Fortunately, key strategies can reduce and improve these symptoms. “The most important strategy is definitive treatment for the depression with psychotherapy and medication,” said William Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery.

For instance, psychotherapy helps individuals become more aware of their cognitive symptoms, which can be subtle, Dr. Marchand said. It also teaches individuals specific techniques to improve their symptoms. And it helps clients gain a more accurate perspective on their illness.

“Because of the negative thinking associated with depression, there is a tendency to interpret symptoms as personal failings rather than as symptoms of an illness. A therapist can help one see things as they are – rather than through the distorting lens of depression,” Marchand said.

In addition to professional treatment, there are many strategies you can practice on your own to improve cognitive symptoms. Below are several techniques you can try.

Revise Distorted Thoughts

“I think it’s vital to teach any depressed individual how to ‘think happy,’” Serani said. Revising problematic thought patterns is key because they only fuel the fog and despair of depression.

“This approach definitely takes some time, patience and elbow grease, but once [it’s] learned, [it] enhances well-being.”

The first step is to monitor your negative thoughts, which you can record in a journal. A negative thought is anything such as “I’m a total loser” or “I can’t do anything right,” she said.

It’s also important to focus on how a negative thought affects your mood. By and large, it derails it. “Generally, [negative thoughts] will worsen mood, decrease hope and lower self-esteem.”

Next, challenge the reality of your thought, and replace it with a healthier one. Serani gave the following example: “Am I really a loser? Do I really do everything wrong? Actually, I get a lot of things right in life. So I’m not really a loser.”

Finally, review how each realistic thought affects your mood. According to Serani, it “leads to a healthier frame of mind. Now this new, healthy thought replaces the negative one and shifts mood into a less depressive place.”

Use Your Senses

“For helping with executive functioning skills for memory, focus and decision-making, I always recommend using your sense of sight, hearing and touch,” Serani said.

Technology can be especially helpful. For instance, you can set reminders for taking medication, attending therapy and running errands on your smart phone, computer or tablet.

If you don’t have access to technology or prefer pen and paper, Serani suggested placing brightly colored notes with reminders around your home and office. “Using touch to write will track the task more deeply into your memory and the visual cue to ‘see’ the reminder will help you keep your focus.”

Your sense of touch also can help when making a decision, said Serani, who uses this technique herself, “especially if I’m struggling with a significant melancholic mood.” She suggested a grounding practice, which “helps you be in the moment”: Place your hand on your heart, take a deep, slow breath and ask yourself the question you need to know. “Slowing things down and focusing on your sense of self can better help you make decisions.”

Take Small Steps

“Depression has a way of taxing you physical[ly], emotional[ly] and intellectual[ly], so taking smaller steps will help keep your energy reserve from burning out,” Serani said. Break down longer, more complicated tasks into bite-sized steps. This helps you “rest, refuel and re-attend [to your task].”

Have A Cushion

Therese Borchard, a mental health blogger and author of the book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes, also struggles with cognitive symptoms from time to time. Whenever possible, she reduces her workload. “I’ve always prepared for days like that by working a little harder on the days I feel good, so I have a little cushion.”

Take Breaks

Because depression is so taxing on your brain and body, taking breaks can help. When she’s working, Borchard takes breaks every two hours, or “every hour if I’m really struggling.” Your breaks might include stretching your body or taking a walk around the block.

Be Kind To Yourself

“One of the most important things to do is remember not to be too hard on yourself if you still find you’re forgetful, have trouble focusing or making decisions,” Serani said. “Remember that you are experiencing a real illness.” Blaming yourself and losing patience only adds “to your already full plate.”

As Borchard noted in this piece on working from home with a mental illness, “When I was in the midst of my most severe depression, I couldn’t write at all. For almost a year…I try to remember that when I have a bad day where my brain feels like silly putty and I am not able to string two words together. I try to remember that courage isn’t doing a heroic thing, but getting up day after day and trying again.”

Yet cognitive symptoms are quite common. “[They] are actually significantly prominent in depression,” said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression.

And these symptoms are incredibly debilitating. “In my opinion, when cognitive symptoms of depression hit, they are more of a pressing concern than physical symptoms.”

Cognitive symptoms can interfere with all areas of a person’s life, including work, school and their relationships. Problem-solving and higher thinking, according to Serani, are greatly diminished. “This can leave a person feeling helpless and without a plan of action to defeat depression.”

Poor concentration can cause problems with communication, and indecisiveness may strain relationships, according to William Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery.

The cognitive symptoms of depression also may get confused with other conditions, complicating diagnosis. Here’s a specific list of symptoms along with similar disorders.

Cognitive Symptoms of Depression

“Cognitive symptoms can be subtle and often go unrecognized,” according to Dr. Marchand. Fortunately, psychotherapy can help individuals become more aware of these symptoms, such as distorted thinking, he said.

Marchand and Serani shared these cognitive symptoms of depression:

• Negative or distorted thinking
• Difficulty concentrating
• Distractibility
• Forgetfulness
• Reduced reaction time
• Memory loss
• Indecisiveness

Disorders That Mimic Depression

“The cognitive aspects of depression usually involve a person’s thinking being sluggish, negative or distorted in quality,” Serani said. However, there are many other disorders that share these similar symptoms, because they, too, inhibit cognitive function. Unfortunately, this means that the “risk for misdiagnosis is high,” she said.

For instance, Serani mentioned attention deficit hyperactivity disorder (the inattentive type), post-traumatic stress disorder and substance abuse.

Co-occurring disorders can add to the confusion. “In many cases there are comorbid conditions such as dementia (in elderly individuals), adult ADHD and generalized anxiety disorder, and it can be difficult to sort out which condition is causing the cognitive symptoms,” Marchand said.

It’s critical to receive a proper and comprehensive evaluation to make sure that you have depression or another condition. Again, psychotherapy and medication can improve cognitive symptoms along with other symptoms of depression. Also, there are many strategies you can try on your own to reduce symptoms and feel better (which are explored in another article).

Have you ever gone to an online news source to suddenly, surprisingly encounter a gut-wrenching headline or photo? Did it make you feel sucker-punched in the stomach?

Now, don’t get me wrong: I think as citizens we have an obligation to know about certain events that may be tragic, hurtful, sad, distressful or disturbing. I’m not saying that horrible events shouldn’t be reported. However, as a psychologist, I would argue that as a society we should have somewhat ‘safe spaces’ in which we can receive news without the proverbial punch in the stomach, if we know, at least in that moment, that we just simply can’t handle it.

As a psychologist, I work with veterans, many with PTSD. Sometimes, they, like many of us, log onto online content to feel more socially connected. Like a self-therapeutic gesture, we do this to sometimes feel more soothed, or distracted from dark or lonely feelings as we delve into novel online content.

Typically, when looking for that sense of connection, or delight, or enrichment, one may turn to news of recent politics, world news, sports scores, entertainment news, comedy sites, book reviews, health & science news, pictures of natural wonders, and so on. However, for many seeking engagement with the news in such a way, they may instead find that their initial encounter will be overshadowed by abrupt headlines detailing deaths, deaths of children, or tortured children on the front page of a particular news site. Even if one is Internet-savvy enough to skip to the front page of these news sites and go straight to their section of interest, horrific headlines and pictures of death and torture will await them on the sidebars. These are non-sequiturs popping up on the same page as articles devoted to meditation, real estate, sports, comedy, and parenting.

Not being able to control encounters with this type of devastating news can be psychologically problematic. It’s not just a problem with combat veterans, or those with PTSD. In fact, I repeatedly hear about this problem from people from many walks of life. Combat veterans and parents of young children are particularly vocal about it. I believe this phenomena causes something that I’ve coined as “news blues.” News blues causes distress when one is not expecting it or prepared for it. It often causes the reader to disengage in that moment from reading the news altogether.

As an avid online news reader, I too have personally felt the news blues. There has been the sting of an unexpected photo, the headline of atrocities to children when I am expecting to read something more benign at night, such as sustainable architecture awards.

Yes, I listen to horrible stories of atrocities for a living. I am able to listen fully, in the right context. For me, there is a large difference between learning about tragedy and atrocities when one feels empowered to help in some way, as a psychologist helps a patient, and then reading about it passively from a new source, with no way to help. The other piece of this is the element of surprise. It is easier to cope with news of such events when it is expected. This allows people to then prepare for such news and work to be emotionally ready for it.

We are rapidly losing control over when and how we are exposed to devastatingly detailed headlines and their accompanying graphic photos.

Some news sites are better able to provide content of all types without the surprise gut-wrenching punch from the headline itself. Although they don’t have a perfect track record, the New York Times often is able to report on crimes important to the nation and world without giving the reader panic attacks or news blues from the headline.

In contrast, the Huffington Post and the Daily Beast -– ironically, two of my favorite news aggregator sites — do so less well. Recently, both sites had headlines on their front page announcing the murder of children in Afghanistan, accompanied by an actual photo of the corpses of these dead children. There was no warning label obscuring the view. There was no “click here” for those who were willing to see. In other words, the visitor on the front page/home page of these sites had no choice but to see this.

What can happen from not being able to control what one sees? For those adults with anxiety and mood disorders, this can set off a whole slew of anxious and harmful sequelae. For those adults without mental health issues, I contend that this can cause news blues. A common emotional response is difficulty in processing the surprise graphic encounter with a horrible atrocity and tragic image, followed by a decision to shut off the news site all together, and ending, at least for the time being, seeking out news.

My concern, apart from the emotional health of readers, is that news blues has the potential to contribute to a civic crisis. When adults stop reading the news, our responsibility as a populace to be informed is eroded. Everyone may not be experiencing news blues. Yet, many report they are becoming desensitized, and this is also problematic. We need to be informed and maintain compassion for other humans.

The social norms of what can be shared in the U.S media have shifted. Where are the honest-but-gently-worded headlines that beckon readers to read more about an important tragedy within the content of the article, instead of disclosing the most disturbing aspects within the headline? Where are the online hyperlinks that can protectively place graphic and upsetting photos behind further ‘clicks’ for the intrepid, willing, and prepared adult readers? Where are the warnings that inform and caution the reader that “some of the following photos may contain graphic content” ?

If, while reading online, we want to know what the “7 Foods We Shouldn’t Live Without Are” or where the “Happiest Cities in the World” are, we have to get there by a dozen clicks and endure slow-loading slide shows. Yes, I know that’s how these sites gauge our engagement which they then use to earn money from advertisers. But why hide this benign information behind a multitude of clicks and slow-loads and then put images of the corpses of dead children openly on the front page and openly on the side-bars of every news page?

“Will you come with me to the next meeting?” Another parent has called. “Whenever I get in one of those meetings, I get overwhelmed. I get so upset by what the teacher and principal are saying that I end up not saying all I want to say. I don’t think they really do it on purpose but it seems I can’t get a word in.”

“I’ve got to get my son to a residential program. We just can’t handle his behaviors anymore. The school says it’s not their problem. Their problem is only providing an education. But my wife and I need relief. We want the school to help us find a place where his mental health issues can be managed and his behaviors can be controlled so he can actually learn something.” This dad was at the end of the proverbial rope.

Maybe one of these conversations — or a part of one — sounds familiar. Your child is having difficulty in school. Perhaps he has been diagnosed with ADHD or a learning disability. Maybe she has autism, a developmental disability or a significant behavior problem. You know your child is entitled to additional support but the school doesn’t respond as you had hoped to your requests for services. With every passing month, you know that opportunities to ameliorate the situation are being lost and the behavior may be growing worse or more entrenched. You are frustrated, upset for your child and just upset. What can you do?

While trying to manage a challenging or troubled child, we parents are somehow also expected to know how to navigate the complicated legal and social systems that could provide help. The school is often our first point of entry to getting the extra supports our child needs. But it isn’t easy. Often it’s contentious. We’re rank beginners while the school personnel have knowledge and experience from working with other families. Even when everyone is well-intended, it can feel like a conflicted situation from the start.

Tips for becoming a successful advocate:

• A little understanding goes a long way. Like everyplace else, schools are straining to stay within budgets and to stretch their money the best they can. Yes, we all understand that. But when it’s our own child who is suffering or whose learning is falling behind, it’s hard to stay compassionate. One parent I know was told by a distressed special education director, “If we send your child to a residential school, it means that we may have to let go of a kindergarten teacher next year.” It wasn’t legal or helpful for her to say it. But that doesn’t mean that it wasn’t the truth. Kids with big needs cost the community big bucks. Services for one child can mean that 20 other kids are in an overcrowded classroom. We do have to advocate well for our children, but it helps us be more collaborative when we can also appreciate the position it puts school officials in.
• Get support for yourself. Joining a parent support group or talking with other parents who have kids with special needs can be both a relief and a help. Some of those parents are way ahead of you in the process. They know the ropes. They can provide you with important factual information and they can give you emotional support when you need it. Many communities also have volunteer and professional advocates who can explain the law to you and go with you to meetings to make sure you get heard and that the school responds as it should. If it’s a paid service, consider whether some money spent now can prevent higher-cost legal help later.
• Know your child’s rights. It’s very important to be conversant with your state’s education laws and the policies of the local school system. That way you won’t waste people’s time by asking for things that you aren’t entitled to. You will be taken more seriously by administrators if you have taken the time to learn and understand what you have to work with.
• Always prepare for meetings. Take along a list of talking points and questions. Your time is valuable. So is the time of the people convened to meet with you. You want to use the time you have as best as you can.
• Always take your partner or a friend with you to meetings. Often there are six or more professionals arrayed around the table. It can be daunting. It’s very difficult to take in everything that is said in a meeting when you are emotionally invested. When you have an ally with you, it’s easier to stay focused and to make sure you cover everything you want to cover.
• Leave younger children at home. Small children aren’t always cooperative when parents need to be focused. If you can’t afford a sitter, ask a neighbor or relative for a child care swap. If you really, truly can’t find someone to take care of your younger child, make sure you bring a snack and something to keep the child busy while you talk.
• Work with the school personnel, not against them. That means being open-minded as they try to find ways to meet both your child’s needs and the needs of the other children they serve. Sometimes there are creative, less expensive ways to provide support beside adding staff or sending a child to an out-of-school placement. Interns from local colleges, some parent participation, or in-home support are options that should at least be explored. There is usually more than one way to help a child be successful.
• Keep your cool. It is never helpful to approach with anger and threats people who have something we need. It only makes the other person defensive and resistant. Keep your sense of humor. If you find yourself reaching the boiling point, end the phone call or meeting before you say something you’ll regret or that may backfire on your child. You don’t want to have school personnel running for cover when you want to talk to them. You want their willing participation in solving your child’s problem.
• When following up, don’t wear out your welcome. Yes, you do need to have regular contact about how your child is doing and whether supports are in place. But if you attempt to micro-manage, school personnel are going to become “deaf” to your requests. Keep calls to a minimum. Always have a clear idea of what you want to accomplish before you call or ask for a meeting. School staff are legitimately busy with often a dozen or more other parents who have equally compelling needs.

Some individuals experience a decline in mood with a sense of loss, he said. Others experience a loss of interest or pleasure in activities they previously enjoyed. Still others experience “an increased irritability, impatience or lower tolerance for the normal stresses of daily life.”

Chronic pain also creates many stressors, which can lead to depression, said Beverly Thorn, Ph.D, Clinical Health Psychology Professor and Chair at The University of Alabama whose research focuses on painful conditions. Chronic pain interferes with a person’s daily functioning. It lasts at least three months, more days than not, she said.

“People might be unable to work or work the way they used to.” Consequently, they might have financial problems, and a new role in their family. Patients have told Thorn that not being the main provider has made them feel worthless or like they’re not contributing to their family unit.

Treating Both Conditions

It’s important to treat both chronic pain and depression, Kerns said. “Many people with pain and depression say things like ‘If you had my pain you’d be depressed, too,’ or ‘If you would treat my pain, I wouldn’t be depressed.’ However, reducing pain doesn’t necessarily reduce symptoms of depression, he said.

That’s why Kerns suggested people work with providers who treat each condition (instead of an either-or approach). Some studies suggest that a collaborative and integrative approach is best. This study published in the Journal of the American Medical Association found that a course of antidepressants followed by a pain self-management program improved both depression and pain.

If you haven’t yet, consult a pain specialist for a treatment plan, along with a mental health specialist for a proper evaluation and treatment for depression, Kerns said. It’s also important to communicate regularly with your providers and pay attention to changes, Thorn added.

When to Proceed with Caution

One of the biggest challenges of treating both pain and depression is that feelings of helplessness and hopelessness lead people to try cures that are ineffective and even damaging, according to Kerns. “Continued doctor-shopping is problematic.”

Also problematic is pursuing more and more aggressive pain interventions, which he said only reinforce the “sense of helplessness and hopelessness and demoralization.”

Opioid medication is another concern. According to Kerns, there’s very little evidence that opioids are helpful for chronic pain. Instead, there’s “abundant evidence of the potential harm of long-term opioid therapy.”

For people with pain and depression, “who may be vulnerable to pursue these kinds of interventions,” it’s best to be cautious. Most experts “argue for very limited use of pharmacological agents and support education, encouragement and judicious use of non-opioid, over-the-counter [medication],” along with a healthy lifestyle and self-management techniques, he said.

How Psychotherapy Helps

Experts used to think that the amount of pain a person felt was equal to the amount of damage in their body, Thorn said. Today, however, we know that our thoughts and emotions can influence the perception of pain, making it much worse or less intense, she said. Psychotherapies, such as cognitive-behavioral therapy (CBT), harness this concept “by re-teaching your brain.”

Research has found that CBT is highly effective for managing both pain and depression. (“Some of the strongest evidence supports CBT,” Kerns said. But he also noted that other therapies such as behavioral activation and Acceptance and Commitment Therapy show promise.)

For instance, CBT teaches individuals to pay attention to their thought processes, which can maximize or minimize pain. Thoughts like “This pain has ruined my life, and there’s nothing left to be done,” negatively affect your emotions and behaviors, said Thorn, author of Cognitive Therapy for Chronic Pain: A Step-by-Step Guide. They also make you more likely to get depressed and withdraw. Plus, “If you feel like there’s nothing you can do, you won’t do anything,” which is “really dangerous for someone with chronic pain.”

For instance, one of Thorn’s clients, who has lower back pain, kept saying that his spine was disintegrating because his MRI showed some damage. Thorn asked him how this thought was affecting his emotions and behavior. “It makes me panic, and I’m afraid to do anything.” This thought also spiked his blood pressure, breathing and heart rate. Thorn suggested he find another perspective that’s more realistic and less of an emotional noose. He came up with the following thought: “There’s still some damage to my spine, but no amount of surgeries will help that damage. [However] it is the kind of damage that would be helped with muscle strengthening.”

Today, Thorn’s client plans to work with a physical therapist to strengthen his muscles. “As soon as someone has an empowering thought, they start to feel like they have a little bit more control over their life,” Thorn said. “His spine is damaged. He’s had three surgeries. But does he have control? Yes, he does.”

Paying attention to your thoughts is especially helpful when your pain level rises. For instance, Thorn suggested asking yourself, “What just went through my mind? What am I saying to myself?” If you become aware of a negative thought that’s emotionally laden for you, “stop, breathe and then consider your options.” This helps to interrupt your reflexive reactions, such as lashing out at yourself or your loved ones. It helps you choose a different path, and reminds you that you have more control than you think you do, she said.

In CBT, along with other therapies like behavioral activation, clinicians also help patients discover the kinds of physical activities they can engage in without exacerbating their pain, Thorn said. They also help them make realistic goals and manage defeatist thinking.

For instance, a person who used to run 10 miles might be able to walk for a few minutes today. They might easily think that such a minor activity isn’t even worth it. However, as Thorn said, walking for 5 minutes several days a week adds up. Soon you might be able to walk for five days, and so on. “That kind of gradual increase will build on itself.” Plus, regular physical activity helps to improve mood and energy levels.

Living with chronic pain can be especially debilitating. It can lead to or exacerbate clinical depression. Fortunately, these conditions are highly treatable. The key is to seek treatment for both, and to remember that a fulfilling life is absolutely possible.

Further Reading

Thorn and Kerns both recommended the book Managing Pain Before It Manages You by Dr. Margaret A. Caudill. Kerns suggested John Otis’s Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook.

Also, these are excellent organizations: the American Chronic Pain Association, led by people with chronic pain, and the American Pain Society, Kerns said.

Unfortunately, this is a common occurrence for those with obsessive-compulsive disorder (OCD), and often becomes a vicious cycle. OCD isolates the sufferer, and this detachment from others, where the person suffering from OCD is left alone with nothing but his or her obsessions and compulsions, can exacerbate OCD.

In Dan’s case, many of his obsessions revolved around him causing harm to those he cares about. What better way to prevent this from happening than by avoiding friends and family? And this is exactly what he did. Even though in reality he could not even hurt a fly, in his mind the “safest” thing to do was to stay away from everyone. This is just one example of how OCD steals what’s most important to you.

Another common example is those OCD sufferers who have issues with germs. Avoiding any place or person that might carry germs (so pretty much everyone and everything) is about as isolating as you can get. Or maybe they are not even worried about getting sick themselves but rather are terrified they might contaminate others.

There are many other reasons why OCD sufferers might isolate themselves. Their compulsions might be so time-consuming that there is simply no time to interact with others; OCD has taken up every second of their lives. Or perhaps it is just too exhausting to be out in public, pretending everything is okay.

Let’s also not forget the stigma that is still associated with the disorder. Many with OCD live with the fear of being “found out.” How can they best prevent that from happening? Yup — they isolate themselves.

When someone is suffering deeply, whether it is with OCD, depression, or any illness, support from friends and family is crucial. Friends who reach out to the isolated person often are ignored, and after a while, they might stop trying.

This is what happened to Dan. I have no doubt his friends genuinely cared for him, but they didn’t realize the extent of his suffering, because Dan never let on. When their efforts to connect with him were rebuffed, they, not knowing what else to do, left him alone.

In some situations — college, for example — friends are the first ones to notice another friend’s isolation. Young people need to be made aware that withdrawal from others might be a serious cause for concern, and help should be sought.

OCD sufferers can isolate themselves from family as well. When Dan’s OCD was severe, we felt separated from him, even when he was living with us. He kept to himself and would not engage in conversation. He seemed as if he was in his own world, which in many ways he was: a world dictated by OCD. As difficult as it was to connect with him, our family never stopped trying, but it was mostly a one-sided effort. It wasn’t Dan’s fault that he couldn’t communicate with us, and it wasn’t our fault that we couldn’t get through to him. This insidious disease, OCD, was to blame.

While the Internet cannot take the place of face-to-face interaction, I do believe that social media sites have the potential to lessen the feelings of isolation that OCD sufferers feel. Connecting with others on forums, or even just reading about people who are suffering as they are, can help reduce loneliness, and in the best-case scenario, prompt those with OCD to seek appropriate help.

When those with OCD, or any mental illness, cut off those who care about them, they lose their lifeline. The support, encouragement and hope that are all so important for recovery no longer exists. I find this heartbreaking, as I truly believe the more we are pushed away, the more likely it is we are needed. This is something we should all be acutely aware of, and if we find ourselves or our loved ones becoming increasingly isolated, we should seek professional help immediately.

But it’s actually not uncommon for the first treatment to be unsuccessful. In fact, about 40 to 50 percent of people don’t respond to the first antidepressant they’re prescribed, according to Jonathan E. Alpert, M.D., Ph.D, the associate director of the Massachusetts General Hospital Depression Clinical and Research Program and co-founder and co-director of the Depression and Anxiety Group Practice.

Still, the people who stick with treatment do get better. So there is hope – real, tangible hope. Below, you’ll learn why treatment might not work, along with what you can do and how you can advocate for yourself.

Why the First Treatment Doesn’t Work

There are many reasons why the initial treatment doesn’t take. Here’s a selection.

Incorrect diagnosis. The treatment might be ineffective because the person doesn’t have depression in the first place. For instance, medical illnesses such as hypothyroidism can look like depression. Hypothyroidism produces significant fatigue, lack of motivation and difficulty concentrating, Dr. Alpert said.

A person might have another psychiatric disorder such as bipolar disorder. “On average bipolar disorder takes 7 years to diagnose,” said Kelli Hyland, M.D., a psychiatrist in outpatient private practice in Salt Lake City, Utah. Or an individual might have a personality disorder, which doesn’t respond to medication, she said. (In fact, “medication is often contraindicated.”)

Even if the diagnosis is correct, medical conditions can blunt the effect of antidepressants, Alpert said.

Stressors. Sometimes, the person is “living in an untenable situation,” Alpert said. So it doesn’t matter how well the antidepressant is working because the individual is still surrounded by stress – either at home or at work – that needs to be addressed, he said.

Adherence. Some people might stop taking their medication because they’re concerned that it’s habit-forming, addictive or a crutch, Alpert said. Other individuals might stop because they actually feel better. But, as he said, “Once someone responds, they need to stay on medication for a minimum of 6 to 9 months to ensure they don’t have a rapid relapse.”

Another reason people stop taking their medication is side effects, such as nausea, diarrhea, sexual dysfunction or weight gain, he said. (“Many of these side effects can be addressed by switching to a lower dosage or a different antidepressant or sometimes by prescribing a second medication that helps alleviate the side effect.”)

Alcohol or drug use. “Alcohol and drugs interfere with antidepressant response,” Alpert said. Even having a beer or glass of wine at night can mess with your medication, Hyland said.

Other medications. Hyland noted that other medications, such as steroids and hormones, can interfere with antidepressants. (Being perimenopausal or menopausal also can affect efficacy, she said.)

Sleep problems. “I tell my patients that if you’re not sleeping, we can take medication ‘til the cows come home,” Hyland said. “Insomnia exacerbates mood, anxiety and coping.” Treating an underlying sleep disorder or trauma is important, she said.

Severity of illness. With moderate to severe depression, people often do best with medication and therapy, Hyland said. And sometimes two or three medications aren’t enough, she said.

The Next Steps

If your first ineffective treatment was medication, there are several ways physicians proceed. Alpert begins by examining the reasons the medication didn’t work. If he can eliminate the above as culprits, he might increase the dose of the medication. He also might switch the patient to another antidepressant within the same class (such as switching from one selective serotonin reuptake inhibitor, or SSRI, to another). He then might choose a medication from another class.

Another technique is to add a medication to augment the effects of the initial antidepressant, “especially if there is some evidence of a partial response,” Alpert said. In other words, if a person thinks they’re about 20 percent better and they’re tolerating the medication well, the doctor may prescribe a second antidepressant that works on a different mechanism of the brain, he said. An example is combining an SSRI, which targets serotonin, with Wellbutrin, which works on dopamine and norepinephrine.

Physicians also might prescribe an atypical antipsychotic, such as Abilify or Seroquel, to bolster the effects of the original antidepressant, Alpert said.

Psychotherapy, including cognitive-behavioral therapy and interpersonal therapy, is highly effective for treating depression. Therapists help clients learn about their illness, cope with stressors in their lives, identify and change dysfunctional thinking, and take action to get better.

If you’re only taking medication, seeing a therapist can be tremendously helpful. (If you’re solely working with a therapist, it’s also possible that you might need medication.)

The book is divided into three contrasting sections. The first part is the author’s personal account of her psychic experiments, which developed seamlessly into psychosis without her noticing. The second part is her mother’s account of the author’s hospitalizations, and her denial and final acceptance of her mental illness. Part three contains sections from Jacobs’s diaries, written at the time of her psychosis, as well as clinical and legal documents relating to the same period.

Jacobs was born in Christchurch, New Zealand, in 1965. Throughout her childhood, though she had loving and close relationships with her parents and siblings, she was tormented in school about her weight. After leaving school, she worked in banking for several years, then traveled to Europe to broaden her experience. Recovering from a broken relationship, she enrolled in law school. After graduating in 2005, she set up independently as a family barrister.

Three years later, her business was thriving, yet Jacobs suddenly found herself pining for her deceased grandmother. The loss of her loved one led her to Don’t Kiss Them Goodbye, by psychic medium Allison Dubois. After reading the book, Jacobs began to feel her grandmother’s presence, and to notice other spiritual signs. Within months, she was experimenting with a crystal ball, in which she began to see images and words that were to have a profound influence on her life. It was only a short time before she began to hear the voices of her spirit guide, Wes, initially pleasant and helping her through life.

As time went by, Jacobs began to believe that many of the people around her were actually spirits that had passed over. She lost the ability to distinguish between fantasy and reality, yet somehow managed to get through her daily routine as a barrister. As she plunged deeper into psychosis, she spent more and more time communicating with her “spirit friends,” who included Heath Ledger, Princess Dianna, and Albert Einstein. Her world was now comprised of overlapping layers where real people and her imaginings were distinguishable only by their means of communication.

Then things took a turn for the worse. The author’s fragile world became overrun by demons, whom she believed were out to kill her. Less than a year later, the demons had become more than she could deal with and she sought treatment in hospital. It would take another 12 months before she could finally accept her illness and deny her demons. Happily, she is now able to live a peaceful life, and she continues to maintain her legal practice.

In contrast to the often terrifying flights of psychosis in the first chapters, Jacobs’s mother’s story is one of grief, guilt, and harrowing concern. Beginning with Kerry Jacobs’s first admission to hospital, Pam Jacob’s story is raw with emotion as she battles with her daughter’s reluctance to accept her illness, and a healthcare system that is not fulfilling its promises.

“I felt guilty most of the time because my heart sank every time she visited me,” Pam Jacobs writes, “and I knew that I would be on edge the whole time, watching her for obvious signs of psychosis.”

While Pam Jacobs tries on numerous occasions to help her daughter, Kerry Jacobs refuses to let her be involved in her care. The mother’s chapters fill in the gaps in her daughter’s memory from this time, recounting the trauma and failure of a range of medications. Finally, after 18 months of turmoil, Kerry Jacobs’s psychiatrist changes her medication and suddenly she began a symptom-free life.

Reading the book, I had to stop on several occasions to reflection my own experiences as both a sufferer of and caretaker for someone with bipolar disorder. I wish that I’d had this book during the time I was struggling to get my adolescent son’s symptoms stabilized. Learning about Jacobs’s most difficult periods of psychosis and her subsequent stable life and successful legal practice would certainly have given me strength. Readers with a connection to bipolar disorder will feel less isolated when they read Jacobs’s book.

From Psychic to Psychotic and Beyond: A true story about my bipolar disorder
CreateSpace Independent Publishing Platform, December, 2012
Paperback, 188 pages
$9.95

Before reaching a tipping point, people often are able to balance known or unknown ADHD challenges with strategies they may not have even realized they were using. They had been able to adapt and cope well with their symptoms. Their symptoms may not have interfered with their functioning, so that they avoided an official ADHD diagnosis.

But for some reason a life change — a job promotion, relationship change, school change, or myriad other things — renders the current strategies ineffective. Over time there is a sense that things are no longer going well and in fact, life seems to be falling apart in a big way.

Here are some life situations that could be possible tipping points::

1. New problems at school.

Often, when higher elementary or middle school hits, students begin unraveling. They experience more responsibility in juggling multiple classrooms, more homework and larger classes. Suddenly it seems like nothing is working anymore. They can’t get things done that they want to get done, everything becomes chaotic, things start to come undone. Their schoolwork starts to suffer; they may have trouble concentrating in class, forget to hand in homework or start to experience difficulties with old friendships.

Often, no one recognizes these warning signs as being ADHD-related because the students previously had managed or were able to compensate for their challenges. Parents and educators start to feel helpless when a previously successful student seems to become unmotivated. Students are told they just need to try harder. Everyone is unsure how to get the child back on track and the students begin to feel stupid, lazy and incapable.

2. Inability to cope after significant life changes.

Some people with ADHD experience their first tipping point after a significant life change, even a positive one such as getting married or moving into a new home. These major life celebrations are anticipated with great joy, but often may be a change that tips the balance. Perhaps you’ve been able to balance your own life and your own schedule and where you put things up until now. But then you get married and now your spouse has a different way of doing things or expectations of the way things should be organized that differ from your views. That’s not to mention having to deal with the extra stuff in your space.

Slowly you notice that things are not working as well as they had before, and because this is supposed to be the happiest time of your life, you think there must be something wrong with you — right? Wrong! Significant life changes such as getting married, having another child or moving homes often can upset an unknown balance.

3. Unable to transition successfully into a new role at work.

Up until your “tipping point” you have been performing really well in your job — so well, in fact, that you are promoted. Slowly you may start to notice that you are not doing this new job as well as everyone expected, and you begin to isolate yourself, dread going to work and may eventually get fired.

What happened? You reached your tipping point. Not because you didn’t deserve the job, but because changes in work often come with changes of staff, support, work space, etc. that throw you off.

4. Change in family dynamics.

If you find yourself with new responsibilities and changes in your family, such as taking in an elderly parent, adding members to your family, or getting a new roommate, the additional responsibilities, change in routine and stress can gradually sink in and leave you overwhelmed and unable to cope as you have previously. It is so easy to begin to think you are a terrible mom, unfit for the responsibilities of a family or that you may be destined to live alone.

It’s not you. You were thrown off-balance, and your ability to compensate for your ADHD with your old routine, structures or systems is no longer working. But instead of seeing the truth, that it isn’t anything you’ve done wrong, or knowing that you can fix this, you’re filled with undeserved guilt and shame.

5. Physical injury.

People often experience their tipping point when an ADHD-management strategy such as exercise decreases or activity level changes. Unbeknownst to many people with ADHD, participation in sports or daily exercise provides some additional dopamine to our brain and helps to create structure and routine in our lives that help to better manage ADHD symptoms.

Tipping points are common for high school athletes who have earned success not only in their sports but academically, only to go off to college and experience failure for the first time. Without the rigorous physical training and structure of high school, they begin slowly to fall apart. Another common tipping point for people with ADHD is when they have experienced an injury and have to decrease their activity or exercise level. This change in routine and absence of daily dopamine boosts can challenge previous steadiness, energy levels and ability to focus. Life begins to wobble.

As you can see, there are many reasons, often beyond your control, that might lead you to your tipping point. A tipping point means that you are at a crossroads. You have a choice which way you will react. You can continue down that path to chaos and overwhelm, or you can get restructured and relearn ways to to cope and get back on track.

Food allergies or intolerances can have a great effect on your mood. For example, if you have gluten allergy or intolerance, consumption of gluten (found largely in wheat products) can leave you feeling sluggish or even depressed. Dietary changes have been suggested for children with ADHD or autism. This suggests there is a strong link between food, mood and behaviors.

Fluctuations in blood sugar also can change your mood. High blood sugar often can lead to irritability, while low blood sugar can bring about feelings of anxiety, depression and lethargy.

Research also suggests that low levels of vitamins, mineral deficiencies, and low intake of fatty acids and omega-3s can contribute to altered moods and mimic various mental health issues. Some believe that these deficiencies actually cause mental health issues. Insufficient levels of vitamin D, in particular, can lead to mood swings, depression and fatigue. If you have any deficiencies, your mood may be improved simply by adding supplements.

If you are interested in exploring how food may be affecting your moods, keep a food diary for at least two weeks. Record everything you eat and drink and your moods before and after. It may sound tedious, but it is beneficial. If you notice a pattern, you may wish to seek a nutritionist or experienced health care provider to assist you in making the necessary changes. Since diets should be individualized, you will want to make sure the changes you are making are appropriate and healthy for you.

Many people feel that it is difficult to eat healthy or to change their eating habits. It’s really simple if you keep it simple. Start slow and make changes over time. Using the all-or-nothing approach to cutting out certain foods typically leads to failure.

You can also make changes by slowly substituting bad foods with good ones. Experiment with different grains, fruits, and vegetables. Get online and find exciting new recipes, and you just may fall in love with a good food you never imagined you would eat.

Remember every change you make matters. If you fall off the wagon, just get back up. It’s about making changes to improve your emotional health. Don’t get discouraged or depressed if you slip up. Consider that day as a misstep and make healthier choices in the future. Here’s to a healthier you!

A few months ago, he was under scrutiny for standing up to the Rockets’ lawyers and officials. He requested that his anxiety issues be treated the way other players’ physical illnesses and injuries are treated. For instance, NBA players are expected to fly frequently to cities where their games are played. White’s anxiety disorders makes it so that sometimes he is unable to do so. He requested to be able to travel by bus, and if he is delayed he doesn’t want to be fined the same amount as players who miss practice because they overslept.

Both parties struggled to reach a resolution, but after many discussions and meetings, the Rockets and White were able to reach a compromise in some areas. He was reassigned to the Houston Rockets’ D-league team, the Rio Grande Valley Vipers.

White’s story is of interest to many who are afflicted by mental illness. He is not in denial of his challenges, but he is not being quiet about it either. He has taken on the cause to help decrease the stigma society continues to place on mental health issues.

The Anxiety and Depression Association of America reports that there are “40 million American adults who suffer from anxiety disorders and only one-third of those suffering from an anxiety disorder receive treatment.” Anxiety itself has found its way into everyday language by many who experience stress. Yet, there are still many people who have no idea that anxiety disorders can be paralyzing and should not be trivialized.

Many individuals are embarrassed about their illness because they fear discrimination or that it’ll be a stumbling block in their careers or jobs. White has taken the risk and has decided that his basketball career is important, but becoming a “poster child” to decrease the stigma is more significant.

If you personally are struggling with mental illness or have a loved one who is, how are you handling it?

• Acknowledge it.

  Mental illness does not discriminate against race, gender, age, religion, or economic status. However, many sufferers may be in denial because they believe that asking for help, taking medication, or seeking therapy is a sign of weakness and irresponsibility. They don’t want to admit they have a problem and will only accept help when their normal functioning has deteriorated significantly, and they can no longer afford to suffer alone.People in prominent positions may be embarrassed to admit they have a mental illness. I’m not necessarily talking about movie stars or other celebrities. I am referring to individuals who have been able to succeed in life despite their mental adversities. They need to speak up to help normalize the disrespect many still receive due to their mental ailments.

• Speak up.

  When people share their struggles, others will become aware and even be surprised that their friend, boss, best friend’s daughter or spouse also is experiencing emotional and mental pain. Successful men and women with a mental illness can be an example to society and can contribute to the idea that a mental disorder does not define the person. The media seem to highlight the negative situations and many sufferers feel embarrassed and despondent. Thus, they choose to continue their silence.

• Connect with others.

  A dear friend has found that when he shares the challenge of having a son with mental health struggles, others connect emotionally with him. They trust him and are able to share their own journey with him. Your story of having been there may make a difference to someone who is feeling hopeless.

Society needs to understand that a person can be “normal” and still have mental health challenges.

Royce White is a hero. We need more heroes to stand up and speak up for mental health. Depression and ADHD are becoming more accepted as those in the limelight continue to talk about their experiences. Even people not in the public eye can tell our stories and help someone.

Will you be a hero for someone else? Take a stand. It will be worth it!

While the above questions are obvious appeals, they are not the only way that OCD sufferers seek reassurance. Indeed, the very nature of OCD centers around making certain that all is well. The disorder is characterized by unreasonable thoughts and fears (obsessions) that lead the sufferer to engage in repetitive thoughts or behaviors (compulsions). Obsessions are always unwanted and cause varying degrees of stress and anxiety, and compulsions temporarily alleviate these feelings. Compulsions are always, in some way, shape, or form, a quest for reassurance; a way to make everything okay.

A good example is the case of someone with OCD who is obsessed with a fire starting because he or she left the stove on. The compulsion of continually checking the stove is a recurring attempt to reassure oneself that the stove is indeed off and nobody will get hurt. Another OCD sufferer may fear germs (obsession) and wash his or her hands until they are raw (compulsion). The compulsion of hand-washing is an effort to make sure that his or her hands are clean enough so that there will be no germs.

My son Dan suffered from OCD for a few years before we even knew anything was really wrong. In retrospect, I realize he had a lot of reassurance-seeking behaviors. While he never asked the “Are you sure?” questions, he would often apologize for things that did not warrant an apology. If we went to the supermarket together he would say, “Sorry I spent so much money,” when, in fact, he had only picked out a few items. I, in turn, would reassure him that he hadn’t spent much at all. Dan would also thank me over and over again for things that most people might say “thank you” for only once, if that. Again, I would reassure him by saying, “You don’t have to thank me,” or “Stop thanking me already.” My responses to Dan in these cases gave him the reassurance he needed to feel certain that he hadn’t done anything wrong, had behaved appropriately, and all was well.

Of course hindsight is a wonderful thing and I now know that how I reacted to Dan at these times was actually classic enabling. I did him more harm than good. My reassuring Dan that all was well reinforced his misconception that he had to be certain, to have no doubt at all in his mind. While I helped reduce his anxiety at the moment, I was actually fueling the vicious cycle of OCD, because reassurance is addictive. Psychotherapist Jon Hershfield says:

If reassurance were a substance, it would be considered right up there with crack cocaine. One is never enough, a few makes you want more, tolerance is constantly on the rise, and withdrawal hurts. In other words, people with OCD and related conditions who compulsively seek reassurance get a quick fix, but actually worsen their discomfort in the long term.

So how can those with OCD “kick the habit?” It’s not easy, as sufferers continually wrestle with the feeling of incompleteness, never truly convinced that their task has been completed. There is always doubt.

But there is also always hope. Exposure Response Prevention (ERP) Therapy involves facing one’s fears and then avoiding engaging in compulsions. Using the stove example again, the sufferer would actually cook something on the stove and then shut the burner(s) off. He or she would then refrain from checking the stove to make sure it was off. No reassurance allowed. This is incredibly anxiety-provoking initially, but with time it gets easier. And while it is difficult to watch a loved one go through “withdrawal” it is imperative that family members and friends learn how not to accommodate or enable the sufferer.

Without reassurance, how will those with OCD achieve that need for certainty that they so desperately desire? Indeed, how can all of us make sure that nothing will ever go wrong? How can we control our lives, and the lives of those we love, so that nothing bad will ever happen?

The answer, of course, is that we can’t. Because as much as we’d all like to believe otherwise, much of what happens in our lives is beyond our control. Through ERP therapy, OCD sufferers will focus on the question “How can I live with uncertainty?” as opposed to “How can I be certain?” And instead of dwelling on the uncertainties of the past and the future, those with OCD can begin to live life to the fullest by concentrating on what matters most – the present.

Although SAD is not a “standalone” diagnosis in the current Diagnostic & Statistical Manual (DSM-IV-TR), published by the American Psychiatric Association, it has received much attention by the medical community over the past several years.

The most common symptoms of winter-onset SAD are:

• Loss of energy
• Weight gain and an increase in craving carbohydrates
• Anhedonia (inability to experience pleasurable activities)
• Anxiety
• Depressed mood
• Difficulty concentrating
• Social withdrawal
• Hopelessness/helplessness
• Decreased sex drive

The most common symptoms of spring/summer-onset SAD are:

• Anxiety
• Poor appetite
• Increased sex drive
• Insomnia (difficulty sleeping)
• Irritability
• Weight loss

Some believe SAD can be caused by a dysregulation in the biological clock (circadian rhythm); melatonin levels (a hormone that assists in the regulation of mood and sleep patterns); duration of sunlight; and serotonin levels (a neurotransmitter in the brain that affects mood).

Treatment options include:

• Phototherapy (light therapy). Light therapy is an easy way to decrease the symptoms of SAD. Most people can purchase a light therapy box and put it in their homes or office. The light from the light therapy box mimics outdoor, full-spectrum lighting. Some insurance companies will pay for a light therapy box if you have a prescription from your physician.
• Medication. You can speak with your physician, psychiatrist or nurse practitioner about psychotropic medications that may help decrease the symptoms of SAD.
• Psychotherapy. A mental health therapist can assist you in changing your negative thought processes and behaviors that contribute to your overall mood. Therapists understand how difficult it is to manage the stress of life, especially when you are feeling depressed. Therapists treat each person in a holistic manner and guide you along the way to wholeness.

Many researchers have found that a combination of psychotherapy, medication management and light therapy are beneficial to the treatment of SAD. Please speak to your physician or mental health professional if you believe you are experiencing SAD or any other mental health condition.

Other ways to combat SAD include:

• Exercise. Getting any amount of exercise is better than no exercise at all! If you work in a high-rise building then take the steps and if you have steps in your home then use them for 10-15 minutes each day. Join a gym; the cost of memberships this time of year tends to be pretty fair.
• Get adequate sleep. Sleep is vital to regulating your mood and behaviors. Try to get 6 to 8 hours of sleep per night.
• Relaxation. We are bombarded in our world with cell phone calls, text messages, Facebook posts, Twitter, and emails. We go to work each day and are overwhelmed, then come home and the kids need our attention. This week spend 10 minutes alone in your car or a quiet space in your home. Turn off the radio, television and cell phone so you can BE.Become a watcher of your thoughts but do not analyze or react to them at all. Watch the thoughts drift by like clouds in the sky. If you begin to think about the grocery list, then focus on your breath. Some people benefit from counting breaths to keep the mind focused on the number being mentally said instead of their thoughts. If this works for you it is helpful to count to 10 and then return to 1. If you are able to get to 10 with no interruption of thoughts then that is great! Most people begin and only get to 5 or so until they run away with a thought. If this happens, return to 1 and begin again.

  Spend the 10 minutes in being instead of doing. Start off with five minutes if 10 is too much. Your breath will return to normal and your body will get the chance to rest, even for a brief period. Do this once per day and then increase the time if you are able. This simple exercise is best done sitting in a comfortable chair or on the floor in a comfortable position; it is not recommended to do this in bed because your body is already trained to sleep in that space.

• Eat well. You do not need to be a dietitian in order to eat well. Listen to your body and eat what it innately craves. Replace unhealthy “fast foods” with alternatives such as sandwiches and salads.
• Get more sunlight. If it happens to be a nice day, then go outside when it is sunny. It may also help to get more sunlight into your home by opening your blinds up or sitting closer to a window with light coming in.
• Find balance. You can be the best you can be when your body, mind and spirit are aligned. Do not be too hard on yourself. Many people make New Year’s resolutions and often fail. It takes almost one month to change any bad habit, but be gentle with yourself and love yourself. Nobody is perfect and you cannot change every “bad” characteristic all at once. Instead of swearing off alcohol, fatty foods, men, women, cigarettes, or whatever your vice may be, look at your life and ask yourself, “Where in my life am I out of balance?” If you believe you work too hard, then you need to rest a little more. If you exercise too much, then you need to relax more.The adage “what we resist persists” is true. If we focus on the negative, that is what we will receive. For example, the “battle to lose weight” idea focuses on weight loss being a war of some sorts; however, if we shift our perspective to “eating healthy for me” then there is no negative related to thoughts around our food intake. If we believe eating is always going to be a battle, then chances are it will be a battle that we cannot win. So, our thinking patterns do affect our outcomes.

It might be helpful to enjoy a sunrise, spend time in your spiritual place (church, temple, mosque, spiritual home), laugh more, and enjoy the life you were meant to live. Everything is always changing and balance is a healthy way to endure the changes we face. We were not created to be overstimulated and out of balance. Focus on your strengths and positive ways to introduce balance back into your life. Remember that you are whole, complete and perfect — half the battle is in believing it.

The statistics regarding obesity in America are alarming. Currently, 35 percent of American adults are obese (CDC, 2012), and that number is projected to rise to over 50 percent in most states by 2030 (Henry, 2011). We’ve been fighting the so-called “war against obesity” since the 1980s, and yet despite all of our efforts, the problem has only gotten worse. Clearly, what we’ve been doing to try to solve this problem isn’t working and is possibly making it even worse. In my opinion, the reason for this is that the psychological piece hasn’t been addressed yet and until it is, we will have an increasing problem on our hands.

Years ago I was seeing a client who we’ll call Sarah. Sarah was very obese and desperate to lose weight. Her doctor had recently told her that if she didn’t lose a significant amount of weight she would lose her mobility as well as have a host of other medical consequences. Sarah tried numerous diets and exercise programs but nothing worked. She even enrolled in a weight loss clinic but had no success. She actually ended up gaining even more weight during this time. Not knowing what else to do, Sarah’s doctor told her that she needed to talk to a therapist.

When I met Sarah she was quite desperate to lose the weight and very depressed. Much to her surprise, I told her that I didn’t want us to work on her losing weight, but rather I wanted to work on her depression and teach her to accept and love herself unconditionally. This seemed the opposite of what she needed in order to lose weight, but Sarah decided to trust me anyway. You see, like a lot of people, Sarah thought that if she could just hate herself enough, that would motivate her to do whatever it took to lose the weight. As a therapist, I know that that is simply not going to work. We therapists follow something called the “Rogerian hypothesis,” which states that people tend to move in a positive direction only when given unconditional love and acceptance. Well, I’m happy to say that after we had alleviated Sarah’s depression and she had learned to love and accept herself, the weight came right off.

The current methods for helping people lose weight seem to be the opposite of love and acceptance. Much of the efforts seem to involve trying to shame and scare people into losing weight. This simply doesn’t work. The worst thing you can do is give someone more anxiety and depression regarding their weight, and I’m going to explain why that is later on. Also, the ways we go about teaching people to lose weight are much more complicated than they need to be. One should not have to read a book, go to a clinic, or take a class to learn how to lose weight. There is a very successful diet that has been around for thousands of years and all of the big celebrities do it. Can you guess what it is? It’s called “Moving more and eating less.” How you go about accomplishing this is up to you. I believe that losing weight is not complicated and that people intuitively know how best to do it when it comes to themselves. They simply need to stop feeling so anxious and depressed about it.

Obesity and Genetics

Before I talk more about how obesity is linked to depression and anxiety, I first want to briefly address the popular belief that obesity is purely a problem of bad genes. This is the popular belief and I can see why it is so popular. In a society where people are constantly trying to shame you about your weight, it can feel good to be able to say “Hey, you have no right to shame me about my weight! It’s not something I can control! It’s because of these bad genes I have!” But in order for this to be true, it means that our genes would have had to somehow change since the 1960s. Scientists agree that genetics is not responsible for the obesity epidemic, although they do agree it is a factor. Depending on which study you look at, genes only account for between 1 percent and 5 percent of a person’s body mass index (Li et al., 2010). I think that most people would agree that 5 percent of bad genes doesn’t excuse the 95 percent of it that scientists claim is due to bad habits.

When confronted with these facts, people often cite that most of the people in their family are also obese, so it must be genetics. However, the more likely possibility is that families tend to eat the same foods and have similar habits. Genetics also doesn’t explain why obese people also tend to have obese pets (Bounds, 2011). Obviously the dog doesn’t share the same genes as the owner, but they do share the same environment. Of course, we can’t mention genetics without looking at twin studies. Since identical twins have identical genes, researchers often compare twins to examine the effects of genetics and the environment on a person.

Obesity and Depression

Researchers aren’t quite sure if obesity causes depression or if depression causes obesity, but the two are definitely linked. In fact, the two conditions are so intertwined that some are calling obesity and depression a double epidemic. Studies have found that 66 percent of those seeking bariatric, (weight loss) surgery have had a history of at least one mental health disorder. And of course, it doesn’t help that the medications people take for depression and other mental health issues can cause dramatic weight gain.

Consider this: According to the CDC, half of Americans will suffer from some sort of mental illness, and most of them will not receive any treatment for it. 63 percent of Americans are also overweight or obese. There are almost as many Americans taking diet pills as there are taking antidepressants (8 percent and 10 percent). People with mental health issues are twice as likely as those without them to be obese, and that’s even before they start taking psychiatric medication (McElroy, 2009).

So why are people with mental health issues so much more likely than those without them to be obese? We know that depression and bipolar depression slows down your metabolism (Lutter & Elmquist, 2009). Depression also depletes our willpower, making us less likely to avoid eating unhealthy foods. Depression also causes us to crave high-fat foods and sugar. This is where emotional eating comes in. When we’re feeling down, fatty and sugary foods make us feel better, at least temporarily. Of course, you don’t need to have depression or a mental illness in order to engage in emotional eating. It’s something we learn at a very young age. Eating something unhealthy is much easier than fixing the problem or dealing with what’s causing us to feel unhappy. Teaching people how to deal with unpleasant moods other than by eating would certainly cut down on emotional eating and would certainly lead to significant weight loss.

So if depression causes weight gain and antidepressants cause weight gain, then what is the solution? Well, research has shown that talk therapy is just as effective at relieving depression as antidepressant medication (Doheny, 2010), and talk therapy doesn’t have the negative side effects that medication does. Another option is exercise. In a 2005 study on the effects of exercise vs. Zoloft (anti-depressant medication) on the treatment of depression, participants were randomly placed into two groups. On group received 150 mg of Zoloft while the other group engaged in 20 minutes of cardiovascular exercise three to four times a week. After eight weeks, they found that the exercise was just as effective at reducing depression as the Zoloft! Another thing to consider is that Zoloft has negative side effects such as weight gain, sleep problems, and sexual dysfunction. As you can imagine, the side effects of exercising are the opposite of that.

In its latest installment, Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?, primary author J. Welsey Boyd and Eric Metcalf delve into the sensitive time when one’s drug use has become troubling, but has not yet reached the diagnostic criteria for addiction.

Is all drug use bad? How do we know if we need help and when or how to seek it? What can we make of the fact that two states recently legalized marijuana? Boyd sets out to draw a road map for these tough questions for both the substance user and his/her loved ones. A medical doctor and Ph.D., he uses his impressive list of credentials — including faculty psychiatrist at Harvard, staff psychiatrist at Boston Children’s Hospital Adolescent Substance Abuse Program, and co-founder/director of the Human Rights and Asylum Clinic. The end result is a useful guide — but with a few flaws.

Because the “almost” concept may seem foreign to someone who hasn’t read one of the previous books in the series, Boyd spends time going over exactly what this means. He writes that to qualify as an almost addiction, a behavior must fall outside of what is considered normal, but, at the same time, not meet criteria for a DSM diagnosis; that it’s causing identifiable problems; that it might progress to a full-blown condition or, at least, cause substantial suffering; that an intervention should be able to help; and that stopping the behavior will improve quality of life. The benefit of identifying drug-using behavior as “almost addicted,” he writes, is that it offers an opportunity to stop and turn your life around before a problem progresses into full addiction, which is much more difficult to treat. He compares the value of this early intervention to that of spotting glucose intolerance and pre-hypertension before they turn into diabetes, heart attack, or stroke.

There is a case study in each chapter to help reader determine if a drug use is an “almost addiction,” as well as to illustrate the points raised in each section in a relatable, anecdotal way. The book gives an overview of the classes of drugs and their effects, as well as the definition of addiction and how it differs from abuse. Later, it explores possible roots of addiction, including the role of one’s family history, a drug’s effects and initial appeal during a hard time, and self-treatment for a mental health issue.

One section is geared toward family members and friends who are concerned about another’s drug use. Boyd notes that almost addiction is especially hard to see in successful people, as the effects are not nearly as obvious as those of full-blown addiction. Even health professionals miss it a lot between their time constraints and the sensitivity of the issue, he writes. He also stressed that there are things you can and can’t do to help: for instance, you can cease enabling the behavior, but you can’t force a person to seek treatment.

Next, Boyd presents materials and resources aimed directly at the almost-addicted reader, including information on helping oneself and figuring out when it’s time to find professional help (there’s a helpful, if simplistic, chart on page 223). Boyd talks about the non-physical aspects of drug use, such as how it’s woven into a daily routine, and prepares the reader for what the recovery process could look like, and what to do afterward to continue living a drug-free life.

While Almost Addicted is, overall, a valuable addition to the literature on drug use and abuse, it does have a few issues. For starters, it is at once meant for an audience of almost-addicted readers and for an audience of concerned loved ones. Granted, Boyd does try to divide guidelines into separate sections, but it’s still difficult to distinguish the approach he intends for each group.

Boyd also attempts to mention and include all drugs, yet concentrates overwhelmingly on marijuana. Pot is becoming more and more accepted, though, and instead of scapegoating it as the source of all drug problems (which seems simplistic at best), I wondered why Boyd didn’t focus more on prescription drugs—especially since this is the fastest growing area of abuse and addiction.

Finally, there’s a bit of a problem in the last part of the book, where Boyd recommends seeing a primary care doctor to begin the recovery process: The suggestion comes after an entire section on how primary care practitioners don’t have time, motivation, or expertise to notice, let alone care about, the almost-addicted population.

Boyd himself identifies one problem with his “almost addicted” framework: “I wish I could offer some completely black and white advice about using drugs that would be applicable for everyone, but doing so would probably be intellectually dishonest,” he writes. “You’ll have to decide where to draw the line on what kind of presence that drugs — legal or not — can have in your life.”

Regardless of these issues, Almost Addicted is still a well-researched and cited work with information and advice for those who are verging on succumbing to addiction. The emphasis on early intervention, before one experiences traumatic consequences, is not only valid, but an essential concept that will hopefully push our notion of drug treatment forward.

Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
Hazeldon Publishing (Harvard Health Publications), 2012
Paperback, 264 pages
$14.95