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12 Ways to Keep Going with Depression

This is an interesting article I found on: www.psychcentral.com

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About once a week I hear the same question from a reader, “What keeps you going?” The short answer is lots of things. I use a variety of tools to persevere through my struggle with depression because what works on one day doesn’t the next. I have to break some hours into 15-minute intervals and simply put one foot in front of another, doing the thing that is right in front of me and nothing else.

I write this post for the person who is experiencing debilitating symptoms of depression. The following are some things that help me fight for sanity and keep me going, when the gravity of my mood disorder threatens to stop all forward movement.

Find a good doctor and therapist.

I have tried to beat my depression without the help of mental health professionals and discovered just how life-threatening the illness can be. Not only do you need to get help, you need to get the RIGHT help.

A reporter once referred to me as the Depression Goldilocks of Annapolis because I have seen practically all of the psychiatrists in my town. Call me picky, but I am glad I didn’t stop my search after the third or fourth or fifth physician because I did not get better until I found the right one at Johns Hopkins Mood Disorders Center. If you have a severe, complicated mood disorder, it is worth going to a teaching hospital to get a consultation.

Be just as choosy with your therapist. I have sat on therapy couches on and off for 30 years, and while the cognitive behavioral exercises were helpful, I didn’t begin making real progress until I started working with my current therapist.

Rely on your faith — or some higher power.

When everything else has failed, my faith sustains me. In my hours of desperation, I will read from the Book of Psalms, listen to inspirational music, or simply yell at God. I look to the saints for courage and resolve since many of them have experienced dark nights of the soul — Teresa of Avila, John of the Cross, Mother Teresa. It is of great consolation to know that God knows each hair on my head and loves me unconditionally despite my imperfections, that He is with me in my anguish and confusion.

A substantial amount of research points to the benefits of faith to mitigate symptoms of depression. In a 2013 study, for example, researchers at McLean Hospital in Belmont, Massachusetts, found that belief in God was associated with better treatment outcomes.

Be kind and gentle with yourself.

The stigma attached to depression is still, unfortunately, very thick. Maybe you have one or two people in your life who can offer you the kind of compassion that you deserve. However, until the general public offers persons with mood disorders the same compassion that is conferred on people with breast cancer or any other socially acceptable illness, it is your job to be kind and gentle with yourself. Instead of pushing yourself harder and telling yourself it’s all in your head, you need to speak to yourself as a sensitive, fragile child with a painful wound that is invisible to the world. You need to put your arms around her and love her. Most importantly, you need to believe her suffering and give it validation. In her book Self-Compassion, Kristin Neff, Ph.D., documents some of the research that demonstrates that self-compassion is a powerful way to achieve emotional well-being.

Reduce your stress.

You don’t want to give into your depression, I get that. You want to do everything on your to-do list and part of tomorrow’s. But pushing yourself is going to worsen your condition. Saying no to responsibilities because your symptoms are flaring up isn’t a defeat. It is act of empowerment.

Stress mucks up all your biological systems, from your thyroid to your digestive tract, making you more vulnerable to mood swings. Rat studies show that stress reduces the brain’s ability to keep itself healthy. In particular, the hippocampus shrinks, impacting short-term memory and learning abilities. Try your best to minimize stress with deep-breathing exercises, muscle-relaxation meditations, and simply saying no to anything you don’t absolutely have to do.

Get regular sleep.

Businessman and author E. Joseph Cossman once said, “The best bridge between despair and hope is a good night’s sleep.” It is one of the most critical pieces to emotional resiliency. Practicing good sleep hygiene — going to bed at the same time at night and waking up at a regular hour — can be challenging for persons with depression because, according to J. Raymond DePaulo, Jr., M.D., co-director of the Johns Hopkins Mood Disorders Center, that’s when people often feel better. They want to stay up and write or listen to music or work. Do that too many nights, and your lack of sleep becomes the Brussels sprout on the floor of the produce aisle that you trip over. Before you know it, you’re on your back, incapable of doing much of anything.

Although pleasing our circadian rhythm — our body’s internal clock — can feel really boring, remember that consistent, regular sleep is one of the strongest allies in the fight against depression.

Serve others.

Five years ago, I read Man’s Search for Meaning by Holocaust survivor and Austrian psychiatrist Viktor Frankl and was profoundly moved by his message that suffering has meaning, especially when we can turn our pain into service of others.

Frankl’s “logotherapy” is based on the belief that human nature is motivated by the search for a life purpose. If we devote our time and energy toward finding and pursuing the ultimate meaning of our life, we are able to transcend some of our suffering. It doesn’t mean that we don’t feel it. However, the meaning holds our hurt in a context that gives us peace. His chapters expound on Friedrich Nietzsche’s words, “He who has a why can bear almost any how.” I have found this to be true in my life. When I turn my gaze outward, I see that suffering is universal, and that relieves some of the sting. The seeds of hope and healing are found in the shared experience of pain.

Look backwards.

Our perspective is, without doubt, skewed during a depressive episode. We view the world from a dark basement of human emotions, interpreting events through the lens of that experience. We are certain that we have always been depressed and are convinced that our future will be chock full of more misery. By looking backwards, I am reminded that my track record for getting through depressive episodes is 100 percent. Sometimes the symptoms didn’t wane for 18 months or more, but I did eventually make my way into the light. I call to mind all those times I persevered through difficulty and emerged to the other side. Sometimes I’ll take out old photos as proof that I wasn’t always sad and panicked.

Take a moment to recall the moments that you are most proud of, where you triumphed over obstacles. Because you will do it again. And then again.

Plan something fun.

Filling my calendar with meaningful events forces me to move forward when I’m stuck in a negative groove. It can be as simple as having coffee with a friend or calling my sister. Maybe it’s signing up for a pottery or cooking class.

If you’re feeling ambitious, plan an adventure that takes you out of your comfort zone. In May, I’m walking Camino de Santiago, or The Way of Saint James, a famous pilgrimage that stretches 778 kilometers from St. Jean Port de Pied in France to Santiago de Compostela in Spain. The anticipation of the trip has fueled me with energy and excitement during a hard stretch of my life.

You need not backpack through Europe, of course, to keep moving forward. Organizing a day trip to a museum or some local art exhibit could serve the same purpose. Just be sure to have something on your calendar other than therapy and work meetings.

Be in nature.

According to Elaine Aron, Ph.D., in her bestseller The Highly Sensitive Person, approximately 15 to 20 percent of the population is easily overwhelmed by loud noises, crowds, smells, bright lights, and other stimulation. These types have rich interior lives, but tend to feel things very deeply and absorb people’s emotions. Many people who struggle with chronic depression are highly sensitive. They need a pacifier. Nature serves that purpose.

The water and woods are mine. When I get overstimulated by this Chuck E. Cheese world of ours, I retreat to either the creek down the street or the hiking trail a few miles away. Among the gentle waves of the water or the strong oak trees in the woods, I touch ground and access a stillness that is needed to navigate difficult emotions. Even a few minutes a day provide a sense of calm that helps me to harness panic and depression when they arise.

Connect with other warriors.

Rarely can a person battle chronic depression on her own. She needs a tribe of fellow warriors on the frontline of sanity, remembering her that she is not alone and equipping her with insights with which to persevere.

Five years ago, I felt very discouraged by the lack of understanding and compassion associated with depression so I created two forums: Group Beyond Blue on Facebook and Project Hope & Beyond. I have been humbled by the level of intimacy formed between members of the group. There is power in shared experience. There is hope and healing in knowing we are in this together.

Laugh

You may think there’s nothing funny about your depression or wanting to die. After all, this is a serious, life-threatening condition. However, if you can manage to add a dose of levity to your situation, you’ll find that humor is one of the most powerful tools to fight off hopelessness. G.K. Chesterton once said, “Angels can fly because they take themselves lightly.” That’s what laughter does. It lightens the burden of suffering. That’s why nurses use comedy skits in small group sessions in inpatient psychiatric units as part of their healing efforts. Humor forces some much-needed space between you and your pain, providing you a truer perspective of your struggle.

Dance in the rain.

Vivian Greene once said, “Life isn’t about waiting for the storm to pass, it’s about learning to dance in the rain.”

When I was first diagnosed with depression, I was sure that the right medication or supplement or acupuncture session would cure my condition. Ten years ago, when nothing seemed to work, I shifted to a philosophy of managing my symptoms versus curing them. Although nothing substantial changed in my recovery, this new attitude made all the difference in the world. I was no longer stuck in the waiting room of my life. I was living to the fullest, as best I could. I was dancing in the rain.

References

Rosmarin, D.H., Bigda-Peyton, J.S., Kertz, S.J., Smith, N., Rauch, S.L., & Björgvinsson, T. (2013). A test of faith in God and treatment: The relationship of belief in God to psychiatric treatment outcomes. Journal of Affective Disorders, 146(3): 441-446. Retrieved from https://www.sciencedirect.com/science/article/pii/S016503271200599X

Hildebrandt, S. (2012, February 6). How stress can cause depression [blog post]. Retrieved from http://sciencenordic.com/how-stress-can-cause-depression

Frankl, V.E. (1959). Man’s Search for Meaning. Cutchogue, NY: Buccaneer Books.

Aron, E. (1996). The Highly Sensitive Person. New York, NY: Carol Publishing.

12 Ways to Keep Going with Depression

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Which Should We Treat First: Mental Illness or Addiction?

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Substance use can alter behaviors, moods, and personalities so severely for people with addiction that without specialized knowledge and experience, it’s difficult to determine underlying causes such as mental illness or trauma.

I credit psychological intervention for pushing me into recovery from alcoholism.

Addiction is a mental illness, but is it one that needs to be treated before anything else? Or should we be stopping people from hitting their addiction bottom and helping them recover from their comorbid conditions concurrently?

What Is Addiction?

Before we can discuss treatment, we need to understand what addiction is and how it is defined. The two major guidelines for diagnosing mental health conditions around the world are the DSM and the ICD. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the standard diagnostic tool for mental health conditions in the United States and often used in North America. The ICD (International Classification of Diseases) is endorsed by the World Health Organization and often used in Europe.

In the DSM-5, substance abuse and substance dependence are combined under the same name of substance use disorder, which is diagnosed on a continuum. Each substance has its own sub-category, but behavioral addiction is also in the DSM-5, with gambling disorder listed as a diagnosable condition. Other similar entries, such as internet gaming disorder, are listed as needing further research before being formally added as a diagnosis. In the ICD-11 there is a subset of mood disorders called “substance-induced mood disorders,” which are conditions caused by substance use. To qualify for this category, one must not have experienced the mood disorder symptoms prior to substance use.

Hypothetically, a person who has alcohol-induced mood disorder might find health with abstinence alone, but substance use disorders do not occur in a vacuum and no one can go through the experience of addiction without it altering their mind and body, sometimes irreversibly. With enough time, substance-induced disorders change the function of the brain and alter emotion regulation. That doesn’t mean that addiction will cause another mental disorder; addiction is a mental disorder.

Not everyone with an addiction is concurrently experiencing another mental disorder. Substance use can alter behaviors, moods, and personalities so severely for people who are addicted that without specialized knowledge and experience, it’s difficult to determine what, if any, underlying cause is responsible for the changes. Drugs, even those that are prescribed and used as directed, can have side effects that seem to mimic the symptoms of other diagnosable conditions. These effects can also appear if a person is in withdrawal. Because of this inability to isolate co-occurring conditions, there was a time when it was popular for doctors and clinicians to first treat substance use disorders before exploring the possibility of other mental illnesses.

That is no longer considered the best approach to care…

So, what is considered the best approach then? Keep reading for more information about therapy to recognize addiction, integrated treatment, the consequences of discriminating against people with substance abuse disorder, and more over at the original article Addiction or Mental Illness: Which Should You Treat First? at The Fix.

Which Should We Treat First: Mental Illness or Addiction?

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