Enter Dr. Jane Baxter and her book, Manage Your Depression Through Exercise.  It is a five-week plan to assist depression sufferers in starting an exercise routine and battling through their depression.  She is a cheerleader and friend through the book, motivating and encouraging the reader in their journey.  With her career in psychotherapy and as a personal trainer, Dr. Baxter tackles depression head-on in her book, incorporating the physical, mental and spiritual aspects of living a healthy lifestyle. 

So how is her book any different from other exercise books?  Many exercise books and programs can make beginners feel like they are being thrown into the deep end of a pool to learn to swim.  Dr. Baxter takes a slower approach; she holds your hand and guides you into the pool using the steps in the shallow end.  Do not misconstrue this as coddling or babying.  In her first chapter, she clearly states, “excuses are not welcome.”  She explains that everyone must take responsibility for his or her own life and actions.  Enough blaming and finger pointing; she lays it out and tells readers that if they want a change, it is up to them. 

The program begins light in the first week; workouts are only five to 15 minutes a day.  She even provides pictures of the exercises.  Each week the exercises progress in intensity.  Dr. Baxter also includes other forms of exercise other than the ones that she specifically refers to in her book. 

What exercise book would be complete without nutrition advice?  Rather than go to an extreme, Dr. Baxter advises to “find a diet and exercise plan that works for you.”  She encourages readers to “eat like a pig.” What she means is to stop counting calories, worrying about what other people are eating, or feeling ashamed on the scale. Balance is key.  Balancing proteins and carbohydrates will help maintain energy at a constant level, rather than riding a rollercoaster of sugar highs and crashes.  She addresses the issues of food addiction but there is not a sense of pity in her words.  Rather, she is matter-of-fact, explaining the process of food addiction as it relates to the various areas of the brain:

Motivation is a junction of brain signals and those signals depend on reliable messengers and intact nerve pathways.  When we look at addiction as a neurological malfunction rather than as a moral failure, it suddenly takes on the form of something that can be fixed.

She encourages readers to look at the role that food plays in their lives.  Do you eat when you are bored?  Sad?  Lonely?  Stressed?  How do you feel after you eat?  Gross?  Unhappy?  Delirious?  There is a chart to fill out when you are hungry, how hungry you are, and how you are feeling emotionally before, during and after you eat.

The most important aspect of Manage Your Depression Through Exercise is the constant attention to readers’ emotions. There are charts for the reader to track their emotional state before, during, and after each workout.  Dr. Baxter includes areas to write any distracting thoughts and emotions that may be getting in the way of the workout.  There are personal exercises that provoke readers to look at what they want out of their lives and how they express their emotions.  Do you want to get out of your depression?  Do you vocalize your anger in a healthy manner?  Alternatively, do you explode and throw objects? 

Each chapter has at least two or three sections to remind readers to pay attention to what they are feeling.  Although this sounds redundant, Dr. Baxter addresses various emotions in each section in order to cover the full spectrum by the end of the book.  Therefore, regardless if the real issue is loneliness, food addiction, or anger, Dr. Baxter provides questions and suggestions for working through emotional blocks.

I found Dr. Baxter’s book truly motivating.  Although I personally do not suffer from depression, I can say that I understand being emotionally wrapped up and unable to motivate myself to move.  Within the first few pages of her book, I felt like going for a jog.  During my workouts, I remembered many of the things that she discussed. For example, she comments on working through any emotions that come up during a workout because, physiologically, I have turned up a notch by going for a run. 

I feel that Manage Your Depression Through Exercise is an excellent book for anyone who has struggled with being overwhelmed emotionally. I have already put my copy in the mail to a friend.

Manage Your Depression Through Exercise: The Motivation You Need to Start and Maintain an Exercise Program
By Jane Baxter, PhD
Sunrise River Press: August 15, 2011
Paperback, 192 pages
$14.95

These individuals may have treatment-resistant depression or refractory depression. While there’s some debate over the precise definition, treatment-resistant depression is typically thought of as failing to achieve remission after two treatments or two antidepressants, according to George Papakostas, M.D., director of Treatment-Resistant Depression Studies in the Department of Psychiatry at Massachusetts General Hospital.

Why Some People Have Treatment-Resistant Depression

People develop treatment-resistant depression for many reasons. Some struggle with severe depression, which is difficult to treat. Medical illness and comorbid psychological disorders — such as drug or alcohol abuse or eating disorders — also complicate treatment response, according to Dr. Papakostas and Yvette Sheline, M.D., professor of psychiatry and the director for the Center for Depression Stress & Neuroimaging
 at the Washington University in St. Louis. Severe stress also can impact improvement, Dr. Sheline said.

A variety of genetic, neuroimaging and electrophysiological studies have investigated the underlying causes of treatment-resistant depression. And researchers know one thing for sure: Refractory depression is not the result of one brain region or neurotransmitter system.

Preliminary research suggests that individuals with depression may have abnormalities in the frontal and temporal regions in the brain and dysfunction in serotonin modulation. Also, the subgenual cingulate (Cg25), which is located under the cortex along the midline of the brain, may play a role. Cg25 is activated when an individual experiences sadness. It also connects to other regions involved in mood, motivation and sleep. When antidepressants are effective, this area is less active. Some researchers have hypothesized that in refractory depression, Cg25 doesn’t turn off. In general, according to Papakostas, there isn’t enough evidence to show a consistent or unifying theory.

Other individuals may not have refractory depression after all. For instance, according to Sheline, a thyroid problem may mimic depression. Individuals may have bipolar disorder — though there’s recent evidence that bipolar disorder may be overdiagnosed in patients who appear to have treatment-resistant depression — or a long-term low-grade depression called dysthymia. If a treatment isn’t working, it’s critical that your physician re-evaluate your diagnosis.

Treatment Options for Refractory Depression

According to Sheline, there’s disagreement about the number of medication trials a person needs to try before moving onto more invasive interventions. While physicians determine this on an individual basis, it’s important for patients to have an adequate dose of medication for an adequate amount of time, Sheline said. “Each antidepressant has different therapeutic dose ranges, and these also vary according to individual factors, such as age,” she said. An adequate duration of treatment is usually six weeks. If there’s partial improvement, doctors may recommend patients stay on the medication for six to 12 weeks, Papakostas said.

This is why it’s especially important to take medication as prescribed. Many patients stop taking their medication after a week if they don’t get better, Sheline said. But this isn’t enough time to see improvement. Skipping or forgetting a dose can decrease a medication’s efficacy and make it look like it’s not the right medication for you. Also critical is practicing healthy habits, such as engaging in physical activities and getting enough sleep, and managing stress. Exercise boosts mood, while stress and lack of sleep exacerbate depression.

If one antidepressant truly doesn’t work, physicians will typically prescribe an antidepressant from a different drug class. Or they’ll prescribe an augmenting agent, such as lithium or an atypical antipsychotic medication to boost the effectiveness of the antidepressant.

If medication and psychotherapy are unsuccessful, these are other options:

Electroconvulsive therapy (ECT). ECT involves placing electrodes on a patient’s scalp, which sends a specific current that induces a short seizure in the brain. In the 1950s, ECT developed a bad reputation because it was administered without anesthesia and with a high voltage, Sheline said. But today, it’s a completely different treatment, she said.

ECT is administered with general anesthesia and the voltage is carefully controlled. In fact, Sheline noted that there is ongoing work to decrease the pulses to minimize side effects. There’s also been concern that ECT is involuntary, Papakostas said. He clarified that ECT is voluntary and requires a patient’s informed consent.

ECT does have various bothersome side effects, including memory loss and headaches. It’s understandable why patients would hesitate to try it, Papakostas said. However, both Papakostas and Sheline agree that a large body of research substantiates ECT’s efficacy. When compared with medication and psychotherapy, ECT appears to work faster and has a higher chance of success, according to Papakostas. It also has the most efficacy data of all the more invasive interventions.

Transcranial magnetic stimulation (rTMS). According to Papakostas, this treatment is second to ECT in quality of data. Transcranial magnetic stimulation doesn’t require anesthesia or induce a seizure like ECT. Instead it creates a magnetic field that produces an electric current in a specific area of the brain. It’s typically used for mild to moderate depression. The Food and Drug Administration has approved one device called the NeuroStar TMS to treat depression, which may be used after one antidepressant has failed.

Vagus nerve stimulation (VNS). In 2005, the FDA approved vagus nerve stimulation for treating treatment-resistant depression. The device is surgically implanted onto the vagus nerve on the left side of the neck and delivers mild electrical impulses. Think of it as a cardiac pacemaker. According to the University of Maryland Medical Center, it sends 30-second impulses to the vagus nerve every five minutes.

For over a decade, VNS has been used to treat patients with epilepsy. Researchers began studying VNS for refractory depression when they noticed that some patients’ moods improved. Whether VNS is an effective treatment for refractory depression is unclear. It appears to help some people tremendously but not others. To date, “the data [on VNS] just isn’t on par with ECT or rTMS,” Papakostas said.

Not finding a treatment that lifts your depression can be utterly frustrating and make you feel hopeless. But while it may take more time and effort, together with your physician, you can find a treatment that works for you. Remaining optimistic is important. “Being able to maintain a positive, hopeful attitude is as critical as [getting the right treatment], Papakostas said.

Drawing on her own experiences and her observations of others, Schoen explains exactly what a “gentle self” is.  This type of narcissist puts others ahead of themselves because the narcissist feels that he or she is unworthy of love or respect.  I can definitely relate to the gentle self.  Schoen spends half the book comparing and contrasting the two types of narcissist.  You may be thinking, “How can someone who puts others first be a narcissist?  Isn’t that the exact opposite of what a narcissist is?”  Schoen addresses this very question.  She explains that a narcissist is anyone who is self-absorbed.  The gentle self is self-absorbed in the sense that they are constantly thinking about how they don’t feel like they belong, how they aren’t worthy of love, etc.

The second half of The Gentle Self is about how to overcome depression, anxiety, shyness, and low self-esteem.  Schoen offers such advice as, “If you feel strong anxiety or pain or even a nervous breakdown approaching, the first rule to remember is: leave yourself alone.”  She goes on to say, “We often tend to put more pressure on ourselves in the form of ‘I can’t possibly burst into tears right now,’ ‘what’s wrong with me,’ or ‘I hate myself,’” and suggests trying to “be your own friend” when others are being negative toward you.

In romantic relationships, Schoen recommends bringing the spontaneity that we crave into the relationship instead of waiting for our partners to do so.  If we sit around waiting for our partners to read our minds and do what we want them to do, our relationships will end in failure.  Affairs are a not uncommon problem in relationships with gentle narcissists.  In friendships, Schoen says that gentle narcissists should get out and meet people.  Since it’s human nature to crave connection, meeting strangers on the street can feel refreshing and give the gentle self the confidence he or she needs to feel good the rest of the day.

Some other practical methods that Schoen provides for dealing with personal issues are the typical options: psychotherapy, meditation, and growing up.  The phrase “growing up” means something different to everyone.  In the context of The Gentle Self, growing up can be explained with three ideas:

• Leave yourself alone.
• Stay involved with other people.
• Take care of somebody else such as a child, grandparent, or pet.

If you, or any other gentle self, can get your mind off of how you feel about yourself, you get out with friends or meet new people regularly, and you have someone you can pour your affection into, your life might just start to look a little bit brighter.

All in all, I’m not too sure how effective Schoen’s methods are.  I’ve tried meditation before with little success.  Though I do feel a little better when I’m interacting with people, when that interaction has ended, I’m back to feeling how I did before—worthless and unimportant.  There are a lot of things that I agree with in The Gentle Self.  As I read, I could see so many parallels with my life.  Everything from distant parents trying to live through me to my fear of intimacy in romantic relationships—Gerti Schoen covered it all.  I have yet to try psychotherapy, but it is something I’ve been looking into.  As for taking care of someone else, I don’t know what I would do without my pets.  The only way I can explain how I feel about my pets is how a parent feels for a child.  They mean everything to me and I would be lost without them.

On the whole, The Gentle Self was a slow read.  There are a few grammatical and spelling errors, but nothing that the average mind would notice unless it was looking for them.  Schoen offers sound advice.  Her methods work more often than not.  Ultimately, I would have to say that The Gentle Self is definitely a book I would recommend to anyone who suffers from major depression or bipolar disorder.  You may see yourself in the pages.

The Gentle Self: How to Overcome Your Difficulties with Depression, Anxiety, Shyness, and Low Self-Esteem
By Gerti Schoen
CreateSpace: August 25, 2011
Paperback, 136 pages
$7.20

Personal relationships form a safety net around individuals to protect them from too much isolation. Long ago, people who strayed from a group had a much harder time surviving the elements or avoiding starvation. While it’s physically safer now to live a solitary life, emotional isolation can still threaten a person’s mental well-being.

Social support is a vital and effective part of depression recovery. It can turn around damaging isolation, affect a person’s life focus, and generate solutions for depression management. Learn more about how this powerful social force can positively effect someone living with depression.

Social Connection Curbs Your Sense of Isolation

Depression is a selfish, abusive captor. It enjoys nothing more than seeing you all alone, feeling like nobody would miss you if you weren’t around. It magnifies your sense of shame, making sure you believe that no one could understand or care about your struggles. You can easily imagine rejection and ridicule for speaking up. Holding your tongue might keep you isolated, but at least you’d avoid petrifying embarrassment.

This can seem like the lesser of two evils and a reasonable tradeoff. But in the end, isolation breeds only more isolation. This creates a reclusive lifestyle that can cut you off from people who mean a lot to you. Your hopelessness and thoughts of despair will only get worse over time. Your isolation can put you at much greater risk for suicidal thoughts (1). So how does social support counteract this destructive spiral?

People are meant to be social beings, and we have better lives when we care about each other. Sharing your innermost feelings can seem like a huge risk. Human beings often do whatever they can to avoid complete rejection from others. But relationships aren’t just for the good times. People lift each other up when they go through tough situations. This often strengthens their personal ties as well. Why? Because it’s real life, and genuine real life has fear, uncertainty, and problems. The good times mean even more when you’ve been through some valleys together.

The isolation that comes with depression can cut you off from these important relationships. Getting help from a caring person isn’t about pity or being a “defective” human being. It’s just the way people are supposed to be with each other. You may need to choose your confidants carefully. If you have a few people in your life who are genuinely concerned for your well-being, then hold on to them. They are a priceless part of your life and depression recovery. However, if you have toxic, unreliable individuals in your life, be very careful. These people may use your personal vulnerability to their advantage, hurting you time and again. A pastor or mental health counselor may be a good place to start if this is your situation.

Social Support Keeps You Connected with Life

An isolated, depressed person can slowly die on the vine, believing the world is better off without him or her (or that that person is better off without the world). Thoughts of death coupled with intense negative emotion are two of the most dangerous aspects of depression. A person who keeps meaningful connections with others stays connected with life. He or she can visualize the future, making plans to keep on living and stay out of harm’s way.

When you are depressed, isolation turns you away from life. This creates a self-fulfilling cycle where you feel increasingly rejected and remain disconnected, increasing the chances that your connections might fade or weaken. This dangerous combination affects how you see your very existence. Instead of turning your vision toward growth and living, you become focused on avoiding the most pain. And unfortunately, death can easily become the leading candidate for pain relief.

Sometimes a support person has to forcibly break through strong walls of isolation to make a connection. This may be met with fierce resistance, especially if isolation has been prolonged or you are feeling suicidal. However, if you have some flicker of life inside (even if it is deeply covered) or you have a great deal of trust in your support person, you can turn your vision from death to life. When the pattern is changed to include regular social time with positive, trusted people, depression’s grip can be loosened. Life is put back on center stage, giving death less and less time in the spotlight.

Social Connection Helps You Find Solutions

If you have depression and you reach out to a trusted, non-depressed person for help, you highlight one of the more important aspects of social support. Helping people, if chosen wisely, will have a vision of health that you can’t muster yourself. A non-depressed person can create and capture a healthier vision of your life, something you truly need in order to get better. It’s so easy to lose perspective when you are inside depression, even forgetting what healthy periods of your life looked and felt like.
Until you can truly capture that vision for yourself, a supportive person can hold on to it for you. It’s hard to reach a goal when you can’t figure out what it looks like. This “borrowed” vision from a support person can keep it real and thriving, even broken down into smaller pieces when that’s all you can handle. As you improve, you can live out and see the vision more clearly. The support person acts much like a compass, helping to reorient you to a healthier path of life.

Depressed thinking often involves replaying many of the same problems, the same negative scripts, and predicting the same (or worse) outcomes from the past. It’s really hard to be innovative or logical about what you really need to do if you only consult yourself. Friends, counselors, trusted health professionals, loving family members, and other supporters can help you generate a variety of solutions.

If you are still quite doubtful or confused about your options, a support person can gently help you see which ones might be the most helpful. You may have clear ideas about what you need but not about how to get started. You may also have a good idea about what hasn’t worked, but not why. When you bounce these issues off someone else, you open yourself up to their encouragement and their fresh ideas. Sometimes, all it takes is some new perspective on your situation to expose more effective solutions.

Social Support: A Vital Part of Depression Recovery

Depression recovery can be a complex process, but you don’t have to do it alone. Social support goes way beyond your friends trying to cheer you up a little. It’s about making genuine connections and spending time with people who care about you. It’s about knowing that you matter to other people. Depression can create a pit of despair and hopelessness inside you. With your loved ones nearby, the pit won’t be nearly as frightening. Your safety net is ready to keep you from falling in.

Reference

Depression, Lack of Social Support Trigger Suicidal Thoughts in College Students

The Lonely Screams, by Sean Seepersad, presents a curated collection of essays contributed to Seepersad’s website, Web of Loneliness. The stories are often wrenching and sad, and Seepersad follows each essay with his thoughts about the origin of and solution to the writer’s loneliness.  Aside from his clinical and academic interest in the subject, Seepersad has a personal interest; the final chapter is his own essay about his experiences of loneliness.

Two-thirds of the contributors to this book are women, and most describe feeling lonely for as long as they can remember. The contributors tell personal stories of loss, betrayal, childhood bullying, parental abuse and abandonment, romantic relationships gone awry, and of opportunities missed or simply not available in their lives. Most writers try to understand why they experience chronic loneliness, and they often point to events from their childhood that set the pattern in motion. Jack, for instance, writes “From my earliest memories I have always felt alone and not totally accepted. I have learned that when I was a baby, out of frustration my mother would hit me to stop me crying.” He concludes his essay hopelessly: “Loneliness kills potential. I can see no future for myself. I will give myself a few years, though. I would not ever kill myself, no matter how much of a failure I become.” In his analysis, Seepersad comments on Jack’s resignation and notes that Jack responded to his childhood loneliness by becoming a chameleon, “changing himself to fit the world around him,” and this kind of separation results in the loss of the hurt child within. Seepersad’s solution for Jack is to “get in touch with his true self, realize his true desires, and pursue his own dreams.”

The Web of Loneliness project is not set up with a rigorous experimental design, run within the auspices of a university lab; it’s a website, and anyone who wishes to contribute his or her story is welcome to do so. Contributors frequently comment on their gratitude for being heard, for being able to give voice to the experience of loneliness. At the end of each essay in the book, a URL is provided so the reader can go online and leave comments about the essays, and read comments others have left.

Although the stories were indeed sad, and sometimes difficult to read, they were actually stories of a great many more conditions than loneliness. Many writers were clearly experiencing profound clinical depression, and some experienced suicidality. Of course, depression and loneliness make sorrowful bedfellows, and each contributes to the other in a dynamic way. I wanted Seepersad to focus the book more closely on loneliness. With a public website inviting contributions, I wondered why he chose the particular essays he selected for this book.

My greatest disappointment with this book was in Seepersad’s commentary after each essay. He structured his response in two directions: what he saw as the origin of the individual’s loneliness, and his advice to the writer. Without exception, both halves were shallower than I expected. Seepersad is a clinical psychologist, and I’d anticipated reading more insightful commentary about the origins, and less glib advice.

Additionally, his thoughts about the origins are often contradictory. For one writer, who sought close relationships despite expressing a concern about intimacy, Seepersad wondered why she sought relationships, if she was afraid of intimacy? To a later essay, he commented that the need for belonging is a basic human need, like hunger.  As a psychologist with access to (if not familiarity with) the literature, he could have presented a more in-depth examination of the conflict between a basic human need, like belonging, and the anxiety associated with fear of intimacy. Such an explanation needn’t be heavily academic — given the book’s audience, which is probably people who feel lonely, he could have presented more complex information in an accessible way.

With a stated goal of offering each writer advice about what they might do to change their circumstances, Seepersad takes on a big job, especially for a slim book of this type. The answers are certainly complex, given the lifelong patterns these lonely people describe, but Seepersad resorts to an essentially light, hand-waving response, as he offered at the end of Pat’s story: “If you are suffering from this inner loneliness as well, it may well mean you need to undergo your own deep, transformational process as well.” With such a shallow answer (pointing to an enormous and difficult task), he would have been better off formulating a different structure for his responses to the essays. Had he organized his responses with a tighter focus on illuminating the source of each writer’s loneliness, he could have gone into greater depth and made his contribution more valuable.

In the end, reading this book felt like reading a public website, and I did not come away with a greater understanding of “the complex world of the lonely,” as the book’s subtitle promised. Seepersad has access to such rich material, I hope his next effort takes the questions a little more seriously.

The Lonely Screams: Understanding the Complex World of the Lonely
By Sean S. Seepersad
CreateSpace: May 18, 2011
Paperback, 186 pages
$8.99

Yet, it’s exceedingly misunderstood — even by medical and mental health professionals.

“You should hear the things I hear from moms across the country — awful things that are said to them by partners, family members, co-workers, nurses and doctors,” said Katherine Stone, an advocate for women with PPD, founder and editor of the award-winning blog Postpartum Progress and a survivor of postpartum OCD.

After reaching out for help, some moms don’t even hear back. Some receive a prescription with no followup or monitoring. Some are informed that they can’t have PPD. And some are told to simply perk up, stop being selfish or get out of the house more, she said.

There’s confusion about everything from PPD’s symptoms to its treatment. Myths also often portray women with PPD in a negative light, which dissuades many from seeking help. Moms worry what others will think, whether they’re even fit for motherhood or, worse, if their kids will be taken away, according to Stone and Meltzer-Brody.

As a result, most moms with PPD don’t get the treatment they need. “Some studies show that only 15 percent of moms with PPD ever get professional help,” Stone said. Untreated PPD can lead to long-term consequences for both mom and child, she said.

The good news is that PPD is treatable and temporary with professional help, Stone said. And education goes a long way! Below Stone and Meltzer-Brody dispel five common myths about PPD.

1. Myth: Women with PPD are sad and cry constantly.

Fact: According to Meltzer-Brody, “Women with PPD usually have low mood, prominent anxiety and worry, disrupted sleep, feelings of being overwhelmed, and can also feel very guilty that they are not enjoying their experience of motherhood.”

But this disorder can look different in every woman. “PPD is not a one-size-fits all illness,” Stone said. She frequently hears from moms who didn’t even realize that their symptoms fit the PPD criteria.

Indeed, some women do feel sad and cry nonstop, she said. Others report feeling numb, while still others mainly feel irritable and angry, she said. Some moms also have fears that they’ll inadvertently harm their kids, which amplifies their anxiety and distress, Meltzer-Brody said. (The myth that moms with PPD harm their kids only heightens these fears and fuels their suffering, she said. More on that below.)

Many moms appear to function just fine but struggle in silence. They still work, take care of the kids and seem calm and polished. That’s because most women experience more moderate symptoms of PPD, Meltzer-Brody said. “They are able to function in their roles but have significant anxiety and mood symptoms that rob them of the joy of being a mother and interfere with their ability to develop good attachment and bonding with their infants.”

2. Myth: PPD occurs within the first few months of childbirth.

Fact: Most women tend to recognize their symptoms after three or four months post-childbirth, Stone said. However, “you can have postpartum depression any time in the first year postpartum.”

Unfortunately, the DSM-IV criteria for PPD leaves this information out. According to Stone, “Since it doesn’t say that in the DSM-IV, I can’t tell you how many moms finally get up the courage to go see the doctor in the second half of their baby’s first year and are told that they ‘can’t have postpartum depression.’ So then the mom goes back home and wonders whether she should have asked for help in the first place and why no one can help her.”

3. Myth: PPD will go away on its own.

Fact: Our society views depression as something to “rise above and overcome,” Meltzer-Brody said. Depression gets dismissed as a minor issue, fixed with a mere attitude adjustment. “I’ve had many patients tell me that they felt so guilty and judged by friends and family for not being able to ‘just snap out of it and focus on the positive,’” she said.

Again, PPD is a serious illness that requires professional help. It’s highly treatable with psychotherapy and medication. The medication part worries some women, and they avoid seeking help. However, treatment is individual, so what works for one woman won’t work for another. Don’t let such misconceptions stop you from seeking the help you need. Both experts underscored the importance of prompt treatment. (See below on how to find help.)

4. Myth: Women with PPD will hurt their kids.

Fact: Almost without fail when the media reports on a mom who hurt or killed her kids, there’s mention of postpartum depression. As Stone reiterated, women with PPD don’t harm or kill their kids, and they’re not bad mothers. The only person a woman with PPD may harm is herself if her illness is so intense that she has suicidal thoughts.

There is a 10 percent risk for infanticide or suicide with a different disorder called postpartum psychosis, Stone said. Moms may harm their kids during psychosis.

Postpartum depression is often confused with postpartum psychosis. But, again, they’re two different illnesses. Postpartum psychosis is rare. “About 1 in 8 new moms gets postpartum depression whereas 1 in 1,000 gets postpartum psychosis,” Stone said.

(Here’s some information about postpartum psychosis symptoms.)

5. Myth: Having PPD is somehow your fault.

Fact: Women often blame themselves for having PPD and experience guilt over their symptoms because they’re not basking in some magical bliss of motherhood. But remember that PPD isn’t something you choose. It’s a serious illness that can’t just be willed away.

According to Meltzer-Brody, hormones play a substantial role in PPD susceptibility. Some women are especially susceptible to rapid fluctuations in estrogen and progesterone, which occur at childbirth, she said. It’s likely that genetics predispose women to mood symptoms during these fluctuations. A history of abuse and trauma also might increase risk in women who are already genetically vulnerable, she said.

As Stone said, “I know it’s hard to believe that it’s not your fault, that you ever should have become a mother, and that you’ll ever get better. I know because I’ve been there. You will get better.”

Again, PPD is a real illness that requires expert help. Dismissing it can negatively affect both mom and baby. Don’t be casual about PPD, and don’t hope for the best, Stone said. Instead, find real hope and recovery with professional treatment.

Getting Help for Postpartum Depression

Below, Stone offered several suggestions for finding a professional for a proper diagnosis and treatment. Many of the links come from Stone’s Postpartum Progress, which is an excellent resource! In fact, just recently it ranked #6 in Babble’s list of top 100 mom blogs.

• Start by reading this page on Postpartum Progress, which lists the best PPD treatment programs.

• Contact the nonprofit organization Postpartum Support International, which has coordinators in almost every state who can help you find an experienced professional in PPD and related illnesses.
• See if your state has its own advocacy organization for moms with perinatal mood and anxiety disorders. Postpartum Progress has a list of advocacy organizations.
• If you’re not sure how to talk to a doctor or therapist about your symptoms, print out Postpartum Progress’s list of PPD symptoms to start the conversation.

Ashley’s Perspective

Ashley was 19. She had been away at college her freshman and sophomore years when her life unraveled again. In high school, she had struggled for several years with escalating depression, drinking, and marijuana use, and the painful feeling that her mother was ashamed of her. Her parents did not recognize the seriousness of the situation until she began to scratch and then cut her arms with sharp objects, at which point her mom got scared and sought help. During her senior year of high school, her mom forced her into treatment, and with intensive individual, family and group therapies she become sober and psychologically stable.

Before leaving for college, Ashley was much better. She felt strong, proud of herself, and grateful to her parents for the ways they changed and learned to support her. Ashley even seemed to rise above her past — becoming an informal spokesperson for treatment and sobriety and seeking out ways to help friends and others in trouble.

At college Ashley initially participated in the support system set up for her, but then her attendance at therapy became sporadic. She became absorbed with campus life and seemed to revel in her independence. Ashley told her parents she felt “fine,” and announced that she no longer needed any antidepressants and had gone off them.

Toward the end of first semester, Ashley tried to avoid her parents’ calls. When they did speak, she was short with them, refusing to talk about school or therapy. When Ashley came home during winter break, she spent much of her time sleeping and staying in her room on Facebook. Though having agreed to get a job, she became too anxious to follow through the process. When her grades arrived, she could no longer hide that she had failed a course and was on probation. Ashley felt ashamed but promised her parents she would do better next term and go to her therapy appointments.

Unfortunately, the same cycle occurred the following year, culminating in a mounting emotional crisis toward the end of spring semester which she attempted to hide from her parents. When they questioned her over the phone about how she was doing, she told them she didn’t want to talk about it and wanted space. Her parents complied and backed off. When she was home over the summer, however, the signs that she was sinking became harder for her parents to ignore. (The warning signs of her depression included poor grades and failure at school, avoidance, inertia, withdrawal, staying in bed too much, weight gain, lack of motivation, irritability, and depressed mood.) Though her words stated otherwise, Ashley had again fallen into the danger zone.

Parents’ Perspective

Ashley’s mom, Laura, was a successful surgeon. She struggled with tremendous guilt over her role in her daughter’s emotional problems and failure to heed warning signs that Ashley was in trouble until things were so bad that Ashley started cutting herself.

Laura recognized that, due to her own upbringing, she had been unable to be available emotionally to Ashley and, on top of that, was perpetually disappointed with her. She came to understand that she had tried to mold her daughter into someone more conventional and ambitious, pressuring Ashley to be more like her, thereby giving her the message that she was not good enough.

Ashley’s dad, Tom, was an easygoing guy who generally aimed to please. He loved Ashley very much and gave her whatever she wanted, but did not comprehend what was going on with her psychologically. Tom did not like conflict and feared Ashley’s anger. When she went to college and pulled away, he worried that if they upset her, they could lose her and she might no longer want to come home or no longer want a relationship with them.

Ashley’s mom made remarkable progress in her own therapy during Ashley’s senior year of high school, propelled by motivation and willingness to be honest with herself. This progress was noticeable and quite important to Ashley. By taking explicit responsibility for her own mistakes as a mom, learning to accept and appreciate her daughter as she was, and acting as a supportive presence and guide, Laura played an important role in her daughter’s recovery and helped mend their relationship. Before Ashley went off to college Laura felt good about herself as a mom for the first time, and her relationship with her daughter became more solid than ever.

Once Ashley went off to school, however, Laura began to feel pushed away, and their relationship changed. Laura sacrificed so much to help Ashley and it now seemed to have been wasted effort. As she became aware of Ashley’s failures at school, she wondered whether her daughter was just a slacker, capable of doing better but manipulating the situation to get away with whatever she could. Feeling angry, defeated, and unappreciated, Laura commented that being a mom was a thankless and hopeless job. She wanted to give up and, pulling away in anger, she decided she would stand back and not do anything.

Psychologically Speaking

Laura took it personally when she felt her daughter pull away, becoming consumed by an emotional reaction which obstructed perspective on what was really happening. For all of us, executive functions go “offline” when we are triggered into dysregulated emotional states and overreaction. When this happens, our capacity to respond flexibly, think clearly, and react with good judgment is compromised. When the part of our brain that allows for reflection is deactivated by intense emotion (often originating from unprocessed experiences from our own childhood), instead of being thoughtful about how to respond to children’s needs, we are driven to react automatically and reflexively, as Laura did in her hurt and anger.

When a child’s distress is not taken seriously, and responded to appropriately by the parent, it can fuel an increasingly dangerous situation in which the child feels unconsciously compelled to continue “upping the ante” until the parent shows that they feel something empathically on the child’s behalf. Laura’s failure to recognize Ashley’s state of mind and step in to help led to her daughter’s continued escalation and deterioration, just like in high school when Ashley’s experience of not being “seen” in her pain perpetuated her self-destructiveness. During family therapy in high school, Ashley told her mom that she had felt out of control and driven to cut herself to produce physical evidence of her suffering – desperately hoping her mom would “get it.”

Another problem here was that when Laura was able to step back from her anger, she felt scared and helpless in the face of her daughter’s fragility. She feared that if she took action to set limits, Ashley would be forced to face the truth about her own limitations and might then want to kill herself. The truth was that Ashley was, of course, already aware – at least unconsciously – of her limitations and forced to be alone in it. She needed her parents or someone to step in and take charge.

Attempting to shield children from what they know intuitively to be true usually backfires, impeding the possibility of growth and causing them to feel shame, confusion, and aloneness. Projecting her own anxiety onto Ashley and colluding in a family-wide denial, Laura in effect reinforced Ashley’s sense of shame — and left her feeling unseen again.

Having the courage to face children’s limitations with them and offer help lends courage, builds coping skills, and is reassuring. Despite fears to the contrary, shame is actually decreased when parents are not afraid to face their children in a nonjudgmental way, and do not feel compelled to pretend or hide what is really going on.

SAD affects around 14 million Americans, according to author and SAD specialist Norman E. Rosenthal, M.D., in his book Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. (About 14 percent of American adults struggle with the winter blues.)

People with SAD experience a variety of physical, emotional and cognitive symptoms that impairs their daily functioning. They’re usually unable to perform at school or work and have difficulty interacting with others. Tasks that once seemed simple, such as household chores or paying the bills, suddenly become overwhelming.

The ability to think clearly also becomes impaired. In fact, according to SAD expert Dr. John Docherty, the disorder causes many problems for people at work. Dr. Rosenthal cites Docherty in his book. He lists these at-work problems by how often they occur: “decreased concentration, productivity, interest, and creativity; inability to complete tasks; increased interpersonal difficulties in the workplace; increased absences from work; and simply stopping work.”

According to Rosenthal, the physical symptoms can be especially prominent and debilitating. They include sleeping problems, fatigue, a revved-up appetite, loss of interest in enjoyable activities and diminished sex drive. And while mood changes are salient, individuals may feel the physical signs first. In the book, a middle-aged woman describes her physical symptoms:

I don’t really feel depressed. I just feel like all my systems have been turned off for the winter. I feel leaden and heavy and just want to lie about all the time. It’s only when I am expected to do something out of the ordinary, and I realize that I cannot do it, that I feel my mood being pulled down.

SAD Treatment

Light therapy, cognitive-behavioral therapy and antidepressants are effective in treating SAD. In 2006 the Food and Drug Administration approved the antidepressant Wellbutrin XL for preventing episodes of SAD.

Extensive research has shown that light boxes work well in boosting mood and energy. Light boxes emit artificial light that mimics the sun’s rays. They emit anywhere from 2,500 lux to 10,000 lux. (Lux is a measure of intensity.) Light therapy requires a daily commitment. It’s best to use light boxes in the early morning for 30 minutes or more during the winter months. (The 2,500-lux light boxes might even require two hours.) However, you can read or talk on the phone as you’re receiving light therapy. According to Rosenthal, you can do anything during your sessions, as long as your eyes are open, you’re facing the light box and there’s a proper distance between you and the box.

Early research has shown that CBT for seasonal affective disorder may be even more effective than light therapy (and doesn’t require the extensive time commitment as light boxes do). In this 2009 study, Rohan and colleagues compared SAD-tailored CBT to light therapy (along with a combination of both treatments and a wait-list condition). They found that CBT, light therapy and both CBT and light therapy were all effective in treating SAD.

However, at the one-year followup, participants treated with CBT were doing much better than individuals in the light therapy condition. In secondary analyses, Rohan also controlled for ongoing treatment, and the CBT participants still fared better.

Rohan is currently conducting a five-year randomized trial with 160 participants to further test CBT’s effectiveness.

CBT for Seasonal Affective Disorder

So what is SAD-tailored CBT? Specifically, it helps clients identify and incorporate enjoyable activities into their lives and to identify, challenge and change negative thoughts, according to Rohan. It’s classic CBT with a focus on coping more effectively with the wintertime.

For instance, people with SAD tend to view winter very negatively. They commonly say that they hate the cold and can’t do anything during the winter months. Rohan helps clients gain a more realistic perspective. She begins by challenging the strong word “hate.” Remember that you can hate poverty or prejudice, but you probably dislike the winter or simply prefer the warmer months. This slight shift in perspective is a big help. She also asks clients to come up with the evidence that they can’t do anything during the winter and to think of the times they have done fun things. Together, they also devise a plan that includes enjoyable activities.

As Rohan noted, this sounds a lot easier than it really is. Depression zaps your energy and desire to do anything, so engaging in activities may be incredibly difficult. That’s why Rohan starts small. Clients commit to doing 10 minutes of a specific activity. They also discuss potential barriers to engaging in the activity and problem solve to overcome them.

Seeking Treatment for SAD

If you think you might have SAD, it’s vital to see a therapist for a proper evaluation. “It can be dangerous to try to engage in self-diagnosis and self-treatment,” Rohan said.

In his book, Rosenthal outlines the signs to seek medical help:

• Your functioning is significantly impaired. You have difficulty completing tasks that were easier before; you’re falling behind with bills and chores; you make mistakes more often or take longer to finish projects; you tend to withdraw from loved ones.
• You feel considerably depressed. You feel sad more often than not; you feel guilty or hopeless about the future; you have negative thoughts about yourself that you don’t have at other times of the year.
• Your physical functions are greatly disrupted. During the wintertime, you sleep more or have a hard time getting up in the morning; you’d rather stay in bed all day; your eating habits have changed.

If you’re struggling with a mild case of the winter blues, the principles of CBT can be helpful, according to Rohan. Identify fun activities that you can do in the cold months, and avoid spending a lot of time in bed and isolating yourself. Also, be mindful of your negative attitudes and thoughts about winter, and try to challenge them.

And remember that SAD is highly treatable, and there’s always hope!

Of course, we did go on, as people do. But that year our conversation was more subdued than usual because we were all so aware of the empty chair at our table; the absence that couldn’t be denied.

As the years have gone by, the loss has become less painful. Now our memories of David and others who’ve passed out of our lives are laced with humor and nostalgia. The chairs are empty. But the relationships with the people who once occupied them continue on in our shared memories and stories.

Negotiating through the first holiday season following a death is seldom uncomplicated. Although the traditions that evolve in subsequent years may be fine in their own way, holidays without our loved one will never be quite the same. The holidays after a recent death highlight the absence and often throw people into confusion. Grieving people know they should “move on” – whatever that means – but aren’t at all sure they want to and don’t know how. Those who care about the person in mourning want to be helpful but are equally confused about how to do it. It’s a situation that is poignantly human.

For those of you who have lost a loved one within the past year, thinking about the empty chair at the holiday table may intensify grief in all its complex manifestations: sadness, anger, resentment, and maybe even guilt about the loss and, yes, joy and sweetness and gratitude that the person was in your life. For those who care about the grieving person, it can be difficult to know how best to honor the memory without contributing to pain.

Grief counselors generally agree on some basic guidelines that can help you manage a personal loss or help you support those in mourning during the holiday season.

If you are the grieving person:

• Allow yourself the right to grieve. American culture has a tough time with death. For some reason, there is pressure to get on with life within a year after a loss. That expectation is unrealistic and unfair. Most people take three to five years to fully accept the loss of someone they loved. If someone dear to you died during this past year, remind yourself that it’s normal and healthy to want to bow out of some of the events of the winter holidays that emphasize family and togetherness when you are feeling alone in a new and painful way.

• Take care of yourself. Discipline yourself to get enough sleep, to eat right, and to follow your normal routines – especially if you don’t feel like it. You’ll be better able to make good decisions about what makes sense for you to do over the holiday season.
• Plan ahead. Do you want to be alone or will being with those who love you ease the pain? Really think about it. Sometimes being alone makes the aloneness much too hard to bear. Sometimes being in a crowd is overwhelming. Only you know what is best for you. Talk to key family members and ask them to support you in whichever decision you make.
• Rethink hosting the party. If yours is the usual gathering place, think about whether you want to do it this year. Some people like getting lost in the details of planning and managing a dinner for twelve. But if you are one of those who finds it just too hard to make a party when in mourning, know that it’s okay to be “selfish” in times like these and to beg off. People who love you will understand. Those who don’t aren’t worth worrying about. At the very least, ask for help and accept all offers to spread the responsibilities around.
• Give people permission to share stories. Many people have the idea that the best way to help someone in grief is to avoid talking about the person who has passed. Most of the time, they are mistaken. When we stop talking about someone is when they are really lost to the family. Let people know that as hard as it is that the person is no longer with us, it’s important to remember the good times, to laugh about funny things they did or said, and to acknowledge that he or she is missed.
• Do things a little differently. For some people, doing the usual traditions and celebrations makes the loved one’s absence all the more painful. Think about whether doing things a bit differently or going to a different place would be helpful.

If you are a family member or friend of someone who is grieving:

• Allow the person the right to grieve. Everyone does it differently. Some people want to withdraw from the world and work through their sadness alone. At the other end of the spectrum are those who manage by carrying on as usual and tempering the pain through the distraction of people and parties. Carefully consider what your loved one needs, not what you would do in the situation.

• Take care. If you notice that your family member or friend isn’t eating, getting enough sleep, or functioning well at home and work, don’t ignore it. These are signs that the person is possibly getting clinically depressed. Invite the person to a meal. Talk to her about the importance of maintaining routines. If her inability to take care of herself is prolonged, do what you can to get her to a counselor.
• Plan ahead. Ask the person in mourning what he wants to have happen at family events. How would he like to acknowledge the loss and at the same time keep the holiday going for everyone? Some families literally set an empty place at the table and take a moment to share anecdotes about the person who has passed away. Others make a toast to the memories. Still others offer a prayer. Talk together about what will feel best for everyone involved.
• Offer help. If the grieving person is the one who usually hosts family gatherings, see if someone else can offer to do it this year. If she wants to keep up the tradition, get as many family members as possible to help with the shopping, cooking, cleaning, decorating, and whatever else needs to be done.
• Talk to the grieving person about the loss. Listen without judgment. Resist giving advice. Just be there. Understand that grief comes and goes in intensity and frequency for quite awhile. It is by talking and listening that we all integrate sadness and gradually move on.
• Try out a new activity that was never shared by the person who is gone. It’s helpful to do some things that aren’t shadowed by the fact that the last time we did them, the deceased person shared it. If people like the new ideas, they can become part of the family tradition. Or not. Leave that decision for next year.

Time does indeed heal most things. But everyone has his or her own sense of timing. If this is your first holiday season since the loss of a loved one, give yourself permission to feel what you need to feel and do what you need to do to get through it. Find ways to honor the memory of your loved one and to accept the support and care of those who love you.

If you are a friend or family member of someone who is grieving, give them support, love, and concrete assistance. By talking about their loved one and by listening to their stories and feelings, you help reassure them that the sadness may fade but our relationships with people we love never really end.

This article will cover some of the more popular alternative remedies for clinical depression, many of which have significant research backing to support their use. In many cases, trying an alternative treatment may be sufficient to help alleviate the most distressing symptoms of depression. As with anything you try, you should always talk to your health care professional first, to ensure the treatment is right for you (this is especially true if you’re currently taking certain medications, as they may interact badly with some herbs or diets).

As with any treatment for depression, your results will vary in trying any of the below options. People with more serious or severe depression may experience the least benefit from these kinds of treatments.

You should not try more than one alternative treatment at a time, especially when it comes to herbal remedies. Be patient in waiting to experience the full, beneficial effects of any of the below treatments, as it can take anywhere from 4 to 8 weeks for you to feel it.

St. John’s Wort for Depression

Once you get past the weird name, St. John’s wort is actually one of the most effective herbal remedies to try for depression. St. John’s Wort is the common name for hypericum perforatum, an herbal remedy for the treatment of depression that has become increasingly popular over the past decade in the United States. It is widely used throughout Europe, Germany in particular, where it is licensed for depression, sleep disorders and anxiety. Herbal remedies are considered a form of alternative medicine.

St. John’s Wort is a yellow flower with five petals that grows wild in many parts of the world. It is named for St. John the Baptist because it blooms around June 24, his feast day. In ancient times, this herbal remedy was believed to have powers to ward off evil spirits.

Dozens of research studies have been conducted and published throughout the world on the efficacy of this herb. For instance, in early 2005, the British Medical Journal published an article demonstrating that in a large clinical trial, St. John’s Wort is at least as effective as a commonly-prescribed antidepressant and has fewer side effects in the treatment of moderate to severe major depression (BMJ 2005;330:503 (5 March)).

In 2008, the Cochrane Collaboration — a non-profit research organization that analyzes scientific studies to draw conclusions from them — determined that the overall body of research evidence for the effectiveness of St. John’s Wort in the treatment of depression was strong (Linde et al., 2008).

Cochrane Researchers reviewed 29 trials which together included 5,489 patients with symptoms of major depression. All trials employed the commonly used Hamilton Rating Scale for Depression to assess the severity of depression. In trials comparing St. John’s wort to other remedies, not only were the plant extracts considered to be equally effective, but fewer patients dropped out of trials due to adverse effects. The researchers said, “Overall, we found that the St. John’s wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects.” In other words, it works.

When trying St. John’s wort, stick to name brands and look for tablets or capsules standardized to 0.3 percent hypericin. The usual dose is 300 milligrams is two to three times a day with food. Like almost anything you take for depression, it seems like it may take 4 to 8 weeks to experience the full positive effects of this treatment.

S-adenosyl methionine (SAMe)

S-adenosyl methionine (also known as S-adenosylmethionine or simply SAMe) appears to be an effective treatment for depression, as least for short-term use. In a meta-analytic review of 7 studies, a significant improvement was found for patients taking SAMe versus placebo in the treatment of depressive symptoms (Williams et al., 2005). Another, more recent review found virtually the same result, but also lamented that many of the studies examined were of poor scientific quality (Carpenter, 2011).

When considering taking SAMe, again, look for brand name products which typically have higher quality control standards. It’s generally recommended that you look for SAMe in enteric-coated tablets of either 200 mg or 400 mg. The effective dose varies between 400 to 1,600 milligrams a day, taken on an empty stomach. You can take lower doses (under 800 milligrams) once a day, a half hour before the morning meal. Anything over 800 mg you should split into at least two doses, taking the second one a half hour before lunch.

Omega-3 Fatty Acids (Fish Oil)

Omega-3 fatty acids such as eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA) might have an impact on depression because these compounds are widespread in the brain. The evidence is not fully conclusive, but omega-3 supplements are an option. One to two grams of omega-3 fatty acids daily is the generally accepted dose for healthy individuals, but for patients with mental disorders, up to three grams has been shown to be safe and effective.

Supplements that contain amino acids have been found to reduce symptoms, possibly because they are converted to neurotransmitters in the brain that help alleviate depression. For example, serotonin is made using the amino acid tryptophan. Dietary supplements that contain tyrosine or phenylalanine, later converted into dopamine and norepinephrine, are also available.

You can get omega-3 from a variety of sources, both natural and supplemental. Naturally occurring omega-3 can be found in large amounts in beans (kidney, navy or soy), walnuts and flaxseeds. Fish, winter squash and olive oil also can act as a rich source of omega-3. Omega-3 supplements can usually be found as “fish oil” supplements. There has been no recommended standard doses of such supplements.

Vitamins and Minerals

Deficiencies of magnesium and vitmains B and D have been linked to depression. Research suggests that patients treated with 0.8mg of folic acid per day or 0.4mg of vitamin B12 per day will have reduced depression symptoms. Patients treated with 125 to 300mg of magnesium with each meal and at bedtime have shown a more rapid recovery from major depression.

Hoang and colleagues (2011) found that low vitamin D levels are associated with greater depressive symptoms — especially in people with a prior history of depression. Taking between 1,000 and 2,000 IU of vitamin D each day may help with keeping depression at bay.

Exercise for Depression

Although it’s mentioned all the time, people still seem often reluctant to try one of the easiest ways of helping to improve depressive symptoms — exercise. This is not surprising, however, since some of the symptoms of depression that many people experience include lethargy and a lack of motivation and energy. How can one exercise when one feels so unmotivated to do anything?

There’s no easy answer, but study after study has demonstrated the beneficial effects on mood of even occasional, moderate exercise. For instance, simply walking for 20 to 30 minutes per day, every other day, is sufficient to gain some mood-lifting benefits. If outdoor exercise isn’t possible, find a physical activity you can do at home or even consider joining a gym.

Other Herbs

There have, as of this writing, been only a small number of studies conducted on other possible herbal remedies for depression (Sarris et al., 2011). Therefore, based upon the evidence to date, none of these herbs are recommended as potential treatments for depression. In two randomized controlled clinical trials of C. sativus extract, beneficial effects were found in alleviating depression symptoms. These studies also noted that anxiety, tachycardia, nausea, dyspepsia and changes in appetite are possible side effects of this herb. Rhodiola (Rhodiola rosea) has had only a single study demonstrating its effectiveness in depression, and is therefore not recommended. Echium amoenum also has had only a single study that has examined its effectiveness in treating depression symptoms and is also not recommended.

Are Herbal Remedies Safe?

In general, yes, herbal remedies are safe when purchased from a major retail outlet and are a name brand product. Herbal remedies have come a long way in the past decade, as their formulations have become more standardized across manufacturers. Since herbal remedies are considered “food” by the U.S. government, they are not regulated in the same manner as prescription medication, so they may not adhere to the same stringent manufacturing requirements.

You should always carefully read the herbal packaging and ensure you understand the specific type and amount of the herb you’re intending to take. As pointed out in a recent medical journal article, contamination, mislabeling, and misidentification of herbs are important problems. In general, if you are taking an herbal remedy or thinking about it, discuss it with your physician. This is particularly important if you have several medical illnesses and are taking prescription medications.

References

Carpenter, DJ. (2011). St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Review, 16, 17-39.

Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES. (2011). Association between low serum 25-hydroxyvitamin d and depression in a large sample of healthy adults: the cooper center longitudinal study. Mayo Clin Proc., 86, 1050-5.

Linde K, Berner MM, Kriston L. (2008). St John’s wort for major depression. Cochrane Database of Systematic Reviews 2008, 4. DOI: 10.1002/14651858.CD000448.pub3.

Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. (2011). Herbal medicine for depression, anxiety and insomnia: A review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol.

Williams AL, Girard C, Jui D, Sabina A, Katz DL. (2005). S-adenosylmethionine (SAMe) as treatment for depression: a systematic review. Clin Invest Med., 28, 132-9.

One of the first questions clinical psychologist Elvira Aletta, Ph.D, asks her depressed clients is about their appetite, sleep and movement. All three are “fundamental to our ability to function [normally]” and affect our energy levels, which directly affects our mood, said Dr. Aletta, the founder of Explore What’s Next, a comprehensive psychotherapy practice.

Some people unwittingly search in all the wrong places to perk up their energy. For instance, they might drink a whole lot of coffee, which increases energy temporarily but then causes a crash. Or they might attribute their fatigue to lack of sleep. But getting more sleep can backfire. According to Dr. Aletta, this notion is “a real trap, because you can end up sleeping 16 hours a day.” Below, she shares five effective ways readers can lift their energy levels.

1. Take it one step at a time.

Making changes when you’re in the depths of depression can seem overwhelming (and impossible), which only worsens your mood. This is why Dr. Aletta stressed the importance of taking small steps and creating feasible goals at your current state. Before creating any goals with her clients, she asks: “Where are you now?” and “What can we do to stretch that out so it’s achievable?”

If someone is so depressed that they stay in bed all day, a good goal for them is to get up and take a shower. For another person who’s also depressed but makes it to work, their goal might be to engage in one pleasurable activity per day. (An example is spending 10 minutes dancing while blasting favorite tunes.)

Also, remember that making a small stretch, as Dr. Aletta calls it, is a step in the right direction to overcoming depression. Some people berate themselves because taking a shower is a seemingly trivial target. But remember that it leads to another step, which leads to another step. All these steps are simply the building blocks to getting better.

2. Practice good sleep hygiene.

Sleep is essential for high energy levels, and getting too much or too little can dramatically affect how you feel. One of Dr. Aletta’s clients had terribly low energy and slept 12 hours a night. To top it off, she worked from 3 p.m. to 11 p.m., and went to bed at 2 a.m. To figure out an optimal sleep schedule, Dr. Aletta and her client counted back from the time she needed to be at work. They talked about a reasonable number of hours for her to have before and after work. This included sleeping from 2 a.m. to 9 a.m. The first week, not surprisingly, she felt groggy. But in the long run, this schedule improved her energy.

For more on sleep hygiene, check out these articles:

• 14 Strategies for Sleeping Better
• 12 Ways to Shut Off Your Brain Before Bedtime
• The First Line of Treatment for Insomnia That’ll Surprise You

3. Eat energy-rich foods.

Certain food groups help to sustain energy, while others, such as simple carbohydrates (think candy) create swift spikes in blood sugar and subsequently crash. “Our goal is to keep blood sugar going up and down in a gentle way,” Dr. Aletta said.

Foods that keep your energy up are complex carbs, including fruits, vegetables and whole grains, and proteins, the building blocks of cells. Dr. Aletta suggested thinking of protein as hardware and complex carbs as the fuel that propels this hardware.

Listening to your body and anticipating the signs of low blood sugar also helps. Dr. Aletta worked with a nurse whose hectic schedule gave her little time to sit down and eat a full meal. She experienced dramatic dips in her energy whenever she let hours go by without eating. She’d become irritable, be hard on herself and have trouble focusing. She learned to tune into her body and notice the early signs of her dips. She also started keeping snacks like granola bars in her locker to boost her blood sugar.

Dr. Aletta underscored that everyone is different and has different food preferences. For instance, one of her clients hated vegetables. So Dr. Aletta didn’t force the issue, and instead recommended that he take certain vitamins.

4. Move your body.

Many of Dr. Aletta’s clients say that they don’t have the energy to go to the gym. And she says to them: “No problem.” Movement isn’t about going to the gym. You don’t have to lift weights or run on the treadmill to gain the benefits of moving your body — unless that’s what you like.

Movement is any physical activity that you enjoy, such as walking your dog, dancing, swimming or playing tennis. Dr. Aletta helps her clients connect to those activities that bring them the most pleasure. One of her clients was so depressed that he forgot how much he loved riding his bike. He couldn’t even remember where he left it. He bought a new bike and began riding it in the park. At the end of their sessions, he was participating in long-distance races.

Movement isn’t only vital to get our hearts pumping and energy soaring, it’s also “a real gift we give to ourselves,” she said.

5. Identify and reduce other energy-zappers.

There are many other factors that can affect your energy levels, Dr. Aletta said. Medication is one culprit. Sometimes taking too many prescription drugs or a dose that’s too high for you can reduce your energy. Don’t hesitate to bring this up to your doctor. Technology also depletes energy. So limit the time you spend watching TV or using your computer or other devices.

And finally, try not to get hung up on the end result. Therese Borchard, author of the blog Beyond Blue and the book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes, reminds herself and her readers to “’dance in the rain,’ because you can’t wait for the storm to be over to be productive, or else you may not be productive for a long time.” Instead, the key, she said, is to keep moving.

Serani explains the different types of depression (as well as other mood disorders, such as bipolar), the different treatments available for depression, and even provides information and resources for navigating the hoops, roadblocks, and all-around time wasters that comprise the American healthcare and insurance systems.  The remaining 84 pages are filled with lists of famous people who suffer or have suffered from mental illness, resources for finding and getting treatment, references for cited materials, and a glossary and index for important terms used throughout the book.

“Dad’s gun is in the left-hand drawer of his dresser.”  From the get-go, this book slaps the reader across the face.  Serani goes on to tell of her lifelong struggle with depression.  She details her attempts at treatment.  She notes her suicidal impulses.  Most important, I think, is that she offers a sense of hope.  After giving the reader a brief introduction into the life of a person with depression, Serani turns away from memoir mode and begins writing in a more technical yet still straightforward manner.

It is nearly impossible to talk about mental illness knowledgeably without using big words that not everyone can figure out how to pronounce—“cholecystokinin,” for example—but Serani manages well enough.  She details the different types of mood disorders, gives a breakdown of several treatment options (both traditional and alternative) for depression, and then gives her insider information on how to most effectively get treatment when the rest of the world seems to be against you.

Next, Serani explains why it is important to understand that your depression is not your neighbor’s depression.  She also gives some lifestyle advice for avoiding depressive episodes.  Says Serani, “Becoming familiar with what pushes your buttons, sets you off, or presses heavily on you can help minimize relapse or recurrence of depression.”  Then, Serani details what she calls “The 5 R’s.”  These are: Response, Remission, Recovery, Relapse, and Recurrence.  She also gives pointers on how to prevent relapse and recurrence.

Serani dedicates an entire chapter to understanding and preventing suicide.  She gives lists of risk factors, as well as signs of improvement.  Most important, she outlines a plan that someone experiencing suicidal thoughts can implement in his or her own life to get away from the thoughts of suicide.

The closing chapters outline how to deal with the stigma that surrounds mental illness and how to effectively live with depression.  Serani notes that stigma can be anywhere.  It can be in one’s mind, it can be in the workplace.  Even loved ones may demonstrate some kind of fear or irrationality toward someone with mental illness because of their illness.

One thing is very clear: depression is a very real, very dangerous illness.  Having experienced lifelong depression myself, I find it highly encouraging to see that one of my own is fighting to save the lives of others.  Living with Depression really is an amazing book.  It is a quick read, and the advice is practical.  I’ll be keeping this book handy for when I need a reality check.  Perhaps, one day, I’ll even have the courage to seek treatment for my depression.  This book will definitely be a great tool to have when that time comes.  Until then, I’ll be using Serani’s guide to help discover what sparks my depression.  Realistically, I should be implementing her personal suicide prevention plan as well.

Living with Depression is an amazing book authored by an amazing woman.  It captures the essence of depression and lays it all on the line for the sake of bringing light into the lives of the depressed.  I know my attitudes about my depression changed in the few hours it took me to read this book.  I strongly recommend this book to anyone who wants to know more about depression and its treatment, or to anyone who wants to but doesn’t feel they are ready to take that important step toward getting treated.  You may even learn something fun along the way.  Who knew that such great minds as F. Scott Fitzgerald (author of The Great Gatsby), Dr. Stephen Hawking (a physicist), and even pop-culture icon Lady Gaga all suffered from depression?  Knowing that gives me reason to believe that anything—even overcoming mental illness and leaving behind a legacy worth remembering—is possible.

Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing
By Deborah Serani
Hardcover: 199 pages
Rowan and Littlefield, July 2011: $29.95

Regardless, loss is something that we work with often in counseling. One thing we can be certain of is that loss is universal and comes in many shapes and sizes.

What Is Complicated Grief?

Grief can look different depending on the individual doing the grieving. There is no set or “normal” time period for grieving, or fixed way of grieving for that matter. Each of us grieves as a result of the unique, subjective, contexts from which we come. According to Walsh-Burke (2006), traditionally, grief can be described as “the emotional, psychological, and physical reactions to loss” (p. 29).

According to Walsh-Burke (2006), complicated, problematic grieving can be characterized as “prolonged distress after the loss has occurred” (p. 49). Often, this type of grief will persist regardless of the amount of support that the individual receives from others (Walsh-Burke, 2006). Individuals with this type of problem will often have difficulty with their everyday functioning due to their grief. For example, making it through an entire school day or work day can be difficult for them; focusing on tasks that they once did with ease can become impaired; relationships can suffer; feelings of hopelessness can ensue; and depression can result.

How Our Thinking Influences How We Feel

I am a practitioner of cognitive-behavioral therapy. I cannot tell you how many times how, after experiencing a loss and meeting with me for counseling, many of my clients have said to me: “Tyler, I understand that you are saying that I can change how I think about this loss, but how else am I supposed to feel about it?” This can be a problem-inducing belief: the belief that it is possible to feel only sadness after a loss. Many of my clients believe that they should feel sad or depressed after a loss because it is the “proper” or “correct” thing to do. By no means would I ever hope for a client to be happy with losing a job, pet, or loved one, but I do believe that we can alleviate problematic thinking that contributes to feelings of hopelessness and despair, thus easing an individual’s pain.

When a client’s grief becomes complicated, their underlying belief is that it is wrong to go on with living their lives, or to be happy at all for that matter, after experiencing a loss. Essentially, they believe: “I must continue to react to this situation with sadness. Doing anything else would make me a bad person;” “How can I be happy after losing my job? That would not be normal. How can I move on when I am this depressed?;” “I regret…;” or “I can’t be happy after my children have left the nest. I no longer have a purpose.” These types of responses come in many shapes and sizes and are often colored by an individual’s unique, subjective experiences and thought processes. Are these the types of responses that people you know have had after a loss? Maybe you have even had some thoughts like this yourself during your time of grieving.

Around seven years ago I started having mania with depression systems so I decided to move 1,000 miles in hope of a better life. The move helped for a while due to a new adventure, but a while later the bipolar escalated beyond what I thought it could ever reach and the options were bleak at the time. I hated myself (hidden learning disabilities, also thought I had to fit into the extrovert world) already and I felt like I was somewhat cheated, so it was like pouring gasoline on fire when other people would say harsh judgments to me whether they were true or false. I was lost, trapped, hopeless, helpless, felt like a burden, felt worthless, and to sum up my manic systems – they were unbearably frightening especially at night time because I felt like I could run 100 miles an hour (this was not a good feeling) but at the same time I wanted to knock myself out cold because I knew that I was doomed.

The whole year I contemplated suicide (I’ll spare the graphic details), and had to be admitted to a hospital for a week and then another for two weeks. I remember when I left the last hospital I had a couple of good days (nothing like now though), but would go back to felling just as suicidal as before. I know this will not make anyone feel better that lost a loved one to suicide, but this is how sick my mental state got – I tried to go through the actions of offing myself, but I could not muster up the courage to go through with it; not because I was scared of dying, for I was scared of not doing it right and ending up paralyzed.

Four years ago on this month my hope (a music genre that I heard for the first time ever) came out of nowhere. The music (I listen on average 45 minutes a day) vs. a talk therapist (I know this helps a lot of people though) is: the talk therapist made me feel safe (because every time I thought I would be cured when I left) for the hour, but when I left the session I would feel just as miserable as ever. The new music genre makes me feel good when listening to it, but most importantly I feel safe (words cannot describe this for me) and at ease when I’m not listening to it.

I will admit the first two years out of my bad mental state were my favorite. I would have a blank look on my face with the biggest inside smile and broke down every so often; this was because the hope was new to me as well a shock and then combining it with thinking that I should be dead just manifested these emotions – mainly because I was drained of being suicidal every second of the days and never thought I would have so much joy for life and be at ease. I took advantage to just be one with nature and enjoyed doing different things that I never got the chance to before. One example would be in my miserable mental state I never enjoyed sunsets and rises; instead I would look off a five-story building trying to make myself jump off; right after the hope came I started to recognize with mindfulness on how peaceful sunsets and rises are as well as other unique scenery.

Some of the other things after the hope came: I no longer felt lonely, I loved waking up every morning, the best part was and still is having no suicidal intentions or thoughts (I never thought they would go away), harsh judgments bounce off better (90 percent of the time), I appreciate what I have, I no longer chase goals, dreams, and enjoy living in the present by living the life of journey vs. destination (this goes for everything in life) and not to be embarrassed, ashamed, disappointed, and frustrated in myself for not accomplishing certain things. Funny thing is some could have been a disaster after I got out of my bad mental state. My beliefs and what I wanted were altered kind of like I was reborn. I also never thought I would enjoy learning about science, sociology, history, politics, religions, cultures, art, and etc. As well as I finally enjoy independent movies (Into the Wild is one of them) that have life lessons and makes you think of life in someone else’s shoes.

The last two years I’ve incorporated some task in my life, so if and when I fail at something it’s not a big deal, because my hope makes me feel that failure (as long as I enjoy the task and try my hardest) is OK and that life (a joyful mental state and freedom) is much bigger than success.

Throughout the novel we witness Mark’s growth as he begins relationships with his housemate Daniel and a girl named Leah, both of whom are struggling with issues of their own. It is Daniel who pushes Mark to expand his social horizons, including persuading him to increase his involvement with members of the opposite sex. Though hesitant at first, Mark eventually takes Daniel’s advice and begins to socialize more. During a visit to the mental health clinic, he meets Leah, in whom he immediately takes interest. The novel centers on the relationship between Mark and Leah. Through their story, we see how trauma and emotional distress can make it more difficult to form bonds between people, yet at the same time strengthen those bonds that are made.

As a mental health professional, I can’t help but be compelled to examine the novel on multiple levels. As with any novel, the writing and story need to engage the reader. Yet in a work such as this, I feel it is also important that the reader be provided with an accurate depiction of people with mental illness. All too often the portrayal of characters with mental illness is fraught with stereotypes and inaccuracies. In Sleeping With Gods author Michael Fontana provides a refreshingly realistic glimpse at life with mental illness. There are no overly dramatic scenes depicting characters in a psychotic state. You will not find any mental health facilities described like a setting for a Stephen King story.

Instead, Michael Fontana gives the reader a believable portrait of a young man and his attempt to struggle with depression and other stresses. Whether the main character is meeting with his therapist or having a conversation with his housemate, there is a very natural feel to the dialogue. While Mark is shown be morbid at times, you get the impression that he is really just trying to find his way through the world. Although he might be labeled as “mentally ill,” you get the sense that he in the end he is not all that different from anyone else.

Overall, I have mixed feelings about this novel. On one hand, I appreciate the fact that the author is able to provide an accurate representation of characters coping with mental distress. Mark, Leah, Daniel, and the other characters in the novel for the most part are realistically envisioned. When Mark states that by journaling he is “turning language into a control box for the chaos ensuing around me,” I was reminded of several different clients that I have worked with. I have read many books and seen many TV shows and movies depicting characters with mental illness, and Sleeping With Gods contains some of the most honest, true-to-life characters I have seen.

On the other hand, while the novel has a variety of interesting characters, the plot leaves a bit to be desired. The novel is made of a mix of scenes alternating between various points in the narrator’s life. While these scenes give us a better sense of Mark’s psyche, there are certain points when the reader is left to wonder what a particular anecdote has to do with the central relationship in the story between Mark and Leah. Looked at separately, some of these stories make for an entertaining read. However, it feels as if the novel jumps around too much to give the overarching story any coherent flow.  I don’t want to spoil the novel’s ending, yet I will say that it seemed to be somewhat forced.

Sleeping With Gods is not a must-read novel by any means. Yet I would recommend it for anyone who enjoys coming-of-age stories and is interested in reading one with a mental health angle. Author Michael Fontana also deserves praise for providing a rare authentic take on what it’s like to be inside the mental health system. It would be interesting to see how some of the themes in this work (such as mental illness, suicide, trauma, and recovery) might be further explored as he continues to grow as a writer.

Sleeping With Gods
By Michael Fontana
Apodis Publishing, Inc: April 1, 2010
Paperback, 216 pages
$13.95