Categorization of Bipolar Illness: DSM IV Resources: For Health Professionals
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling
Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal
Tuesday, January 18, 2011
The Latest Info On Life As I Know It
It’s been a few years since my last entry to Crazy Doctor. I am no longer a practicing medical doctor. I surrendered my medical license in 2005. While I was in the transitional process, I became a licensed drug and alcohol counselor (LADC) and tried my hand albeit perhaps less than successfully at two drug treatment jobs. The first offered minimal opportunity to function as an actual bone fide CD counselor and the second left me unhappy both with my new milieu and I encountered insufficient help to unravel the mysteries of the new technology of charting.
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
Sunday, December 12, 2010
Avoiding The Holiday Blues
By Tim Kuss, LADC, LMFT
As we approach the winter holidays it’s good to remember that they can be difficult to negotiate for some of us.
I remember, for example, visiting my parent’s home in a small town for a few days around Christmas. I became delusional and found myself driving around town in the middle of the night. I eventually wound up at the power plant because there were people there.
I was into my old “There’s something special for me” thinking. They eventually figured out who I was and called my parents.
One of my theories about holiday stress is that we have such high expectations. When we were kids it was a magical, miraculous time. As adults we may become aware of the loss of that magic. Now, our losses and our lack of accomplishments may loom large.
It may be best to keep our expectations down. Just plan to have an OK time for the holidays. Aim for comfortable get-togethers with your family and friends.
Forget about big presents!
Survive. If anything better happens then you’re ahead.
It’s hard to be disappointed if you don’t set yourself up for it.
As we approach the winter holidays it’s good to remember that they can be difficult to negotiate for some of us.
I remember, for example, visiting my parent’s home in a small town for a few days around Christmas. I became delusional and found myself driving around town in the middle of the night. I eventually wound up at the power plant because there were people there.
I was into my old “There’s something special for me” thinking. They eventually figured out who I was and called my parents.
One of my theories about holiday stress is that we have such high expectations. When we were kids it was a magical, miraculous time. As adults we may become aware of the loss of that magic. Now, our losses and our lack of accomplishments may loom large.
It may be best to keep our expectations down. Just plan to have an OK time for the holidays. Aim for comfortable get-togethers with your family and friends.
Forget about big presents!
Survive. If anything better happens then you’re ahead.
It’s hard to be disappointed if you don’t set yourself up for it.
Tuesday, November 2, 2010
Social Rhythm
By Tim Kuss, LADC, LMFT
It should come as no big surprise to those of us in recovery from chemical dependency that consistent, predictable contact with other people is a stabilizing force. For years as a counselor, I have been advising clients to find a “home” AA or NA group to attend on the same night at the same time every week and to meet with a sponsor for at least an hour a week outside of meetings. We have also recognized that support from spouses, parents, siblings and friends can be an important part of recovery. I have also advocated for finding “mentors”, respected “elders” like ministers, teachers, etc, not necessarily in recovery, to connect with regularly.
So when Ellen Frank suggested that social rhythm is important in managing bipolar disorder it seemed to make sense. As part of Interpersonal Social and Rhythm Therapy she suggests that we keep track of our contact with others, as well as other daily events. Her 5 item social metric asks people with bipolar disorder to track their time out of bed, first contact with another person, the start of work, school, or other activity, dinner time and bed time.
I have long recognized that structured, “meaningful” activity aids with stability, chemical or psychological. I have seen many clients start patterns of heavy drinking after retirement, while other elderly people seem to create a new structure in their lives that gives them things “to do”. Unfortunately, some clients with chemical and mental health problems are unable to work, or are, at least, temporarily out of work. I advise them to find volunteer work and to create a “busy” schedule at least 5 days a week, which can include social activities, like cards at the senior center, church activities, projects at home, visits to museums, libraries, etc. Most communities have community education programs that offer inexpensive classes. One of the main assets of a schedule could be spending time with and around other people.
Contact with others provides “grounding” and “reality testing”. It’s harder for our thinking to get off track if we are communicating with others. Also, we are more likely to experience a sense of well-being if we are in positive, supportive relationships. It is important for families to learn positive communication and conflict resolution skills. Sometimes family therapy is necessary for this. It is also possible for one person to learn better skills and to teach by example.
I think that individuals within a couple or family may each need their own support network to some degree. It is OK for men to go to a men’s group and to spend time with buddies and for women to have their own groups and friends It is also a good idea for the couple or family to have support as a unit. Churches, temples and synagogues used to provide predictable support for families. Unfortunately, we have increasingly busy lives and often do not think of the concepts of “self-care” and “nurturing”. Predictability and regularity count a lot in terms of mood stability.
So, the concept here is “Social rhythm”. The thing to think about is our amount, types and quality of human contact. If you experience episodes of mania or depression, whether mild or severe, it may be a good idea to look at your social rhythm and how it could be adjusted.
The first step in changing social rhythm is to notice our “routine” of social contact. When one is depressed it is generally a good idea to increase our contact with others. When one is manic it is a good idea to look at the quality of our connections with others and to be on the lookout for making too much of new relationships based on too little. The type of connection we need is consistent, predictable and nurturing.
It should come as no big surprise to those of us in recovery from chemical dependency that consistent, predictable contact with other people is a stabilizing force. For years as a counselor, I have been advising clients to find a “home” AA or NA group to attend on the same night at the same time every week and to meet with a sponsor for at least an hour a week outside of meetings. We have also recognized that support from spouses, parents, siblings and friends can be an important part of recovery. I have also advocated for finding “mentors”, respected “elders” like ministers, teachers, etc, not necessarily in recovery, to connect with regularly.
So when Ellen Frank suggested that social rhythm is important in managing bipolar disorder it seemed to make sense. As part of Interpersonal Social and Rhythm Therapy she suggests that we keep track of our contact with others, as well as other daily events. Her 5 item social metric asks people with bipolar disorder to track their time out of bed, first contact with another person, the start of work, school, or other activity, dinner time and bed time.
I have long recognized that structured, “meaningful” activity aids with stability, chemical or psychological. I have seen many clients start patterns of heavy drinking after retirement, while other elderly people seem to create a new structure in their lives that gives them things “to do”. Unfortunately, some clients with chemical and mental health problems are unable to work, or are, at least, temporarily out of work. I advise them to find volunteer work and to create a “busy” schedule at least 5 days a week, which can include social activities, like cards at the senior center, church activities, projects at home, visits to museums, libraries, etc. Most communities have community education programs that offer inexpensive classes. One of the main assets of a schedule could be spending time with and around other people.
Contact with others provides “grounding” and “reality testing”. It’s harder for our thinking to get off track if we are communicating with others. Also, we are more likely to experience a sense of well-being if we are in positive, supportive relationships. It is important for families to learn positive communication and conflict resolution skills. Sometimes family therapy is necessary for this. It is also possible for one person to learn better skills and to teach by example.
I think that individuals within a couple or family may each need their own support network to some degree. It is OK for men to go to a men’s group and to spend time with buddies and for women to have their own groups and friends It is also a good idea for the couple or family to have support as a unit. Churches, temples and synagogues used to provide predictable support for families. Unfortunately, we have increasingly busy lives and often do not think of the concepts of “self-care” and “nurturing”. Predictability and regularity count a lot in terms of mood stability.
So, the concept here is “Social rhythm”. The thing to think about is our amount, types and quality of human contact. If you experience episodes of mania or depression, whether mild or severe, it may be a good idea to look at your social rhythm and how it could be adjusted.
The first step in changing social rhythm is to notice our “routine” of social contact. When one is depressed it is generally a good idea to increase our contact with others. When one is manic it is a good idea to look at the quality of our connections with others and to be on the lookout for making too much of new relationships based on too little. The type of connection we need is consistent, predictable and nurturing.
Managing Anxiety
By Tim Kuss, LADC, LMFT
This assignment is for anyone who experiences anxiety, which includes worry and fear. You may or may not have a diagnosis of anxiety disorder.
1. Describe how you experience anxiety, fear or worry.
a. If you have fear, what are you afraid of?
b. If you worry, what do you worry about?
c. Obsessive compulsive behavior can be a sign of anxiety. If you have this behavior, what is it about?
d. Are there physical symptoms? How do you breath when anxious? What happens to your heart rate? Your blood pressure?
2. Dysfunctional behavior?
a. Did you use chemicals to feel better? If so, what kind of chemicals? What effect did they have? How did you feel when the chemicals wore off?
b. What other things did you do to try to feel better? Sex, gambling, spending? How did those things work?
3. Did you know that some medications can relieve anxiety?
a. Anti-depressant meds, specifically SSRI’s can help. Are you willing to try that?
b. Benzodiazepines, such as Valium, Xanax and Klonopin are NOT good ideas for people with chemical dependency.
4. Individual therapy could be helpful
a. If you are willing to try this, please ask the therapist if they have experience with working with people with anxiety.
b. Some group therapies, such as cognitive or rational-emotive therapy can help.
5. Even if you take meds and go to therapy, it’s still a good idea to learn other COPING SKILLS for managing anxiety
a. Mindfulness skills include deep breathing and progressive muscle relaxation, including imagery and affirmations.
b. Yoga, acupuncture, or meditation may also be helpful
c. Cognitive restructuring is another positive method. This means noticing your negative self-talk, and learning to challenge and change it.
d. Distraction can help. This means doing activities like tv, reading, video games, housework, walking, work, etc,
e. Have a support network and connect with them on a regular basis
For example, find at least one person who you can share your worries or fears with and talk with them at least once a week. You can tell them that you don’t need advice and just need someone to listen. Or you can ask for suggestions some times.
6. Be involved in healthy activities that help you prevent anxiety
a. exercise for at least 15 minutes 3 to 4 times a week.
b. maintain a healthy diet. See your doctor if you need a plan for this
c. sleep 6 to 10 hours a day, depending on personal need
d. Have a daily schedule go to bed and get up about the same time every day
eat meals about the same time every day
e. Do fun stuff every day. Set aside time to do fun stuff for 1 to 3 hours at a time every week.
f. Connect with people who care about you regularly. Put it on your schedule.
7. Take a daily inventory of your anxiety, fear and worry
a. Make a plan to use coping skills to manage each one.
Questions:
What new things did you learn about anxiety, fear and worry?
What coping skills and/or strategies do you plan to use in the next week?
What skills or strategies do you plan to improve, or to develop through practice?
Read pp 12-15: Overcoming Major Anxiety Disorders and Addiction by Ihson M. Solloum, MD, MPH and Dennis Daley, MSW to get more ideas.
This assignment is for anyone who experiences anxiety, which includes worry and fear. You may or may not have a diagnosis of anxiety disorder.
1. Describe how you experience anxiety, fear or worry.
a. If you have fear, what are you afraid of?
b. If you worry, what do you worry about?
c. Obsessive compulsive behavior can be a sign of anxiety. If you have this behavior, what is it about?
d. Are there physical symptoms? How do you breath when anxious? What happens to your heart rate? Your blood pressure?
2. Dysfunctional behavior?
a. Did you use chemicals to feel better? If so, what kind of chemicals? What effect did they have? How did you feel when the chemicals wore off?
b. What other things did you do to try to feel better? Sex, gambling, spending? How did those things work?
3. Did you know that some medications can relieve anxiety?
a. Anti-depressant meds, specifically SSRI’s can help. Are you willing to try that?
b. Benzodiazepines, such as Valium, Xanax and Klonopin are NOT good ideas for people with chemical dependency.
4. Individual therapy could be helpful
a. If you are willing to try this, please ask the therapist if they have experience with working with people with anxiety.
b. Some group therapies, such as cognitive or rational-emotive therapy can help.
5. Even if you take meds and go to therapy, it’s still a good idea to learn other COPING SKILLS for managing anxiety
a. Mindfulness skills include deep breathing and progressive muscle relaxation, including imagery and affirmations.
b. Yoga, acupuncture, or meditation may also be helpful
c. Cognitive restructuring is another positive method. This means noticing your negative self-talk, and learning to challenge and change it.
d. Distraction can help. This means doing activities like tv, reading, video games, housework, walking, work, etc,
e. Have a support network and connect with them on a regular basis
For example, find at least one person who you can share your worries or fears with and talk with them at least once a week. You can tell them that you don’t need advice and just need someone to listen. Or you can ask for suggestions some times.
6. Be involved in healthy activities that help you prevent anxiety
a. exercise for at least 15 minutes 3 to 4 times a week.
b. maintain a healthy diet. See your doctor if you need a plan for this
c. sleep 6 to 10 hours a day, depending on personal need
d. Have a daily schedule go to bed and get up about the same time every day
eat meals about the same time every day
e. Do fun stuff every day. Set aside time to do fun stuff for 1 to 3 hours at a time every week.
f. Connect with people who care about you regularly. Put it on your schedule.
7. Take a daily inventory of your anxiety, fear and worry
a. Make a plan to use coping skills to manage each one.
Questions:
What new things did you learn about anxiety, fear and worry?
What coping skills and/or strategies do you plan to use in the next week?
What skills or strategies do you plan to improve, or to develop through practice?
Read pp 12-15: Overcoming Major Anxiety Disorders and Addiction by Ihson M. Solloum, MD, MPH and Dennis Daley, MSW to get more ideas.
Understanding Depression
By Tim Kuss, LADC, LMFT
I am suggesting a bio-psycho-social approach to understanding and coping with depression. The biological component comes in as we have noticed that mood disorders, such as depression, bipolar disorder and anxiety disorder tend to be found in successive generations of a family. As with alcoholism, what is inherited is a genetic predisposition to mood disorders. That means, if you have a parent, grandparent or other family member with a mood disorder, you are more likely than others to have one. It might not even be the SAME mood disorder. For example, someone’s grandmother may have had Major Depressive Disorder (depression) and that person may have bipolar disorder. We have learned that people with depression and bipolar disorder have a chemical imbalance. Medications can allow our bodies to work properly and maintain the right balance of neurotransmitters.
SSRI’s and other chemicals work as antidepressants, while lithium and certain anticonvulsants work as mood stabilizers to help manage bipolar disorder. Taking medications consistently can help us avoid episodes of depression.
The biological approach for managing depression intersects with the behavioral approach in that behaviors such as regular exercise, proper nutrition and sleep hygiene help us to avoid or cope with episodes of depression. Exposure to the sun or artificial sunlight also helps our body relieve depression.
The best psychological approach for managing depression is Cognitive Behavioral Therapy(CBT). In their book, Depression:Causes and Treatment, Aaron Beck and Brad Alford state that major depression is the leading cause of disability worldwide. They note that studies have shown changes in thyroid hormone levels in response to cognitive therapy, showing that our bodies and minds are linked. They say that depression results in a complex pattern of deviation in feelings, thoughts and behavior.
Symptoms of depression include low mood, pessimism, self-criticism, agitation, problems with memory and concentration, and physical complaints such as pain. There may be a loss of gratification with activities that starts with a few areas and expands. Activities that involve responsibility, obligation or effort become less satisfying and there is greater satisfaction in passive pursuits, including recreation, relaxation and rest..
People with depression begin to distort reality, They become preoccupied with continuous, repetitive negative thoughts(perseveration). There is often a contrast between a depressed person’s image of themselves and the objective facts. They dwell on mistakes, imperfections and inabilities, convinced that others will reject them, and that they will lose jobs, relationships, and friendships. They continue to think in themes of deprivation and defectiveness
Depression seems to be a reversal of human nature, of the survival instinct to eat and sleep and the desire to experience pleasure. Others need to respond with concern, empathy and acceptance and to be aware of the client’s difficulty in concentration and in formulating thoughts. People with depression are hypersensitive to rejection and discouragement.
The cognitive approach to managing depression involves recognizing the negative thoughts or negative self-talk that continues and increases depression. We can learn to challenge the negative thinking and replace it with neutral or positive thinking. For example, if I notice that I’m not functioning as well as normally at work, I can encourage myself to do the best I can. Instead of thinking that “I can’t do anything right” or “I’m doing so badly, that I might as well quit”, I can realize that this thinking doesn’t help the situation, and pay more attention to what I am doing well and think about what I can do today to improve the situation.
The behavioral approach involves doing things that help relieve depression. A depressed person is likely to withdraw from emotional attachments and tends to isolate from others. We can notice this and purposely spend time with others. If necessary, we can ask others to just let us be there without demanding conversation or interaction. Depression includes lethargy, but it is better to be active. Daily rituals such as walking the dog, biking, walking or swimming several times a week can be helpful.
Routine and structure can provide relief from nagging negative thoughts and feelings, so it is best to go to work or school, or to do volunteer work, or be involved in group activities, like crafts or sports. A person with depression needs to “push the envelope” in terms of involvement and activity, striving to get beyond his or her comfort zone. It’s best to start with a few small steps and keep expanding.
There is no reason why we shouldn’t pay attention to our biology, our thoughts and our behavior during the same time frame. There is no shame in taking medication for depression. We wouldn’t hesitate to take an antibiotic regardless of what people might think of us. We need to pay attention to seasonal changes including the amount of sunlight we are getting, healthy sleep habits, proper nutrition and exercising. We need to avoid isolation and too much unstructured time. We need to adjust our thinking to encourage ourselves to do all of these healthy things. Depression IS treatable. We are the prime agents in our own recovery!
I am suggesting a bio-psycho-social approach to understanding and coping with depression. The biological component comes in as we have noticed that mood disorders, such as depression, bipolar disorder and anxiety disorder tend to be found in successive generations of a family. As with alcoholism, what is inherited is a genetic predisposition to mood disorders. That means, if you have a parent, grandparent or other family member with a mood disorder, you are more likely than others to have one. It might not even be the SAME mood disorder. For example, someone’s grandmother may have had Major Depressive Disorder (depression) and that person may have bipolar disorder. We have learned that people with depression and bipolar disorder have a chemical imbalance. Medications can allow our bodies to work properly and maintain the right balance of neurotransmitters.
SSRI’s and other chemicals work as antidepressants, while lithium and certain anticonvulsants work as mood stabilizers to help manage bipolar disorder. Taking medications consistently can help us avoid episodes of depression.
The biological approach for managing depression intersects with the behavioral approach in that behaviors such as regular exercise, proper nutrition and sleep hygiene help us to avoid or cope with episodes of depression. Exposure to the sun or artificial sunlight also helps our body relieve depression.
The best psychological approach for managing depression is Cognitive Behavioral Therapy(CBT). In their book, Depression:Causes and Treatment, Aaron Beck and Brad Alford state that major depression is the leading cause of disability worldwide. They note that studies have shown changes in thyroid hormone levels in response to cognitive therapy, showing that our bodies and minds are linked. They say that depression results in a complex pattern of deviation in feelings, thoughts and behavior.
Symptoms of depression include low mood, pessimism, self-criticism, agitation, problems with memory and concentration, and physical complaints such as pain. There may be a loss of gratification with activities that starts with a few areas and expands. Activities that involve responsibility, obligation or effort become less satisfying and there is greater satisfaction in passive pursuits, including recreation, relaxation and rest..
People with depression begin to distort reality, They become preoccupied with continuous, repetitive negative thoughts(perseveration). There is often a contrast between a depressed person’s image of themselves and the objective facts. They dwell on mistakes, imperfections and inabilities, convinced that others will reject them, and that they will lose jobs, relationships, and friendships. They continue to think in themes of deprivation and defectiveness
Depression seems to be a reversal of human nature, of the survival instinct to eat and sleep and the desire to experience pleasure. Others need to respond with concern, empathy and acceptance and to be aware of the client’s difficulty in concentration and in formulating thoughts. People with depression are hypersensitive to rejection and discouragement.
The cognitive approach to managing depression involves recognizing the negative thoughts or negative self-talk that continues and increases depression. We can learn to challenge the negative thinking and replace it with neutral or positive thinking. For example, if I notice that I’m not functioning as well as normally at work, I can encourage myself to do the best I can. Instead of thinking that “I can’t do anything right” or “I’m doing so badly, that I might as well quit”, I can realize that this thinking doesn’t help the situation, and pay more attention to what I am doing well and think about what I can do today to improve the situation.
The behavioral approach involves doing things that help relieve depression. A depressed person is likely to withdraw from emotional attachments and tends to isolate from others. We can notice this and purposely spend time with others. If necessary, we can ask others to just let us be there without demanding conversation or interaction. Depression includes lethargy, but it is better to be active. Daily rituals such as walking the dog, biking, walking or swimming several times a week can be helpful.
Routine and structure can provide relief from nagging negative thoughts and feelings, so it is best to go to work or school, or to do volunteer work, or be involved in group activities, like crafts or sports. A person with depression needs to “push the envelope” in terms of involvement and activity, striving to get beyond his or her comfort zone. It’s best to start with a few small steps and keep expanding.
There is no reason why we shouldn’t pay attention to our biology, our thoughts and our behavior during the same time frame. There is no shame in taking medication for depression. We wouldn’t hesitate to take an antibiotic regardless of what people might think of us. We need to pay attention to seasonal changes including the amount of sunlight we are getting, healthy sleep habits, proper nutrition and exercising. We need to avoid isolation and too much unstructured time. We need to adjust our thinking to encourage ourselves to do all of these healthy things. Depression IS treatable. We are the prime agents in our own recovery!
Managing Depression
By Tim Kuss, LADC, LMFT
Several things influence the development of depression. Some people inherit depression. This means that their body does not work properly and they will probably need to use medications to stop their depression. Things that happen to us also influence depression. People who have bad things happen to them as children may continue to feel sad about these things long after they have grown up. The good news is that we can move beyond these effects by changing our behaviors and our thoughts. Things that happen to us and around us today also influence depression. The good news is that we can learn to cope with life events in positive ways and reduce the sadness and other negative feelings we experience.
Let’s try this.
1. What is one thing that happened or is happening to you that you feel sad about?
2. What do you think about what happened.
3. How have you acted related to what happened?
4. What have been the consequences of your thoughts and actions?
5. What can you do about the situation?
6. How can you think differently about the situation?
Would you consider taking anti-depressant medication? Why?
Would you consider going to individual therapy?
Complete pages 12 to 17 and 20,22,23 from UNDERSTANDING DEPRESSION AND ADDICTION by Daley and Thase
What are 5 ways to improve your mood?
Coping with depression:
People with depression often don’t want to get out of bed. However, getting out of bed and getting active is healthy for us. We also tend to want to stay in the house. It is better to get out of the house. Fresh air and sunshine work against depression. Activity, including exercise and work raise the level of endorphins so that we feel better. We may not want to eat, but a healthy breakfast will give us energy. It is also a good idea to set short-term achievable goals. Having daily goals that are measurable and that we can accomplish will provide encouragement and raise self-esteem. Practicing morning rituals will give us a good start to our day. Our habits can provide good structure for those days when we have low mood and aren’t sure what we want to do or if we want to do anything. Washing your hands and face, brushing your teeth and styling your hair can all provide positive feelings, while lounging around unkempt can contribute to negative thoughts and feelings about yourself.
When depressed we tend to want to isolate. We might think that we don’t measure up to other people, or that they don’t have anything to offer us. In this case we need to challenge the negative thoughts and practice positive behavior. Feel free to comment with your own positive skills for managing depression.
Several things influence the development of depression. Some people inherit depression. This means that their body does not work properly and they will probably need to use medications to stop their depression. Things that happen to us also influence depression. People who have bad things happen to them as children may continue to feel sad about these things long after they have grown up. The good news is that we can move beyond these effects by changing our behaviors and our thoughts. Things that happen to us and around us today also influence depression. The good news is that we can learn to cope with life events in positive ways and reduce the sadness and other negative feelings we experience.
Let’s try this.
1. What is one thing that happened or is happening to you that you feel sad about?
2. What do you think about what happened.
3. How have you acted related to what happened?
4. What have been the consequences of your thoughts and actions?
5. What can you do about the situation?
6. How can you think differently about the situation?
Would you consider taking anti-depressant medication? Why?
Would you consider going to individual therapy?
Complete pages 12 to 17 and 20,22,23 from UNDERSTANDING DEPRESSION AND ADDICTION by Daley and Thase
What are 5 ways to improve your mood?
Coping with depression:
People with depression often don’t want to get out of bed. However, getting out of bed and getting active is healthy for us. We also tend to want to stay in the house. It is better to get out of the house. Fresh air and sunshine work against depression. Activity, including exercise and work raise the level of endorphins so that we feel better. We may not want to eat, but a healthy breakfast will give us energy. It is also a good idea to set short-term achievable goals. Having daily goals that are measurable and that we can accomplish will provide encouragement and raise self-esteem. Practicing morning rituals will give us a good start to our day. Our habits can provide good structure for those days when we have low mood and aren’t sure what we want to do or if we want to do anything. Washing your hands and face, brushing your teeth and styling your hair can all provide positive feelings, while lounging around unkempt can contribute to negative thoughts and feelings about yourself.
When depressed we tend to want to isolate. We might think that we don’t measure up to other people, or that they don’t have anything to offer us. In this case we need to challenge the negative thoughts and practice positive behavior. Feel free to comment with your own positive skills for managing depression.
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