range of treatment for all levels of depression. The techniques can be a great way to lift yourself a little if you feel ‘a bit depressed’. I also think it should be part of every assessment and treatment of depression. It is common in medical approaches to encourage people with severe depression to exercise, to socialise (not isolate themselves), to engage in positive activities and to ask about eating and sleeping patterns. All of these things are rightly seen as relevant factors and breathing should have no less a place in a plan of treatment.

What causes depression?

Depression is usually multi-factored and generally best seen as a bio-psycho-social condition. It is biological in that there are physiological changes in the body, particularly changes in brain chemistry. The most popular medications for depression boost the brain’s serotonin, a neurotransmitter which is understood to be low in patients suffering depression. Exercise is also helpful in many ways, including affecting the balance of these brain chemicals, as it triggers a release of endorphins, which are linked with feelings of enjoyment.

Depression is also psychological in that the person’s thoughts and feelings are very much affected. Cognitive behavioural therapy (CBT) is the most widespread psychological treatment in recent times and this particularly addresses the person’s thoughts, which tend to be distorted and unrealistically negative. Rumination, or thinking about negative things over and over, is a common factor in depression, and this can be changed. 

People’s feelings are affected not only in the obvious sense of feeling bad, but also due to the tendency for different feelings to roll into one — so while the person might have reason to feel sadness, grief, resentment or other emotions, they tend not to be able to deal with them one-by-one but just feel an overall ‘black cloud’. Counselling is often helpful to tease apart and acknowledge these feelings and enable them to be addressed. Each feeling on its own is much more manageable than all of them massed together.

Depression is social in that people often feel cut off from others and this may be exacerbated by relationship problems. It is also social in that the meanings we give to what is worthwhile, good or bad tend to derive from our culture and social groups, so the depressed sense of being a ‘bad person’ can link with comparing oneself to social norms and expectations.

Breathing can help the biological and psychological aspects and provide a way to interrupt negative thoughts, interrupt other patterns, raise energy and refocus.

Interrupting depressed states 

One type of depression is being stuck with a deep sadness. In deep sadness there can be prolonged holding out of the breath.

I have seen many people who have been depressed, very sad or grieving show a pattern of sighing deeply and holding the breath out. This reinforces a flattening of energy and a sense of stuckness. Changing the breathing pattern, such as using triangular breathing below, can help to lessen this.


Triangular breathing

Gently holding the breath can lift energy.

There should never be any strain, so the extent of the hold will vary. You should aim, however, to have the in-breath and out-breath the same length, and a hold in between. One ratio would be to breathe in for a count of four, hold the breath for up to a count of four (as long as it is comfortable), and breathe out for a count of four. If four is too long then in for four, hold for two and out for four; or in for six, hold for three and out for six. The number of the count does not matter — just keep a regular ratio. Do this for several rounds of breathing and finish the controlled breathing on an inhalation. Finishing the controlled breathing on an in- breath heightens energy a little — which is usually what you want with depression — while finishing on an out-breath flattens the energy a little.

It may sound a bit strange, but it is hard to feel quite so flat and down when you have taken a full breath and are holding it. When people are depressed they also tend to be stuck in depressive thoughts, and breath holding tends to lift people a little out of such thought loops.

Once you are lifted a little through the controlled breathing it becomes a bit easier to think about what is best to do. This may be to refocus on a task or to challenge depressing thoughts that are distorted. Sometimes this might be to recognise and acknowledge specific feelings that have fed into the general feeling of depression – some pain and sadness at times is part of life, but depression is often like a heavy blanket of feeling where all the bad feelings roll into one; separating these feelings out is helpful.


Armpit breathing

It is hard to be depressed if you are exposing your armpits.

If you feel down, sit or stand and extend your arms down by your sides, palms facing backwards. When you breathe in, raise your arms with the breath so that at the end of the breath your arms are up (and armpits exposed). As you exhale, slowly lower them again. Do several rounds. When I do this I find it hard not to smile. If I feel down it lifts me at least a little. It acts to open the front of the body and this has an uplifting effect.

One of the problems with being depressed is a lack of energy or motivation. So often people don’t want to try something when they are flat. With this in mind, try the armpit breathing now, so you have at least tried it, and can use it as necessary at other times.


Passive supported resting breath for depression 

If it feels too hard to do anything else, there are ways of resting which can help with depression.

When people are depressed they generally tend to slump forward, closing in their chest and reducing their breathing. A simple way to helpfully rest is to get a blanket (or two large towels) and fold it so that it forms a rectangle a couple of inches thick (you can play with the width and height to find the shape comfortable for you) and at least 1 metre (3 ft) long. Place it on the floor and lie on it, facing upwards with your spine along the blanket, with one end level with your lower back, just above the hips, allowing the natural curve of the spine, and with your head also on the blanket. You might also like a small pillow under your head. Let your arms rest on the floor out to your sides, at about a 30-degree angle, palms facing up. This gives a gentle passive opening to the chest. As you lie like this, do the full breath for several rounds and then relax, allowing your breathing to follow its own rhythm.

At the end, gently roll to your right-hand side, and rest a moment on your side before getting up.

Breathing can be linked with other interventions for depression and is, of course, only one aspect of self-care, but in doing breathing exercises, you can feel more balanced, more energised and less down. 

Dr Greg Smith is the author of Purposeful Breathing

Further reading

My depression is harming my relationship: what can I do?

My journey with therapy and chronic depression

Is depression killing my sex drive?

Keeping up a mindfulness practice with depression

How do depression and anxiety affect concentration?