Guest Post: Progress with Prozac

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The following is a piece written by fellow advocate, Justin Birckbichler. I had the privilege of meeting Justin recently at an incredible conference for online advocates of chronic illnesses, HealtheVoices. The conference was sponsored by Janssen, the pharmaceutical division of Johnson and Johnson, as a way for them to give back to the communities for whom they serve. Justin advocates for testicular cancer. He is an incredible advocate who is knowledgeable, funny, supportive, and caring. He helped me further the work of my own advocacy, as well. Justin also happens to be a teacher!

Read more about Justin at the bottom of this post.

Please note: if you are a man, please consider taking his very short survey for his research on the topic of testicular cancer. A link for the survey is included in his bio.

For now, enjoy this intriguing piece of writing:

Progress with Prozac 

Around the five month mark post chemo, I realized something was not quite right. It wasn’t my new fascination with discussing balls at every opportunity; it was more than that – my mood was not what it should have been. At first, I thought it was just the stress of returning to work and transitioning back to being a normal person instead of a cancer patient.

Upon closer inspection, I realized I was still feeling down, but it was summer, so the job reason didn’t make sense. If you’re not at regular reader of A Ballsy Sense of Tumor, I am a teacher, and teachers don’t work in the summer – that’s the main reason we chose this, duh. (If you’re my principal and you’re reading this, please understand that this is a joke.)

However, a new school year began, and I noticed that I was feeling off and just not as enthusiastic as I once was about teaching. It wasn’t that I hated my job; it was that something internally wasn’t quite right, and it was having an impact on my ability to teach to the best of my abilities. My students were still learning, growing, and seemingly enjoying themselves, so they didn’t appear to notice my internal struggle. Nor did my administrators, who are awesome and amazingly supportive of me, or my co-workers, who are also pretty great and put up with endless ball puns during team meetings. Regrettably, we don’t teach about spheres during the geometry unit.

In addition to feeling slightly off at work, I also realized I was feeling irritable and was much quicker to get angry at home. In October, I experienced a full on panic attack while watching an episode of Stranger Things on Netflix on the eve of my orchiectomyversary. Overall, hobbies like reading and cooking didn’t bring me as much pleasure as they once did, and I just felt generally pretty flat.

As I’ve alluded to numerous times through my writing on ABSOT, I battled with depression in high school. However, since my only job at that point in my life was to be a student (and school had never been a struggle for me, since I was in the gifted program), it didn’t have an impact on my “job.” It dawned on me that I was now feeling some of the same effects I did back them.

Knowing that having depression at a young age puts me at risk for a recurrence later in life, I decided to look into research about cancer survivors and PTSD/depression to fully understand just how stacked the cards were against me. It didn’t bode well when I first typed “cancer survivors and…” into Google, and “PTSD” and “depression” popped up as the first two suggested results (followed by “alcohol”).

As I researched more, I found this study from 2017 that said about 20% of cancer survivors experience PTSD symptoms within six months of diagnosis. The CDC also reports that cancer survivors take anxiety and depression medication at almost twice the rate of the general population.

After finding this information, I decided to ask for help, specifically in the form of antidepressants at my follow up visit in December. Dr. Maurer agreed to prescribe them, and I thought it would be all pretty rainbows and fluffy unicorns immediately.

However, about four weeks later, I felt no different. I knew antidepressants could take up to six weeks to show major changes, but I wasn’t feeling even slightly better. Perhaps I even felt worse, as I had these “happy pills” and I still felt down. Maybe something was just wrong with me – beyond the missing testicle.

I’ve learned to be open with my health and feelings, so at my med check up with NP Sullivan, I basically said, “Hey, I don’t think these are working.” Since I am obviously super medically qualified (read as: not qualified at all), I supported my theorem by saying I was on the same dosage I was in high school, and High School Justin was about fifty pounds lighter and ten years younger (and had a terrible taste in hairstyles and girls, but that’s a different story for another day).

NP Sullivan actually agreed with me and decided to increase my dosage. I wish I could say that this was the end of my frustration, but it wasn’t.

However, this new struggle wasn’t internal – it was externally driven towards insurance companies and American healthcare in general. If you’re an international reader (and I know you’re out there, since according to Blogger’s data I have readers on every continent, except Antarctica, which is a shame since it’s cold as ball(s) there), appreciate it if you have a better healthcare system.

When Dr. Maurer first prescribed the pills in December, my prescription was denied, since the pharmacy needed to get “pre-authorization” because apparently, a doctor’s orders aren’t enough. This wouldn’t have been a huge deal, but I was going out of town for a week and wanted to start the pills immediately. Out of desperation, I ended up paying out of pocket for that first fill. About two weeks after starting the pills, the pre-authorization came through, just in time for my dosage increase.

And just in time for another claim denial. Apparently, my original pre-auth covered me only for the original dose. The fact that insurance claims can be denied through an automated system by non-medical professionals is ridiculous to me. Insurance companies, do better.

Long story short, the insurance claim handlers at Dr. Maurer’s office are awesome, and I got pre-authorized for the new dose. (Maybe my mini-rant on Instagram story helped too!) This new pre-auth lasts for a year, and hopefully, I won’t need any more increases.

To be honest, I don’t think I will need it. I’m not really sure when I noticed that I was feeling better, but when I wrote my “12 Months Later” post in late-January, things were definitely looking up. I was getting more into the swing of lesson planning and teaching, minor things didn’t bother me as much, and I didn’t find myself complaining as often. I wish I could say that colors were suddenly more vivid, but I’m colorblind and colors don’t ever look bright.

It’s now the end of February, and I feel so much better than I did in September. (Side note – I really feel like Christopher Nolan with the amount of time jumps in this post. My bad.) While I would never say I hated work, I definitely have a better attitude when I walk through the doors of Room 31. Exercise, writing, reading, and cooking have become more enjoyable again. While writing this post, I realized that this one has a better feel and tone, as compared to some of the posts I wrote between September to January, even though it’s about depression, I feel more like myself on a day-to-day basis. I haven’t resumed any sort of formal therapy program, but I know that is definitely recommended while on these pills. It’s on my to-do list to look into in the future.

My biggest takeaway from this all is to ask for help if you feel you need it. There seems to be such a stigma around mental health and this post is an effort to be open and transparent to help dispel it. Sometimes, mental health isn’t even viewed as a necessary thing to take care of or treat as a serious matter. We treat our bodies and help them to heal when we are sick or injured; why should our mental health and brains be different?

The debacle with the insurance company and preauthorization helps to underscore this issue. When I had “probable strep” in January, although the test came back negative, the company had no problem approving amoxicillin, even though it probably wasn’t necessary. Any other prescription for my myriad of side effects during chemo was filled without an issue. But needing antidepressants? I had to jump through hoops to get those.

I recently saw a Tweet that said, “Depressed people don’t need Prozac. They need running shoes and fresh air.”

That’s a damaging narrative. I tried that, and continue to exercise, but it wasn’t that simple for me. If that’s your opinion, fine. Go run or whatever else works for you. But don’t shame other people for trying what might work for them. Just as I’m not going to fault you for trying homeopathic medicine, don’t go throwing crystals at me for what I’ve chosen. Positive thinking just isn’t enough sometimes.

I hope that this dosage continues to keep my mood elevated and on the upswing. I have no idea how long I’ll need to be on the antidepressants, but I’m not worried about it. What matters to me is that my emotional healing is beginning to catch up to my physical healing, the disparity between the two being something that has been nagging at me since I was cleared for remission.

However, this is something that I should have seen coming. They removed half of my “lower brain” and left my upper brain fully intact… no wonder it’s taking twice as long to heal!

About the Author: Justin Birckbichler is a fourth grade teacher, men’s health activist, testicular cancer survivor, and the founder of aBallsySenseofTumor.com. From being diagnosed in November 2016 at the age of 25, to finishing chemo in January 2017, to being cleared in remission in March, he has been passionate about sharing his story to spread awareness and promote open conversation about men’s health. Connect with him on Instagram (@aballsysenseoftumor), on Twitter (@absotTC), on Facebook (Facebook.com/aballsysenseoftumor) or via email (justin@aballsysenseoftumor.com).

Currently, Justin is running a research study based on males of any age who have had a physical exam done by a doctor and their experiences related to testicular exams. I

This six-question survey is brief. All responses are anonymous, and all information is kept completely confidential.

If you’re a male, please visit bit.ly/absotdoctorsurvey to help further the research. If you’re not an owner of testicles yourself, please share the link to help maximize the reach. Thank you in advance!

Shame & Its Connection to the Stigma

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As I was recovering from my second major bout of depression, I was introduced to Brene Brown’s well-known TedTalk on shame. It didn’t really make a lot of sense to me at the time. However, looking back on my two bouts of major depression and their lengthy recoveries, it is clear that I had a great deal of shame.

The first experiences I’m reminded of when I think of shame were the times I would go to the local pharmacy to pick up my medications (originally, several). I would wander around the store to make sure that there were no neighbors who I knew that would see me purchasing medications. What would I say if they happened to ask what medications I was getting? How would I respond if they asked me if I was sick? Now, also in hindsight, there was clearly a component of anxiety in play at the time. Anxiety often goes hand-in-hand with depression. That being said, there was clearly a component of shame in taking medications for a mental illness. When I’d return home from the stressful trip to the pharmacy, not only would I immediately throw out the receipt or any other evidence that I was taking an anti-depressant, but I would be sure to first tear it into many pieces. I also quickly hid the medicine in my underwear drawer, just in case someone would come into our master bedroom and see them.

When I first had depression, I would see my family doctor for medications. I remember sitting in the waiting room, wondering what would happen if someone from work  would happen to see me? Would I lie and say that I was there for a physical? I remember jockeying to find a seat in the waiting area that was conspicuous enough spot so that very few people could see me. I’d even hold a magazine near my face, covering it as best possible without being obvious. Focusing more on not being seen than actually reading any of the words on the pages. All of these actions, again, based upon my shame of needing to see a doctor for depression.

I was concerned about having to take too much time off from work in order to make it to my doctor appointments, particularly when I was first diagnosed seeing the doctor frequently. What would the staff at the school I worked at think if I was gone frequently for appointments, coming in late or leaving early? More shame. And once my depression got more severe, I had to starting seeing a psychiatrist. The psychiatrist who I chose to see was at a Behavioral Health clinic. I certainly knew the excuse of being there for a routine physical or a nasty cold wasn’t going to fly had I seen someone I knew. They’d instantly know I was there for some type of behavior health concern. Solely based on my shame of bumping into someone who might recognize me from the large school district I had been working in for many years, I considered changing doctors. In the end, I decided that seeking out a new psychiatrist would be too stressful and not feasible. So I gritted through the experience of sitting in the waiting room for each of my appointments, hoping desperately not to bump into someone I knew or who even looked vaguely familiar.

Early on in my depression, I ordered two books about depression (as shame would prevent me from purchasing these books in person at a bookstore where people may see me making such a purchase). These were incredible books by Matthew Johnstone that do an amazing job of helping others understand what it’s like to live with depression, or to live with a loved one who has depression. I read them, shared one with my wife, and then gently hid them away on the top of a tall bookcase in the basement. Not on the top shelf, but on the top of the bookcase, concerned, due to my shame, that someone who was visiting us at some point in the future might just see the books and ask about them.

When my suicidal thoughts became pervasive and plausible, I had to make the excruciating decision to take time off from work in order to check myself into a partial hospitalization program. Excruciating, as I nervously wondered what the staff who I supervised would say if I was gone for three weeks or more? What would I say when I returned? The shame was powerful. I nearly chose not to take time off and not to receive the help that I needed because of this shame. I had brought my wife and sister to my final appointment to advocate for me, as I did not have much confidence in the psychiatric physician’s assistant who I was seeing. Sure enough, the psychiatric physician’s assistant played into that shame, sharing with me how challenging taking off work may be. I was thankful for bringing my wife and sister who strongly advocated for me to enter a partial hospitalization program. In the end, I believe taking work off and entering such a program actually saved my life!

It was shame that kept me indoors when I took sick time away from work. I knew that it would be better to get outside. I knew I should be helping my family by running errands and driving our kids to activities. I knew that going for walk, getting a bit of exercise and fresh air, rather than isolating myself inside of the house, was important. However, the fear, once again, of bumping into someone I knew and having to explain why I wasn’t at work was terrifying for me. The shame of taking work off for depression was preventing me to do the things I needed to do in order to recover from depression and to help support my family.

What does stigma have to do with this, you may ask? I believe that a strong stigma still exists in much of the US. I believe the shame that many people face in dealing with a mental illness is directly related to this stigma. Because of the stigma, people are often uncomfortable to talk about mental illnesses. People with a mental illness are often judged and/or labeled. A mental illness is just like any other illness and should be treated as such. As many people say, mental illnesses are invisible. Yet, it’s important to understand that they are just as real as any other illness. A mental illness doesn’t make anybody any less intelligent and it certainly doesn’t make them violent, as a fair amount of myths may lead one to believe.

We need to normalize conversations around mental health, just as we have around cancer, diabetes, heart disease, and many other serious illnesses. One way to normalize our conversations is by sharing our stories of mental illness. Sharing our stories helps to educate those who may not understand mental illnesses and to support those who are struggling. The more we talk publicly and openly about mental illness, the more we do away with the stigma and the less shame people living with a mental illness feel.

Shame is powerful. Shame is dangerous. Shame often prevents people from getting the help they need. Shame played a role in me nearly taking my own life. Help normalize the conversations around mental illness, help end the shame!

Please tune in to my podcast, The Depression Files to hear me interview men who have struggled with depression. Inspirational stories of hope and perseverance!

As always, I welcome and encourage comments to this post. Thank you!

 

Guest Post: An Excerpt from Author & Advocate Steve Austin’s Upcoming Book

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Steve Austin was the very first guest I had on my podcast, “The Depression Files”. I had reached out to him after I had learned of his advocacy work and his book, “From Pastor to a Psych Ward”.

Steve is now about to release his fifth book: “Catching Your Breath: The Sacred Journey from Chaos to Calm”. Steve is a skilled writer who gracefully shares his story in the hopes of supporting others.

Please enjoy this excerpt from his upcoming book. If at all possible, please check out his Kickstarter page in order to support the launch of this important book:

When I was just a little boy, our family was vacationing at a motel on the outskirts of Nashville. My dad’s best friend from high school lived in the area, and we always had such a great time with their family. I was standing on the stairs at the shallow end of the pool, mesmerized as I watched my Dad take a deep breath and disappear under the water.  Dad has always been in fantastic shape, and I just knew he could do anything. I stood there, anxiously watching and waiting for him to return from the other side of the pool. It felt like he was down beneath  the surface of those deep waters forever and might never return.


For the first few seconds, it was so cool, but to a kindergartener, staying under past the count of ten seemed either impossible or superhuman. Dad finally returned, and I cheered. “Whoa! Dad! That was awesome! I counted all the way to 100 while you were underwater!” As incredible as it was, I always felt better when my Dad was near me. The water was an uncertain thing to me, and I didn’t like feeling alone.

It’s interesting to note that children can’t hold their breath as long as adults, but the older we become, the longer we teach ourselves to hold it in. The same is true in life. There are many people holding their breath and fears, just waiting to exhale. Every day, we have an opportunity to exhale all the pain, anxiety, anger, and everything else we have been holding on to and breathe-in calm and newness.

When I was much older than the little boy in the shallow end, I became acutely aware of what it feels like to hold your breath so long that the pain and shame feels like drowning. For me, the end of the rope looked like waking up in an ICU room after a serious suicide attempt. This was the point where I started to learn how to breathe again. I’m not a medical professional, I’m just a guy who has survived a shipwreck and found the courage to talk about it. Not everyone has an official mental health diagnosis, but  everyone knows what it’s like to feel completely overwhelmed by life.

Much like the day my Dad returned from the deep end, laid his head against the edge of the pool, and finally exhaled, my journey from chaos to calm started after years of holding my breath. No matter how superhuman someone may seem, we have all been overwhelmed at one time or another, and we are all looking for the safety of the shallow end.

– Excerpt from Steve Austin’s upcoming book, Catching Your Breath. Support the Kickstarter campaign today at kickstartmybook.com and get more details on this powerful new book at catchingyourbreath.com.

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Guest Post: nOCD Improve lives with 24/7 care

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The following post is the first Guest Post on my blog. This post describes an app that has been created to support those living with Obsessive Compulsive Disorder (OCD). While I personally do not live with OCD and have not utilized this app, I cannot personally endorse it. That being said, I believe in sharing possible resources that may improve one’s life. Please feel free to post comments or questions! Thank you. Al

Due to the first hand experience that our founder and other team members have had with the OCD recovery process, nOCD was started. We were fed up with the issues surrounding its affordability, accessibility, and quality. nOCD, standing for “No OCD”, is an online platform that we believe would have helped us during the worst of our struggles and that currently is already helping thousands of others with OCD today. The platform is designed to help people with OCD during all four phases of treatment: 1) coping with the onset of OCD symptoms, 2) selecting a care team, 3) actively managing OCD treatment, and 4) maintaining OCD treatment progress. Our team is able to address each phase of treatment using a unique combination of highly vivid content and 21st century technology. For instance, people with OCD can view our content on Instagram, Facebook, or Twitter at @TreatMyOCD and download nOCD for free on the App Store (link to the app is on our homepage: (www.TreatMyOCD.com).

People with OCD say the app has been a major difference maker. It gives people guidance in the moment of OCD episodes, a structured platform to do CBT exercises, a major community to talk with others around the world about everything related to this disorder, and real-time data 24/7. Here is more information about how it works:

SOS Guidance:

nOCD offers members clinically effective guidance in the moment of any OCD episode, using OCD specific Cognitive Behavioral Therapy. During an episode, members can hit the button “SOS” on their phone, which tells the app to immediately provide Mindfulness Based Cognitive Therapy and Acceptance Commitment Therapy (Response Prevention). For instance, if the member is obsessing, nOCD will ask questions such as: “Are you experiencing an Obsession or a Compulsion?”,  “What Obsession are you experiencing?”, “What triggered the Obsession?” and “How intense is your anxiety?” Then, based on the answers, nOCD will offer specific Acceptance Based Therapy guidance, to help the member effectively respond to the obsession without doing a compulsion. We believe the SOS feature can empower people with OCD to live their lives fully, knowing help is always in their pocket.

Structured ERP Exercises

nOCD provides members with the tools and organization needed to consistently do planned OCD treatment exercises regularly and effectively, acting like a mental gym. The main challenge with doing these planned mental exercises is that they instigate anxiety. Since the anxiety alone can reduce OCD treatment adherence rates, the app attempts to remove all pain point. It offers members the ability to create loop tapes, scripts, and drawings. It also has built in exercise reminders and educational tips.

Custom Therapy

nOCD customizes the entire treatment process to each member, helping augment therapy with licensed clinicians. Patients can customize their hierarchies, their compulsion prevention messages (acceptance based messages), their ERP schedule and more.

24/7 In-App Support Group

Inside the nOCD app, people with OCD can join different support groups and anonymously post to each groups wall. We’ve created a platform where people can support each other through treatment and learn quickly that they are, in fact, not alone.

Real-Time Data Collection

It collects real-time data about every aspect of the patient’s condition and treatment. It also longitudinally displays the data for every patient and clinician to see at any time. nOCD protects each users PHI data to the highest degree possible. For example, it uses a dedicated (encrypted) Ec2 instance on Amazon Web Services, SSL connection, Touch ID login access, LastPass Password security, and new, monthly, VM keys. nOCD is a HIPAA compliant commercial enterprise.

It’s important to note that we have many improvements and additions coming to all of this. We are growing as a team and will continue to make the whole nOCD platform as efficient and helpful as possible. We understand what the struggle of living with OCD feels like, and we are excited to keep working at this to help the almost 200 million people around the world that are struggling with OCD each and everyday day/night.
 
Twitter: @TreatMyOCD
Instagram: @TreatMyOCD

 

The Depression Files–The Launch!

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I had been “stockpiling” the interviews for several months. My idea was to launch a podcast in which I interview men who had experienced depression. The goal? It was threefold:

  1. To educate people on depression; the serious and often times debilitating nature of the illness
  2. To give hope to those who may be suffering from depression
  3. To help minimize, or even eliminate, the stigma around mental illness

I wanted to create a “stockpile” of interviews to eliminate any stress of getting episodes published on a regular basis.  I knew that I would need to find willing guests, schedule the interviews, record the interviews, and edit them. In the meantime, I was having a friend help me create a temporary logo (one that I hope to change in the near future) so that I could also post to iTunes.

I had a teaser up…and I had even created a “Sampler” for possible guests. I had no interviews published, so I figured possible guests may want to hear a sample of my interview style and get a feel for the project. I had created an intro, but had not yet created an outro. All of this allowed for me to continue down the path of promoting my teaser, without the worry of whether or not the show would be successful once I actually launched it. In the coaching world, we call this the Saboteur…and mine can be HUGE. The Saboteur is the negative self-talk that prevents us from moving forward. For example, “What makes me think I could be a successful interviewer?” or “I’ll never be as good as Terry Gross, Mark Maron, or Larry King” or “What if nobody listens to the show?”

Sometimes, there needs to be something that gives one a big kick in the rear to begin to move forward. That kick in the rear for me…World Suicide Prevention Day on September 10, 2017. I figured, if I were ever going to launch this project, The Depression Files, there would never be a better day than World Suicide Prevention Day. I quickly made an outro, finished editing the show that I had decided would be the first episode, and…launched it! That was a big day for me! My teaser had been published at the end of June and I had been working on the project well before then.

My first episode was an interview with Steve Austin. As someone who is used to public speaking and hosts his own podcast, he was an ideal interviewee that made my “job” pretty darn easy. Steve is a life coach, author, speaker, and host of the #AskSteveAustin podcast. Steve has a website at iamsteveaustin.com. He is the author of the best-selling From Pastor to a Psych Ward: Recovery from a Suicide Attempt is Possible and other books, which can all be found by clicking here.

I have a new episode coming out every other Sunday and have just published my third one. I have been thoroughly enjoying the interviews and learning a great deal from every one of my guests (I believe I have about eleven more interviews recorded, awaiting to be edited).

I hope that you will listen to The Depression Files and that you are able to get something out of them. I hope that you will understand that depression is much, much worse than simply feeling sad. I hope that you will gain a deep sense of empathy for those who may be struggling with depression. In addition, I am hoping that any listeners who may be in the midst of a depressive episode, or living with chronic depression, are able to gain a sense of hope from the show. As cliche as it may sound, after going through major depression myself, I would never wish it upon my worst enemy.

If you would like to read more about the podcast, you can check out one of my earlier posts: Giving a Voice to Men with Depression: New Podcast Coming Soon!

As always, comments to this post are welcomed and encouraged! In addition, I hope that you may be willing to ‘like’ and/or share comments to any of the episodes of The Depression Files. Thank you!

The Essentiality of Sleep Through the Recovery of Depression

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When I think of how important sleep is, I am reminded that sleep deprivation is often used as a form of torture. In Kelly Bulkily’s article titled, “Why Sleep Deprivation is Torture: Prolonged Sleep Deprivation is a Cruel and Useless Method of Interrogation”, he notes that, “The first signs of sleep deprivation are unpleasant feelings of fatigue, irritability, and difficulties concentrating.  Then come problems with reading and speaking clearly, poor judgment, lower body temperature, and a considerable increase in appetite.  If the deprivation continues, the worsening effects include disorientation, visual misperceptions, apathy, severe lethargy, and social withdrawal.” He goes on to say that, “One of the first symptoms of sleep deprivation in humans is a disordering of thought and bursts of irrationality.  Beyond 24 hours of deprivation people suffer huge drops in cognitive functions like accurate memory, coherent speech, and social competence. Eventually the victims suffer hallucinations and a total break with reality.”

It is clear from the depiction above, that decent sleep is an absolute necessity. Often times, when a new patient meets with a doctor regarding depression, sleep is the first issue they attempt to get under control. This is often done with the support of medication. Prescription sleep medication should only be taken upon consulting with your doctor, as it could interfere with other medication that one is taking and may have side effects.

In my case, I became overmedicated. When I entered a partial hospitalization program, I explained that I struggled falling asleep, but once asleep I could stay asleep. The psychiatrist added a prescription antihistamine to my regimen. He believed that the antihistamine would help me fall asleep (induce drowsiness) and the sleep medication that I was previously on would keep me asleep, as it had been doing.

For several weeks, the medication seemed to be just fine and I was sleeping well. However, eventually there were two separate evenings in which I had to get up in the middle of the night. On these two occasions, I experienced fainting spells. The first evening was when our daughter woke in the middle of the night and thought my wife and I were still awake. She went downstairs to the main floor of the house, accidentally setting off the house alarm. I shot out of bed and made it downstairs to the alarm panel. I quickly canceled the alarm and grabbed the phone to call the alarm company to ensure that it had properly been canceled. As I waited for them to answer, I collapsed suddenly to the ground. I came to, I believe a minute or so later, with my face inches from the bottom of the coat rack. Little did I know, that fall would give me a permanent shoulder injury that I still deal with today. After getting up, I walked about six feet, falling to the ground and fainting a second time. After coming to, I again got to my feet, started up the stairs banging off of the stairwell walls like a ping-pong ball, and fainted a third time, falling through the cracked-open door to my bedroom. By this time, my two oldest daughters were in the room with my wife.  I pulled myself up to the bed, lay down on my back, and told my wife I was just fine and needed some sleep. I was apparently as white as snow.

Since I serendipitously had to bring my daughter for a strep test the next day at Urgent Care, I decided I would mention my fainting spells. They checked me out, found nothing wrong, and asked me to call 911 if it happened again. Sure enough, two nights later, one of our two-year old twins was crying in the middle of the night. I got up to tend to Sam. I tried rubbing his back, singing to him (which understandably made him cry even louder), and rocking him. Nothing worked and he continued to kick at me. Getting frustrated, I turned to leave the room. Before I could take a step, I suddenly collapsed to the ground, fainting once again. This time, having fallen flat on my face, I ended up with a slightly bloody nose. My wife came quickly into the room when she heard the thud and attempted to wake me up for a good couple of minutes. After coming to and calling two family members who are doctors, my wife decided to contact 911. An ambulance arrived and two young EMTs were at my side taking my pulse and checking my vitals. After a short, bumpy ambulance ride through a Minnesota winter storm, I ended up in the Emergency Room (ER). I didn’t notice the sarcasm the ER doctor had used until I was walking back to my car. He had explained, “You don’t have to change your medications at all. All you’d have to worry about is death by bumping your head upon another fainting spell.” I quickly weaned off of the sleep medication.

Another possible side effect to be aware of with sleep medication is daytime drowsiness and confusion. It is my understanding that some of the sleep medication can build up in one’s system, making it difficult to wake up, causing drowsiness in the mornings, and adding to confusion. In my case, it was difficult for me to decipher whether some of the confusion and cognitive issues I was having were due to the medication or to the depression. Again, it’s important to take these medications under the consultation of a doctor and to let the doctor know of any possible side effects one may be having.

Some therapists believe that by treating insomnia alone through talk therapy, much of one’s depression may be cured. This type of talk therapy is called Cognitive Behavioral Therapy for Insomnia (CBT-I). According to the Mayo Clinic, “Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems” (Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills). The benefits of the CBT-I also seem to be long lasting. According to Colleen Carney, associate professor of psychology at Ryerson University in Toronto, “…those who successfully resolved their insomnia with cognitive-behavioral therapy were twice as likely to shake depression as well” (Healthline.com). Some of the techniques used in CBT-I include:

  • Stimulus control therapy
  • Sleep restriction
  • Sleep hygiene
  • Sleep environment improvement
  • Relaxation training
  • Remaining passively awake
  • Biofeedback

Typically, the therapist and patient would select a combination of some of the above-mentioned techniques to work on. There are many resources on the worldwide web that explain each of the above techniques in details.

Another way to get sleep under control without the use of medication or talk therapy is through better sleep hygiene. Although this is one of the possible techniques mentioned above that may be used in CBT-I, some people focus solely on improving their sleep hygiene on their own. Sleep hygiene involves changes in lifestyle that will increase your chances for a better night of sleep. Some of the common strategies to improve one’s sleep hygiene include:

  • Limit naps during the day. Naps should be no longer than twenty minutes per day and should be taken well before your evening bedtime.
  • Limit your caffeine intake. Do not consume caffeine after 2pm or so.
  • Have a relaxing nighttime ritual such as reading, taking a warm bath, meditating or drinking some warm tea prior to going to sleep.
  • Use the bed for sleep (and sex) only. Do not read or watch TV in the bed. It is important for your brain to make the connection that equates your bed to sleep.
  • Do not use screens (computers, smart phones, TV, etc) just prior to going to bed. These stimulate the brain and make it more difficult to fall asleep.
  • Exercise, but not immediately before going to bed. Exercising just prior to going to bed will increase your heart rate and, again, make it more challenging to fall asleep quickly.
  • Be sure the room is dark and comfortable for sleep.

Whether it is with sleep medication under direction of a doctor, talk therapy, or better sleep hygiene, the importance of sleep when working towards recovery from depression cannot be over-emphasized.

As with all of my posts, comments are welcomed and encouraged!

(Note: This post was originally published by Psych Central at the following link)

Giving a Voice to Men with Depression: New Podcast Coming Soon!

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I have been a mental health advocate for just over one year. I’ve been blogging, tweeting, and speaking publicly for NAMI. I’ve been invited to attend a conference for online advocates of chronic illnesses, interviewed for podcasts and radio shows, and have been published or quoted in several publications.

Several months ago, I decided that I wanted to do more. I’m in the process of producing a new podcast: The Depression Files. I believe that men experience depression differently. There is often a belief (including by men themselves) that men need to just “be tough” or “pull themselves up by their bootstraps”. Men aren’t “supposed” to talk about their feelings. These stereotypes and this stigma make it more difficult for men to face their depression. Men tend to isolate themselves and are less likely to reach out for the help they need.

I hope that the podcast helps to educate those who have never experienced depression. Depression isn’t just feeling sad. In fact, sometimes sadness isn’t even the feeling at all. It’s been described by many as a feeling of numbness. Hear stories that give a first-hand perspective on how it feels to go through some of the very challenging times of depression and just how debilitating it can be.

I also hope that the podcast gives hope to those who may be struggling currently with depression. These are stories of hope. Stories of living with depression. Managing depression. Overcoming depression.

Please check out my podcast at allevin18.podbean.com. If you are a man who has dealt with depression and would like to be interviewed, please contact me at levi1818@yahoo.com.

 

An Open Letter to Anyone Experiencing Depression

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Dear you,

In my case, depression seemed to come out of nowhere. I remember dropping off a good friend and saying to him, “Something’s going on. I just don’t feel like myself”. From that point on, things went downhill. I wasn’t communicating well with people, I was struggling to get sleep due to my racing mind, and I could barely eat. Any time I was out with my wife, when we returned home, I’d ask her if I had done alright (socially). I began to take medicine and see a therapist. Things continued to deteriorate. I would somehow manage to mask my depression at work, hold it together fairly well with my kids when I returned home, and eventually break down and have uncontrollable crying bouts in the evenings.

I went back to the psychiatrist to inform him of my suicidal thoughts. He increased the medication. My crying bouts increased and my suicidal thoughts became more detailed and pervasive, occurring throughout the day and even in a dream. I brought my wife and sister to my next psychiatrist appointment so that they could help communicate just how bad things had gotten and advocate for more support. I made the decision to take three weeks off of work and checked myself into a partial hospitalization program.

Please know that you will get better. I did and many, many others have. It takes work and effort. I would urge you to consider multiple strategies to work towards recovery, rather than relying on just one. Here are some of the suggestions I have for you to consider:

  • Contact one or two close friends and share with them what is going on. Ask for their support. This may just be requesting that they send you a hopeful text a couple of times a week or invite you out for breakfast or a coffee.
  • Reach out to family members (your parents, siblings, cousins, aunts and uncles, significant other, etc). Have trust that they will care about you and your situation.
  • Join a support group. The more narrow the focus, the better. While others may not be able to really understand what you’re going through and how it feels, these people will. This is a great way to receive support and to support others once you are feeling better. It’s instantly a group of trusted individuals who have been through similar challenges. I still attend a men’s depression support group twice a month.
  • Try to exercise, even if it means a short walk around the block in the beginning. Little by little increase the amount of time you’re exercising and/or the rigor.
  • Consider journaling. I journaled every night while going through my depression. At the end of every entry, I included a piece in which I wrote, “Today, in order to work towards my recovery, I…” Sometimes, it may have been a very short list of something quite simple, such as, “I drove my kids to school”. This is one way to recognize your small successes!
  • Consider medication and talk therapy. If you are trying talk therapy for the first time, do not give up on it if you do not like your therapist. You may need to “shop around” a bit, unfortunately, in order to find a therapist with whom you really click.
  • Try to get back into an old hobby or start a new one. While I was in the partial hospitalization program, I began to make pictures with pastels. I continue this new hobby and share it with my children. I also started to play the guitar.

These are just a few ideas to help you begin to move in the right direction. I believe the more strategies you utilize, the quicker the recovery. It’s critical that you seek out help.

Too many people mask their depression and many begin to self-medicate. Reach out for the help you need. Accept the help. Make the effort necessary to recover. I know that is easier said than done, I’ve been there.

Small steps. You will get there. You will recover. You’re not alone!

With compassion,

Al

The letter above was included in “The Recovery Letters: Addressed to People Experiencing Depression”, Edited by James Withey and Olivia Sagan (2017), p. 93.

This is an incredible book of hope for those currently suffering from depression. There are many more letters much more brilliant than mine. As author Gwyneth Lewis describes, “This book will save lives…”

I want to thank James Withey and Olivia Sagan for including my letter and for creating such a powerful, inspirational book!

You can order your copy by searching Amazon. The following two links are for Amazon US & Amazon UK. For additional information on the book, you can email James Withey directly at therecoveryletters@yahoo.co.uk.

The Catch-22 of Depression

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One of the most challenging pieces of dealing with depression is the Catch-22. Everything one needs to do in order to overcome (or work towards the recovery of) depression is compromised by the very symptoms causing the depression.

Here are several examples. In order to recover from depression, one should…

  1. Eat a healthy diet, yet many people are unable to eat (or overeat) due to the depression.
  2. Exercise regularly, yet depression often takes away one’s energy.
  3. Socialize, yet many of those suffering from depression tend to isolate themselves.
  4. Attempt to get a good night of sleep, yet many with depression struggle with getting enough sleep.
  5. Enjoy their hobbies, yet most people with depression tend to lose interest in their hobbies.
  6. Get outside for fresh air and sunlight, yet many times those with depression are also faced with anxiety that tends to keep them inside their home.
  7. Monitor and stop negative thinking, yet many with depression ruminate and see only the negative side of things, even when there may not realistically be a negative side.

While the purpose of this post is to acknowledge that recovery from depression can be very challenging, it’s essential to maintain hope. Depression is treatable! Reach out for support. Connect with trusted loved ones. Acknowledge small successes! It takes time and effort, but you will recover!

Please see my post titled, “Tips for Dealing with Depression” for more suggestions on how to work towards recovery. If you are attempting to support someone else with depression, I would recommend my post titled, “Supporting One with Depression“, where I offer differentiated tips for supporting a loved one, a close friend, or an acquaintance.

I would like to credit the incredibly informative book, “Coping with Depression: From Catch-22 to Hope” by Dr. Jon G. Allen for many of the ideas in this post.

As always, I welcome and encourage comments to this post. Thank you!

 

A Conference for Online Advocates of Chronic Illnesses

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I feel incredibly lucky to have been invited to a conference in Chicago for online advocates of chronic illnesses: HealtheVoices. Approximately three days prior to the deadline to apply, I received a message in LinkedIn. At first, I had wondered if it was an automatically-generated message that went out as a huge message blast for advertising purposes. However, after reading it a second time, it certainly sounded a bit personalized. A Janssen employee, Kristina Chang, had contacted me directly to apply, as this was their third year in a row of the HealtheVoices conference and they hoped to increase the number of advocates representing mental health. She offered to answer any questions I had by phone.

I decided to take Kristina up on her offer and called her directly. I was able to learn a great deal more about the conference through this conversation. I was a bit skeptical, at first, learning that Janssen was a pharmaceutical company. However, she explained that this is Janssen’s way of giving back to the community they serve and that Janssen would not be marketing to the advocates. I decided to apply. I found out a few weeks later that I had been accepted. All expenses paid by Janssen. I was thrilled and really didn’t know what to expect.

The conference was primarily structured by advocates themselves, with great support (not only financially) from Janssen and Tonic Life Communications. The conference was very well organized. The diverse needs of the advocates attending, many of whom were living with the illness for which they were advocating, were well accommodated.

There were 106 advocates from 30 different states and at least four different countries. The amount of energy at the conference was palpable! I was so privileged to be at a conference with such caring, passionate, and inspiring advocates! I quickly realized that these advocates were not only advocating for an illness, but for so much more; racial equity, poverty, gender equity, and social justice, to name just a few.

There were sessions that included a panel of advocates who shared advocacy strategies and answered questions. There were sessions on tips for blogging, working with the media and engaging legislators. Youtube and Facebook representatives presented on how to maximize their tools as a way to further our advocacy. Two well-known Youtube advocates that were highlighted in the presentation (therapist and mental health advocate, Kati Morton and psoriasis advocate, Huy Ngo)  just happened to be attending the conference. At that moment, I felt as though I was surrounded by celebrities. It confirmed my thoughts; that I was privileged to be a part of a group of passionate people who advocate at a very high level.

Upon returning, I have now created a Facebook page.  I have to admit, one advocate was so amused that I had no Facebook page, that she snapped a shot of me and Tweeted it out. If that’s not incentive to create a Facebook page, I’m not sure what is! I have also registered with a couple of organizations that I had learned about to help expand my advocacy work.

I want to thank all of the the amazing advocates who were a part of the conference. Participating in a conference with them was incredibly inspiring and empowering! I want to thank Janssen for creating such an amazing conference that allows the online advocates to meet in person, learn together, and share ideas. I also want to thank TonicLC for being caring supporters and organizers who helped create such a smooth-running conference. Finally, I want to thank those organizations who sponsored the event and made it all possible! I hope to be invited back next year!

As always, I welcome and encourage comments to this post and any other!

Note: Janssen Global Services paid for my travel expenses for the conference. All thoughts and opinions expressed here are my own.