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Depression Self-Care Action Plan   
Patient: _______________________________________
Provider: ______________________________________
Clinic: ________________________________________
Phone Number: _________________________________
  1.  Stay physically active.

Make sure you make time to address your basic physical needs, for example, walking for a certain amount of time each day.

Every day during the next week, I will spend at least ___minutes (make it easy, reasonable) doing
_______________________________________________________.

  2.  Make time for pleasurable activities.

Even though you may not feel as motivated, or get the same amount of pleasure as you used to, commit to scheduling some fun activity each day - for example, doing a hobby, listening to music, or watching a video.

Every day during the next week, I will spend at least ___minutes (make it easy, reasonable) doing
_______________________________________________________.

  3.  Spend time with people who can support you.

It's easy to avoid contact with people when you're depressed, but you need the support of friends and loved ones. Explain to them how you feel, if you can. If you can't talk about it, that's OK - just ask them to be with you, maybe accompanying you on one of your activities.

During the next week, I will make contact for at least___minutes (make it easy, reasonable) with
____________________ (name) doing/talking about ____________________
____________________ (name) doing/talking about ____________________
____________________ (name) doing/talking about ____________________

  4.  Practice relaxing.

For many people, the changes that come with depression - no longer keeping up with your usual activities and responsibilities, feeling increasingly sad and hopeless - leads to anxiety. Since physical relaxation can lead to mental relaxation, practicing relaxing is another way to help yourself. Try deep breathing, or a warm bath, or just finding a quiet, comfortable, peaceful place and saying comforting things to yourself (like "It's OK.")

Every day during the next week, I will practice physical relaxation at least___times, for at least___minutes each time. (Make it easy, reasonable.)

  5.  Simple goals and small steps.

It's easy to feel overwhelmed when you're depressed. Some problems and decisions can be delayed, but others cannot. It can be hard to deal with them when you're feeling sad, have little energy, and not thinking clearly. Try breaking things down into small steps. Give yourself credit for each step you accomplish.

The problem is ___________________________________________________
________________________________________________________
My goal is _______________________________________________________
________________________________________________________
Step 1: _________________________________________________________
Step 2: _________________________________________________________
Step 3: _________________________________________________________

  5. 

How likely are you to follow through with these activities prior to your next visit?
Not Likely124678910Very Likely


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