Rosenthal shares her battle with Stevens-Johnson Syndrome (SJS), leading us from her diagnosis at age 13 through 24 subsequent years of psychological repercussions. Rosenthal recounts the story of how she fought for years to overcome her PTSD, and managed to slowly climb her way out of a serious case of depression and anxiety, experiencing a rebirth along the way. Ultimately this results in a remarkable tale of personal strength and post-traumatic growth.

The book is divided into four sections: ‘Shock;’ ‘Confusion;’ ‘Clarity;’ and ‘Healing,’ with each of these representing a different stage in Rosenthal’s journey. The first, ‘Shock,’ describes Rosenthal’s life ‘before the world intruded’ – the innocent childhood cut short by the onset of her terrible illness. ‘Confusion’ and ‘Clarity’ cover her emotional journey in coming to terms with this trauma, and ‘Healing’ describes her eventual recovery and return to happiness.

Not only is Johnson one of the 0.5 people per million to suffer from SJS, but in her case it also develops into its most extreme, life-threatening form, Toxic Epidermal Necrolysis Syndrome (TENS).The symptoms of this are a form of blistering so serious that Rosenthal has to be treated in a hospital burn unit. She recounts the condition’s sudden onset with such excruciating accuracy and vivid attention to detail that you may find yourself wincing as you read about the unbelievable pain she had to endure. Rosenthal recalls meeting the hospital psychiatrist, and being unable to put her experience into words at the time:

I did not tell her how drastically I felt changed. I did not say out loud that I was trying to suppress the memory of a pain so intense it defied words. I could not explain that I was struggling not to be overwhelmed by a staggering number of new fears and feelings, nor even the latest fear: that I had survived the physical onslaught only to be outdone by the emotions in its wake.

Indeed, it is these subsequent emotions which later cause Rosenthal to become disconnected from the rest of the world. She survives a near-death experience, and then sinks into a state of deep depression, anxiety, insomnia, and eating disorders.

Rosenthal shares the following quote from Dr. David Biro’s memoir One Hundred Days: My Unexpected Journey from Doctor to Patient:

Doctors love a good zebra. Patients with rare, exotic diseases. We crowd around to see them, touch them, photograph them. We put them on display at conferences. We write their stories in journals. We do all this, I suspect, because they reawaken the spirit that first pushed us into medicine: a fascination with the human body, its incredible achievements and its terrifying failings.

It is this idea of an “exciting zebra” for the medical community that Rosenthal most strongly identifies with throughout her struggle. She reluctantly adopts this as her identity, labeling herself as a “medical anomaly, alone, a freak.”

Eventually, 16 years after her initial diagnosis, and following countless fruitless attempts at a cure by her doctors, Rosenthal decides to seek a different kind of help. She arranges to see a psychotherapist, named Greg. It is this work with Greg, and an introduction to transcendental meditation, that signals a change for Rosenthal: She talks about her experiences for the first time and begins to discover her true voice, escaping the fearful clutches of her Ego voice. Remembering her college days, Rosenthal writes that “[W]riting was good for me. It gave me a focus outside my physical discomfort and limitation. It gave me something in which to bury the emotional angst I carried and also a place to explore how and when and why to find language and choose words.”

As her sessions with Greg evolve, Rosenthal recalls that:

I became more of a full self: I defined boundaries, learned how to communicate, and started more consciously mulling the question, ‘What do I want?’… I made a list of twenty-two things I was afraid of. At the top of the list: ‘I am afraid of myself.’ And yet, I wanted more and more to become myself. Writing seemed to be the path to that connection.

She begins to make significant progress, and to feel in control of her life, so Rosenthal terminates the sessions with Greg. But another onset of the illness sparks a relapse into her depressed state, as she is once again forced to resign herself to the role of patient, or ‘zebra.’ It is this relapse which finally triggers the turning point for Rosenthal, as she fully acknowledges the fear she has lived with – and denied – for so long. She decides once and for all to “reclaim myself,” with Greg’s help:

We break through the fear to a point where I begin to imagine for myself a different life than the invalid one I am used to. This happens oh, so slowly, but I hear the machinery grinding in my head. I fantasize I could be her, the girl of such vast energy I glimpsed for just a moment in the hospital. I imagine myself strong and free and vibrant and healthy and able to succeed without enduring the pitfalls of illness. One day, walking along the beach I feel myself as I would like to be: happy, unafraid, able to live without looking back, a strong source of joyful vitality.

Crucially, through her ongoing therapy sessions, and by reading two life-changing books – Joan Didion’s ‘The Year of Magical Thinking’ (a parent’s perspective of a child’s grave illness) and Elizabeth Wurtzel’s ‘More, Now, Again: A Memoir Of Addiction’ – Rosenthal realizes just how important her writing is to her, and how it can offer her a solution to her problems:

Socrates wrote that language is ‘an activity that moves the soul towards definition.’ Words can deliver us from our solitude, or deepen it. They are our most specific form of translating what exists in a heart through the landscape of a mind. I have always used language as a fence, as a guardrail against truth, definition, and exposure. So often my words have cloaked my self in disguises designed to ensure anonymity. Or, the lack of words has kept me separate from even myself. Recently, however, I sense the ability to use language in another way. I begin writing poetry again, starker poems and more to the point, writing more directly than ever about the aftereffects of illness and its consequence on identity… I begin to feel safe… I understand the problem has been that I never acknowledged my past and then came back to the present. Instead, I have lived in the trauma and run away from myself in every moment. It is time to sit still.

This will certainly sound familiar to anyone who has ever studied the concepts of Narrative Therapy, and it is ultimately — through her writing, a discovered love of music and dance, and a new identity – that Rosenthal finally overcomes the trauma of her illness and truly achieves happiness. At the end of the book she states that:

I can describe myself as if TENS never happened: I am a dancer, I am a writer, a creator, a lover, a partner, a daughter, a sister, a friend. I am a dog owner, a Floridian, a beachwalker, a homeowner. I am a joy seeker. I am a believer in my self. I have conquered the past. Now, I am creating my future as a woman who is connected, strong, and free.

Notably, Rosenthal is many things, but she is no longer a ‘zebra’.

Today Rosenthal works as a post-trauma coach, using the wisdom gained from her own experiences to help others, and employing the philosophy that “we can’t always find meaning in our trauma, but we can learn to make meaning come out of it.”

This is an honest, triumphant story of personal courage in the face of adversity, and will undoubtedly help anyone who has ever dealt with the effects of trauma or illness. At one point in the book, Rosenthal states that “Writing seems like the only thing that can save me,” and I am grateful that it has. Rosenthal is a survivor, and hopefully her story will help many other victims of PTSD work toward their own recovery and post-traumatic growth, finding happiness and a new sense of identity along the way.

Before the World Intruded: Conquering the Past and Creating the Future, A Memoir
By Michele Rosenthal
Your Life After Trauma, LLC: April 9, 2012
Paperback, 230 pages
$14.95

Acts of violence have always been a part of human nature and will continue unless we become some sci-fi world with better living through chemistry and genetic manipulation. Sure, there are general reasons the experts will point to, such as alienation; access to guns; too much exposure to violence; a society whose leaders lack values; and families who are disconnected from community.

But the reality is that the great majority of teenagers are growing up in this environment and not killing anyone. That doesn’t mean we should ignore steps to reduce the negative influences on their lives and ours. It does mean that no matter what we do, there will always be tragedies. We simply do not have that much control over another person’s life. That is a frightening reality for most parents to accept.

But this doesn’t mean that parents shouldn’t be doing things that make it more likely that their children would turn out okay. Inside each home there are parents asking if their son or daughter could be in trouble and the parents might not know it. Or, even scarier, there are parents who see their children struggling and feel powerless to help. What do we know that will help?

Well, the research points to the same issue nearly every time: children who have stronger relationships with their parents are less likely to end up in serious trouble. My emphasis on “serious” is because too often parents are upset about issues that are not life-threatening or life-determining. Clean rooms, grades and homework, being disorganized, being impulsive and screwing up, foul language, a few extra holes in an ear, some grungy friends, some broken curfews, or the protective or manipulative “lies” that children use to try to get away with things – all normal adolescent behaviors that do not alone signify a child “going down the tubes.”

Adolescence is a time for many teens to experience disconnection and disorientation, to become confused and uncertain about their values or about their capacity for success. It is a time to be scared about changing bodies and changing friends and experiencing failures when success may have usually come easily. It is a time to defy and distrust authority. It is a time, especially in with the phenomenon of the Internet, when teens’ worlds expand exponentially and it is quite a challenge for them to digest and manage all to which they are exposed.

Parents often respond to this by waging battles for control. While it is essential to have some unequivocal rules that involve health and safety and to seek help from others if there are signs of more serious trouble (e.g., depression, explosive outbursts, eating disorders, substance abuse, marked change in personality), it is particularly important to focus less on content and more on process.

What does this mean? Simply, that nothing is a substitute for maintaining the connection between you and your teenager. Time must be found for one-to-one interactions. Parents must be ready to give their attention when a teenager is suddenly ready to talk. Parents need to spend some time inside the world of their teenager and try to do so without being too judgmental. Do errands and chores together. Find an activity that can be shared. Take a teenage child out to dinner occasionally. A parent whose work involves travel can bring along a teenage child and turn it into a significantly valuable time together. Know each other!

Remember that you most likely did some things wrong along the way. It can be helpful to share that. Why should your child be open with you if there is not some reciprocity? That includes sharing some of your current anxieties or mistakes. We all mess up. We all have our vulnerabilities. We all seek safety and security. In that way, you and your teen have much in common. The key difference is that a teen’s life has few real choices and does not have a valued place in our society. We ask them to be responsible but there is little immediate reinforcement for that except to keep the adults from being angry and disappointed with them. Believe in your child, even when he or she is struggling, or simply not meeting your expectations.

For some parents, there is the harsh reality that, despite doing a good job, their child is having significant problems, and the parents are being shut out while nothing seems to be helping. This is definitely painful and scary. Even with professional help and support from school staff, some child will fall into a “black hole,” influenced by biology, peers, and social forces. This underscores another reality about the tragedies that have been taking place: All the perpetrators have been male.

Our society gives out powerful messages that are absorbed by our children. What girls hear and respond to leads them to turn against themselves, especially in the form of eating disorders (and a skyrocketing rate of smoking). What boys hear and respond to leads them to turn against others, in acts of verbal and physical abuse. In the face of all this, parents are worried, possibly more than ever, about the health and success of their children.

But I must return to my primary message of urging parents to have a more optimistic outlook and to not let their anxiety sabotage what is most important, the relationship each parent has with each child. A friend and colleague, Bob Brooks, often speaks about the resiliency of children and what contributes to it. The research clearly indicates that the presence of a “charismatic adult” is one of the primary predictors of turning out okay.

So often I read the stories of successful adults who grew up under terrible circumstances and there is always reference to a parent, relative, teacher, or coach who believed in them and provided guidance and an available ear when needed. Dr. Brooks often ends his presentations by challenging parents to be that charismatic adult in the lives of their children. It is no guarantee that everything will turn out all right. Nothing can do that. But it does make it much more likely that you will end up with an adult child who is not only doing well but is also your friend.

In Depression: A Guide for the Newly Diagnosed, Lee H. Coleman, PhD seeks to explain the signs and symptoms of depression as well as some of the ways that people who have been diagnosed can obtain help.

At a little over 150 pages, this book is not meant to be an extensive compendium regarding depression treatment. As the title suggests, it is sort of a beginner’s guide to dealing with depression. For those who have already been in treatment for a significant amount of time, this book probably will not offer much new information.  For individuals who have just been diagnosed (or who feel that they may be suffering from depression), however, this book offers a wealth of information. Also, for anyone who may suspect that they are suffering from depression, this book will serve as a guide on how to go about finding treatment.

The book’s first two chapters explain the definition of depression as well as how to obtain an accurate diagnosis. Dr. Coleman provides information about depression symptoms and also answers questions the reader may have such as “how do you know you’re not just sad?” For the uninitiated, this can be important information, as many people dismiss some of depression’s symptoms for a long time before trying to obtain treatment. The author makes sure to explain the seriousness of depression and the impact it can have on one’s life if treatment is not sought.

The second chapter gives specific instructions about how to find treatment for depression. The author does a good job of explaining the difference between general practitioners, psychiatrists, and other therapists and the roles that different professionals can have in a person’s treatment. I think the reader is provided good information regarding what to expect when they go to seek help.

In chapters 3 and 4, Dr. Coleman gives the reader a glimpse at the various types of depression treatment. As he explains, his goal is to give people “realistic expectations” of what occurs when a person enters treatment. Though the sections are brief, the book does touch on most of the major methods of treatment, including cognitive-behavioral therapy, mindfulness-based therapy, and of course, medication. There is by no means an exhaustive explanation of all the different treatments, but as an introduction, the book serves its purpose.

Perhaps more importantly, the author includes information about how to tell if treatment is working. He answers questions such as “When should you expect to see some changes?” and “What if you’re not getting any better?” He makes it clear that there is no miracle cure for depression and that effective treatment can only be achieved through collaboration between an individual and their mental health professionals.

The second half of the book focuses on providing tips to manage symptoms of depression. Again, this is not meant to be an in-depth self-help book, but the author does give a number of good starting points for dealing with depression.

It’s especially good to see that Dr. Coleman dedicated an entire chapter to “Managing Suicidal Thoughts.” Not only is this one of the most difficult symptoms of depression to manage, it is also perhaps the most serious. In my experience, I have seen even well qualified professionals have difficulty when dealing with people with suicidal thoughts, so I am sure that the advice the author provides in this section will be helpful for its intended audience.

The chapter about caring for yourself after a depressive episode is also a plus. All too often people relapse because they do not make healthy choices once they start to feel better.

Depression: A Guide for the Newly Diagnosed serves its purpose. Mental health professionals would serve first-time clients with depression well by recommending this book. And it’s worth the read if you or someone you know has recently started experiencing depressive symptoms.

Depression: A Guide for the Newly Diagnosed
By Lee H. Coleman, PhD, ABPP
New Harbinger Publications: May 3, 2012
Paperback, 160 pages
$15.95

Family and friends might be unsure if recovery is possible. They question how they can help. Mental illness creates a feeling of helplessness for everyone involved. My and my family’s experience with chronic mental illness has allowed me to understand how important it is to have a support group. It can define the journey taken to recover from mental illness.

My diagnosis is rare. I was diagnosed with bipolar II disorder when I was 12. While my siblings were attending school and playing soccer on weekends, I was confined to a children’s psychiatric hospital. I remember wondering what was wrong with me. I remember my parents, wide-eyed, watching as my moods shifted by the hour, even the minute. We were all terrified. Mental illness is frightening at its core.

Unsure what to do, my parents brought me to doctors, psychiatrists, therapists and even nutritionists. The various doctors told them I had Attention Deficit Disorder; the psychiatrists told my parents they were parenting me badly. They were certain that explained my erratic behavior.

The therapist asked me to draw pictures that they thought would explain my moods. I refused to use any crayon that was not black, threw the toys that were carefully placed around the brightly lit room, and tore up the paper. I was unable to control myself. She dismissed me as being ‘overemotional’ and ‘narcissistic’ at the ripe age of 11. The nutritionist told me I was allergic to dairy products. My family, in a show of support, stopped eating anything containing dairy.

Fourteen years ago, professionals simply could not believe a child could have a serious mental illness−despite our family tree being defined by mental illness and suicide.

The years before my diagnosis were painful and affected our family dynamic immensely. My two siblings watched their older sister fall apart; they viewed their parents trying to catch me as I fell into blackness. My illness was quickly making my family ill.

It is impossible to capture my experience with mental illness in a few words, but I can tell you that without the support of my family, friends and a support team, I would not be writing these words. Twenty-six years old now, I feel I have some experience under my belt (so to speak) and would like to share different ways in which people can support a loved one struggling with mental illness.

Often, a newly diagnosed person is confused and angry. They may believe they do not need help. They might push away family and friends. As a person living with a chronic mental illness, I can tell you that isolation often results from fear. Mental illness carries stigma and it is frightening.

For example: I fall into a severe and crippling depression each winter. Each time it occurs I am, somehow, surprised. I quickly forget that my life is usually full of color and that waking up each morning often makes me smile. When I become ill I am certain I will never be well again.

If a family member or friend is unstable, the most important thing you can do is remind them that they will become well again. Without my family and friends to help me through each winter, to assure me that my life will become mine again, once spring arrives, I would certainly struggle more.

It is important to have a plan of action. Effective communication will be crucial if the person with mental illness shows signs of a relapse. A plan of action for such an event creates a feeling of security both for the person struggling and for those who love them.

An example: My family and I sat down with my psychiatrist−once it was clear my episodes were seasonal−and made a plan, in writing, that stated the steps that would be taken if I became ill. It was a difficult thing to do at the time. Seeing my diagnosis on paper made it real. But that paper provides a feeling of security for all of us.

The plan can include medication alterations, community outreach, and simple things like charting your mood and recognizing patterns. I believe this can be one of the most useful tools when working to help someone recover from a mental illness. It certainly is not a document that is placed on my fridge—it’s hidden away somewhere—but it has been instrumental in my recovery.

The health of those who support the mentally ill person often gets ignored. When I first became ill, my entire family suffered. My parents, while working full-time and taking care of my two siblings, spent years focused on my illness and recovery. In the process, they became unwell themselves. My mother slipped into a depression and my father worked to keep our family functioning. It was not easy.

Often, when a person must spend so much time focusing on someone they love, they forget to take care of themselves. It is impossible to help someone else if you become sick yourself. Ask yourself: “Do I need to step back?” Sometimes you do. My family has learned both to support me and support each other. It is in this way that we have been able to embrace recovery together.

In ECT, two electrodes are placed on a patient’s scalp, which deliver an electrical current that induces a short seizure in the brain. Researchers aren’t sure exactly how it lifts depression, but possible explanations include release of critical neurotransmitters and alterations in brain metabolism and excitability, according to W. Vaughn McCall, MD, MS, professor and chair of the Department of Psychiatry and Behavioral Medicine at Wake Forest University Health Sciences and editor-in-chief of The Journal of ECT.

ECT usually works quickly in most people who try it, which is especially critical for people with acute suicidal thoughts and behaviors.

Numerous studies have demonstrated ECT’s effectiveness, yet it’s still viewed as a murky treatment, often misunderstood and mired in controversy. Mention the letters “ECT,” and you’ll likely get a variety of negative reactions.

But today’s ECT is radically different from the unregulated treatment of the 1940s and ‘50s. Below, Dr. McCall shares five of the most common myths about ECT.

1. ECT is excruciating.

According to Dr. McCall, ECT is commonly misconstrued as “a painful, bone-breaking experience, associated with violent body movements.” But patients don’t feel anything during the procedure. Before ECT is performed, patients are given a muscle relaxant to prevent significant movement. They also receive general anesthesia so they’re asleep for the entire ECT session. Immediately following ECT, patients may be confused and disoriented and have a headache for a short period of time.

2. ECT damages the brain.

Studies that have used magnetic resonance imaging (MRI) to look at the brain haven’t found any evidence that ECT changes brain anatomy, McCall said. (1-3) Animal studies have found that ECT may even promote growth of brain cells. (This 2007 study found that the animal model of ECT encouraged cell growth in an area of the brain responsible for processing emotions.)

3. ECT makes people feel worse.

The research on ECT is extensive and demonstrates that ECT is safe and effective for severe depression. For instance, a 2008 meta-analysis found ECT was superior to sham ECT, placebo and antidepressants.

In McCall’s own research, about 80 percent of people who have ECT report improvements at six-month follow-up. “On the average, the 20 percent who do not respond or stay well after ECT have a quality of life that is unchanged from their pre-ECT condition,” he said. (4-6)

4. ECT erases memory.

“ECT has always been associated with some degree of memory loss,” according to McCall. But “Progressive improvement in technology has led to a progressive decrease in memory loss as a [significant] problem.” Most patients experience short-term memory loss. Some patients experience memory loss of events that happened weeks or months before ECT.

But it’s rare for people to have decades of memories wiped out, he said. More common are difficulties with short-term memory, and the ability to concentrate and pay attention after ECT treatment.

Still, some patients report extensive memory loss. When McCall consults with patients, he explains that while research hasn’t substantiated dramatic memory loss, a small number of individuals do claim considerable loss. It’s unclear how this occurs. Improperly administered ECT may be one reason. “The likelihood of significant memory loss is highly dependent upon ECT technique,” McCall said. (7-8) So it’s important to see a physician who specializes in ECT.

5. ECT is curative.

On the one hand, ECT is viewed as ruining people’s lives, but on the other, it’s seen as a cure-all for depression. But while ECT is effective, its benefits are short-lived, McCall said. In fact, one of the greatest challenges is identifying how to prolong ECT’s gains, he said.

“It’s rare for someone to be well in fewer than four sessions.” Often one course of ECT is around six to eight sessions. Some patients may be given 12 to 15 sessions, but beyond 15 is unusual, he said. While patients undergo treatment, it’s critical for the administering physician to continually assess their progress, he said.

Multiple courses also might be necessary. These additional courses might increase the risk for memory loss and other side effects. McCall treated a 92-year-old woman with late-onset depression who received 91 sessions in the last 22 years of her life. Before she passed away, she donated her brain for research. McCall and his colleagues examined her brain and found no microscopic changes that would suggest damage from ECT. (9)

The need for more ECT courses speaks less about the treatment’s success, McCall said, and more about depression’s high relapse rate.

“Overall, we have to remember that whatever warts ECT has, it’s a treatment for a serious illness,” he said. ECT isn’t indicated for mild depression, as McCall stressed; instead it’s used to treat a severe depression that destroys lives. Opposition to ECT may, in part, stem from people’s misunderstanding of acute depression, McCall said.

Severe depression is disabling and potentially deadly, he said. People become so despondent they can’t get out of bed let alone go about their day. They can lose their appetite and drop weight dramatically. Marriages fall apart. Older people lose their independence and are unable to take care of themselves. Others contemplate or try to commit suicide. For these individuals, ECT provides the necessary relief. For these individuals, the benefits outweigh the risks, McCall said.

Further Reading

1. Coffey CE, Weiner RD, Djang WT, et al. Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study. Arch Gen Psychiatry 1991;48: 1013-1021.

2. Devanand DP, Dwork AJ, Hutchinson ER, et al. Does ECT alter brain structure? Am J Psychiatry 1994;151: 957-970.

3. Wager T, Atlas L, Leotti L, et al. Predicting individual differences in placebo analgesia: contributions of brain activity during anticipation and pain experience. J Neurosci 2011;31: 439-452.

4. McCall WV, Rosenquist PB, Kimball J, et al. Health-related quality of life in a clinical trial of ECT followed by continuation pharmacotherapy: effects immediately after ECT and at 24 weeks. J ECT 2011;27: 97-102.

5. McCall WV, Reboussin BA, Cohen W, et al. Electroconvulsive therapy is associated with superior symptomatic and functional change in depressed patients after psychiatric hospitalization. J Affect Disord 2001;63: 17-25.

6. McCall WV, Prudic J, Olfson M, et al. Health-related quality of life following ECT in a large community sample. Journal of Affective Disorders 2006;90: 269-274.

7. Sackeim HA, Prudic J, Nobler MS, et al. Ultra-Brief Pulse ECT and the Affective and Cognitive Consequences of ECT. Journal of ECT 17:77, 2001.

8. Sackeim HA, Dillingham E, Prudic J, et al. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes. Archives of General Psychiatry 2009;66: 729-737.

9. Scalia J, Lisanby Dwork A, Johnson J, et al. Neuropathological examination after 91 ECT treatments in a 92 year old woman with late-onset depression. Journal of ECT 2007;23: 96-98.

Author’s note: This review of George Mason’s autobiography, Life of Death, is not a review of Mason’s life, but rather of his book. It is difficult to critique the book without appearing critical toward the subject or his life. The book is the lone subject toward which criticism is directed.

Life of Death is not a good book. The life contained therein is indeed an interesting and fascinating one, but the way in which the life is presented to the reader is unquestionably flawed, if not downright dreadful.

Mason’s book, subtitled “a lifetime of depression leads to happiness,” is riddled with typos, grammatical mistakes, blatant misuses of words, and just overall poor writing. Life of Death clearly had no editorial phase in its development. Yet that is exactly what the book so desperately needs, as, again, the content is solid. The content is actually in fact quite riveting. But the manner in which that content is presented—the writing and overall flow (or lack thereof)—is severely substandard.

It is difficult not to dwell on these shortcomings, as their presence never lets the reader get absorbed in the book. The reader can never give himself up to Mason and let the author take him on a ride. The writing is too rigid, too shoddy. The flow is nonexistent. The mistakes are without end. Yes, the book is a matter-of-fact overview of one man’s troubled life, and yes, the book is under 35 pages, but neither of these facts should preclude the work from being enjoyable or even readable.

All that said, Mason certainly has lived an interesting life. He is a recovering alcoholic and drug addict. He spent several years in a mental institution. He was bullied as a child. He was continually under the spells of depression and anxiety. And as Mason writes, he had a “conscious desire to want to die.”

It is clear that Mason has endured tough circumstances, and the fact that he never ultimately gave up is commendable. What is so curious, however, is how Mason claims he was able to overcome his demons: God. Mason does not mention religion or God in any context until the final pages, in which he declares: “I realize I am powerless over my entire life and that following Jesus Christ provides me the solution to my problem. Believing in God is a huge decision on my part. My entire life I have been an atheist/agnostic and thought that those who believed were nuts. Now I believe that I have been mistaken.”

While disputing the existence of God or the extent to which religion benefits Mason’s life are not the goals of this review, it must be noted that their roles in the book are horrifyingly glossed over.

Religion obviously plays a substantial role in Mason’s life. Yet he only devotes a handful of sentences to it. Mason ends the book by writing, “I hope that reading this has helped you even in a small way.” But how could it? Mason simply provides a laconic overview of his life written in a detached, unaffected, almost alien manner. His inclusion of his newly found religious faith thus comes off as just another event in a life. It does not seem to provide any significance.

This is not say that it doesn’t; it certainly does, or else Mason would not have said so. But Mason never actually explains anything. He instead talks at the reader. He never takes the reader beneath the surface of his words and shows him the pain in his life. He merely states it.

Furthermore, and to the point previously made about religion, Mason never explains what religion does for him. All he has to say on the subject is, “I have given my life over to God and I realize I am powerless.” But how did he come to this realization? What affirmed it? Why was he not religious earlier in life? What were his previous experiences with religion? How does actually surrendering himself to God allow him to stay away from drugs and alcohol? If the aim is to write a book that in some way helps the reader, then there must be some semblance of an explanation. Mason, however, does not provide one.

When describing his faith, Mason writes:

Luckily for me I started believing in a higher power, God and Jesus Christ, before I knew I was an alcoholic. As a matter of interest the two times I had an acute pancreatic attack was when I was praying. This I take as a significant correlation.

Why, though? Why does Mason defend these events as matters of divine intervention instead of mere coincidence? What makes him so sure? These questions are not meant to dispute Mason’s beliefs, but rather to dig for answers. For if there are no answers, all that is left is a man admonishing his readers to believe in God without providing even the smallest shred of justification or explanation.

It’s fine to believe in God, but one typically has a reason. It would be fair to posit that Mason does, but it would have been more beneficial had he included it.

As might be suspected, Life of Death cannot be recommended. It is unsatisfactory in all areas, including what is stated as most important to the author: helping the reader. This is not an indictment of Mason or his life; it is instead an expression of disappointment in the book.

Life of Death
By George Mason
CreateSpace: January 4, 2012
Paperback, 32 pages
$5.40

Enter Dr. Jane Baxter and her book, Manage Your Depression Through Exercise.  With her career in psychotherapy and as a personal trainer, Dr. Baxter tackles depression head-on, incorporating the physical, mental and spiritual aspects of living a healthy lifestyle.  She provides a five-week workout plan in order to cement an exercise routine.

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 5 to 15 minutes a day.  She even lays out the exercises with pictures included.  Each week the exercises progress in intensity.  Dr. Baxter also includes exercises other than the ones that she specifically refers to in her book.

What exercise book would be complete without the section on nutrition?  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. 

In regard to nutrition, balance is key.  Balancing proteins and carbohydrates will help keep energy levels maintained, rather than riding a roller coaster ride 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 her reader to look at the role that food plays in his or her life.  Do you eat when you are bored?  Sad?  Lonely?  Stressed?  How do you feel after you eat?  Gross?  Unhappy?  Delirious?  At this point in her book, 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 the 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 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 the reader 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 to have on hand 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
Jane Baxter, PhD
Sunrise River Press: August 15, 2011
Paperback, 192 pages
$14.95

It is a very easy book to read and has many helpful tips to follow.  It contains seven chapters, in addition to the introduction, which starts with a neat description of the symptoms from the point of view of the person experiencing the disorder.  This makes it very easy to understand and makes the readers feel comfortable.

Chapter One deals with the basics and explains depression and mania, using easy-to-read, informative case vignettes. Perhaps the weakness was the overly-inclusive definition of moods which, like all vague, all-encompassing definitions, end up defining very little. However, this chapter also includes a checklist for the reader to use to help them recognize the symptoms of mania and depression.

Chapter Two focuses on how to get help and what young people can expect from professionals. I liked the fact that the authors offered examples of useful questions to ask of various professionals, as well as the type of questions young people likely will be asked by those same professionals. There also was a helpful description of medications and their side effects.

Chapter Three is crucial. The authors dedicated a whole chapter to the issue of accepting the illness. This has a decisive initial role in commitment to therapy. They illustrated this with Ashley’s moving story and her fears of revealing her diagnosis to the wider world, and her all-too-well-known pattern of discontinuing medication. It helps the reader to understand bipolar’s effects on their lives, and how to live with the diagnosis.

Chapter Four is about tools. “You don’t have to be a passive passenger being swept down the bipolar river” is one of the evocative sentences the authors used to introduce the key elements of successful recovery: creating a structured life; managing stress; getting good sleep; and learning to self-monitor.

Chapter Five addresses whether to tell others about the illness. It stipulates that total secrecy is probably not good at all, while exercising some discretion about confidants also is a good measure. The issue of a “helping team” is emphasized. It consists of a close circle of family, friends and trustworthy coworkers.

Chapter Six demonstrates that the book has been written for young people. “Managing Your Independence” focuses on academic overcommitment in college, dealing with ample opportunities for experimenting with drugs, alcohol and excessive partying, and the issues of psychiatric and psychological continuity.

Chapter Seven, “Looking Forward,” addresses the painful reality that sometimes long-term academic and professional goals might not be achieved. The reality of bipolar disorder sometimes forces young people to rethink important life plans. Finding the fine line between being too fatalistic and overly optimistic appears to be a challenge. Focusing on the individual’s strengths rather than weaknesses, the authors propose, will help in finding the optimal middle ground.  And even if things don’t go well, ‘picking yourself up’ appears to be a skill required to enjoy quality of life if you have bipolar disorder.

Overall, this is a good book and would be helpful for young adults diagnosed with bipolar disorder.  The vignettes are among the highlights. They are clear, relevant, and at times very moving. This will maximize the possibility of getting through to young people; frequently they relate much more effectively when the emphasis is on experiences.

Fortunately, academic accuracy has not been sacrificed in the name of accessibility. Important findings in the expert literature also are covered.

Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder
By Russ Federman, PhD and J. Anderson Thomson, MD
New Harbinger: February 2, 2010
Paperback, 176 pages
$16.95

Dysthymia — also known as dysthymic disorder — is typically described as a mild depression. But the data show a different story: Dysthymia is often a serious and severe disorder, said David J. Hellerstein, M.D., professor of clinical psychiatry at Columbia University and a research psychiatrist at New York State Psychiatric Institute. Experts refer to dysthymia as a paradoxical condition because it appears mild day to day but becomes brutal long-term, he said.

Epidemiological studies reveal that dysthymia frequently has a devastating impact on people’s lives. Individuals with dysthymia are more likely to receive government assistance, have high healthcare costs and have elevated rates of unemployment. If they do work, they typically work part-time or report under-achieving because of emotional problems. They also tend to be single because depression can make relationships more challenging.

People with dysthymia also are at increased risk for more severe episodes of depression. In fact, as many as 80 to 90 percent will get major depression, according to Dr. Hellerstein, who’s also author of the book Heal Your Brain: How the New Neuropsychiatry Can Help You Go from Better to Well. “It’s like if you have asthma, you are more likely to get bronchitis and pneumonia because you have this baseline condition all the time,” he said.

There’s evidence that dysthymia boosts the risk for suicidal behavior. One seven-year study found that the rates of suicidal behavior in dysthymia were similar to the rates in major depression.

Comorbidity with anxiety disorders also is common. And dysthymia tends to co-occur with alcohol problems and attention deficit hyperactivity disorder, Hellerstein said.

Dysthymia still largely goes undiagnosed and untreated. As many as three percent of Americans struggle with dysthymia, while less than half ever seek treatment. Part of the problem is that many people mistake the symptoms for their personality, Hellerstein said. They may assume that they’re just pessimistic or self-conscious or moody. After struggling for so many years, people come to view the fog of depression as their normal functioning. If people do seek treatment, it’s usually for other concerns, such as vague physical aliments or relationship problems, he said. As a result, these individuals rarely get evaluated for a mood disorder.

Dysthymia Treatment

There’s a common myth that a look on the bright side cures depression. That if you think positively enough, you’ll simply snap out of it. But individuals can’t snap out of depression any more than they can will themselves out of chronic asthma.

Another misconception is that dysthymia doesn’t require treatment. Lifestyle changes, exercise, and social support are usually enough to improve short-term mild depression, Hellerstein said. But this doesn’t work for dysthymia. Most people with dysthymia have typically tried modifying their lifestyle; yet their depression doesn’t disappear, he said.

Fortunately, people greatly improve with treatment. Unfortunately, the data on dysthymia are still limited, Hellerstein said. Only about 20 pharmacological studies have compared medication to placebo. Most studies show that antidepressants are effective in minimizing symptoms. The response to placebo tends to be low — lower than in major depression research — which speaks to the stubbornness of the condition, Hellerstein said.

As with major depression, the first line of pharmacological treatment is selective serotonin reuptake inhibitors or SSRIs. Wellbutrin and serotonin-norepinephrine reuptake inhibitors (SNRIs) also show improvements. Other classes of antidepressants such as tricyclics and MAO inhibitors also work, but have more side effects. The deciding factor is usually tolerability, Hellerstein said.

He recommends dysthymia patients take medication for two years and taper off very gradually (with monitoring from a psychiatrist). Once depressive symptoms have responded to treatment, there is an opportunity to make lifestyle changes, whether that means looking for a good job, finishing a degree, starting a romantic relationship or establishing healthy routines, Hellerstein said.

If individuals are hesitant to take medication, Hellerstein suggested trying psychotherapy first. But if there’s little improvement after several months, medication might be necessary.

The literature on psychotherapy also is scant. Still, it appears that cognitive-behavioral therapy, interpersonal therapy and behavior activation therapy are helpful for treating dysthymia. These therapies work on challenging maladaptive thoughts and adopting healthier behaviors.

People with chronic depression frequently develop avoidance behaviors, such as procrastinating and ruminating, which only perpetuate symptoms and stress, Hellerstein said. The above therapies help patients take an active approach for solving their problems and achieving their goals, he said. Patients not only feel better but also have the psychological tools to improve their lives and cope effectively with stress.

If you think you might have dysthymia, it’s important to get an accurate assessment, he said. Teaching hospitals or facilities affiliated with a medical school are the best places to find practitioners, because they tend to be especially up-to-date on the latest research.

As Hellerstein underscored, dysthymia is not a hopeless condition. “[With treatment] I see a lot of people who go through an accelerated process of psychological development,” he said. They’re able to return to work, pursue their education, enjoy healthy relationships and lead fulfilling lives.

It is estimated that about 10 to 15 percent of children/teens are depressed at any given time. Research indicates that one of every four adolescents will have an episode of major depression during high school with the average age of onset being 14 years!

These episodes typically last several months when untreated. While this indicates the main problem is likely to abate without treatment, these teens are at much higher risk for suicide which is a leading cause of death during adolescence. In addition, during an untreated episode of major depression, teens are more likely to get into serious substance abuse addictions or suffer significant rates of dropping out of their typical activities and social groups. Thus, even if the depressive episode wanes, significant problems may continue on.

The milder form of depression, called dysthymia, is more difficult to diagnose, especially in elementary school children. Yet this form of depression actually lasts much longer. Typical episodes last seven years and often longer. Many depressed adults can trace their sad, discouraged, or self-dislike feelings back to childhood or adolescence.

With children, although typical adult features may be present, they are more likely to show symptoms of somatic complaints, withdrawal, antisocial behavior, clinging behaviors, nightmares, and boredom. Yes, many of these are common for non-depressed children. But usually they are transient, lasting about four to six weeks. You should become concerned when the symptoms last for at least two months, don’t respond to reasonable parental interventions, and seem to pervade the child’s life rather than be confined to just one aspect.

I have referred to major depression and dysthymia as two primary forms of depression. Very briefly, there are a number of symptoms common to both but with a greater severity in the former. In adults, depressed mood, loss of interest or pleasure in activities, loss of appetite or overeating, sleeping a lot or not being able to sleep, loss of energy, loss of self-esteem, indecisiveness, hopelessness, problems with concentration, and suicidal thoughts or attempts are the signs of depression. People rarely have all of them.

We usually look for at least four or more and, again, severity and longevity are important determinants when making a diagnosis. Teens will exhibit more adult-like symptoms but severe withdrawal is especially significant.

In childhood, boys actually may have a higher rate of depression than girls but it is often missed because many of the depressed boys act out and the underlying depression is missed. In adolescence, girls begin the same predominance as women, about two to three times the rate of males. Contrary to popular belief, research rejects the notion that it is related to hormonal changes associated with adolescence. Instead, just as with adult women, sexual harassment and experiences of discrimination appear to be more significant causes.

Primary causes of depression in children are parental conflict (with or without divorce), maternal depression (mothers interact much more with their children), poor social skills, and pessimistic attitudes. Divorced parents who are still fighting have the highest rate of depressed children (about 18 percent).

Regarding depression in mothers, it is the symptoms of irritability, criticism, and expressed pessimism that are especially significant. Also, the environmental factors contributing to the mother’s depression (marital or financial problems) also may impact directly on the children. Depressed children are more likely to have poor social skills, fewer friends, and give up easily (which also contributes to poor school performance and lack of success in activities). You must differentiate, however, from the shy, loner child who is actually content to spend more time alone.

What to do? When concerned, talk with teachers and pediatricians. (However, both of these front-line professional groups need more training in diagnosing depression.) If there seems to be a valid concern, then seek help from mental health professionals who specialize in working with children. (Parents: above all, follow your instincts because there is a tendency to underdiagnose problems in younger children.)

If marital conflict is present, then seek couples therapy (if divorced, seek help for cooperative parenting). If one or both parents are depressed, then individual therapy may be needed for each. Children’s therapy groups are particularly effective for those with social skills deficits. Family therapy is also very effective, particularly with older children or teens.

Depression does run in families and may have a biological basis. Antidepressants are especially important in these cases and may also be important even if the causes are primarily psychological because they help the child (or adult) attain the level of functioning needed to benefit from other interventions. Since children and teens are less certain to respond positively to medications for depression than adults, it is especially important to use child psychiatrists who specialize in psychopharmacology.

LaPoint herself has a history of depression. She grew up in a family in which the disorder was commonplace, and in her adult life she was forced to endure domestic and sexual violence. With this in mind, it is no wonder LaPoint saw this void in the world of children’s literature.

Depression does not befall only certain types of families. It does not discriminate. LaPoint’s story therefore is capable of speaking to any race, gender, creed or sexual orientation. Coupled with Crystal Eldridge’s beautiful illustrations, When My Mommy Cries is a powerful tale that cuts to the reader’s heart.

Perhaps the most brilliant part about When My Mommy Cries is that its only two characters are nameless. In this way, we are not at all distracted from the central message by attributing our own prejudices to the characters. They are archetypes, and they are meant to be. By virtue of this decision, the story, again, becomes eminently relatable.

The story is told in first person, and it opens with the daughter coming home from school to find her mother in her bathrobe, crying on the sofa. “Her hair was crumpled like her face, / and she seemed so far away.” When the daughter tries to help her mother, she is virtually ignored, as her mother tries to hide the pain in her eyes. Again, the tale is worth quoting: “Yet in the awkward silence… / I saw them just the same.”

The next few pages feature the daughter informing us how her mother’s love is unwavering; she loves her daughter no matter what the situation.

Then one night the daughter hears her mother crying from her bedroom. Afraid to go inside, she finally musters up the courage to witness the sight. When she lays eyes on her mother, she is begged to come over for a hug. At this point, her mother reassures her of her undying love: “‘My baby, please don’t be afraid. / I am always, always here. / Sometimes I just get really sad. / There’s no reason — it’s never you’” (Italics in text).

The most poignant page of the book features a gorgeous illustration of both characters crying while holding each another. “And as we sat there, I can’t say / just who was rocking who.”

Following this catharsis, the mother is now open with her daughter about her depression. But that doesn’t mean the daughter can always help. Clearly, it is hard on her, even at this point, when her mother is sad. “…it’s lonely when I can’t [help].”

The story ends on a tender note, as the daughter affirms to us her newfound perspective: “I love her on the good days / when our world feels safe and true, / just the same as on our saddest days. / And she always loves me, too” (Italics in text).

When My Mommy Cries without question achieves its goal of, in LaPoint’s words, helping “families cope with sadness.” It is interesting to note that LaPoint deliberately presents us with a single mother. There is no mention of any father figure, and the daughter appears to be an only child. Seeing as children’s literature is concerned with brevity, it makes sense that LaPoint does not complicate the story with secondary characters. This is commendable, as their inclusion would only detract from the story’s core message: people—in this case, mothers—get depressed, and it is not a reflection on their children.

From some of the illustrations, it appears that the daughter is around 6 or 7 years old. If this is the case, again, LaPoint should be commended for her thoughtfulness. Sure, we can read this story to our 4-year-olds, but it is doubtful they will comprehend the underlying message, no matter how explicit it appears to us. A 6- or 7-year-old, however, is at the age where signs of empathy start to emerge. Their self-awareness has blossomed enough that they can actually display physical acts of compassion. They can see and feel the pain in others. In this way, When My Mommy Cries is both accurate and realistic in its portrayal.

The book also comes with an accompanying CD, which features a teaching guide as well as a musical number composed by LaPoint herself.

When My Mommy Cries is semi-autobiographical. And it shows. The tone and style of the writing drip with love and care. Moreover, Eldridge’s illustrations are a perfect companion for LaPoint’s heartwarming tale. As the author remarks: “May [this book] help all who read it find deeper empathy for others, gentler patience with themselves, and greater wisdom for facing life’s struggles with the children they love.” LaPoint can rest assured it does.

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