7 Myths of Depression

Depression is often viewed as the “common cold” of mental disorders, because it is so prevalent in our lives. The lifetime prevalence of depression suggests that more than 1 in 9 people could be diagnosed with the disorder at one point in their lives. And unlike some other mental disorders, depression affects virtually every aspect of what you do and how you interact with others. Every year, it wreaks havoc in millions of Americans’ lives, especially amongst those who believe it is something you should just “get over” on your own.

Here are seven common myths about depression, and the facts that answer them.

1. Depression means I’m really “crazy” or just weak.

While depression is indeed a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life. Depression can strike anyone, at any time — whether you’re “weak” or strong, it knows no bounds. Some of the strongest people I’ve met are people who’ve coped with depression in their lives.

2. Depression is a medical disease, just like diabetes.

While some pharmaceutical-influenced marketing propaganda might simplify depression into a medical disease, depression isnot — according to our knowledge and science at this time — simply a pure medical disease. It is a complex disorder (called amental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots. While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure. Get to know the risk factors for depression.

3. Depression is just an extreme form of sadness or grief.

In most cases, depression is not just ordinary sadness or grief over a loss. If it were ordinary sadness or grief, most people would feel better just over time. In depression, time alone doesn’t help, nor does willpower (“Pull yourself up and stop feeling so sorry for yourself!”). Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever. Most people with depression have little or no motivation, nor energy and have serious problems sleeping. And it’s just not for one day — it’s for weeks or months on end, with no end in sight.

4. Depression just affects old people, losers and women.

Depression — like all mental disorders — does not discriminate based upon age, gender, or personality. While generally more women than men are diagnosed with depression, men suffer for it all the more since many people in society believe that men shouldn’t show signs of weakness (even a man’s own upbringing may reinforce such messages). And while aging brings many changes in our life, depression is not a normal part of the aging process. In fact, teenagers and young adults grapple with depression just as much as seniors do. Some of the world’s most successful people have also had to deal with depression, people such as Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan and Michelangelo. So being a loser is not a prerequisite to being depressed.

5. I’ll have to be on medications or in treatment for the rest of my life.

While some doctors and even some mental health professionals believe that medications may be a long-term solution for people with depression, the truth is that most people with depression receive treatment for it for a specific period of time in their lives, and then end that treatment. While the exact amount of time will vary from person to person based upon the severity of the disorder and how well the various treatments may work for each individual, most people who have depression do not need to be on medications for the rest of their lives (or be in treatment for the rest of their lives). In fact, a lot of research suggests that most people can be treated for depression successfully in as little as 24 weeks with a combination of psychotherapy, and if needed, medications.

6. All I need is an antidepressant to treat depression effectively.

Sorry, no, it’s not as easy as popping a pill. While certainly you can have an antidepressant medication quickly prescribed to you by your primary care physician, you’re unlikely to feel any beneficial effects from that medication for 6 or more weeks in most cases. In two-thirds of patients, that first medication won’t even work! Combined psychotherapy treatment with medication is the recommended gold standard for the treatment of depression. Anything else is going to be significantly less effective, meaning most people will suffer with their depressive symptoms longer than they need to.

7. I’m doomed! My parents (or grandparents or great uncle) had depression, and isn’t it inherited?

While in the past there’s been research to suggest the heritability of depression, more recent studies have called into question how much of depression really is genetic. The upshot? While researchers continue to explore the neurobiology of mental disorders like depression, having a relative with depression only marginally increases your risk for getting depression (10 to 15%). Remember, too, that relatives impart a lot of their own coping strategies upon us in our childhood development — strategies that may not always be the most effective when dealing with things like depression (making one more vulnerable to it).

To hell and hopefully…eventually back??

It’s been one HELL of a month, and what I mean by hell is I have felt like hell, my life has been hell, my mood has been hell, and everything went to hell. I’ve been in a deep depression since the beginning of March about. I’ve barely done anything but lay in bed, sleep, and sit on the couch in the living room staring at the wall. My depression has been so bad that suicide has become an issue again. On top of the depression, my anxiety has been atrocious, some days I have up to 3 full blown panic attacks, I take my Ativan but sometimes that’s not even enough so I have learned that using my Cpap helps with managing my breathing which means more time in bed but if it works I don’t care. Now even on top of that my hallucinations have been wreaking havoc on my life as well. The usual 7 people, 6 voices, and now I’ve acquired a lion, a snake, an elephant, and a little monkey. So imagine all this going on at one time. That is my definition of hell. There are some days that all I can think about is killing myself but the one thing that stops me is not wanting to hurting anyone. 2 weeks ago I went to the ER because I was suicidal and they turned me away because, “she seemed fine” but they obviously don’t get it. I go to see my therapist this morning to see what we should do now, I’m running out of options and I’m running out of patience. I want to get better, get back to feeling good but I’m beginning to think that’s never going to happen. It’s extremely hard having an illness that you know you will have to live with and deal with for the rest of your life, it makes things seem a little less hopeful that I will ever have the “normalcy” that I’ve always yearned for. 

5 Essential Remedies for Treating Depression: Coming Back from the Brink

Graeme Cowan suffered through a five-year episode of depression that his psychiatrist described as the worst he has ever treated.

Part of his recovery involves helping people build their resilience and mental fitness as the Director of R U OK? In his book, Back From the Brink: True Stories and Practical Help for Overcoming Depression andBipolar Disorder, he offers advice gleaned from interviews with 4,064 people who live with mood disorders.

He asked the respondents to rate the treatments they had tried and how much each had contributed to their recovery. Here’s what he found.

The following were the top eleven most effective treatments:

  • Supportive psychiatrist
  • Supportive psychologist
  • Support group, emotional support of family and friends
  • Vigorous exercise
  • Psychotherapy
  • Fulfilling work, paid or voluntary
  • Sleep
  • Cognitive-behavioral therapy (CBT)
  • Electroconvulsive therapy (ECT)
  • Reducing intake of alcohol and other non-prescription drugs
  • Belief in God, spirituality, religion

Other helpful treatments include:

  • Mindfulness-based cognitive therapy (MBCT)
  • Acceptance and commitment therapy (ACT)
  • Hobbies, such as gardening, pets, or music
  • Massage
  • Yoga/meditation
  • Medication
  • Relaxation
  • Good nutrition
  • Keeping a gratitude journal
  • Acupuncture

Cowan then categorizes the effective approaches into five major themes:

1. Emotional Support

We are social creatures who crave empathy and connection. That’s why emotional support, reassurance, and compassion from psychiatrists, psychologists, support groups, and family and friends dominate the top ten effective strategies. Cowan’s findings indicate that the emotional support and reassurance provided by psychiatrists and psychologists is judged more important than their treatments, which concurs with previous studies that have shown that the quality of the relationship between a clinician and patient is the best predictor of a successful outcome.

2. Psychological Treatments

Some psychological treatments that were listed as effective: psychoanalysis, counseling, cognitive behavioral therapy, mindfulness-based cognitive therapy, interpersonal therapy, acceptance and commitment therapy, and letting go of unrealistic goals.

3. Lifestyle Strategies

Both vigorous exercise (equivalent of running for 30 minutes 4-6 days per week) and moderate exercise (equivalent of walking for 30 minutes 4–6 times per week) were rated as very effective. Other helpful lifestyle approaches include: getting a good night’s sleep, being able to relax, doing meditation or yoga, engaging in hobbies, getting massages, and reducing intake of alcohol and recreational drugs.

4. Fulfilling Work

Cowan credits his fulfilling work — offering hope to persons stuck in depression — as one of the most powerful tools he uses to stay well. “I experienced personally the benefits of doing voluntary work in my own recovery,” he writes. “My voluntary work involved placing discouraged people (new migrants or people rehabilitating from physical or mental illness) into volunteer positions with charities. I saw how the work lifted their self-esteem and confidence.”

Fulfilling work was rated more highly than cognitive-behavioral therapy, which is often considered a highly effective depression treatment. Cowan cites the Gallup poll that found that only 20 percent of employees like what they do, but that people with a high career well-being were more than twice as likely to succeed in life overall. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, and many other positive psychologists believe that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression.

5. Prescription Medications

The results of Cowan’s surveys found that, while prescriptionmedications can play a vital role to recovery from depression and bipolar disorder, they should not be relied on as the sole strategy. Pharmacology is still in its infancy. A drug that works wonders for one person might not do anything for another except give her a dry mouth and nausea. Cowan writes: “This stresses the importance of working with a doctor who’s highly experienced in successfully treating mood disorders.”

6 Famous People with Depression Who Inspire Me

When a famous actor/actress, politician, or prominent figure of any kind risks ridicule to discuss their mood disorder, the world stops to listen.

For as long as his or her face graces the cover of a glossy magazine or the TV interview runs, folks seem to appreciate the sweat and suffering that those with depression andbipolar disorder endure as part of their illness.

I know that for me, I certainly listen to their stories, empathize with them, and take away lessons that I can use in my own recovery from depression and anxiety. Celebrities, for better or worse, can inspire us.

Here are just six of those celebrities that inspire me.

1. Rosie O’Donnell

What’s not to love about a celebrity who hangs herself upside down for 15 to 30 minutes a day to jumpstart her neurotransmitters (along with yoga and antidepressants) using inversion therapy? Seeing Rosie demonstrate it on “The View,” reading a teleprompter from a swing, made me laugh out loud at all the ways –some quite creative – we depressives use to treat our mood disorders.

2. Art Buchwald

Art Buchwald was unsure if he should go on Larry King Live in the early ’90s to discuss depression; the Pulitzer Prize-winning columnist didn’t want to become a poster boy for mental health. But he did it because the author William Styron had been a role model for him, and because he realized celebrities can play a role in helping depressed people. After that show (which received the most viewer reaction of any Larry King episode ever), Buchwald decided to speak about his depression whenever he received an invitation because it helped him as much as it did the millions of people listening to him.

3. Zach Braff

Actor and director Zach Braff loves it when people tell him that they relate to Andrew Largeman, the depressed character he played in the 2004 movie “Garden State” (which Braff wrote and directed), because in that role, he didn’t have to do much acting. Like his character — an actor confronting his demons when he heads home after his mother dies — Braff doesn’t hide under any celebrity image and isn’t afraid to be himself, he says, even if that self is very emotional and wears sweatpants all day.

4. Marie Osmond

Marie Osmond is one of the most sympathetic entertainers to speak about mental illness. “All I know is that anybody who goes through [depression], I have such incredible empathy,” the actress and singer said on “Larry King Live” in 2003. “I’m telling you that depression is…a very scary, dark place…you see no light.”

5. Brooke Shields

Brooke Shields had just released her book “Down Came the Rain” when I plunged into my most severe depression. My agent sent the book to me as a gift, wrapped in a ribbon. I read the title and wept. I read the back cover and cried some more, feeling as though this actress-model was giving me permission to bawl my eyes out. “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.”

6. Kay Redfield Jamison

As a healer and a patient, Kay Redfield Jamison understands depression and bipolar disorder from every possible angle. Compassionate, wise, and articulate, she speaks from someone who has experienced the sheer terror and heartbreak of a mood disorder firsthand and as a knowledgeable clinical psychologist. My two favorite lines about depression come from her classic book, “An Unquiet Mind”: “tumultuousness, if coupled with discipline and a cool mind, is not such a bad sort of thing. That unless one wants to live a stunningly boring life, one ought to be on good terms with one’s darker side and one’s darker energies.”

Can You Choose Happiness?

The concept of choosing happiness can be an incredibly controversial topic. For anyone who has experienced distressing experiences like anxiety, depression, addiction, chronic pain, trauma or a stress-related medical illness, to say “choose happiness” can appear shaming. When conditions are genetic or biological nature, there is no choice and pain is inevitable. However, while we can never change what happens to us in any given moment, with awareness, we can choose how to respond to it.

Let’s take a closer look at what “choose happiness” can mean and how it may be the most powerful phrase we know to change lives.

First we have to ask ourselves, what is happiness? Some people define it as feeling satisfied with life and having a good mood (subjective well-being), while others find it to be related more with deep meaning and feeling connected (psychological well-being).

In my opinion, to “choose happiness” and to “choose love” are synonymous and not only possible, but essential to real happiness. Real happiness is not about the grin we wear on our face, it’s about learning how lean into loving ourselves and others in the good times and in the bad.

For example, I may be in a downward spiral of depression, but the moment I am aware of this is a choice point. In that choice point I might bring myself to the shower instead of staying in with the covers over my head. I may get outside to exercise or call a friend instead of eating that extra pint of ice cream. This may not put a giant grin on my face, but I am leaning my mind and action toward loving myself. This to me is choosing happiness over depression.

I may be riddled by automatic negative thoughts, but choose to put up the stop sign, engage in a brief mindful check-in and then apply a more self-compassionate break. Here is a good example from Kristin Neff, PhD:

  1. This is a difficult moment
  2. Life is full of difficult moments
  3. May I be kind to myself, May I find freedom from these negative thoughts, May I love myself exactly as I am, May I be happy.

I may have just made a huge parenting mistake, yelling at my kid for yelling in the house. When I become mindful of this at first guilt and shame may overtake me with thoughts such as, “What is wrong with me” or “What a terrible parent I am.” To choose happiness here means to recognize this as a difficult parenting moment and to also recognize the common humanity behind difficult parenting moments and mistakes. Then I might say to myself, “May we all find peace with our imperfections.” With this awareness, I can go back to my child and apologize showing my child that I can be responsible for my own mistakes and this may even bring us closer.

Choosing happiness doesn’t mean putting a happy mask on. In fact, you can choose happiness and still feel deep emotions of sadness, grief, guilt, shame or anger. But it is all about how you respond to it once aware.

It simply means choosing love for ourselves and others.

What would the days, weeks and months ahead be like if there was more love in your day?

With this definition in mind, you can choose happiness and why not choose happiness moment-to-moment.

Depression in Men and Women

In my previous post, I wrote about depression, the signs and symptoms and treatment options. In this post, I will discuss how depression looks different for men and women. Being aware of the differences is important in order for the problem to be recognized and to get the proper help. “While the symptoms used to diagnose depression are the same regardless of gender, often the chief complaint can be different among men and women,” says Ian A. Cook, MD, the Miller Family professor of psychiatry at the University of California–Los Angeles.

Depression in Men: In men, depression is overlooked because they may think that it is a sign of weakness. They deny depression because they usually believe that they need to be strong and in control of their emotions. And in American culture, expressing emotions is usually considered  a feminine trait. Depression in men can also be traced to cultural expectations.  Men are supposed to be successful or have control over their emotions. These cultural expectations can cover up true depression. Depression in men can be overlooked because they usually do not talk about their feelings. Instead, they talk about the physical symptoms that accompany depression such as fatigue, pain, or difficulty concentrating. This can lead to depression being untreated which can lead to negative consequences, such as suicide. Men can experience depression in different ways to women. A man can become irritable, aggressive, drinking more than usual, or overworking. A man can deny his feelings and hide them from others.

There are three common signs of depression in men:

Pain: Backaches, headaches, or sleep problems that do not respond to normal treatment.

Anger: Can lead to irritability, loss of humor, road rage, short temper, or aggression. Can also lead to abusing their wife or becoming controlling.

Reckless behavior: Engaging in risky activities such as driving too fast, having unprotected sex, abusing drugs, or gambling.

There is no single cause for depression in men. Lifestyle changes, stress, biological and psychological causes, lack of social support, anything that makes them feel useless, alone, or hopeless can trigger depression.

Treating Depression in Men:

Don’t try to tough out depression on your own. There is help such as therapy and medication. You could also make lifestyle changes such as exercising, eating well, building a social network, joining a support group, and reducing stress.

There is treatment for depression. What works for one person may not work for another and no one treatment is appropriate in all cases. The best approach involves:

support: talking to someone about how you feel can be great help. The person you talk to needs to be a good listener. Having a strong support system can speed your recovery. Reach out to others, because being alone can make depression worse.

lifestyle changes such as exercise, eating healthy, learning to manage stress, relaxation techniques and challenging negative thoughts can help alleviate depression. I mentioned some relaxation techniques under my post Natural Ways to Cope with Panic and Anxiety Attacks.

balancing emotions: learning how to recognize stress and expressing your feelings and emotions can make you more resilient.

professional help such as talk therapy or medications can help. Therapy can give you tools to treat depression and can give you skills to prevent depression from coming back. 

stock-photo-depressed-woman-sitting-on-floor-isolated-on-black-background-138150662Depression in Women: The causes of female depression and symptoms  are different than from men. There are a number  of theories that explain why women have a higher incidence of depression such as biological changes, hormonal changes and psychological causes:

Premenstrual problems:Hormones fluctuate during the menstrual cycle often causing premenstrual symptoms (PMS). For some women the symptoms are mild, but for others it is severe enough it cause disruption in their lives. Often the diagnosis of premenstrual dysphoric disorder (PMDD) is made.

Pregnancy:Hormonal changes that occur during pregnancy can contribute to depression, especially if you are already at high risk.

Postpartum depression: This is a normal reaction that subsides within a few weeks but for some women it can be severe and can last for a long time. This is also believed to be influenced by hormonal changes.

Health problems: Chronic illnesses and or disabilities can lead to depression.

Negative feelings: Women tend to ruminate when they are depressed which makes the depression worse. Men tend to distract themselves which can reduce depression.

Overwhelming stress: Women tend to develop depression from stress and produce more stress hormones than men do.

Below is a table taken from author Jed Diamond. It shows the differences between men and women depression:

Differences between male and female depressionWomen tend to:Men tend to:Blame themselvesBlame othersFeel sad, apathetic, and worthlessFeel angry, irritable, and ego inflatedFeel anxious and scaredFeel suspicious and guardedAvoid conflicts at all costsCreate conflictsFeel slowed down and nervousFeel restless and agitatedHave trouble setting boundariesNeed to feel in control at all costsFind it easy to talk about self-doubt and despairFind it “weak” to admit self-doubt or despairUse food, friends, and “love” to self-medicateUse alcohol, TV, sports, and sex to self-medicateAdapted from: Male Menopause by Jed Diamond

Treating Depression in Women:

Treatment is the same as everyone. You can refer to my previous post, Not Just the Blues for more information on treatment options or refer above to Treating Depression in Men.

Depression is common and treatable. The goal to recovery is to start small and take things one day at a time. Feeling better takes time, but you get to feeling better by making positive choices for yourself. Talking to someone, seeking help and having a positive support system is also essential in the treatment for depression. Don’t deny your feeling or symptoms. It is important to listen to how you feel and get the proper treatment for recovery.

Newly Diagnosed? What You Need to Know About Depression

This new monthly series reveals tips and insights for individuals recently diagnosed with a mental illness. Future pieces will cover everything from anxiety to bipolar disorder.

Depression is a serious, debilitating illness that’s also one of the most commonly-diagnosed mental disorders. When you’re first diagnosed, you may feel both relief (finally, a name for your pain) and overwhelmed (what the heck do you do next?).

Below, two psychologists who specialize in depression reveal what you need to know about the illness and how to get better.

Make Sure You’re Properly Diagnosed

“Make sure that you’re not leaving with a diagnosis in minutes after meeting a professional,” said Deborah Serani, PsyD, a clinical psychologist and author of the books Living with Depression andDepression and Your Child.

“[M]any medical conditions can mimic, worsen or cause depressive symptoms,” so it’s important to rule those out and have a thorough evaluation, said Lee H. Coleman, Ph.D., ABPP, a clinical psychologist, author of Depression: A Guide for the Newly Diagnosed and assistant director and director of training at the California Institute of Technology’s student counseling center.

Serani agreed: “An evaluation for depression should involve a thorough medical exam, a series of blood and urine tests, and then an assessment from a mental health professional that specializes in mood disorders.”

Also, be honest with your providers about your symptoms and habits, including any substance use, Coleman said.

If your provider diagnoses you with depression, ask them why they think this, and what alternative diagnoses they’ve considered, he said. “A competent healthcare professional will respond to your question respectfully and should even be glad that you asked. She should explain her thinking to you in a way that you understand.”

If you’re still unsure about the diagnosis, get a second opinion.

Depression is Highly Treatable

In the beginning, many people with depression think they’ll feel this terrible forever and they won’t get better, Coleman said. However, “Research clearly shows that depression is very treatable.”

Both psychotherapy and medication are effective for moderate to severe depression. “For milder forms of depression, research shows that talk therapy is extremely helpful,” Serani said.

She uses medication as a last resort with her clients. If a client’s depression isn’t significantly improving in several weeks, she suggests exploring medication.

According to Coleman, there are many types of therapies that can help. For instance, cognitive-behavioral therapy helps clients recognize and challenge negative ways of thinking, and change behaviors that inadvertently exacerbate or perpetuate their depression.

When picking a therapist, inquire about their track record with treating people with depression, he said. Also, it’s critical to have a trusting relationship with your therapist and a clear understanding of the goals you’re working on, he said. (“Therapy shouldn’t be mysterious.”)

“The goal is to find what combination of treatments work best foryour depression, and then create a treatment plan that makes it successful,” Serani said. It’s also important to remember that you and your providers are a team. Be an active participant in your treatment, speak up, ask questions and voice any concerns.

Know Your Medication

If you’re trying medication, make sure you’re clear on the specifics. Coleman suggested asking what you can expect the medication to do; how long it typically takes to notice improvement; what kinds of side effects may occur; and how long you may have to take the medication.

Also, ask your doctor if they’re starting with the lowest dose, instead of an “average” dose, Serani said. “Different metabolisms influence the therapeutic effect of antidepressants, so beginning low and adding over time is the best way to determine which dosage benefits you.”

She also suggested asking about the best time of day to take medication (e.g., taking medication before bed helps you “miss” side effects such as headaches, stomachaches and fatigue “because you sleep through them”); and how to discontinue the medication. Having a plan is key because abruptly stopping antidepressants can trigger side effects, she said.

And “ask how to get in touch with your healthcare provider if you start to notice any problems, side effects or worsening symptoms,” Coleman said.

Treatment Takes Time to Work

Whether you’re taking medication or seeing a therapist (or both), it takes about a month to see improvement, Coleman said. If you’re going to therapy, you should experience a reduction of serious symptoms, such as suicidal thinking, hopelessness and helplessness, within weeks, Serani said.

Antidepressants typically take four to six weeks to relieve symptoms, she said. If you’re not getting better after six weeks, talk to your provider, Coleman said. “Sometimes you might need to change the focus of therapy slightly, or your psychiatrist might want to talk with you about trying a different medication if the first one isn’t working well.”

If you think your symptoms are getting worse, talk to your provider right away, he added.

(It can take time to find the best medication. About 40 to 50 percent of people don’t respond to the first antidepressant they try. Here’s more on what to do when your first treatment isn’t working.)

Monitor Your Symptoms in the Future

Having one episode of depression increases your likelihood of having another episode. So it’s important to monitor your depressive symptoms in the future, Coleman said.

“I liken it to someone with diabetes needing to monitor their blood sugar even if they’re feeling fine.” Talk to your provider about the signs of recurrence, he said.

Be Self-Compassionate

Depression sinks your self-worth. But compassion is crucial, Coleman said.

“If one of my clients had a broken leg in a giant cast, they pretty obviously wouldn’t expect themselves to run a marathon. Because depression isn’t outwardly visible like a broken leg or a cast, though, it’s easy to want to bully ourselves into ‘toughening up’ and ‘snapping out of it.’”

However, this approach just makes you feel worse — and guiltier, he said. Instead, think of it like having the flu: “you’re expected to stay home for a little while and get better, and nobody would think that you’re weak or lazy for doing that.”

Remember that you’re struggling with an illness, and the best thing you can do is to focus on getting better and being kinder to yourself.

I know depression #DayOfLight

Brave.

I hear that word a lot. You think it’s brave that I write this blog. You think it’s brave that I have come out of the “bipolar closet.” You find my honesty akin to bravery.

Thank you for that, but it doesn’t always feel brave. It feels intimidating and vulnerable and uncomfortable a lot of the time. But I do it because I know I am not alone. You’ve reached out to me, dear reader, and told me so.

Today is the “Day of Light,” a day where bloggers everywhere share their experiences with depression. I’ve talked about depression on “Being Beautifully Bipolar” before, but let’s delve a little deeper.

Depression and I are old friends. Quite old. We got to know each other before any of my best friends were my best friends. I took my first antidepressant in 2000 – well over a decade ago. That was in college during my junior year. I was tired and I was irritable and I isolated myself.  I remember what a glorious feeling it was to graduate college because there was a time I didn’t know if I’d make it. I didn’t know I was beautifully bipolar at the time, perhaps because I hadn’t reached a state of full-blown mania or psychosis yet. Looking back I see signs, but for a long time it was just me and my unlikable friend, Depression.

Depression is a hole and it wants to suck you in. It craves all your attention until there is none left for anything else. Depression is an ache in your bones, a weariness. I have spent more days and nights than I care to remember thinking of ways to die. That’s what Depression does. It is a robber – of time and love and relationships and excitement. It is a robber of life.

Depression starts as a day spent in bed that turns into another then another and another after that until soon it has been a week since you’ve showered. Do you know how heavy a toothbrush is? That hairdryers were made for people who aren’t friends with Depression? I do.

I do.

But here’s the best bit, the good bit, the bit I hope you’ve read far enough to reach – it gets better. Depression is treatable. There are medications. There are lifestyle choices like getting enough exercise and plenty of sleep that can really, truly help. I know when you’re “in it” it feels suffocating and like you will never be well again and quite frankly, you don’t care if you are ever well again, you just want to make the aching stop. Now here’s where YOU get to be brave. You have to hang in there for the next ten minutes, then the next hour, then the next day and soon, inevitably Depression will walk out of your life.

I still deal with Depression. He comes to visit – uninvited – from time to time. And the world turns dark despite the shining sun. But I’ve learned just as he comes, so too will he go. I just have to hang in there because tomorrow could always be a better day.

Bipolar Disorder and Winter Depression: I Am Seasonally Affected

I live in the Sunshine State.

It is mid-January, and the high temperature will peak at around 55 degrees Fahrenheit today.

This is cold for Floridians. We take advantage of the sun and warmth we experience most days of the year.

Even though Winter in Florida is a stark contrast to the snow, darkness, and bitter cold that is experienced in many parts of the United States, mood patterns would suggest that I am still affected by this season.

I have been admitted to a psychiatric hospital three times, and all three of those times, it was Winter–December, January, February.

My online mood trackers show that my depression, exhaustion, and irritability causes me more trouble in the Winter than the warmer months of the year.

People often tell me that seasonal mood issues don’t exist in tropical parts of the US like Florida.

I would beg to differ–there is still a pattern here. Winter in Florida is much different from Summer in Florida. We still notice a difference, and I think our brains do too.

It is common for mood issues to wax and wane with bipolar illness, but it is very true that light and temperature can be a triggering factor.

Studies on seasonally-affected bipolar disorder have been conducted in more mild, light-fluctuating areas like the Northern US, but also less light-fluctuating areas like Catalonia, Spain.

There is evidence that some bipolar patients are seasonally-affected, no matter what the geographical location.

The positive side is that seasonal patterns can help clinicians predict when patients with bipolar are likely to become ill.

At these times, medications may need to be adjusted.

If you see a pattern in your moods that might be affected by the seasons, consider talking about it with your clinician. Any mood charts or patterns you provide your doctor are extremely helpful in deciphering course of treatment.

It is just as important for patients with bipolar to monitor their triggers as it is for doctors to find issues and treat them.

Treatment for bipolar requires thinking outside of the box, finding repeat issues, and most of all, a team effort.

Now that I’ve discovered this seasonal pattern, I’ve found the following things helpful:

  • Reminding myself I get more depressed during this time of year, and it will get better.
  • Bringing up any patterns I find with my treatment team.
  • Being cognizant that I have to be even more sensitive to self-care during the Winter.
  • Renewed commitment to using software and other tracking methods to find additional patterns–because I know they exist somewhere.

Not every person with bipolar is seasonally affected, but I have discussed the phenomenon with many of my peer consumers, who have also noticed patterns during the colder, darker months.

Bipolar disorder creates a heightened sensitivity to changes in environmental factors.

I am not surprised at all that changes in weather affect my bipolar symptoms.

Are you affected by the change in seasons? A certain season? How does it affect you? What do you do to help yourself stay well?

How Does Mindfulness Reduce Depression? An Interview with John Teasdale, Ph.D.

All over the world, research has shown that Mindfulness-Based Cognitive Therapy (MBCT) can halve the risk of future clinicaldepression in people who have already been depressed several times. Its effects seem comparable to antidepressantmedications. But how?

In 2007, renowned psychologists John Teasdale, Mark Williams, and Zindel Segan penned the bestsellerThe Mindful Way Through Depression to explain how bringing awareness to all your activities can battle the blues.

Now the authors have followed that up with a workbook, The Mindful Way Workbook, that includes targeted exercise, self-assessments, and guided meditations. I have the privilege of conducting an interview here with coauthor John Teasdale, Ph.D. about how mindfulness can reduce depression.

1. How does being aware of what you’re doing while you’re doing it help with depression?

There are a number of ways in which being mindfully aware of what you’re doing while you’re doing it can help with depression.

Depression is often kept going, from one moment to the next, by streams of negative thoughts going through the mind (such as “My life is a mess,” “What’s wrong with me?” “I don’t think I can go on”). Redirecting attention away from these ruminative thought streams by becoming really aware of what we’re doing while we’re doing it can “starve” the thought streams of the attention they need to keep going. That way, we “pull the plug” on what is keeping us depressed, and our mood can begin to improve.

Being mindful of what we’re doing can be a powerful way to weaken the grip of these thought streams, particularly if we bring awareness to the sensations and feelings in our bodies. By doing this over and over again, we end up living more in the actuality of the present moment and less “in our heads,” going over and over things that happened in the past, or worrying about the future.

Being aware of what we’re doing while we’re doing it offers us a way to “shift mental gears.” Our minds can work in a number of different modes, or “mental gears.” We often operate as if we were on automatic pilot. In this mode, it’s very easy to slide unawares into the ruminative negative thinking that can transform a passing sadness into a deeper depression. When we’re deliberately mindfully aware of what we’re doing, it’s as if we shift mental gears into a different mode of mind. In this mode, we are less likely to get stuck in ruminative thinking – and life is richer and more rewarding.

In mindfulness, we pay attention to our experience rather than being lost in it. This means that over time we develop a different relationship to difficult experiences. In particular, we can see negative depressive thoughts for what they really are – just patterns in the mind, arising and passing away, rather than “the truth” about what kind of person I am, or how the future will be. In that way, we weaken the power of these thoughts to drag our mood down further and keep us trapped in depression.

And, of course, getting into the habit of knowing what we’re doing as we’re doing it allows us to know more clearly what we are thinking and feeling in any moment. In that way, we put ourselves in a better position to deal promptly and effectively with any depression that may arise. If we’ve been depressed in the past, we can, understandably, be reluctant to acknowledge or even be aware of the warning signs of another low mood coming on. That way, we may put off doing anything about it until we are already quite depressed, when it may be difficult to do things to improve the situation.

On the other hand, if we can be more tuned in to our experience from one moment to the next, we are in much better shape to know when our mood is beginning to slip. We can then take early action to nip the downward spiral “in the bud” at a time when simple actions may be very effective in halting the downward slide.

2. What is the biggest obstacle for people with depression to practice mindfulness?

Practicing mindfulness is not, in itself, difficult – we can be mindful in any moment by deliberately changing the way we pay attention, there and then. The difficult piece for all of us, including people with depression, is remembering to be mindful – our minds can become so absorbed in their usual ways of working that we totally forget the possibility of being more mindful. And, even if we remember, the mode of mind in which we usually operate can resist the shift to a different mode, asserting the priority of its own concerns over those of the mindful mode.

If we are depressed, even though our mode of mind is creating suffering, the “magnetic pull” of the thoughts and feelings keeping us stuck in that mode can be very strong, making it more difficult to remember to be mindful or to make the shift when we do remember.

That’s why giving time to practicing mindfulness is so important. By getting into the habit of being more mindful of all our experience, not just the thoughts and feelings that lead to depression, over and over and over again, we develop our skills of remembering to be mindful and of releasing ourselves from the mental gears in which we can get stuck.

3. Is there a practice (breath, body scan, eating) that is more helpful to people with depression?

People vary quite a bit, one from another, in the mindfulness practice they find most helpful. And, within the same person, the practice that is most helpful may vary from one time to another, depending on the current state of mind at the time.

That’s why, in mindfulness-based cognitive therapy (MBCT), participants learn a range of different practices. That way, they can discover what practices work best for them, and how to vary the practices they use depending on their mood.

As a general rule, when we are more depressed, it tends to be easier to focus attention on strong sensations in the body, rather than on more subtle thoughts and feelings in the mind. And if those sensations can be relatively neutral, then they are less likely to provide material for the negative storylines that are such a characteristic feature of the mind at those times.

So, although for many folk mindfulness of the breath is the most commonly used practice, they often find that as they get more depressed the most helpful practice is some form of mindful movement, yoga, or mindful walking. The actual physical movements and stretches involved in these practices provide “loud” signals for the attention to focus on, as well as offering the possibility of energizing the body.

Throughout the MBCT program, we stress the importance of practicing with a spirit of kindness toward the self, to the extent that we can. This becomes even more important as depression deepens and the tendencies to self-criticism, self-judgment, and treating oneself harshly get stronger. Again, practicing bringing kindness to the practice at all times makes it easier to incorporate kindness as you get more depressed.

And, finally, it’s important to stress that the single most important practice in the whole MBCT program is what we’ve called the three-minute breathing space. This is a brief mini-meditation we developed specifically for MBCT that, practiced over and over again, pulls together everything else that is learned in the program. We see it as always the first step to take to shift mental gears when lost in mindlessness, or in difficult or painful states of mind. This practice is particularly important in depression where the fact that it is so brief and well-practiced increases the chance of using it even if you are feeling pessimistic or unmotivated. It can then become a vital stepping stone to any one of a number of further effective practices.

4. Can you practice mindfulness when you are severely depressed?

This is what we say in “The Mindful Way Workbook“:

What If You Are Very Depressed Right Now?

MBCT was originally designed to help people who had previously suffered serious depressions. It was offered to them at a time when they were relatively well, as a way to learn skills to prevent depression from coming back. There is overwhelming evidence that the program is effective in doing that.

There is also growing evidence that MBCT can help people while they are in the midst of a depression.

But if things are really bad right now, and your depression makes it just too difficult to concentrate on some of the practices, then it can be disheartening to struggle with new learning. It might be most skillful to allow yourself to wait a while if you can, or, if you do start, to be very gentle with yourself—remembering that the difficulties you experience are a direct effect of depression and will, sooner or later, ease.