Tag Archives: Depression

Depression: Don’t Fall Prey to Catastrophizing

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Today I got the coffee pot all set to go and forgot to turn it on. The other day, speaking on my cell phone while driving (hands-free), I realized I had missed a turn several minutes (and quite a few miles) after passing it. Another time recently, I struggled for a bit trying to find my car in a parking ramp I had never before used. Do any of these sound familiar to you? All of things happen for various reasons. Sometimes we may have a lot on our mind or we may be in the midst of a conversation. However, they are quite common and we typically do not fret about them. In fact, we often chuckle about these types of mishaps or moments of absentmindedness.

However, in my case, when these things occurred during my major depression, they were unjustified evidence that I was spiraling down, falling deeper into depression, in dire straits. I would perseverate on these mental lapses and turn them into something much larger than they were. This is one type of catastrophizing that can occur during depression. Catastrophizing is clearly not a healthy thought pattern and can be harmful to one’s mental health (even if not in the midst of depression).

Here are a few methods that may be useful in order to minimize, and hopefully end, the catastrophizing:

  1.  The first step is to recognize when it is happening. This is not always easy, but very helpful. Once you recognize it, you can question it and, you will most likely realize that the incident you are catastrophizing is not a sign of spiraling down into a deep, dark depression.
  2. Question it. Having thoughts that you may be on the verge of getting fired? Ask yourself for the evidence of this. How was your last review? What evidence is there that your work performance is going down?
  3. Communicate with others. Share your thoughts with someone you trust to get the opinions from someone whose thought process is not compromised by an illness (depression).
  4. Analyze it. I’m not referring to scouring a great deal of data. Simply ask yourself if there are reasons, other than your illness, for your thoughts. If you’re concerned because you couldn’t find your parked car in a large parking lot, could it be that you’ve lost concentration because you are thinking about the upcoming meeting or presentation at work? Could it be that you were thinking of your to-do list for the day.

It is incredibly important to go easy on yourself. Remember that depression is truly an illness. It compromises your cognition, thoughts, and memory (just to mention a few of its many possible manifestations). Recovering from depression takes time and effort. The effort you put into eliminating catastrophizing will go a long way in your efforts towards recovery!

As always, I welcome and encourage comments to all of my posts.

The Importance of Sharing Our Stories of Mental Illness

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There are many well-known people who had lived with a mental illness.  John Nash, Nobel Prize recipient for economic sciences, lived for many years with paranoid schizophrenia. Composer Pyotr Ilyich Tchaikovsky and poet Edgar Allan Poe were known to have battled depression. Charles Darwin, known for his contributions to the science of evolution, lived with obsessive-compulsive disorder (OCD). These are just a few of the many, many people throughout history who had lived with depression.

Others have not only dealt with living with a mental illness, but have publicly shared their experiences and struggles. George Stephanopoulos, Chief Anchor and the Chief Political Correspondent for ABC News describes his deep, dark depression in his 2000 autobiography, “All Too Human: A Political Education”. Dick Cavette, a well-known TV personality, described his bouts of depression as “Dismal, worthless, black despair” to a room full of reporters at Johns Hopkins in April of 1992. Olympic gold medalist and model Amanda Beard speaks of her own battles with self-mutilation, bulimia and depression in her 2013 book, “In the Water They Can’t See You Cry: A Memoir”. Buzz Aldrin, the second person to have walked on the moon, suffers from depression and shared openly in an interview with The Telegraph in July of 2009.

Recently, many more celebrities have come out to share their stories of depression and other mental illnesses. Just two weeks ago, British fashion magazine Marie Claire published an article titled, “22 Celebrities Speak Honestly About Their Mental Health Battles”. The article includes many celebrities who are very well known; Lady Gaga, Selena Gomez, Miley Cyrus, Demi Lovato, Brad Pitt, and Jim Carrey to name just a few.

Dr. Drew Pinsky, board-certified internist and self-described “addictions-oologist” (and co-host of the nostalgic Loveline radio show–a fond memory of mine), believes that “…when a celebrity goes public with his or her own mental health issue, ‘…it’s an opportunity to learn about it. It’s an opportunity to reduce stigma, reduce fear, reduce shame of an ordinary person—not a celebrity—managing the same problem.'” (E!News)

I believe that it is important for “ordinary” people to share their stories, as well. It may be easy for some people to believe that it is only the celebrities who become mentally ill. While celebrities sharing their struggles with mental illness does a great deal to chip away at the stigma, ordinary people need to see that other ordinary people also have struggles with mental illnesses.  I believe that there are several benefits when people share their stories:

  1. When people share their stories, they help to educate those who have been lucky enough to never have to deal with a mental illness. It helps to give others a better understanding of some of the challenges of living with a mental illness. Until reading about someone’s story, many people may not know, for example, that depression can keep people from getting out of bed for days on end or cause others to lose/gain a massive amount of body weight. Hearing a real story may give a glimmer into the sense of what it feels like to lose all hope, become numb to all feelings, and believe that you have become a burden to others.  When someone like  describes the mania of bipolar disorder as, “Mania is incredible. Yet, it is destructive. Mania is the highest high of your life. Yet, it’s also a cliff, and you just jumped off into the abyss.”, people who have never been through it may just get a sense of what mania feels like. Elissa Farmer believes that some people are under the misconception that mania is fun and exciting, yet she describes it as, “…full blown chaos and catastrophe” in her article “What People Get Wrong About Mania”.
  2. When people share their stories, they support others who may be going through similar struggles. It allows others to see that they are not alone. They are not the only one who is going through the struggles and challenges of a mental illness. Those who are currently struggling can learn about tips and suggestions that helped others get through the difficult times or manage their mental illness. In one of my own posts, titled “9 Tips That Helped Me Manage My Depression”, I share just such suggestions. Lynn Ulrich shares suggestions for those living with Bipolar Disorder in her post titled, “5 Tips That Got My Mental Health Recovery Back on Track After a Crisis”.
  3. Sharing our stories is therapeutic for ourselves. There is a “right” time for everybody to share. The “right” time will look different for many people. People who are living with a mental illness need to decide when the time is right and with whom they want to begin to share. However, I believe the more people one shares with, the more the person with the mental illness will realize that many people have a connection, one way or another, with someone else who has had struggles due to a mental illness. Another thing that happens when we share is that we support others, and supporting others is absolutely therapeutic.
  4. Sharing our stories chips away at the stigma.  By sharing our stories, not only do we educate and support others, but we help to engage more people in the conversations around mental health and therefore help to minimize the stigma. It’s very important for us to do what we can to eliminate the stigma. By eliminating the stigma, people will be able to speak openly about their mental illness and more easily (and more willingly) receive the support they need in order to work towards recovery.

There are more and more websites and blogs on the internet that allow people to share their own stories. Here are a list of just a few:

  • National Alliance on Mental Illness (NAMI)
    • NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. Their website includes a page in which people can share their stories. Click here to read the stories or to share your own.
  • The Mighty
    • Publishes real stories by real people facing real challenges. The Mighty is building a brand and a community around them. Having a disability or disease doesn’t have to be isolating. That’s why The Mighty exists. The Mighty is creating a safe platform for our community to tell their stories, connect with others and raise support for the causes they believe in. We are stronger when we face adversity together, and we know it.
  • Stigma Fighters
    • A mental health non-profit organization dedicated to helping real people living with mental illness. Stigma Fighters has been featured on Good Day New York, Psychology Today, Women’s Health Magazine, and The Washington Post. It is Stigma Fighters’ mission to raise awareness for people who are seemingly “normal” but actually fighting hard to survive. Since its launch in March 2014, hundreds of people have written pieces for the blog.
  • Bring Change 2 Mind (BC2M)
    • In 2010, Glenn Close & Family co-founded Bring Change 2 Mind (BC2M), a nonprofit organization built to start the conversation about mental health, and to raise awareness, understanding, and empathy. BC2M has created a social movement around change by providing people with platforms to share, connect, and learn. To read real stories or to share your own, click here.
  • Stamp Out Stigma
    • Stamp Out Stigma is an initiative spearheaded by the Association for Behavioral Health and Wellness (ABHW) to reduce the stigma surrounding mental illness and substance use disorders. This campaign challenges each of us to transform the dialogue on mental health and addiction from a whisper to a conversation. Share your story with Stamp Out Stigma by clicking here.

There are many more websites where people can go in order to read real stories about real people living with mental illness. Remember, sharing our stories help to educate, support, and minimize the stigma!

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

The Importance of Hope

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One of the most devastating pieces about depression is that it often times squashes all sense of hope. Without hope, people may lose any little bit of “fight” they have to work towards recovery. Dr. Jon Allen states, “I can’t think of anything more important than maintaining hope when you’re striving to recover from depression. Catch 22: at its worst, depression promotes hopelessness.” (Coping with Depression: From Catch 22 to Hope, (2006) p. 249). Depression counselor, Douglas Bloch, considers the presence of hope as an “absolutely essential” part of recovery from depression. He believes that without hope, one may believe that there is “no reason to put the work in today and do what it takes to pursue recovery” (“The Importance of Hope in Healing From Depression”).

One man who I met at the support group that I attend (see my post titled, “The Power of Support Groups”), stated that it was easier to stay on the couch and that he was “fine with it”. He didn’t want to deal with any of the challenges of life and wasn’t willing to put in the necessary effort to recover. This was a man who had been through depression in the past, knew what he needed to do in order to work towards recovery, even blogged in order to support others to work through depression, yet…in the midst of it could not get himself off of the couch.

One member of the group questioned whether or not staying on the couch was easier, as there is no possibility of “failing” if he wasn’t to work towards getting better. There would also be no possibility of being disappointed after being hopeful about a recovery, so therefore, perhaps, it was argued, he had no hope. He must have, however, as it was pointed out, had at least a glimmer of hope, as he was able to tear himself off of the couch in order to make it to the support group. Depression is an awful illness whose symptoms work against everything that should be done in order to become healthy. Many people with depression want to isolate, yet it’s known that connecting with people is helpful. Depression takes the enjoyment out of doing things that in the past were enjoyable. This particular man loved writing and playing music. However, he put down his pen and left his guitar sitting idle in its case throughout his struggle with depression.

Other men from the group reached out to this man, as it was clear that he was in a dark place and needed support (see my post titled, “The Importance of a Support Team”). Suddenly, he was off the couch and in various coffee shops meeting individually with other men from our group. I, too, invited him to coffee. By the time he met with me, he had mentioned that he had been online to seek out resources and programs for recovery. It was clear that he had made a significant and critical shift from having no hope, to having hope. He was getting out of his house, connecting with others, and seeking resources in order to recover. It was a great moment, as I was able to witness the shift from a lack of hope to hope that was energizing and palpable.

The lack of hope can be devastating and even life threatening. It’s important for those suffering from depression to understand that there is hope. People do recover. There are resources. You are not alone.

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

Supporting One with Depression

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The night before I entered a three-week partial hospitalization program for a major depressive episode, I invited two close friends over to my house. I explained the situation to them and asked them for their support. When they asked me how they could support me, I had no idea.  When one is in the thick of depression, it’s difficult to know what is needed and it’s certainly difficult to reach out for support.  Throughout my depressive episode, my wife had the very same question: “How can I help?” She wanted to support me, yet also didn’t know how.

Knowing how to support someone who is suffering from depression can be very challenging.  My goal for this post is to help provide ideas for those who are attempting to support someone with depression.  The support for people may look very different, particularly depending on the relationship one has with the person dealing with depression.  For that reason, I have separated  my suggestions into three categories based upon the relationship; 1) Spouse or family member, 2) Close friend, or 3) Acquaintance. While there may be some overlap amongst the three categories, there are also some significant differences.

Spouse or Family Member:  When supporting a spouse or family member, it is incredibly important to practice patience. (Note that from this point on, when I use the word, “spouse”, it is to include “or family member”).  Your spouse will most likely seem quite different in many ways while depressed compared to when they are mentally healthy. He/she may seem sad or emotionless.  He/she may not be able to do simple tasks around the house that they had normally done. In my case, I found myself sitting on the couch,  resorting to my bedroom, or following my wife around the house not knowing what I should be doing.  Practicing patience, understanding, and being empathetic will go a long way.

Offer to join your spouse for some of their appointments. My wife joined me for several appointments with my psychologist, hoping to gain some insights into what was going on with me and to learn how she might be able to support me. In addition, my wife and sister joined me for at least one of my psychiatrist appointments, particularly when I knew I was going to need their support. My wife was also at my side while at the intake meeting for the partial hospitalization program that I entered. Having her with me was hugely beneficial. She supported me morally and emotionally, as well as providing the support team with accurate answers to the questions that we had to field. Being severely depressed impacted my cognition and memory, so her support was indispensable.

Gently “push” your spouse to get exercise. I remember one bitter cold evening, my wife suggested that I go for a walk around the block. It was highly invigorating (relative to the major depression). Fresh air and exercise are both beneficial in overcoming depression. It may be nice to offer to join the person for a walk.  Understand that exercising, or even the idea of exercising, may feel like a massive chore for someone who is depressed, so there is a fine line in how much to push this piece. Consider asking him/her to walk to the store for an errand, if it’s not too far.  Asking to support with some of the chores around the house may be another way to get your spouse off of the couch or out of the bed.

Ask if there is anything you can do to support your spouse. Simply asking shows that you care and opens the door to a conversation. Do not be offended if the person is not very conversational. Engaging in conversations can be very challenging when depressed.

Provide resources for your spouse. If he/she is not yet a part of one, seek out support groups for him/her. If they are not seeing a psychologist, help him/her seek on out. Ask your spouse if it would be alright if you asked your friends or family members for a referral to a psychologist.

Close Friend:  There are several ways to support a close friend who is going through a challenging time of depression.  The first thing is to make sure to have the conversation. If you are concerned that a friend may have depression, ask the question. Let him/her know that you are concerned and worried.  It is really easy to isolate oneself when dealing with depression.  There’s a good chance that your friend, particularly in the case of males, may be masking his/her depression and may not be the one to broach the topic. Ask the question.

Ask if there is anything that you could do to support him/her. Your friend may not have an answer, but there is a chance that they do know and are able to articulate this for you. It is well worth asking.  Ask if he/she has the resources to support in their recovery. If not, offering to find resources would be a great way to help.

Reach out to your friend. Ask if he/she would mind if you check-in with him/her weekly or so. Ask him/her what the best way to reach out would be. In many cases, simply sending a text once a week or so to ask how he/she is doing is enough. Perhaps they prefer a phone call or an email. In any case, many people who are dealing with depression tend to isolate themselves and avoid friends. It’s important to take the initiative to reach out to your struggling friend.

Invite your friend out.  Again, this is a great way to prevent a friend from remaining inside and isolating him/herself.  It is not wise to drink alcohol when depressed (as alcohol is a depressant), so consider inviting your friend out for coffee, breakfast, or a lunch. Perhaps you could invite your friend to a movie.  One to one would most likely be the best scenario for any of these outings, as people who are depressed often do not want to be with a large group of people.  Consider inviting your friend to join you in an outdoor activity or a walk. This would provide fresh air and a bit of exercise. If you know a hobby or something that your friend typically would enjoy doing, offer that suggestion. I was really able to enjoy myself with a friend who invited me down to the river on a brisk winter day to take some pictures, as he knew that we both enjoy photography. He had to twist my arm gently, but this was a really positive day for me in the midst of my depression.  You may also consider having your friend over to your house to watch a movie or a favorite TV show.

If your friend is married, consider checking in with his/her spouse to see if there is any support the family may need.  Many times, when someone is ill with cancer or other serious illnesses, friends and neighbors create a rotation for bringing over a meal for the family. This rarely happens for one suffering from a mental illness.

Acquaintance: Just as with a good friend, if you’re concerned that an acquaintance may be suffering from depression, it’s worth asking the question. Be sure to ask in private and to let him/her know that you are asking because you are concerned.

Ask if there is anything that you could do to support him/her. Ask if he/she needs some resources and, if possible, offer to seek out resources for him/her.

Ask if you could reach out once in a while to support him/her. As mentioned above, a friendly text message to check-in to see how the person is doing weekly or so may be very supportive.

Encourage him/her to reach out to other trusted and loved ones.  Sometimes people resist reaching out for support.  Encouraging and supporting one in doing so could be very helpful.

In all of the cases, it is important to remember that depression is an illness, just as cancer or any other serious disease is an illness. Understand that it is not the person’s fault for being depressed, just as it is not the fault of anyone who has battled cancer, or again, any other serious illness. The person most likely does not want to be depressed and did not ask for it. He or she is not lazy, but ill.  Educate yourself on depression so that you can have a better understanding of what a person with depression may be experiencing.  Empathy and patience will go a long way! Be compassionate.  Offer support.

(Note: I feel obligated to mention that if you feel that someone is actually considering suicide, ask them the question directly. There is a false assumption held by some people that mentioning suicide will give the person an idea that they never had. This is not the case and has been shown by research. Asking the question will open up this dialogue that the person may never be able to discuss if not asked. If they actually have a plan, seek resources with the person immediately and call 911, if necessary.)

(Another Note: As always, comments to this post, or any of my other posts, are highly encouraged and would be greatly appreciated)

Self-Care in the Shower

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Stop…it’s not what you’re thinking. But…now that I’ve got your attention, let me go on. One well-known strategy for self-care is mindfulness.  “Mindfulness”, as defined by Merriam-Webster is:

“The practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis; also: such a state of awareness”

One of the reasons people practice mindfulness is to stay in the present moment. There is research that provides evidence that when our mind wanders, our thoughts are most often negative. Psychologists Matthew Killingsworth and Daniel Gilbert of Harvard University believe that, ““A human mind is a wandering mind, and a wandering mind is an unhappy mind.” They go on to say that, “The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.” Through their research they estimate that minds wander, on average, 46.9 percent of waking hours and that, typically, this mind-wandering makes people unhappy. They also discovered that people’s feelings of happiness had much more to do with where their mind was than what they were doing (Harvard Gazette, “Wandering Mind Not a Happy Mind”).

One way to prevent the negative mind-wandering is to always stay focused on the present moment. In order to do so, one must work towards minimizing the many  random thoughts that float into our minds. How many times have you read a page from a book, realizing that you have no idea what you just read because your mind was wandering?  I know that I’ve been guilty of playing a card game with my children, only to be focusing on work that I needed to have completed for a meeting the next day. It actually takes focus and practice to stay in the present moment. One easy way to practice staying focused on the present moment is in the shower. I find that the shower is an excellent place to practice mindfulness for a couple of reasons:

  1. I find that my mind wanders frequently in the shower. Sometimes I think about work deadlines or things that I need to get done around the house.
  2. There are many sounds and sensations that are easy to help “pull” you back into the present moment and to focus on the shower.

When I practice mindfulness in the shower, I think about the warm water hitting the top of my head and the feeling that gives me. I focus on the water moving down my body and the sensations of the water on my skin. Again…calm yourself…focus…we’re just talking mindfulness! I listen to the sound of the water hitting my body. When I shift my weight slightly, I notice the pitch of this sound changes and the path the water travels over my body changes. If my mind begins to wander and I catch myself having another thought, I “pull” myself back into the present moment, once again focusing on the sensations and sounds of the shower. Once I practiced this enough, I noticed myself naturally refocusing on the shower when a negative thought would enter my mind.

Gradually take this practice to other activities in your life. Be present. Be mindful. When washing the dishes, focus on the water flowing over the dishes, the sounds you hear and sensations you feel. Focus entirely on washing the dishes and nothing else. This will help you remain focused in other areas of your life, such as spending time (and being fully present) with loved ones such as a spouse or your children.

Be easy on yourself, as our minds wander often. Do not get frustrated, simply pull yourself back into the present moment.

As always, comments to this post (and any of my other posts) are welcomed and encouraged.

We Create Meaning to our Thoughts: Challenging the Negative Thoughts.

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An event (action) happens, we create a thought, a thought can become a belief, the belief becomes a feeling, and we act upon that feeling. This is the typical thought process, neither healthy nor unhealthy, simply a process.  However, when dealing with depression, this often times becomes a very unhealthy process that one needs to monitor and interrupt. This visual will help to understand the process:

It is easy for one to create a negative thought to just about any event when depressed.

I’d like to share an example: Let’s pretend that part of Sam’s role is to provide peer reviews for articles at his place of employment. Now let’s say that one of Sam’s colleagues said to Sam, “That last review you wrote was quite a review”. Sam will then create a thought to that comment. If his thought is, “That sure sounded like he didn’t like it”. His belief attached to this thought may be that he feels that his reviews are no longer of high quality or respected. This may cause Sam to become discouraged and to feel sad and incompetent, perpetuating feelings that he was most likely already having due to his depression. Sam may then change his actions and choose not to review peer work any longer. In other words, the negative thoughts that Sam invented based upon a statement may very well change the entire trajectory of his job and career.

However, this entire scenario may have looked completely different had Sam had a different thought to the initial action. Again, let’s say that Sam’s colleague stated, “That last review you wrote was quite a review”. This time, however, imagine if Sam’s thought was, “Yes! Another review that’s receiving powerful, positive feedback”. His belief that he writes well would be heightened and he may be feeling more confident and proud of his writing. He may even offer to do more peer reviews than he had done in the past.

We have the opportunity to monitor and change our thoughts. If we have a negative thought, it’s important to try to stop the thought. The first step may simply be to say “Stop” to oneself. This may help one from continuing down the path of a negative thought that could become a rumination if not kept in check.  One may take it a step further by asking themself what evidence is there to support the negative thought. Typically, there will not be evidence. When one is depressed, the thoughts we attach to statements people make and actions that occur are often powerfully negative and come with no evidence at all. I think it is also easy, when depressed, to create evidence that is not accurate. For this, it may be helpful to write down the statement, your thought, and the evidence. Once it’s in writing, one can evaluate it at another time, or better yet share with a trusted loved one who can help assess the comments and thoughts.  These thoughts (and even the evidence) that we create when we are depressed are often not accurate and can cause negative beliefs, exasperating the negative feelings and changing our behaviors for the worse; often causing more withdrawal. Another strategy may be to ask yourself, “What would I tell a friend in this same situation, compared to what I’m telling myself?”. Many people are harsher, often times unreasonably harsh, when addressing themselves compared to how they treat others. It’s important to have self-compassion, particularly when depressed, and this is one way to indulge in that compassion.

Much of what I have described comes from the Cognitive Behavioral Therapy (CBT). There are many resources online to help oneself work through these thought processes. One resource that I found online that has several CBT tools is: Specialty Behavioral Health. There is even a tool that is specifically for challenging one’s negative thoughts.  While it is likely much more difficult to challenge one’s own negative thoughts and to work through these thought processes when depressed, it is also all the more crucial.

As always, I encourage you to comment this post (or any other posts on my blog).

*Note: The graphic used in this post was not created by me. It was discovered on the internet, but I could not find the source.

 

Depression: Chances of Relapse?

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There has been a fair amount of research conducted and some pretty dismal, in my opinion, statistics sighted around the chances of relapsing into depression. In “Risk for Recurrence in Depression”, Burcusa and Iacono state that “Depression is a highly recurrent disorder”.  They also note research in their article that states the following: “Once a first episode has occurred, recurrent episodes will usually begin within five years of the initial episode, and, on average, individuals with a history of depression will have five to nine separate depressive episodes in their lifetime.” According to Dr. William Marchand, a clinical associate professor of psychiatry at the University of Utah School of Medicine,   “The risk of recurrence — ‘relapse after full remission’ — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent” Psych Central.

I believe that if you put a substantial effort into beating depression,  you have a much greater chance of preventing relapse. There are those that simply wait for their depression to be resolved over time while they mask the symptoms. Some take a pill, while changing no other piece of their life. In these such cases, I would imagine that the statistics above would be quite accurate. Others, however, take multiple steps and implement many strategies in order to beat their depression. They may seek therapy, take medication, exercise, journal, attend support groups, etc. If these changes (or t least some of them) are continued, even after one’s mental health has returned to their baseline, I believe the chances of relapse are much lower than the numbers mentioned above.

I believe that there is a correlation between the “amount of effort put in to remain mentally healthy” and “relapse”. The more effort and strategies one puts in to remaining healthy, the much less chance there is of relapse.  My motto is “Act Early, Act Heavy!”. It is important to consider and learn the signs and symptoms that appear early in one’s depression. This is different for everybody. Some people notice a feeling in their stomach. Others may notice that they are quicker to anger than usual. Some may catch themselves making excuses to avoid going out with friends or suddenly cease doing things that had normally given them joy. Being conscious of signs and symptoms that occur early in one’s depression is important to know so that the strategies one uses to fight against the depression can be strengthened or added to. If I notice that my feelings are moving towards a downward spiral, I start to think carefully about the strategies I’ve been maintaining and what I could do in addition to these particular strategies. Perhaps I notice that I haven’t been exercising as often as I would like to. I would prioritize increasing my exercise routine. Maybe I notice that I haven’t journaled in a long time, so I would begin to journal religiously again. In my case, I like to “Act Heavy” (strengthen current strategies and add others)…and I “Act Early”…as soon as I notice any signs or symptoms. Having been in a very deep, dark place with major depression has given me just enough fear, and a great deal of incentive, to do what it takes to never return there.

A final strategy that I recommend using in order to prevent (or minimize) a relapse is to solicit support from those you love and spend time with. It’s easiest, but not essential, if the person is someone who lives with you. In my case, I’ve asked for support from my wife.  My wife is pretty certain that she saw my major depressive episode coming on before I knew it. I’ve since asked her to let me know if she notices any signs of depression. She knows me very well and I trust her opinion. Even if she’s wrong, at least the possibility of relapse will have been brought to my attention and I would have the opportunity to honestly assess the situation.

While a relapse from a depressive episode is a very real possibility, there are ways to work towards preventing it. Notice changes in yourself that resemble a past bout of depression and take strong, quick actions to work against it. Solicit the support of others who know you well to inform you if they notice changes that may indicate the possibility of a relapse. By actively working at maintaining positive mental health, I believe it is possible to  greatly minimize the possibility of relapse.

As always, I encourage comments to this post.

(Note: This piece was originally posted in psychreg.org at the following address: http://www.psychreg.org/depression-chances-relapse/)

 

 

The Challenges of Medications for Mental Illness

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Medications and mental illness. This is a topic that seems to quite controversial at times; so much so that I considered not writing on the topic. However, I believe that multiple perspectives are crucial and that is what I provide here…another perspective. I also want to be clear that this post includes my opinions and thoughts. I am not a doctor and do not claim to be one.  There seem to be two very distinct camps when it comes to medications for mental illnesses: 1) Those who are very opposed to medications and even consider them to be detrimental to one’s health, and 2) Those who believe the medications are beneficial and a necessary component to regaining one’s mental health through the challenges of a mental illness. I would imagine there may be a third camp consisting of those who neither strongly support nor strongly oppose the meds, yet these are the voices seldom heard. I would classify myself in this camp for several reasons. I do not believe medications are for everybody, I believe strongly that they work for some people, I believe there should be more research conducted, and I believe that the business of pharmaceuticals and the amount of money in the industry can certainly allow for questioning the ethics and morals of those in the business.

I have heard some horror stories from people on medications and I have heard some stories that attribute the medications to successful recoveries. In my own case, one medication that had worked in the past did not seem to be working any longer. The psychiatric PA switched me to another medication in the same family (both were SSRIs). I began to have general thoughts of suicide on my new medication. I asked the psychiatric PA if my thoughts of suicide could be due to the medication, as antidepressants have a known possible side effect of causing suicidal ideations. In fact, in 2004, the FDA required manufacturers of all antidepressant medications to add a black-box warning to their drugs stating that they may increase suicidality in children and adolescents (drug watch.com). How ironic…antidepressants that cause suicidal thoughts? I guess this speaks to part of the complexities of mental illness medications.  After I had asked the question, the doctor responded exactly as I was expecting, “It could be the medication or it could be the depression.” He increased the dosage of my new medication, something I should have questioned at the time. A psychiatrist I was to meet with later told me that he never would have increased the medication that I had been taking, as there was no evidence of any further efficacy with a higher dose than what I was taking. My once general thoughts of suicide now became very detailed. I developed a plan and thought of it often throughout the day. It felt as though the thought was invading my brain. It would come out of nowhere and, at times, I could not stop thinking about it. It really began to frighten me after having a dream about the plan one evening. I found myself looking in a mirror, thankfully only with my finger and thumb acting as a gun, determining the angle I would need to hold the real gun at against my temple. Suddenly, I broke down into tears (uncontrollable crying bouts had become an evening ritual by this point), shocked at what I was doing. I became very fearful that suicide was going to become a reality.

Due to this overwhelming feeling of fear, I shared with my wife that I needed more support.  She and my sister joined me for an appointment with the psychiatric PA and we all shared that I needed more support. I made the decision, with the help of my sister and wife, to take time off from work in order to enter a partial hospitalization program.

At my intake meeting, I met with another psychiatrist (the one who had suggested that he never would have increased my previous medication). This psychiatrist spoke with my wife and me at length and, together, we came up with a new medication to try. This was based partly on what had worked for family members and partly based on the medications that I had previously tried. These medications seemed to work like magic. I had the significant side effects that the doctor had mentioned for the first few days; dry mouth, increased anxiety, slight dizziness. However, the side effects subsided within the first few days, never to return again. We had to discuss other medications, as well. My previous psychiatrist had me on sleep medication. I had mentioned that I seemed to sleep well once I fell asleep, but I was still struggling initially falling asleep.  I took this doctor’s suggestion and began to take a prescription antihistamine to get me to fall asleep, while continuing the other medication to keep me asleep (reminder that I believe all meds are different for all patients and this is not necessarily best for all-consult your doctor if you think this may be helpful for you).  Sleep medications, I discovered the hard way, are also something to be concerned about. Have a conversation. While it’s important to get proper sleep while recovering from depression, it’s also important not to overmedicate. While I was in the partial hospitalization program, I would return home in the evenings and my wife was kind enough to allow me to sleep through the nights. Once I had made it through the three-week partial hospitalization program and was on my way towards recovery, my wife (rightfully so) decided that I could wake at night to help with our crying three-year old twins. Due to the large amount of sleep medication, combined with the prescription antihistamine, I fainted soon after getting out of bed in the middle of the night. The first night, I fainted three times when I got out of bed. Two nights later I fainted again after getting out of bed in the middle of the night. This time, we decided to call 911 and I was taken to the Emergency Room for evaluation. After checking my blood and heart, the doctor was quite certain that my fainting spells were due to the medications. He casually informed me, “You can leave things the same…no need to change your medications…the only risk you would have to worry about is that of accidental death from banging your head from another fall after fainting.”  Still being depressed, the sarcasm of his comment didn’t sink in until I was in the parking lot. Working with my psychiatrist, I quickly weaned off my sleep medications.

I believe it is absolutely critical to discuss one’s medications with their doctor. Ask questions. If on multiple medications, what is the purpose for each of the medications and how might they interact with one another? What are the side effects? How long might I need to be on these medications? If your doctor does not seem to value you or your questions, if his/her answers do not satisfy you, seek another opinion. It’s very common to get second opinions for other serious diseases and I believe that if you do not have trust in your current psychiatrist or family doctor, one should seek another opinion.  I would also highly recommend, if at all possible, to bring a loved one to any appointment in which you think a change in medications may be discussed. As I had mentioned, I was too depressed to question the doctor, too depressed to answer questions accurately and probably would have left the appointment eating dog food if that was what the doctor had suggested.

Another issue to be sure to consult with one’s doctor is the weaning of medication.  I have heard of many people who, because they were feeling so much better, stopped their medication too soon. I believe it is absolutely essential to work with your doctor if you plan to stop your medication. Together, you would come up with a plan to wean. I believe it is common practice to wean most medications that are given for mental illnesses, rather than to stop abruptly.

As a final note, while some people may believe in the medications and others may not, I believe it is very important not to judge people for the choices they make. Mental illnesses and their medications are very complex and complicated. People faced with a mental illness have enough on their plate. They do not need to be judged, they need to be supported.

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

Structured Days & Depression

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I found, through experience, that while suffering from depression it was very important for me to have a schedule for the day. In the hopes of allowing a new medication to kick in, I took nine, unstructured days off of work. In hindsight, I think this was a terrible mistake for several reasons.

I isolated myself during these nine days. I believe that isolating oneself while trying to recover from depression can be very damaging. I feared that if I went out during the day, I may bump into someone who I knew. As a public school administrator in a large urban district for more than fifteen years, I often bumped into familiar faces throughout the city. I was fearful of bumping into someone I knew whether it was a parent of a student at the grocery store or a neighbor on a walk to get fresh air. On a rare occasion, I would join a friend for a cup of coffee or breakfast. I became very anxious at those times and always tried to find the most inconspicuous seat in the restaurant, scanning the place on my way to my seat to make sure nobody was there who I knew. How would I explain not being at work? How could I be on a  mental health leave, yet be out shopping or grabbing a coffee? This anxiety and isolation did nothing to support my recovery. In fact, I believe it was quite detrimental to my recovery.

Without a schedule or anywhere that I needed to be, the lack of motivation that comes along with depression only grew. I would spend time sitting on the couch and then soon laying down on the couch. I would use the excuse to my wife that my therapist shared with me that depression is like a brain injury and rest is needed. However, this turned into an excuse to retreat to my bed and hide behind the safety of my closed bedroom door. Unable to sleep, I would lie in bed for hours at a time, essentially waiting for the day to come to an end. When I managed to drag myself out of bed, I would often end up, only minutes later, sitting on our living room couch. The sitting soon turned to lying and there I was again, hoping for the day to come to a close so that I could be in the comfort of my bed, only to find myself rolling around unable to sleep. In the evening, my wife and I would make a list of simple things for me to do for the following day; fold the laundry, clean a bathroom, empty the dishwasher…none of which I could accomplish.

The isolation and lack of motivation caused more frustration with myself, fed my depression and increased the ruminations. Thoughts of myself became very negative and easy to defend. I convinced myself that I was an awful father (with four young children) and an unsupportive husband. I convinced myself that I was no good at my job. I no longer could focus on the moment, my mind always wandering into self-loathing. I noticed this while I tried to play with my children, unable to focus on the game or to really be fully engaged in conversation with them. I remember my wife taking me out to a professional hockey game with a couple from her work. Normally a very outgoing person, I struggled to engage in any kind of conversation at all with this couple I had never met. My wife would try to get me to at least focus on the game as she could tell I was ruminating in my own negative world the entire game.

In contrast, after attempting to go back to work and finding myself only getting deeper into the depression, I took three more weeks off from work and checked myself into a partial hospitalization program for what was diagnosed as major depression. This program offered me a place to be and a structured scheduled from 9:00am-3:00pm. While the program offered a great amount of learning and support, one of the most critical pieces it gave me was the structure. It allowed me to focus on my recovery, rather than ruminate between the walls of my house. I had a reason to get out of bed in the morning and a destination other than the couch in my living room or my bed behind a closed door. It  offered me a sort of forced socialization that allowed me to meet others who were going through a similar experience. This structure, I believe, was critical in working towards my recovery.

Soon after returning to work, I had heard that a friend of mine had recently taken a leave of absence from their job. I contacted my friend immediately, suspecting that it may have been a leave for mental health. She shared with me that it was, in fact, for mental health. When I asked her what her plan was for her time off, she responded with a quizzical, “Plan?”. I shared with her my thoughts and offered her some resources I knew of. Within a day or two, she had entered a program and was very thankful that we had spoken.

I urge anybody who is taking time off from work to somehow create structure in their days.  Whether it’s creating your own schedule of some kind or entering a rehabilitation program, I believe that having structured days will prevent the negative ruminations that often go alongside of depression.

As always, I encourage you to comment on this post.

Mind-Wandering, Depression, & the Risks of Driving

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There has been a great deal of research regarding the huge amount of time people experience “mind-wandering” and how the thoughts that occur during mind-wandering are most often negative thoughts unrelated to what the person is doing at the present moment.  “Killingsworth and Gilbert (of Harvard University) concluded that people spend 46.9 percent of their waking hours thinking about something other than what they’re doing, and this mind-wandering typically makes them unhappy.” (Is Mind-Wandering a Good or Bad Thing-Psychology Today). I believe that this is a large part of the reason that mindfulness has become such a hot topic in our society these days.  If we are able to maintain focus on the task with which we are doing, our mind is less likely to wander and therefore our negative thoughts are reduced.

I believe that people battling depression need to pay special attention while driving a vehicle.  While I was battling through a major depressive episode, I found that my mind would wander often…and the thoughts were always negative. I particularly noticed my mind wandering while I was driving. There were several times in which my wife had to get my attention because there was a car in the lane I was about to move into or to remind me that we needed to turn at an upcoming nearby intersection.  At one point, I got lost driving with my eldest daughter as we were picking up a friend in our carpool who lived less than a mile away. We had been to the house several times. I found myself disoriented and had to pull over to get my bearings with the help of a map on my phone.  Pulling out the map on my phone became a regular occurrence throughout my depression, even for very short and familiar drives.

I believe that the struggles of driving while suffering from depression should be reiterated by health professionals. While attending a partial hospitalization program for recovery from my depression, the risks of driving were never mentioned.  However, there was one day when, rather than finding one of our fellow patients in group, we found her during lunch in a wheelchair with a large brace on her leg sitting in the hospital cafeteria.  She explained to us that she had unintentionally driven through a red light, causing a multi-car accident. I was not at all surprised, recounting the number of times my mind had wandered while driving. Please try to pay extra close attention to the roads if you are driving while struggling with depression. Not only could an accident impact the lives of others, but it would also most likely impact your path to recovery. Be safe!

As always, I encourage comments to any of my blog postings. Thank you.