Tag Archives: mental illness

Shame & Its Connection to the Stigma

As I was recovering from my second major bout of depression, I was introduced to Brene Brown’s well-known TedTalk on shame. It didn’t really make a lot of sense to me at the time. However, looking back on my two bouts of major depression and their lengthy recoveries, it is clear that I had a great deal of shame.

The first experiences I’m reminded of when I think of shame were the times I would go to the local pharmacy to pick up my medications (originally, several). I would wander around the store to make sure that there were no neighbors who I knew that would see me purchasing medications. What would I say if they happened to ask what medications I was getting? How would I respond if they asked me if I was sick? Now, also in hindsight, there was clearly a component of anxiety in play at the time. Anxiety often goes hand-in-hand with depression. That being said, there was clearly a component of shame in taking medications for a mental illness. When I’d return home from the stressful trip to the pharmacy, not only would I immediately throw out the receipt or any other evidence that I was taking an anti-depressant, but I would be sure to first tear it into many pieces. I also quickly hid the medicine in my underwear drawer, just in case someone would come into our master bedroom and see them.

When I first had depression, I would see my family doctor for medications. I remember sitting in the waiting room, wondering what would happen if someone from work  would happen to see me? Would I lie and say that I was there for a physical? I remember jockeying to find a seat in the waiting area that was conspicuous enough spot so that very few people could see me. I’d even hold a magazine near my face, covering it as best possible without being obvious. Focusing more on not being seen than actually reading any of the words on the pages. All of these actions, again, based upon my shame of needing to see a doctor for depression.

I was concerned about having to take too much time off from work in order to make it to my doctor appointments, particularly when I was first diagnosed seeing the doctor frequently. What would the staff at the school I worked at think if I was gone frequently for appointments, coming in late or leaving early? More shame. And once my depression got more severe, I had to starting seeing a psychiatrist. The psychiatrist who I chose to see was at a Behavioral Health clinic. I certainly knew the excuse of being there for a routine physical or a nasty cold wasn’t going to fly had I seen someone I knew. They’d instantly know I was there for some type of behavior health concern. Solely based on my shame of bumping into someone who might recognize me from the large school district I had been working in for many years, I considered changing doctors. In the end, I decided that seeking out a new psychiatrist would be too stressful and not feasible. So I gritted through the experience of sitting in the waiting room for each of my appointments, hoping desperately not to bump into someone I knew or who even looked vaguely familiar.

Early on in my depression, I ordered two books about depression (as shame would prevent me from purchasing these books in person at a bookstore where people may see me making such a purchase). These were incredible books by Matthew Johnstone that do an amazing job of helping others understand what it’s like to live with depression, or to live with a loved one who has depression. I read them, shared one with my wife, and then gently hid them away on the top of a tall bookcase in the basement. Not on the top shelf, but on the top of the bookcase, concerned, due to my shame, that someone who was visiting us at some point in the future might just see the books and ask about them.

When my suicidal thoughts became pervasive and plausible, I had to make the excruciating decision to take time off from work in order to check myself into a partial hospitalization program. Excruciating, as I nervously wondered what the staff who I supervised would say if I was gone for three weeks or more? What would I say when I returned? The shame was powerful. I nearly chose not to take time off and not to receive the help that I needed because of this shame. I had brought my wife and sister to my final appointment to advocate for me, as I did not have much confidence in the psychiatric physician’s assistant who I was seeing. Sure enough, the psychiatric physician’s assistant played into that shame, sharing with me how challenging taking off work may be. I was thankful for bringing my wife and sister who strongly advocated for me to enter a partial hospitalization program. In the end, I believe taking work off and entering such a program actually saved my life!

It was shame that kept me indoors when I took sick time away from work. I knew that it would be better to get outside. I knew I should be helping my family by running errands and driving our kids to activities. I knew that going for walk, getting a bit of exercise and fresh air, rather than isolating myself inside of the house, was important. However, the fear, once again, of bumping into someone I knew and having to explain why I wasn’t at work was terrifying for me. The shame of taking work off for depression was preventing me to do the things I needed to do in order to recover from depression and to help support my family.

What does stigma have to do with this, you may ask? I believe that a strong stigma still exists in much of the US. I believe the shame that many people face in dealing with a mental illness is directly related to this stigma. Because of the stigma, people are often uncomfortable to talk about mental illnesses. People with a mental illness are often judged and/or labeled. A mental illness is just like any other illness and should be treated as such. As many people say, mental illnesses are invisible. Yet, it’s important to understand that they are just as real as any other illness. A mental illness doesn’t make anybody any less intelligent and it certainly doesn’t make them violent, as a fair amount of myths may lead one to believe.

We need to normalize conversations around mental health, just as we have around cancer, diabetes, heart disease, and many other serious illnesses. One way to normalize our conversations is by sharing our stories of mental illness. Sharing our stories helps to educate those who may not understand mental illnesses and to support those who are struggling. The more we talk publicly and openly about mental illness, the more we do away with the stigma and the less shame people living with a mental illness feel.

Shame is powerful. Shame is dangerous. Shame often prevents people from getting the help they need. Shame played a role in me nearly taking my own life. Help normalize the conversations around mental illness, help end the shame!

Please tune in to my podcast, The Depression Files to hear me interview men who have struggled with depression. Inspirational stories of hope and perseverance!

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

 

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The Depression Files–The Launch!

I had been “stockpiling” the interviews for several months. My idea was to launch a podcast in which I interview men who had experienced depression. The goal? It was threefold:

  1. To educate people on depression; the serious and often times debilitating nature of the illness
  2. To give hope to those who may be suffering from depression
  3. To help minimize, or even eliminate, the stigma around mental illness

I wanted to create a “stockpile” of interviews to eliminate any stress of getting episodes published on a regular basis.  I knew that I would need to find willing guests, schedule the interviews, record the interviews, and edit them. In the meantime, I was having a friend help me create a temporary logo (one that I hope to change in the near future) so that I could also post to iTunes.

I had a teaser up…and I had even created a “Sampler” for possible guests. I had no interviews published, so I figured possible guests may want to hear a sample of my interview style and get a feel for the project. I had created an intro, but had not yet created an outro. All of this allowed for me to continue down the path of promoting my teaser, without the worry of whether or not the show would be successful once I actually launched it. In the coaching world, we call this the Saboteur…and mine can be HUGE. The Saboteur is the negative self-talk that prevents us from moving forward. For example, “What makes me think I could be a successful interviewer?” or “I’ll never be as good as Terry Gross, Mark Maron, or Larry King” or “What if nobody listens to the show?”

Sometimes, there needs to be something that gives one a big kick in the rear to begin to move forward. That kick in the rear for me…World Suicide Prevention Day on September 10, 2017. I figured, if I were ever going to launch this project, The Depression Files, there would never be a better day than World Suicide Prevention Day. I quickly made an outro, finished editing the show that I had decided would be the first episode, and…launched it! That was a big day for me! My teaser had been published at the end of June and I had been working on the project well before then.

My first episode was an interview with Steve Austin. As someone who is used to public speaking and hosts his own podcast, he was an ideal interviewee that made my “job” pretty darn easy. Steve is a life coach, author, speaker, and host of the #AskSteveAustin podcast. Steve has a website at iamsteveaustin.com. He is the author of the best-selling From Pastor to a Psych Ward: Recovery from a Suicide Attempt is Possible and other books, which can all be found by clicking here.

I have a new episode coming out every other Sunday and have just published my third one. I have been thoroughly enjoying the interviews and learning a great deal from every one of my guests (I believe I have about eleven more interviews recorded, awaiting to be edited).

I hope that you will listen to The Depression Files and that you are able to get something out of them. I hope that you will understand that depression is much, much worse than simply feeling sad. I hope that you will gain a deep sense of empathy for those who may be struggling with depression. In addition, I am hoping that any listeners who may be in the midst of a depressive episode, or living with chronic depression, are able to gain a sense of hope from the show. As cliche as it may sound, after going through major depression myself, I would never wish it upon my worst enemy.

If you would like to read more about the podcast, you can check out one of my earlier posts: Giving a Voice to Men with Depression: New Podcast Coming Soon!

As always, comments to this post are welcomed and encouraged! In addition, I hope that you may be willing to ‘like’ and/or share comments to any of the episodes of The Depression Files. Thank you!

The Catch-22 of Depression

One of the most challenging pieces of dealing with depression is the Catch-22. Everything one needs to do in order to overcome (or work towards the recovery of) depression is compromised by the very symptoms causing the depression.

Here are several examples. In order to recover from depression, one should…

  1. Eat a healthy diet, yet many people are unable to eat (or overeat) due to the depression.
  2. Exercise regularly, yet depression often takes away one’s energy.
  3. Socialize, yet many of those suffering from depression tend to isolate themselves.
  4. Attempt to get a good night of sleep, yet many with depression struggle with getting enough sleep.
  5. Enjoy their hobbies, yet most people with depression tend to lose interest in their hobbies.
  6. Get outside for fresh air and sunlight, yet many times those with depression are also faced with anxiety that tends to keep them inside their home.
  7. Monitor and stop negative thinking, yet many with depression ruminate and see only the negative side of things, even when there may not realistically be a negative side.

While the purpose of this post is to acknowledge that recovery from depression can be very challenging, it’s essential to maintain hope. Depression is treatable! Reach out for support. Connect with trusted loved ones. Acknowledge small successes! It takes time and effort, but you will recover!

Please see my post titled, “Tips for Dealing with Depression” for more suggestions on how to work towards recovery. If you are attempting to support someone else with depression, I would recommend my post titled, “Supporting One with Depression“, where I offer differentiated tips for supporting a loved one, a close friend, or an acquaintance.

I would like to credit the incredibly informative book, “Coping with Depression: From Catch-22 to Hope” by Dr. Jon G. Allen for many of the ideas in this post.

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

 

The Importance of Sharing Our Stories of Mental Illness

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

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

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

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

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

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

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

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

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

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

Supporting One with Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Depression: Chances of Relapse?

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

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

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

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

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

As always, I encourage comments to this post.

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

 

 

The Challenges of Medications for Mental Illness

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

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

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

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

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

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

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

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