Therese J. Borchard – World of Psychology Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999. Sun, 25 Jun 2017 20:30:07 +0000 en-US hourly 1 111817284 On Trying Too Hard with Depression Thu, 22 Jun 2017 15:45:08 +0000 Mindy McCready

There’s such a thing as trying too hard.

Anyone who has ever suffered through a case of insomnia knows this well. The harder you try to sleep, the less rest you get. Sleep only comes if you can relax and let go.

It’s true for many other things, too. Like garage-door controls.

The other day, I was trying to get into my neighbor’s house to walk his dog and pressed the code into the box outside the garage more than 20 times, but the garage wouldn’t lift.

“You’re pressing the buttons too hard,” my daughter told me.

She did the sequence one time, pressing the buttons effortlessly, and up the garage went.

And this definitely applies to managing your thoughts.

The Harder You Try, the More Negative Things Can Get

A study published in August 2007 in The Journal of Neuroscience showed that there was a breakdown in normal patterns of emotional processing that prevented depressed and anxious people from suppressing negative emotions. In fact, the more they tried, the more they activated the fear center of their brain — the amygdala, which fed them more negative messages.

In the study, Tom Johnstone, PhD, then of the University of Wisconsin in Madison, along with colleagues there and at Tufts University in Medford, Massachusetts, examined 21 adults diagnosed with major depressive disorder and 18 non-depressed people of comparable ages. Participants were asked to view a series of emotionally positive and negative images and then specify their reaction to each one. A few seconds after the presentation of each picture, participants were asked to either increase their emotional response, to decrease it, or simply to continue watching the image.

The results showed distinctive patterns of activity in the ventromedial prefrontal cortex (vmPFC) and the right prefrontal cortex (PFC), areas that regulate the emotional output generated from the amygdala: the almond-shaped group of nuclei located deep within the temporal lobes of the brain that play a primary role in the processing of memory, decision-making, and emotional reactions. The vmPFC is compromised in depression, possibly because of the inappropriate engagement of right PFC circuitry in depressed individuals.

It even applies to exercise.

Why Too Much Exercise Can Be Too Much

While regular and moderate exercise can boost longevity, cardiovascular health, and mood — and improve symptoms of all kinds of chronic conditions — long-term endurance exercise and working out too hard can actually harm our health, according to recent research, such as a study published in 2015 in the Canadian Journal of Cardiology that linked excessive exercise to heart rhythm issues.  Such exercise has been linked to pathological structural remodeling of the heart, enlargement of arteries, and increases in anxiety and depression.

Too much exercise can also exacerbate autoimmune disease, gut dysbiosis, and adrenal fatigue. According to Chris Kresser, an acupuncturist and leader in functional and integrative medicine, overtraining affects blood levels of important neurotransmitters like glutamine, dopamine, and 5-HTP, and can negatively impact the hypothalamic-pituitary axis, possibly causing conditions like hypothyroidism. Extreme exercise also increases levels of the stress hormone cortisol, which can cause sleep disturbances, digestive issues, depression, weight gain, and memory impairment.

I know consciously that trying too hard doesn’t always render the best results, but when I experience a depressive episode, I automatically start pedaling faster, thinking that I will escape the biochemical storm sooner if I just try harder.

When Self-Help Is No Help

I showed up recently to my psychiatrist appointment with another self-help book in my hands: Mental Health Through Will Training, by Abraham Low, MD, the late professor of psychiatry at the University of Illinois College of Medicine in Chicago who founded Recovery International, a self-help group for people with nervous, mental, and emotional problems. The book is an invaluable resource that has plenty of wisdom and insights for managing chronic depression, and I was using it as an adjunct to psychiatric care. But its provocative “push yourself as much as you can” philosophy was exactly what I shouldn’t be reading in a dangerous, mixed state of bipolar disorder.

“I think you should stay away from all self-help books right now,” my doctor told me, reminding me of all the times before when I’d been in this state of mind and looked for the answer in mental health literature or self-help groups or mindfulness techniques — as if I were missing some key cognitive behavioral strategy that would instantly deliver me to the land of sanity. Moreover, pushing too hard, she said, has typically led to setbacks in my recovery rather than helped me heal.

People often ask me how much they should push themselves when it comes to managing their depression: Should they go into work, or call in sick? Should they force themselves to socialize, or stay home and recover? Having read way too many self-help books, I can say there is research to support both perspectives. The right answer is going to be different for everyone, and will vary for the same person at different times.

For me, though, right now I’m learning the hard lesson of patience and trust and moderation.

I’m learning, once again, that more isn’t always better.

In fact, sometimes less is more.

Originally posted on Sanity Break at Everyday Health.

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When Yoga, Meditation, and Diet Aren’t Enough to Cure Depression Thu, 15 Jun 2017 20:30:48 +0000 learning-to-let-go

I thought I had it all figured out.

I even had a book title picked out: Whole-ish — On Healing Myself Naturally from Depression and My Messy Path to Well. And I had outlined some of the chapters:

  • Why restoring your gut health and generating good intestinal bacteria will improve mood
  • The science behind optimal nutrition and how certain foods reduce inflammation of the brain, while others (sugar) send a message of distress to your immune system, affecting your entire nervous system
  • How green smoothies help eliminate disease states
  • The therapeutic faculties of yoga and how it primes our parasympathetic system
  • Mindfulness meditation and neuroplasticity

And then the floor beneath me dropped out and I fell into a dark, ominous abyss — a life-threatening place that was more frightening than any depressive episode of my past, where the suicidal thoughts were so intense and so constant that I was absolutely sure I wouldn’t be around to celebrate my daughter’s 13th birthday. In the last five months, I have never been so scared for my life, positive that I was going insane and that I was destined to follow the path of my aunt (who was also my godmother), who took her own life.

What started out as a good and right endeavor became a dangerous dance in which I made a few critical mistakes that almost cost me my life.

Doing Everything Right

Two-and-a-half years ago, I was frustrated that I couldn’t get rid of my death thoughts after being on so much medication for so many years. So I dove into the world of integrative and holistic medicine.

I took every saliva, blood, and stool test that exists to measure my cortisol, hormones, gut status, nutrients, and food intolerances.

I transformed my diet and eliminated gluten, sugar, caffeine, and dairy (I’d already cut out alcohol). I did extensive research on which supplements to take and added vitamins B-12, C, D, and E; probiotics; turmeric; omega-3 fatty acids; alpha lipoic acid; amino acids; magnesium; coconut oil; and iron. I drank two green smoothies every day.

I took the eight-week intensive Mindfulness-Based Stress Reduction (MBSR) program based on Jon Kabat-Zinn‘s work at the Stress Reduction Clinic at the University of Massachusetts Medical School in Worcester, and started to meditate each day.

I immersed myself in hot yoga, practicing five or six times a week .

I committed myself to helping others, trying to transcend my pain that way, creating two online forums dedicated to people struggling with treatment-resistant depression.

I attached myself to the new science called epigenetics, the study of genetic changes that aren’t caused by a change in DNA sequence. Pamela Peeke, MD, best-selling author of The Hunger Fix, explained it to me this way: “If you can change certain key choices — your diet, how you handle stress, your physical activity — it’s like writing notes in the margin of your genome, and you can flip the switch to support and protect your health.”

Epigenetics is closely related to the concept of neuroplasticity that says we aren’t stuck with the brain that we were born with: We have more room than we think we do to direct our health toward healing and wholeness.

Thinking in Black and White

I wanted to believe more than anything that I could cure myself of my bipolar disorder and my treatment-resistant depression with the right diet, exercise, stress reduction tools, and meditation.

All of my actions over the course of nine months were able to deliver me to a place where the death thoughts ceased.

So I assumed that the medications I had been taking really didn’t do anything but cause or contribute to a host of chronic illnesses I had developed over the course of 10 years: connective tissue issues (Raynaud’s phenomenon), thyroid disease (nodules), a pituitary tumor, inflammatory bowel disease (small intestine bacteria overgrowth, or SIBO), and heart disease.

That’s where I went wrong.

Black-and-white thinking.

Raised in an alcoholic home, I have always struggled to achieve a nuanced perspective.

I stopped working with my psychiatrist because I believed I could naturally heal from my mood disorder with the help of a holistic doctor. An excellent integrative physician, he has successfully guided my general health (all of the conditions mentioned above). But a mood disorder as complex and severe as mine requires psychiatric expertise, which he is without. I began to taper off of my psychotropic medications too aggressively. The tapering coincided with some other stressors.

And I fell into the abyss.

I fell harder than I ever have.

A New Perspective from My Daughter

Resolved to find a non-drug solution, I tried transcranial magnetic stimulation (TMS), a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. Approved by the FDA in 2008, TMS involves a large electromagnetic coil that’s placed against your scalp. The coil generates focused pulses that pass through your skull and stimulate the cerebral cortex of your brain, a region that regulates mood.

While I did feel an initial lift from my depression following TMS treatment, my anxiety worsened, creating suicidal thoughts that were even more intense and compulsive — as if there was a very thin veil between life and death, and I didn’t know how long I could muster the self-control to stay on the right side. The series (45 sessions in all) sent me into a dangerous, mixed state of mania and depression — something that can happen if a bipolar person does the treatment without enough of a mood stabilizer.

At one point halfway through the series, I was crying when I picked my daughter up from school. I couldn’t quiet my painful ruminations even when I was with her.

“I feel like you are never going to get better,” she said, starting to cry herself.

She paused and then said, her breathing broken, “I just feel like someone is going to die.”

She began to wail.

As much as I didn’t want her to be right, I knew she was.

My little girl has always been extremely intuitive, and she could feel it in her soul that I was not far away from the grave. Two weeks after she said that, we lost a family member to suicide.

His death forced a new perspective.

Living With a Life-Threatening Illness

I realized I had to do absolutely everything I could to protect my life. In a pursuit to heal myself naturally, I had been flirting too closely with death, and I couldn’t say how long I could survive doing this dance. I was finally ready to accept chronic illnesses and tumors and nasty side effects in order to stay alive.

For the first time since my aunt and godmother took her life 30 years ago, I saw the life-threatening angle of my illness and knew that, while I can certainly improve my symptoms with natural remedies and possibly reduce the amount of medication I need, there is no escaping entirely from my mood disorder.

In the harrowing months since Thanksgiving, I’ve learned three key things that I hope I never forget as long as I’m battling bipolar disorder:

  • It is absolutely critical to be under the right care.
  • Medication can be lifesaving and is sometimes necessary.
  • While we can all hope to heal ourselves in the wider sense of the word, some of us simply can’t cure ourselves entirely of our conditions; at best, we can manage them with a variety of treatments, both natural and traditional.

I returned recently to my former psychiatrist who had managed to keep me stable for 10 years, as well as to my therapist, whom I’ve worked with for nine years. Feeling a little bit like the prodigal son, I thanked her for her excellent care in years past and asked for her help in getting well once more.

We’ll get there, she said.

We’ll get there.

Join Project Hope & Beyond, a new depression community.

Originally posted on Sanity Break at Everyday Health.

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How I Found Joy Again After Depression Thu, 08 Jun 2017 22:30:55 +0000 “Joy does not simply happen to us,” wrote spiritual author Henri Nouwen. “We have to choose joy and keep choosing it every day.”

I find choosing joy and trying to experience joy to be among the most difficult tasks when you are depressed. And yet it is critical to try to reconnect with those persons, places, and things that were once able to give us enjoyment.

I am fortunate to be working with a doctor who has known me for more than 10 years. When I fall into a depressive episode, her solutions are much more comprehensive than just a medication adjustment or a suggestion for a cognitive-behavioral technique.

This last week, her instructions, written out on her medical pad, included:

  • Exercise, but not too hard
  • Time in nature — enjoy the flowers
  • Light reading only, NO self-help
  • Find ways to experience pleasure — old TV series, favorite albums, etc.
  • No work this week

I took the assignment seriously, and it was much more challenging than I thought it would be. How hard can it be to find joy in your life? Yet when your amygdala (fear center of the brain) is under attack by a flood of chemicals and hormones, and a sense of panic permeates most of your hours, letting loose and soaking in the breeze requires a surprising commitment and perseverance.

My modus operandi is to reach for one or more of the following: self-help books, work, mindfulness strategies, intensive workouts, or more therapy to try to fix my symptoms. So this exercise was uncomfortable for me. I wanted to file her instructions with my list of household chores, like decluttering and going through my bookshelves and kids’ closets — to be done at a later time when I feel better.

But I told myself these directions were just as important as if she’d written out a prescription for a mood stabilizer. So this week, I made time to do the following:

  • Listen to Frank Sinatra
  • Play volleyball with my daughter
  • Go on many nature walks
  • Get a massage
  • Kayak
  • Bike along the Severn River
  • Watch Anchorman, Minions, and reruns of How I Met Your Mother
  • Have lunch and coffee with friends
  • Swim
  • Pack a picnic
  • Read for pleasure (Wild), not self-help
  • Walk the dogs with my husband

I wish I could say that my symptoms disappeared with these activities. They didn’t. The death thoughtspanic, and sadness persisted — at least for some of the time. But I believe that our muscles have memory, and those memories will eventually help us to recover. For example, when I swim, even though I may be in a depressed state, there are subconscious memories of my childhood days swimming — some of my happiness days — and some great adult moments, too, preparing to swim across the Chesapeake Bay with friends. My body knows it has experienced joy before doing this activity, and that joy will return when I’m not in such a biochemical storm.

I remember the words of the psychiatric nurse when I was hospitalized at Johns Hopkins’ psychiatric unit. During group therapy one day, she had us all go around a circle and mention one thing that brought us joy — one activity that we loved to do when we were feeling well.

“You will enjoy those things again,” she said. “You must trust me on that.”

That’s the hard part: hanging on to the optimism that says that joy is near and that it will return, as long as we persevere and continue to do those things that once brought us happiness.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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Does Weather Affect Your Mood? Fri, 02 Jun 2017 18:30:50 +0000 Is your mood influenced by weather?

I am clearly affected by rain — especially when it rains consistently for weeks as it has lately. I know other people who are, too, so I thought I’d study why the extra precipitation alters the limbic system (emotional center) of the brain and review the research regarding mood and weather.

Studies that Link Mood and Weather

John Grohol, PsyD, founder and CEO of Psych Central, offers a great overview of the studies that exist on weather and mood. There is research that says weather has little to do with mood, he notes, but “the overall preponderance of evidence suggests that weather can have more than just ‘a little effect’ on you mood.”

Here are some of the studies Dr. Grohol presents.

The largest, published in 1974 in the journal Acta Paedopsychiatrica, involved 16,000 students in Basel City, Switzerland. In the study, 18 percent of the boys, and 29 percent of the girls, responded negatively to certain weather conditions, exhibiting symptoms of fatigue, dysphoric moods, irritability, and headaches.

In a small study published in 1984 in the British Journal of Psychology, a group of 24 men were studied over 11 days. It was determined that humidity, temperature, and hours of sunshine had the greatest effect on their mood. The finding on humidity was the most interesting to me. “High levels of humidity lowered scores on concentration while increasing reports of sleepiness,” the researchers wrote.

Finally, in a study published in Psychological Science in 2005, researchers followed 605 participants in three separate studies to determine the connection between mood and weather. They found that pleasant weather (a higher temperature or barometric pressure) was related to higher mood, better memory, and “broadened” cognitive style during the spring as subjects spent more time outside. The abstract states, “These results are consistent with findings on seasonal affective disorder, and suggest that pleasant weather improves mood and broadens cognition in the spring because people have been deprived of such weather during the winter.”

Warmer Isn’t Always Better

According to an analysis published in Emotion in 2008, much of the research indicates that warmer weather seems to bring cheerier moods.

But heat can also make people more aggressive.

In a study published in Science in 2013, researchers reported that as temperatures rose, the frequency of interpersonal violence increased by 4 percent, and intergroup conflicts by 14 percent. The same fluctuation in behavior occurred with extreme rainfall.

I’ve always found it curious why suicides spike in spring and summer. Isn’t that when depression is supposed to lift?

Dr. Grohol mentions a comprehensive study review published in 2012 in Acta Psychiatrica Scandinavica that examined the literature on suicide seasonality between 1979 and 2009. As a group, the studies confirmed a seasonal pattern for both the Northern and Southern hemispheres: an increase in suicides during spring and early summer, and a decrease in autumn and winter months. In addition, the studies suggested that there is an especially strong pattern of suicide in the spring for men and older individuals, and for violent methods of suicide.

The “Happy Complex” of Spring

In my blog post about spring depression and anxiety, I offered a few theories as to why moods dip in April and May: change and transition (which is harder on some of us), hormone fluctuation as we adjust to more sunlight, allergies and toxins in the air, and perhaps the “happy complex”: Everyone else is humming as they work in their garden, delighted that spring has arrived — and you feel that pressure to be happy as well, which makes you even more, well, unhappy.

Some people feel left out of the increased social interaction that happens in spring. Experts believe that more suicides happen in spring because the warmer weather provides a person with the extra energy to pursue a suicidal plan that they didn’t have the energy to pursue during the winter months.

Weather and the Highly Sensitive Person

Weather is going to affect you more if you are a highly-sensitive person, as defined by Elaine Aron, PhD, in her best-seller, The Highly Sensitive Person. If you answer yes to these and most of the questions on Aron’s website, you’re probably in the club, which represents 15 to 20 percent of human beings. Are you easily overwhelmed by bright lights and noise? Do you startle easily? Do other people’s moods influence you? Does caffeine have a great effect on you?

Research has indicated that hypersensitive people are genetically different from folks who have a normal degree of sensitivity. This might explain why the rain or cold or heat affects some of us much more than others, and why some people would thrive in a humid, hot climate, while others would wilt. Your response to weather would depend on your sensitivity type.

What’s Your Weather Personality Type?

In a study published in Emotion in 2011, researchers defined weather-reactivity types by linking self-reported daily moods across 30 days with objective weather data. They found that there were four distinct types of people when it comes to reactions to weather. As they wrote in the abstract:

The types were labeled Summer Lovers (better mood with warmer and sunnier weather), Unaffected (weak associations between weather and mood), Summer Haters (worse mood with warmer and sunnier weather), and Rain Haters (particularly bad mood on rainy days). In addition, intergenerational concordance effects were found for two of these types, suggesting that weather reactivity may run in the family.

I know my weather type. I’m a Summer Lover and a Rain Hater. Without question, I am also a highly sensitive person, which makes my mood very vulnerable to the changes in the weather.

All Rain Haters and highly sensitive types are welcome on my ark.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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Ketamine: A Miracle Drug for Depression? Wed, 24 May 2017 22:30:14 +0000 A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.

Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.

Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.

In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.

In the most recent study published online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.

“This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments,” said Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression. “By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”

In response to the Nature report, Sara Solovitch of The Washington Post wrote that “experts are calling [ketamine] the most significant advance in mental health in more than half a century.” She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.

It all sounds too good to be true, right?

The Drawbacks of Ketamine

The predominant drawback of ketamine is the lack of data.

There haven’t been enough clinical trials on the drug to assure its safety, and there’s a lack of information on the long-term effects of its use.

Ketamine’s effects are also short-lived. To be used as an effective antidepressant, it would need to be administered regularly, which leads to concerns about addiction, tolerance, and, again, long-term effects. The data that we do have on long-term use comes from people who have taken ketamine recreationally, as well as those who have used it to treat chronic pain. One 2014 study published in the British Journal of Clinical Pharmacology included among possible side effects psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.

Still, the drug holds promise for uncovering new ways of treating depression and offers hope for the most severe and complicated mood disorders that baffle psychiatrists today.

“Unraveling the mechanism mediating ketamine’s antidepressant activity is an important step in the process of drug development,” said Richard J. Hodes, MD, director of the National Institute on Aging, about the most recent NIH study. “New approaches are critical for the treatment of depression, especially for older adults and for patients who do not respond to current medications.”

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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How Faith Helps Depression Thu, 18 May 2017 14:20:24 +0000 A substantial amount of research points to the benefits of faith to mitigate symptoms of depression. In one study, for example, researchers at McLean Hospital in Belmont, Massachusetts, found that belief in God was associated with better treatment outcomes. They followed 159 individuals over the course of a year to examine the relationship between a person’s level of belief in God, expectations for treatment, and actual treatment outcomes. Individuals with no belief — or only a slight belief — in God were twice as likely to not respond to treatment than people with stronger beliefs.

Of all my sanity tools, my faith is what has kept me alive during severe depressive episodes. When I’m convinced that no one else could comprehend the intense suffering I’m experiencing, I cling to my belief in a God who created me for a reason, who knows my pain more intimately than any other human being, and who will see me through to the other side.

Faith Provides Hope

I was just 11 years old when I learned of faith’s power to strengthen someone in the midst of a deep depression. In the year of my parent’s separation, my mother, devastated by the loss, prayed a novena to Saint Thérèse of Lisieux. On the fifth day of five consecutive days of prayer, when tradition holds that the person will receive a shower of roses, our neighbor Mr. Miller, who kept an impeccable garden, was pruning his rose bushes. He gave six dozen flowers in stunning shades to my sister to surprise my mother. I’ll never ever forget the tears of hope she cried when, on the fifth day of her novena, she walked into a kitchen that looked and smelled like a rose garden. Through the intercession of St. Thérèse, she knew her prayer had been answered and God would give her the resolve she needed to get through her depression.

For a nonbeliever, I know it may appear lame to depend on such “signs” from God — superstitious attempts to make sense out of nothing. But these “signs” have provided me immense comfort during critical times in my mental health journey; they’re consolation that God is with me. They’ve even saved my life at times, reminding me that although I can’t always feel God’s love, He is with me.

Faith Changes Your Brain

One reason that faith protects against depression could be that religious practice actually changes the brain. According to research conducted by Lisa Miller, professor of clinical psychology at Columbia University’s Teachers College, a thickening of the brain cortex is associated with spiritual and religious activities. This study links the protective benefit of spirituality or religion to previous studies that identified large expanses of cortical thinning in specific regions of the brains of adult offspring of families at high risk for major depression. A previous study by Miller and her team published in September 2011 in The American Journal of Psychiatry showed a 76 percent decrease in major depression in adults who said they highly valued spirituality or religiosity, and whose parents suffered from the disease.

Faith Assigns Meaning to Suffering

All religious traditions, especially the Jewish and Christian faiths, offer plenty of examples of how some very bad situations (think Job) were redeemed in the end, and all the suffering actually had a purpose — some greater good came out of it. The Christian story is a powerful provider of redemption and hope in Jesus’s life, death, and resurrection. Pope John Paul II explains in his encyclical on suffering, Salvifici Doloris, that because of the Cross, all suffering has a purpose and is even a vocation. I, for one, find immense consolation in that concept: that my tears and angst have a greater purpose and can be used for goodness. The Psalms are full of verses of inspiration for those caught in depression’s hold, saying that God is there in our trials and will carry us through the valley of despair.

Faith Provides a Support System

According to research conducted at the University of Colorado in Boulder, regular churchgoers live longer than people who never go to worship services. One reason associated with the longevity is the social support gained by a church community. One consistent key to happiness is weaving a network of support for yourself: We all need a security net. If you go to church regularly — and especially if you get involved in your parish or church community — that social support is provided. Also, regular churchgoers are more likely to GIVE support to others, and this act of generosity, or any altruistic activity, really, promotes better health.

Faith Provides Heroes and Inspiration

We do better navigating the dark night when we know people have walked the same steps before us and arrived at the light. Different faith traditions offer us plenty of heroes we can turn to for inspiration. Like my mom, I have always maintained a strong devotion to St. Thérèse of Lisieux, my patron saint. In my deepest depressions, I would read her Story of a Soul over and over again, trying to imitate her faithfulness and little ways despite her despair at the end of her life. So many of the saints have known profound anguish and depression, which is why they can be helpful guides to anyone with inner pain.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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What I Would Do Differently if I Were Diagnosed with Depression Today? Wed, 10 May 2017 10:30:20 +0000 man-person-legs-grassSomeone in recovery circles once told me that if you have one foot in the past and another in the future, you are essentially peeing on the present. I try to remember that when I’m engulfed in regret — obsessing about all the things I did wrong in the past and wishing to God I had made different decisions. However, writing about my mistakes has always been healing for me because I’d like to think this small action could possibly prevent someone else from making the same ones. If I can help a young person or anyone who has recently been diagnosed with depression take a more direct route to healing, it seems irresponsible on my part not to share my detours and missed cues, to keep to myself the information that I now have.

Each mental health journey is so very unique. Therefore, I can’t tell you what’s right for you. My wish is that my story might give some person out there an ounce of hope that if she never stops thinking for herself, and is involved in the decisions of her health, it is possible to live a full life with depression.

What would I have done differently?

I Would Have Made Sure I Was Under the Right Care

When I was first diagnosed with depression, I settled with the first doctor I met, a man who saw me for about ten minutes every month, with whom I felt very uncomfortable. I put my health into his hands because, at 18 years old, I thought all doctors were the same, and I didn’t have an option for better care.

I spent 10 years going through seven doctors who all misdiagnosed me. Needless to say, I missed out on a lot of life during that time.

I’d advise people to go to a teaching hospital for the best psychiatric care, where you will find physicians conducting research on new therapies and medications to treat depression, tackling complex conditions by drawing from their own collection of data. It is there, in those classrooms and labs, that evidence-based information is produced – the gold that leads to miracles.

At a teaching hospital, you’re more apt to find a psychiatrist who will spend a few hours at your initial consultation and prescribe medications they know work, like Lithium, which has been around for a long time but isn’t going to make anyone rich.

I Would Have Been a Difficult Patient

As I said in another post, it’s only in the last three years that I have become a “difficult” patient — a woman who isn’t afraid to ask questions and probe her physician for more information. A good psychiatrist can handle it. She wants you to get well and will welcome additional research, inquiries, doubts, etc. If a doctor is threatened by queries, which I have experienced, I think this is a red flag that ego issues could impede optimal care.

If I were sitting in my first psychiatrist’s office today, 25 years later, I would be my own health advocate. Only I know my body — the way I suffer after eating sugar and white flour, the systemic weaknesses that surface when managing too much stress, the gut problems that go back to when I was a baby, my adverse responses to certain medications. Physicians can access useful medical data and pull information from their years of training and practice, but they need a patient’s input to customize treatment plans for difficult depression cases. If I could go back, I would have been invested 100 percent in my own health and been a difficult patient.

I Would Have Treated Any Underlying Causes

It took me more than two decades to consider some underlying causes of my mood disorder, health conditions that worsen my depression. I am growing more convinced that persons who suffer from chronic depression and anxiety usually have other ailments contributing to their symptoms that they are unaware of: hypothyroidism, gastrointestinal disorders, Lyme disease, hormonal imbalances, adrenal fatigue, sleep apnea, alcoholism or substance abuse, anemia, autoimmune conditions, and nutritional deficiencies.

Because of the current healthcare system, psychiatrists and primary-care physicians don’t have the time (and many simply don’t have the insight) to ask about a person’s digestive history or any other general health questions that would provide clues to an underlying condition feeding the symptoms of depression and anxiety. For me, cleaning up my gut issues, addressing my pituitary tumor, taking some key supplements like Vitamin D and Vitamin B12, and changing my diet made a substantial impact on my mood.

I Would Have Been More Educated About Medications

There is a place for medication. I absolutely believe that. Having recently gone through hell trying to taper off my meds, I am now more convinced than ever that drugs can be life-saving. I just wish I would have been more knowledgeable about their side-effects so that I could have better assessed the benefit-risk ratio, especially during those periods of my life in which I might have been okay with less, and definitely during the time when I was with a psychiatrist who overmedicated me.

I Would Have Learned Ways to Calm Myself Down

So many of my depressive symptoms are tied to my stress reaction. As I’ve said in other posts, I believe that my mood disorder is essentially a stress disorder — the tension generates static in my central nervous system and other biological systems that promote “dis-ease” in every sense.

Looking back, I wish I would have invested some time in the activities I do now — like deep breathing and yoga and mindfulness and Epsom-salt baths and massage and aromatherapy — to prime my parasympathetic system and reverse the detrimental stress reaction that can cause depressive symptoms. I wish I would have attended the Mindfulness-Based Stress Reduction (MBSR) course back then. I would have felt more in control of my emotional health.

I Would Have Focused on Epigenetics Along With Genetics

We all have genes that predispose us to certain illnesses — in my case, most of what’s inside the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — but the key word here is “predispose.” When I was first diagnosed with depression, I was stuck on my aunt’s severe bipolar disorder and suicide and felt certain that, because I shared some of her genes, I would end up hospitalized on and off for the rest of my life, as well. Looking back, there were too many conversations between my therapist and me about family history and what I should be careful about, and not enough about the freedom I had to take my health in a direction vastly different from my aunt’s.

I know that I need always remember my family history; it serves as a reminder of what can happen if I don’t take my mood disorder seriously. However, alongside genetics, I am also concentrating on the new science called epigenetics (meaning “above” or “outside” of genetics), the study of cellular variations that are not caused by changes in the DNA sequence. Epigenetics is closely related to the concept of neuroplasticity that says that we aren’t stuck with the brain that we were born with. We have more room than we think we do to direct our health toward healing and wholeness.

Join Project Hope & Beyond, the new depression community.

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How to Let Go of the Thoughts that Cause Depression Sun, 30 Apr 2017 10:30:15 +0000 pexels-photo (1)Depression is different from other illnesses in that, in addition to the physiological symptoms (loss of appetite, nervousness, sleeplessness, fatigue), there are the accompanying thoughts that can be so incredibly painful. For example, when my Raynaud’s flares up, the numbness in my fingers can be uncomfortable, but it doesn’t tell me that I am worthless, pathetic, and that things will never ever get better. During severe depressive episodes, however, these thoughts can be life-threatening: They insist that the only way out of the pain is to leave this world.

Being able to manage our thought stream will direct us toward health, as our thoughts are constantly communicating with the various systems of our body, either sending certain glands or organs an SOS in distress, or a note that everything is fine, resulting in calm. But being able to harness this craziness in the midst of depression and anxiety is so very difficult.

Here are some of the ways I try to let go of the thoughts that cause depression and anxiety. Some days I am much more successful than others.

Identify the Distortions

I have benefited immensely from David Burns’ book Feeling Good: The New Mood Therapy — from doing the cognitive behavioral therapy exercises he prescribes to identifying the various distortions in my own thinking that he presents in his book and his workbook. They include:

  1. All-or-nothing thinking – I look at things in absolute, black-and-white categories.
  2. Overgeneralization – I view a negative event as a never-ending pattern of defeat.
  3. Mental filter – Dwelling on the negatives and ignore the positives.
  4. Discounting the positives  Insisting that my accomplishments or positive qualities don’t count (my college diploma was a stroke of luck … really, it was).
  5. Jumping to conclusions – I conclude things are bad without any definite evidence. These include mind reading (assuming that people are reacting negatively to you) and fortune telling (predicting that things will turn out badly).
  6. Magnification or minimization – I blow things way out of proportion or shrink their importance.
  7. Emotional reasoning – Reasoning from how I feel: “I feel like an idiot, so I must be one.”
  8. “Should” statements – I criticize myself or other people with “shoulds,” “shouldn’ts,” “musts,” “oughts,” and “have-tos.”
  9. Labeling – Instead of saying, “I made a mistake,” I tell myself, “I’m a jerk” or “I’m a loser.”
  10. Blame – Blaming myself for something I wasn’t entirely responsible for, or blaming other people and overlook ways that I contributed to a problem.

It doesn’t take long to identify one or more of these in your thinking. Just recognizing these traps can be helpful. You might then try one of the methods listed in Burns’ 15 Ways to Untwist Your Thinking. A warning, though: I’d wait until you have emerged from a severe depressive episode before you attempt some of these exercises. I’ve made the mistake of trying too hard to “fix” my thinking during severe depression, which has made it worse. It’s better to focus on the other ways listed below.

Focus on the Present

Although every self-help book I read touches on this, I am just beginning to really learn what it means to focus on the present and to appreciate the healing power of mindfulness, which, according to meditation teacher and bestselling author Jon Kabat-Zinn, is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” If we continue to practice this, he explains, “this kind of attention nurtures greater awareness, clarity, and acceptance of the present-moment reality.” It’s not that we don’t feel the hurt, rage, and sadness that lives at the surface of our minds. It’s not an attempt to escape all the suffering that is there. But if we can observe all of our projections into the past and future — and all of the judgments that are part of our thought stream — and simply get back to what is happening right now, right here, we can allow a little room between our thoughts and our reality. With some awareness, we can begin to detach from the stories that we spin and from the commentaries that are so often feeding our pain.

One of the best ways we stay present is by keeping our attention on our breath. Vietnamese Zen Buddhist Thich Nhat Hanh instructs us that with each in-breath, we might say, “Breathing in, I know that I am breathing in.” And with each out-breath, “Breathing out, I know I am breathing out.” In his book You Are Here, he explains that mindful breathing is a kind of bridge that brings the body and the mind together. We start by this simple gesture of watching our breath, and then by this mindfulness of breath we begin to stich the body and mind together and generate a calm that will penetrate both.

Apply Self-Compassion

“Self-compassion doesn’t eradicate pain or negative experiences,” Kristin Neff, PhD, explains in her book Self-Compassion. “It just embraces them with kindness and gives them space to transform on their own.” It gives us the “calm courage needed to face our unwanted emotions head-on.” When I’m in the most pain — especially during a severe depressive episode — it is self-compassion more than anything else (cognitive behavioral therapy techniques, mindful breathing, etc.) that saves me and restores me to sanity. Nhat Hanh says that we should treat our depression tenderly, as we would treat a child. He writes:

If you feel irritation or depression or despair, recognize their presence and practice this mantra: “Dear one, I am here for you.” You should talk to your depression or your anger just as you would to a child. You embrace it tenderly with the energy of mindfulness and say, “Dear one, I know you are there, and I am going to take care of you,” just as you would with your crying baby.

It is so easy to be so cruel to ourselves without even realizing it. The ruminations that are part of depression beat us down and shred us until there is practically nothing there. That’s why it is so critical to apply self-compassion from the start, and treat ourselves, as well as our depression, as the scared little child that needs comforting, not scorn.

Acknowledge the Transience of Things

One of my favorite prayers is St. Teresa of Avila’s “Bookmark” that says:

Let nothing disturb you,

Let nothing frighten you,

All things are passing;

God only is changeless.

Patience gains all things.

Who has God wants nothing.

God alone suffices.

If the religious language bothers you, Eckhart Tolle says much the same when he writes in A New Earth:

Once you see and accept the transience of all things and the inevitability of change, you can enjoy the pleasures of the world while they last without fear of loss or anxiety about the future. When you are detached, you gain a higher vantage point from which to view the event in your life instead of being trapped inside them.

Absolutely everything, especially our feelings and emotions, is impermanent. By simply remembering that nothing ever stays, I am freed from the suffocating thoughts of my depression — the formidable fear that this sadness will always be with me, as well as the circumstances that are causing it. By acknowledging the transience of life, I am again called to pay attention to the present moment, where there is more peace and calm than I think.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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When Family Members and Friends Don’t Understand Depression Tue, 25 Apr 2017 15:45:02 +0000 pexels-photo-341378We’ve come a little way in reducing the stigma that’s associated with mental illness, but not nearly far enough.

Consider these results pulled from a public attitude survey in Tarrant County, Texas, conducted by the county’s Mental Health Connection and the University of North Texas in Denton to determine the community’s view of mental illness:

  • More than 50 percent believe major depression might be caused by the way someone was raised, while more than one in five believe it is “God’s will.”
  • More than 50 percent believe major depression might result from people “expecting too much from life,” and more than 40 percent believe it is the result of a lack of willpower.
  • More than 60 percent said an effective treatment for major depression is to “pull yourself together.”

Unfortunately, these beliefs are often held by those closest to us, by the very people from whom we so desperately want support.

Resenting them for their lack of understanding isn’t going to make things better, though. It almost always makes things worse. Whenever I hit a severe depressive episode, I am reminded once more that I can’t make people understand depression any more than I can make a person who hasn’t gone through labor understand the intense experience that is unique to that situation. Some people are able to respond with compassion to something that they don’t understand. But that is very rare.

Don’t Mistake Their Lack of Understanding for a Lack of Love

Whenever I try to open the doors of communication and express to a family member or friend how I am feeling, when I try to articulate to them the pain of depression, and am shut down, I usually come away extremely hurt. I immediately assume that they don’t want to hear it because they don’t love me. They don’t care enough about me to want to know how I am doing.

But distinguishing between the two is critical in maintaining a loving relationship with them. My husband explained this to me very clearly the other day. Just because someone doesn’t understand depression or the complexity of mood disorders doesn’t mean they don’t love me. Not at all. They just have no capability of wrapping their brain around an experience they haven’t had, or to a reality that is invisible, confusing, and intricate.

“I wouldn’t understand depression if I didn’t live with you,” he explained. “I would change the subject, too, when it comes up, because it’s very uncomfortable to a person who isn’t immersed in the daily challenges of the illness.”

This is a common mistake that many of us who are in emotional pain make. We assume that if a person loves us, he or she would want to be there for us, would want to hear about our struggle, and would want to make it better. We want more than anything for the person to say, “I’m so sorry. I hope you feel better soon.”

The fact that they aren’t able to do that, however, does not mean they don’t love us. It just means there is a cognitive block, if you will, on their part — a disconnect — that prevents them from comprehending things beyond the scope of their experience, and from things they can see, touch, taste, smell, and feel.

Don’t Take It Personally

It is incredibly difficult not to take a person’s lack of response or less-than-compassionate remark personally, but when we fall into this trap, we give away our power and become prey to other people’s opinions of us. “Don’t Take Anything Personally” is the second agreement of Don Miguel Ruiz’s classic The Four Agreements; the idea saves me from lots of suffering if I am strong enough to absorb the wisdom. He writes:

Whatever happens around you, don’t take it personally … Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.

Even when a situation seems so personal, even if others insult you directly, it has nothing to do with you. What they say, what they do, and the opinions they give are according to the agreements they have in their own minds … Taking things personally makes you easy prey for these predators, the black magicians. They can hook you easily with one little opinion and feed you whatever poison they want, and because you take it personally, you eat it up ….

Protect Yourself

I have learned that when I fall into a dangerous place — when I am so low that mindfulness and other techniques that can be helpful for mild to moderate depression simply don’t work — I have to avoid, to the best of my ability, people who trigger feelings of self-loathing. For example, some people in my life adhere tightly to the law of attraction and the philosophies of the book The Secret by Rhonda Byrne that preach that we create our reality with our thoughts. They have been able to successfully navigate their emotions with lots of mind control and therefore have trouble grasping when mind control isn’t enough to pull someone out of a deep depression.

I struggle with this whenever I fall into a depressive episode, as I feel inherently weak and pathetic for not being able to pull myself out of my pain, even if it means simply not crying in front of my daughter, with the type of mind control they practice, or even mindfulness or attention to my thoughts. This, then, feeds the ruminations and the self-hatred, and I’m caught in a loop of self-flagellation.

Even if they aren’t thinking I’m a weak person, their philosophies trigger this self-denigration and angst in me, so it’s better to wait until I reach a place where I can embrace myself with self-compassion before I spend an afternoon or evening with them. If I do need to be with people who trigger toxic thoughts, I sometimes practice visualizations, like picturing them as children (they simply can’t understand the complexity of mood disorders), or visualizing myself as a stable water wall, untouched by their words that can rush over me.

Focus on the People Who Do Understand

In order to survive depression, we must concentrate on the people who DO get it and surround ourselves with that support, especially when we are fragile. I consider myself extremely lucky. I have six people who understand what I’m going through and are ready to dole out compassion whenever I dial up their numbers. I live with an extraordinary man who reminds me on a daily basis that I am a strong, persevering person and that I will get through this. Whenever my symptoms overtake me and I feel lost inside a haunted house of a brain, he reminds me that I have a five hundred pound gorilla on my back, and that my struggle doesn’t mean that I am a weak person not capable of mind control. At critical periods when I’m easily crushed by people’s perceptions of me, I must rely on the people in my life that truly get it. I must surround myself with folks who can pump me up and fill me with courage and self-compassion.

Depression support groups — both online and in person — are invaluable in this regard for offering peer support: perspectives from people in the trenches who can offer key insights on how to deal with the invisible beast. I created two online groups, Group Beyond Blue on Facebook and Project Beyond Blue, but there are many forums worth checking out, like the ones at Psych Central. Actual support groups hosted by such organizations as National Alliance on Mental Illness (NAMI) and Depression and Bipolar Support Alliance (DBSA), and support offered by a therapist, are also great resources to help give you the coping tools you need to get by in a world that doesn’t get it.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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10 Famous People with Depression, Bipolar Disorder or Both Thu, 20 Apr 2017 22:30:26 +0000 abraham-lincoln-lincoln-memorial-washington-dc-lincolnWhenever I hit a depression rut, where I feel disabled by the illness and therefore pathetic for being brought to my knees by a bunch of thoughts, it helps me to review celebrities — esteemed politicians, actors, musicians, comedians, astronauts, writers, and athletes — that I admire from both the past and present who have also wrestled the demons of depression and bipolar disorder. I feel less alone knowing that this infuriating condition doesn’t discriminate, and that I’m fighting alongside some of the world’s most talented and accomplished people.

Here are a few of the luminaries that have, over the course of their lives, shed some of the stigma of mental illness with their stories and who serve as inspiring role models for those of us in the trenches.

1. Ashley Judd

While visiting her sister, country singer Wynonna Judd, at a treatment center in 2006, counselors suggested that the actress and political activist check herself in, too. So Ashley Judd did just that and spent 47 days in a Texas treatment facility for depression and emotional problems. In a Today interview, she told Matt Lauer:

I was absolutely certifiably crazy, and now I get to have a solution. And for those who are codependent or suffer from depression, there is a solution.

In her memoir, All That Is Bitter and Sweet, Judd describes the abuse and neglect in her turbulent upbringing that led, in part, to her emotional pain and breakdown — and also the hope she feels by focusing on humanitarian work around the world.

2. Catherine Zeta-Jones

Academy Award winning actress Catherine Zeta-Jones never wanted to become a poster child for bipolar II disorder after she went public with her illness in April 2011, but she has nevertheless become a beautiful face behind the disorder. I, for one, am relieved the world can make a connection between one of the most talented and glamorous movie stars and a misunderstood illness.

I found it especially reassuring when she checked into a 30-day program in April 2013 to treat her disorder. The fact that a star can give herself permission to withdraw from the world in order to heal helps me feel less shame when I have to take a time-out for self-care myself.

3. Abraham Lincoln

Award-winning author Joshua Wolf Shenk did a masterful job of exposing the inner demons of the 16th president of the United States in his book Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness. I go back and read certain chapters whenever I need to be reminded that this curse can render gifts if we have the strength and perseverance to tame it, as Lincoln did. Shenk writes:

With Lincoln we have a man whose depression spurred him, painfully, to examine the core of his soul; whose hard work to stay alive helped him develop crucial skills and capacities, even as his depression lingered hauntingly; and whose inimitable character took great strength from the piercing insights of depression, the creative responses to it, and a spirit of humble determination forged over decades of deep suffering and earnest longing.

4. J.K. Rowling

When the author of the runaway bestselling Harry Potter series was a struggling writer in her twenties — a single mother and newly divorced — she suffered from severe depression and contemplated suicide. She sought help through cognitive behavioral therapy, and after nine months, the suicidal thoughts disappeared.

“I have never been remotely ashamed of having been depressed,” she said in an interview on “Never. What’s there to be ashamed of? I went through a really tough time and I am quite proud that I got out of that.” Today she doesn’t hesitate to talk about her depression in order to fight the stigma associated with mental illness.

5. Jared Padalecki

Supernatural star Jared Padalecki openly talks about his struggles with depression and feels so passionately about supporting people battling emotional demons that he initiated Always Keep Fighting, his T-shirt campaign through to benefit the nonprofit organization To Write Love on Her Arms (TWLOHA), which supports people struggling with depression, addiction, self-injury, and suicide.

During filming of the third season of Supernatural, Padalecki broke down in his trailer after shooting an episode. A doctor soon diagnosed him with clinical depression; he was 25 at the time. Padalecki recently told Variety:

I, for a long time, have been passionate about people dealing with mental illness and struggling with depression, or addiction, or having suicidal thoughts and, strangely enough, it’s almost like the life I live as well. These characters that we play on Supernatural, Sam and Dean, are always dealing with something greater than themselves, and I’ve sort of learned from the two of them that they get through it with each other, and with help and with support.

6. Brooke Shields

Brooke Shields had just released her book Down Came the Rain in 2005 about her bout with postpartum depression when I plunged into a severe depression and was hospitalized. A friend sent the book to me, and I’ll always remember the relief I felt when I read the back cover copy — feeling as though this actress-model was giving me permission to feel the pain: “Sitting on my bed, I let out a deep, slow, guttural wail,” she writes. “I wasn’t simply emotional or weepy … This was something quite different. This was sadness of a shockingly different magnitude. It felt as if it would never go away.”

She also wrote a brave op-ed piece for The New York Times following Tom Cruise’s infamous rant with Matt Lauer on NBC’s Today about psychiatry, lambasting Shields and others for taking antidepressants. “Once we admit that postpartum is a serious medical condition,” she writes, “then the treatment becomes more available and socially acceptable. With a doctor’s care, I have since tapered off the medication, but without it, I wouldn’t have become the loving parent I am today.”

7. Winston Churchill

British Prime Minister Winston Churchill referred to his depression as his “black dog”: recurrent episodes of darkness that permeated his life, influencing his career and political leadership. Some people surmise that it was Churchill’s depression that ultimately allowed him to assess the threat of Germany. British psychiatrist Anthony Storr writes:

Only a man who knew what it was to discern a gleam of hope in a hopeless situation, whose courage was beyond reason and whose aggressive spirit burned at its fiercest when he was hemmed in and surrounded by enemies, could have given emotional reality to the words of defiance which rallied and sustained us in the menacing summer of 1940.

He was born into a family of mental illness, and his daughter Diana committed suicide in 1962. Still, he managed to lead the United Kingdom as prime minister from 1940 to 1945 and again from 1951 to 1955, to thrive as a writer and historian, winning the Nobel Prize in Literature, and to be the first person to be made an honorary citizen of the United States.

8. Art Buchwald

He was one of the most successful newspaper columnists of his time, the recipient of a Pulitzer Prize, and a comic genius. But I appreciated Art Buchwald most as one of the three “Blues Brothers” (with Pulitzer Prize winner William Styron and former 60 Minutes reporter and cohost Mike Wallace), who spoke and wrote publicly about his bouts with depression and bipolar disorder.

Buchwald was hospitalized for clinical depression in 1963 and for manic depression in 1987. He was suicidal both times, and credited prescription drugs, therapy, and the hospital staff for saving his life. Had the nurses not been there to “rock him like a baby” during his harrowing dark night, he said he believed he might not have survived to see the light at the end of the tunnel.

9. Amanda Beard

Amanda Beard seemed to have the perfect life: four Olympic medals by age 18 and a promising modeling career. But in a People interview, she confessed that when she went home, “it was just darkness.” Her self-loathing led to bulimia, cutting herself, and depression. In September 2005, Beard began taking antidepressants and seeing a therapist. “It’s not like I went to therapy and — poof! better,” she said in the interview.

Today she’s off her medication, and she hasn’t cut herself since 2008. I admire that she’s real about the enduring struggle. “Even today I have my issues,” she says, “The key is saying, ‘Let’s enjoy this — life is short.’”

10. Jane Pauley

Jane Pauley, the former host of Today and Dateline NBC, was diagnosed with bipolar disorder in 2001 and wrote about her illness in her 2004 memoir, Skywriting: A Life Out of the Blue. During a leave from the network, she was admitted to a psychiatric clinic and treated, but no one at the time knew about her struggles. Now she is outspoken about living with bipolar disorder and depression and raises awareness about mental illness.

In a 2004 Today interview, Pauley explained that her diagnosis was a shock and a relief. She believes it surfaced due to a combination of antidepressants and steroids she took for a case of hives. About taking lithium, she said to Matt Lauer:

It just is stabilizing. It allows me to be who I am. A mood disorder is dangerous. You’ve got to get those dramatic highs and lows stabilized. It’s dangerous if you don’t.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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7 Tips to Manage Your Weight When Taking Psychiatric Medication Wed, 12 Apr 2017 14:20:50 +0000 belly-body-calories-diet-42069Weight gain is one of the main reasons that people diagnosed with depression and other mood disorders stop taking their medication. Some people gain as much as seven percent of their body weight — or more — from psychiatric meds. In a study funded by the National Institute of Mental Health that was published in July 2006 in the Archives of General Psychiatry, researchers reported that nearly one in four cases of obesity is associated with a mood or anxiety disorder.

But following a strict treatment plan that involves meds doesn’t have to mean shopping for a larger pants size. There are effective ways to manage your weight on psychiatric meds.

Here are some strategies that you might find helpful:

1. Control Food Portions

Skip the diet. Just limit your portions. Restaurants today tend to serve two to three times the amount of a healthy portion. We’ve added 570 calories A DAY to our diets since the late ’70s, and half of those calories can be attributed to large portions, according to research from the University of North Carolina in Chapel hill.

“Even though today’s serving sizes can be more than triple what the USDA recommends, they’ve become our new normal, and anything smaller can seem puny by comparison,” Lisa R. Young, PhD, RD, wrote in a Fitness magazine article.

I try to carve out an acceptable portion before I dig in, since it’s difficult to determine how much you’ve consumed otherwise. Sometimes I’ll use a smaller utensil to remind myself to savor the food and take small bites.

2. Eat Slowly and Chew Your Food

You’ve most likely at some point wolfed down a massive meal and felt fantastic until 15 minutes later, at which time you secure a few plastic bags because you’re convinced that you’ll explode on your kitchen floor.

It takes an average of 20 minutes for your brain to recognize that your stomach is full — a definite waiting period between the time that the fork delivers its bite to the mouth and the bite’s arrival to the stomach. Getting in sync with this digestive schedule can not only save you from discomfort, but can also trim your waistline. If you take your time to savor the food, you’ll feel more satisfied by eating less.

RELATED: Your 10 Biggest Antidepressant Problems, Solved

This is one of the reasons that French people don’t get fat, according to a study from Cornell University in Ithaca, New York. They can better gauge when they’re full by using internal cues to know when to stop eating, unlike Americans who stuff their faces while watching TV or graze all day long, never sitting down for an official meal. The French may eat baguettes and brie, croissants and butter, and all the other forbidden foods, but they enjoy them at a table with friends or family.

3. Keep a Food Journal

Taking notes keeps you accountable for everything you put in your mouth. It’s all there on paper for you to read as many times as you want. Knowing that you’ll record everything as you’re stuffing your face with a pastry can be the difference between eating one chocolate croissant and four. You’ll also keep your momentum when you’re in a groove because you’ll see your progress as recorded in your journal. Finally, you can pick up on patterns of eating behavior during the month and connect binge eating to various stressors or other events.

4. Get Support

Just as it’s difficult to stop smoking if you live with a smoker, it’s much more challenging to lose pounds when you’re surrounded by junk food addicts. You’ll be less tempted to snack on Twinkies if they’re not in your house. Obviously, you can’t put the people in your household on a diet with you, but there’s a level of support you can ask from them. You might also try an online or local weight loss support group to discuss weight loss challenges and frustrations.

5. Set Realistic Goals

It can be tempting to set a goal of losing five pounds every week — or some other unrealistic goals for weight loss — much like we set New Year’s resolutions that never stick. It’s better to be conservative and realistic. The safest rate of weight loss is between 0.5 to 2 pounds a week. Typically, if you lose weight at a slower, consistent pace, you tend to keep it off.

It’s helpful to break down your goals into incremental steps. For example, you might want to start walking for 10 minutes a day for two weeks, bumping it up by five minutes every week. You could also try to adopt a healthy diet in stages. For example, you might start limiting sweets for a few weeks before you attempt to cut out white bread.

6. Start an Exercise Program

You don’t need to run a marathon to get a good workout. Walking up to 30 minutes, three to four days a week is often enough to get your heart rate up and your pounds off. Choose an activity that’s convenient for you to do on a regular basis, and make it part of your day. It’s best to set a consistent time and stick to it.

7. Tap into Your Emotions

Often, eating isn’t about hunger. It’s about soothing some emotional wound. Food can be a powerful source of comfort to relieve stress, sadness, anxiety, loneliness, or boredom. But there are more effective ways to soothe uncomfortable feelings, like calling a friend, walking, or engaging in a support group. By recognizing the behavioral and emotional cues, you can better direct your angst.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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20 Quotes on Courage to Help You with Your Depression Tue, 04 Apr 2017 18:10:36 +0000 pexels-photo-239329Living with depression — and especially coping with chronic depression — demands courage over any other virtue: the courage to incorporate the lessons we’ve learned from the past in our strategies for better health in the future; the courage to ask for help when we need it, and to persevere in new directions of healing; and the courage to keep moving through self-defeating thoughts, meeting our pain with compassion, and keeping our body and mind in motion — on the path toward emotional resilience.

If you are like me, you need all the pep talks you can get to practice courage day in and day out. Here are some of my favorite inspirational quotes:

  1. Courage is not the absence of despair; it is, rather, the capacity to move ahead in spite of despair.
    – Rollo May
  2. You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.
    – Eleanor Roosevelt
  3. Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light gets in. 
    – Leonard Cohen
  4. We must build dikes of courage to hold back the flood of fear. 
    – Martin Luther King, Jr.
  5. Courage is grace under pressure.
    – Ernest Hemingway
  6. We can do anything we want if we stick to it long enough.
    – Helen Keller
  7. Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.
    – Mary Anne Radmacher
  8. When you walk to the edge of all the light you have and take that first step into the darkness of the unknown, you must believe that one of two things will happen: There will be something solid for you to stand upon, or you will be taught how to fly. 
    – Patrick Overton
  9. Courage is not simply one of the virtues, but the form of every virtue at the testing point.
    – C. S. Lewis
  10. Consult not your fears, but your hopes and your dreams. Think not about your frustrations, but about your unfulfilled potential. Concern yourself not with what you tried and failed in, but what is still possible for you to do.
    – Pope John Paul XXIII
  11. Courage is being scared to death … and saddling up anyway. 
    – John Wayne
  12. The person who risks nothing does nothing, has nothing, is nothing, and becomes nothing. He may avoid suffering and sorrow, but he simply cannot learn and feel and change and grow and love and live. 
    – Leo Buscaglia
  13. You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life. 
    – Steve Jobs
  14. A man can only do what he can do. But if he does that each day, he can sleep at night and do it again the next day.
    – Albert Schweitzer
  15. Let nothing disturb you, let nothing frighten you. Everything passes away except God; God alone is sufficient. 
    – St. Teresa of Avila
  16. Courage is fear holding on a minute longer. 
    – George S. Patton
  17. The greatest test of courage on earth is to bear defeat without losing heart. 
    – Robert Green Ingersoll
  18. True courage is like a kite; a contrary wind raises it higher.
    – John Petit-Senn
  19. Instead of seeing the rug being pulled from under us, we can learn to dance on the shifting carpet.
    – Thomas Crum
  20. It may be that some little root of the sacred tree still lives. Nourish it then, that it may leaf and bloom and fill with singing birds.
    – Black Elk

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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How to Find Accurate, Evidence-Based Information on Mood Disorders Tue, 21 Mar 2017 15:45:17 +0000 trust

If I had to choose just one piece of advice to give to the person disabled by depression or any mood disorder, it would be this: Work with the right professionals and seek out accurate, evidence-based information.

In 2006, having spent years absorbing inaccurate information and working with amateurs, I needed a miracle. I was dangerously close to taking my life. I made an appointment with the Johns Hopkins Mood Disorders Center and was evaluated by two savvy doctors, one of which became the psychiatrist that I have today.

The center saved my life. This physician saved my life. Visit

Now you have an opportunity to ask the Department of Psychiatry and Behavioral Sciences at Johns Hopkins any general question about mood disorders including diagnosis, treatments, research, what to expect, how to care for a loved one, and how to talk about symptoms. Simply visit and type your question in the space on the right-hand side.

The physicians, nurses, social workers, public health practitioners, psychologists, and researchers under the leadership of Dr. J. Raymond DePaulo Jr., M.D. and Dr. Kay Redfield Jamison, Ph.D., Directors of the Johns Hopkins Mood Disorders Center, will go through all questions submitted and pick one each week that they will answer with an engaging video. All videos will be posted for anyone to see with a library of all prior responses available in the ‘Q&A’ Page of this site.

Why I Believe in the Site

One of my largest regrets in life is wasting too much time and money on the wrong professionals and books and websites touting the latest fad or quick fix or theory for depression. Over and over again, I tried out advice based on circular reasoning (the person’s own opinion) or sales gimmicks, believing that all doctors and “experts” were created equal.

That’s why I now urge people to go to a teaching hospital for the best psychiatric care. The physicians of academic institutions and medical centers work together as a team to solve problems, conduct research on new therapies and medications to treat depression, and rely on their own collection of data — producing the invaluable evidence-based information that leads to miracles.

The Department of Psychiatry and Behavioral Sciences at Johns Hopkins Medicine is a recognized expert in the research of illnesses that afflict mental health and behavior. It is dedicated to providing proper diagnosis and treatment to patients, as well as educating the public on mental illness. In an age of ubiquitous access to technology, mobile devices and a population seeking to obtain information immediately online in engaging ways, the department seeks to create an online multimedia education project that reaches a wide public audience and provides reliable evidence-based information.

Try It Out!

I believe in this new resource.

I think it has the capacity to educate and inform in a way that will reduce suffering of those burdened by the symptoms of mood disorders.


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5 Ways to Free Yourself From Dark and Obsessive Thoughts Wed, 15 Mar 2017 10:30:39 +0000 pexels-photo-320273Stuck thoughts. Painful ruminations. Unrelenting obsessions. They are the curse of depression — among the most excruciating symptoms, in my opinion. “When a child gets lost, he may feel sheer terror,” explains Byron Katie in her bestseller Loving What Is. “It can be just as frightening when you’re lost inside the mind’s chaos.”

I can usually gauge the severity of my depression based on the intensity and frequency of my stuck thoughts. Sometimes they can outright debilitate me. One seemingly benign thought — often a rumination about a decision I have made in the past, a regret of one form or another, or sometimes something that makes no sense at all — is packed with panic and plays over and over in my mind, keeping me awake at night and besieging me with anxiety during the day.

More than any other symptom of my depression — more so even than unrestrained tears and bawling my eyes out in public — the stuck thoughts make me feel truly insane, scared to be living inside my body and mind.

In my post 9 Ways to Let Go of Stuck Thoughts, I offer some tools to deal with obsessions. But since I’ve been imprisoned by this insanity as of late, I thought I’d share more of the ways that have helped me escape, if only for a few minutes, to a place of peace.

1. Rely on Other Brains

In the state of severe rumination, your brain is toast. You have to fully admit that — it’s the first step of most 12-step programs. You can’t rely on your logic or any of the content that’s streaming through your neurons, because it’s all inaccurate. You need to rely on other brains to help you sort out the stuck thought and tease it apart until you arrive at the truth.

Fortunately, I have a handful of friends who know the insanity of ruminations and have walked with me through this in the past. They know it’s what I do when I get depressed. I get hooked on one thought and use it to beat myself to the ground until I feel absolutely worthless. So I have to believe in their logic. They remind me of why I made certain decisions, why they were the right ones, and why that decision has absolutely nothing to do with the panic that is raging through my body.

When I’m on the phone with them, I write down everything they say like a newspaper reporter because I will need that information handy for when the thoughts come — and I can’t afford to bother them again. I have a journal filled with the reasonable logic of my friends, and sometimes (not always) accessing their truth calms me down as if I’m talking to them again. I try to trust them because I know I can’t trust my own brain.

2. Investigate the Thought

“I have never experienced a stressful feeling that wasn’t caused by attaching to an untrue thought,” writes Katie. “Depression, pain, and fear are gifts that say, ‘Sweetheart, take a look at what you’re thinking right now. You’re living in a story that isn’t true for you.’” In her book, she explains what she calls The Work, a way of inquiring or investigating your thought with four simple questions:

It it true?

Can I absolutely know that it’s true?

How do I react when I think that thought?

Who would I be without the thought?

Then you turn the thought around. You rewrite your statement as the opposite. If you said, “I am a failure,” your turnaround might be, “I am a success.” And you find three genuine, specific examples of how the turnaround is true in your life.

If my ruminations are severe, this strategy doesn’t always work. As I mentioned in my other piece, sometimes it’s better not to analyze the thought. But just asking myself the first question, “Is this true?”, can sometimes forge a little distance between the rumination and my symptoms of anxiety or be a reminder that I’m caught in a story that isn’t accurate.

3. Visualize the Thoughts as Hiccups

Ruminations are symptoms of depression just as nausea or fatigue are symptoms of the flu. If my fever spiked or I developed a bad case of hiccups, I wouldn’t berate myself for those symptoms. Yet I feel totally at fault for my stuck thoughts, as if they are a weakness of my character, which further pushes me down the rabbit hole of despair. One of my friends recently yelled at me over the phone, “THEY ARE NOT YOUR FAULT!!” when I told him that all the mindfulness exercises I had been doing were making me feel even worse — as though I were creating the ruminations by not being able to let go or detach in the right way.

He reminded me that when they reach a certain intensity — when they are making me hyperventilate over the phone to a friend as I was doing, or they totally disable me — mindfulness doesn’t work. At this point, I’m better off imagining them as physical symptoms of an illness and say, “Here they are again …” rather than to constantly try to meditate them away or release them in the zen fashion that I would like.

4. Use a Mantra

“When my thoughts become intense,” a friend told me recently, “I will use a mantra as a kind of racket to hit the ball back.” Repeating a mantra helps her be prepared for the thoughts when they come. She told me to look through Scripture and find something that resonates with me. I chose “Be not afraid,” as it appears throughout the Bible more than any other phrase, and is also my favorite hymn — one that I would sing all the time as a young girl when I was scared — based on my favorite psalm. A mantra doesn’t have to be religious, of course. It can just be a simple phrase, like “Peace be with me.” Or “I am okay.” Or “This will pass.”

5. Do the Thing in Front of You

I said this recently in my piece on suicidal thoughts. When I’m battling severe ruminations, my head is usually trapped in the past or in the future, fretting a decision I’ve made a month ago or worrying about something a week or a year from now that may never even come to be. The thoughts engulf me in a world that is not real and spin panic everywhere I look. At this point, I can’t handle a day’s worth of concerns, or even 15 minutes of them.

What helps immensely is to concentrate only on the task in front of me. If I’m working, this means trying my best to craft a sentence that makes sense. If I’m with the kids, it means helping with their math problems or making a snack. Sometimes it helps to have an anchor to the present moment, such as concentrating on my breath or tuning into my senses.

But when mindfulness doesn’t work, I try to tell myself that all I have to do is the thing I am already doing.

Join Project Hope & Beyond, a depression community.

Originally posted on Sanity Break at Everyday Health.

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How Does Your Depression Affect Your Child? Tue, 07 Mar 2017 16:45:38 +0000 bigstock--146093621Tracy Thompson begins her thoughtful book The Ghost in the House with two brilliant sentences: “Motherhood and depression are two countries with a long common border. The terrain is chilly and inhospitable, and when mothers speak of it at all, it is usually in guarded terms, or in euphemisms.”

If depression happened in a vacuum, it would be so much easier.

But it doesn’t. It happens in the context of a family, raising kids, being responsible for other human beings even as you can’t take care of yourself.

My Worst Fear for My Children

“Even when it is relatively mild, depression may cause subtle shifts in the interactions between mother and child, and a mother’s depression may negatively affect her child’s development and well-being,” explains Ruta Nonacs, MD, PhD, in A Deeper Shade of Blue.

This is my worst fear for my kids — that my tears, anxiety, apathy, and sadness will destroy them and will cause them to have psychiatric conditions down the road. In the midst of an uncontrollable crying session, I hear Jackie Onassis’s words: “If you bungle raising your children, I don’t think whatever else you do well matters very much.”

The other day, my son, daughter, and I were in Michaels, the craft store picking up some face paint for spirit week at school.

“Can I have some gum, Mom?” my son asked me. We’re in the candy aisle.

“Sure,” I said, putting aside my efforts to de-sugar him.

“Do you want anything?” I asked my daughter.

“Yes,” she said. She looked up at me with tears in her eyes. “I want you to not be depressed.”

My heart broke in half.

Ten minutes earlier I was crying in the car. The painful ruminations wouldn’t stop, and I felt besieged by anxiety. As much as I try my best to hide my symptoms from them, not crying in front of them feels like not being able to pee during the day. The tears flow like Niagara Falls.

“Sweetie, I know you want that,” I said to her. “I want that, too. And I will get there. I promise. The magnets [transcranial magnetic stimulation, or TMS] are helping me, and I am getting better.”

I offered her hope even as I couldn’t access it myself.

Later, I cried to a friend.

“I’m ruining them,” I told her. “They need another mom — a more stable, capable woman who can run them to Michaels without tears running down her cheeks.”

“You can’t put the pressure of being well or being perfect on yourself,” she said. “That burden is too heavy.”

She urged me to forget about all the statistics that haunted me — studies that suggest children of parents with mood disorders have a much greater risk of developing psychiatric disorders themselves.

“Look at all the kids whose moms have breast cancer,” she explained. “They cope. They become resilient. They know their mom is ill, and they just might develop more compassion and empathy as a result. They might grow in ways they wouldn’t have if they hadn’t had to deal with it.”

“The difference is that a mom with breast cancer doesn’t feel the kind of guilt that you do about having cancer,” she continued. “She usually doesn’t fault herself for having to go through chemotherapy and losing her hair.”

She’s right about that. The guilt associated with this illness is what imprisons depressed mothers and stymies recovery.

In order to be the best mothers we can be, we must move beyond our guilt and focus all of our energy on doing whatever we can do to get better. In my case, that’s going to my TMS treatments, doing yoga, talking to friends, eating the right foods, lowering stress, sleeping, and calming myself down as much as possible. We can’t entertain statistics about how our crying might psychologically damage our kids — we just can’t go there. We must pray the serenity prayer with conviction so that we can separate the things we can change (like seeking the best treatment possible and taking care of ourselves) from the things we can’t (like symptoms that come with our present condition).

I Will Be Back to Myself One Day

A few years ago I wrote a children’s book for kids with a depressed parent called What Does “Depressed” Mean? It included messages like “You are not to blame” and “Don’t take it personally” and “You are still loved.” But the concept that I think is most important for kids to hear (and for depressed persons to hear as well) is that “Your loved one will be back.”

I paraphrased this paragraph to my daughter in Michaels:

It is hard to imagine that the person who is now depressed will one day be back to herself. It is scary when you think that she might be sad for the rest of her life. However, you must trust that the same person who read bedtime stories to you, or tickled you until you screamed “Stop!” or took you on Saturday errands will be back! For real!

Yes, for real.

Join Project Hope & Beyond, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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