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Arch-Enemies 02/11/2011

Do you have arch-enemies?

I do.  Mine haunts me.  I can never seem to beat it.

There are the odd occasions when I do really well against it and I win.  It feels great.  I could walk on air.

Sometimes they last for a short stretch of time – a few days, a week – two if I’m lucky.  I could fly.

And then

it all comes

crashing

down

in

a

great

big

thud.

OUCH!

And it’s not just me who is affected.

It’s not a small thing with small consequences.

What happens, you ask?

Okay I’ll ‘fess up.

I don’t wake up.  Or if I do – I drop right off back to sleep before I can haul by backside out of bed.

Then I am late for anything that I have on for the day – visits, appointments, ….work.

And we’re talking regularly 30 – 40 mins late during the mid spring and autumn – and every now and then it’s a couple of hours.  It affects other people when that happens – workers, patients … if I don’t get my work done it slows down the process of referrals going through, information getting to people in hospital and their treating teams for planning, people going home.  It means groups can’t run or other people have to cover me.  I nearly lost my last job over it.  Even when well I’m often 10 – 20 mins behind my start time.  I survive because I start before my boss and I always work back – but I can’t keep it up.

And it doesn’t seem to matter what time I ‘m supposed to start – I’ve adjusted starting times.  It’s simply the process of getting out of bed and waking up in the morning.

Once I’m up, my sensory routines are helpful.  I’ve started to experiment with some mindfulness exercises when I get time – which help a lot.  But actually waking up and getting out of bed is jolly hard work.

The other thing that happens to me is that I lose time in the mornings.  I do.  Even when I’ve gotten up on time and have been running on time something happens – I space out in the shower or getting myself a drink and meds and time just vanishes.

I started a new experiment earlier this week that I think holds promise for the latter issue – I’ve started using a mindfulness breathing meditation exercise as soon as I get up that goes for about 10 mins to raise my level of alertness.  If it keeps working at keeping me focused, I’ll be writing about that in a couple of weeks.  But for it to work – I need to get up in time to have time to do it.  It doesn’t need to be earlier – because I’ve worked out that I do everything else more efficiently when I do it.  But I need to get up.

Sleepy-head

At present I use two alarm clocks set 5 mins apart – one to arouse my attention if I am in deep sleep so that by the time the second goes off I won’t sleep through it even if I sleep through the first.  Part of me wonders whether it’s worth investing in a bed vibrating alarm clock – they make them for deaf people.  It might be uncomfortable enough to help me move out of bed more easily.  Has anybody ever used one?

I know the rules – go to bed early and get up and the same time every day.  I’m awfully undisciplined at doing that.

Take your meds at the same time every day.  I tend to get lazy and just take them on the way to bed – which admittedly is probably half of the problem.  There are some very sleepy meds among my cocktail.

Every day is a new day with no mistakes in it – yet.  Thank you, Anne Shirley – but other people remember and I need to work out the best way to deal with their memories and keep myself focused on the present so that I don’t drown in fright.

So here it is.  My arch-enemy.  The alarm clock.  That moment in time that I’m supposed to get up.  To get moving.  To get started with the day.

Please – anybody with your own ghouls – what helps you haul yourself out of bed every morning?

 

… and Again 01/11/2011

This morning I did something awful.

Well I did a lot of good things.  But today I’m not writing about the good things.

Today I made decisions that meant that I did a lot of very useful things.

I just did one awful thing.

The very useful things helped me all day.

The awful thing was left behind this morning.

Perhaps sometime, when I have been at it for longer I will blog about one of the very useful things that I did.

Today I blog about the awful one.

I felt fan-tas-tic after every one of the good things that I did.

I shocked myself with the awful thing.

BUT

I was pleased that I shocked myself.

I don’t think I have ever had it shock me before.

It means that – perhaps the good work that I have been doing is working.

It means the therapy I did has continued to change me with practice.

…. even if I did do something awful.

This morning, not far from the start of the day

I said,

“#*@t Jill, you’re stupid!” in disgust.

And I meant it.

 

calm blue ocean … Calm Blue Ocean … CALM BLUE OCEAN!!! 28/10/2011

Now this is exercise

Now this is exercise

I don’t know about you, but I was very sceptical about relaxation exercises for a long time.  I would always think back to school days when guidance counsellors would take us through guided imagery sequences featuring a calm blue ocean or some such scenic place and tell us how we relaxed we were while the class clown made farting noises, his followers giggled, the teachers reacted and everyone else just rolled their eyes and waited for the session to finish.  At other times, attempting to relax has been more stressful than relaxing because the facilitator just wasn’t on the same wavelength as me.  I find it annoying when that happens.

It took a long time to realise that relaxation was a skill that required practice.  It has taken longer still to discover that there are many different types of relaxation exercises that you can do.  Recently while looking for a site for someone, I found one that had a variety of sound tracks for relaxation exercises ( http://www.allaboutdepression.com/relax/index.html ).  I decided that I would sample all of the relaxation exercises on this site to see what I thought of each of them – to give each a chance.  Today, I’d like to share with you a little about the exercises that I did and my thoughts on each.

Basic Breathing Exercises

Breathing exercises have been proven to be great for managing anxiety.  If you suffer from anxiety and have not already worked on some form of breathing exercises, may I recommend that you start here.  It is simple.  It is easy to follow.  It’s long enough to get a feel for what you’re supposed to be doing without being so long that you feel like you are going to be chained to the computer forever.  Furthermore the first three exercises are all breathing exercises that build upon each other.  You start with Diaphragmatic Breathinghttp://www.allaboutdepression.com/relax/diaphragmatic/diaphragm1QT.html), move on to Deep Breathing 1 (http://www.allaboutdepression.com/relax/deep1/deep11QT.html ) and then Deep Breathing 2 (http://www.allaboutdepression.com/relax/deep2/deep21QT.html ).  You don’t need to be able to do all three, but I would recommend doing the diaphragmatic breathing before any of the other exercises because it does help.

I thought that these were very useful.  Each of them was effective, and they were particularly effective when used in series.  The educators recommended that for those with anxiety disorders, your levels of anxiety will reduce by doing breathing exercises regularly as maintenance – and I can believe this given the difference that it made in the amount of tension in my body.

For those who do not have anxiety – like me … I did my mood diary scoring after I did relaxation exercises and my scores were significantly higher than they had been on any of the recent days leading up to these times.  I have been experimenting recently with http://www.moodscope.com which is a computer based system – so I was not simply giving myself a better score out of 10.

Progressive Muscle Relaxation

Progressive Muscle Relaxation is a favourite of mine.  It essentially involves tightening a group of muscles, holding them tight and noticing the tightness, then releasing the tension entirely and noticing the absence of muscle tension.  You then systematically work through to the next group of muscles and do the same thing.

I will usually start with my toes, progress to the soles of my feet and calves, the upper foot and shins, my thighs, my butt, then my hands, wrists and arms, elbows and biceps then shoulders; then I go back to my trunk and tighten and release my abdomen, then lower back, upper back, chest, shoulders (again), front of neck, back of neck, tilt neck left then right, then I work through my face so my forehead, nose, cheeks, mouth, jaw and tongue (pressed against the roof of my mouth).  Then I finish by either breathing exercises for a while or by standing and shaking out my arms and legs and stretching.  But that’s me and that takes anything from 10 to 20 mins depending on how many repetitions you do of  each muscle group.  Sometimes for really tight groups, I’ll repeat the actions a couple of times eg shoulders.

The progressive muscle relaxation sequence on the All About Depression site goes for 8mins40sec and is nice and efficient while still covering what needs to be covered (http://www.allaboutdepression.com/relax/pmr/pmr1QT.html ).  I found it satisfying and was pleased with the result at the end of the session.

Guided Imagery

I need to be frank here and admit that I am not someone who is a great fan of guided imagery sequences.  I find someone else’s descriptions of a place that they think should be relaxing for me to be kind of distracting.  I’d much rather be left to breathe or if there needs to be an image, then I’ve done sequences where the person guiding the sequence has left room for the person relaxing to select a place they like and guided by asking questions like “what can you see?”, “What can you smell?”, “Look around you and explore the colours.”  I found that kind of guided imagery more engaging.

There are two different sequences on the All About Depression site, one set on a beach and another in a forest clearing.  I think that I liked the second best in this case.  (http://www.allaboutdepression.com/relax/beach/beach1QT.html ,  http://www.allaboutdepression.com/relax/forest/forest1QT.html )

Relaxing Phrases

I came to this exercise expecting it to be grossly annoying and to loathe it.  It was actually one of my favourites.  I’m not sure whether it was because of the sequencing of the exercise, or the conscious repetition of phrases (I repeated most of them in my head because I found that doing it out loud made it difficult to breathe deeply and evenly), but this exercise really worked for me.  I want to go back and learn the phrases and the sequence to use at any time.  http://www.allaboutdepression.com/relax/phrases/phrases1QT.html

Mindfulness Oriented Relaxation Exercises

Mindfulness is about being ‘just in the moment’.  In this context, the relaxation exercise is about focusing oneself on relaxing just into the moment.  A lot of the rationale for this is that a lot of distress occurs surrounding things that have already happened or have not happened yet and that sometimes the sadness, anxiety, pain or negative feelings are easier to bear in the immediate moment if we are not contemplating past or future at that point in time.

Just this Breath

This exercise focuses upon observing your breathing.  Not changing it, simply observing it in the instant that it is happening.  It is difficult to get the hang of, but very rewarding and worth the effort.  Definitely worth a shot.  http://www.allaboutdepression.com/relax/mindfulness/mm11QT.html

Increasing Awareness

This is one of my favourite relaxation exercises.  It starts out with breathing, then gradually asks you to notice things with your other senses, in particular where your body has contact with other surfaces, the feel of your clothes and the sense of the weight of your arms and legs as you’re supported by your chair (in my case) or where ever you are resting.  I loved the sensation of my clothes on my skin as I was breathing – I was wearing a particularly soft shirt the day that I did the exercise for review.  A definite must in my books  (http://www.allaboutdepression.com/relax/mindfulness/mm21QT.html ) although regulars will know that I’m a fan of mindfulness as a strategy in general.

Mindfulness with Guided Imagery

Remember what I wrote earlier about guided imagery?  Well it’s no less true where the imagery is attached to mindfulness strategies.  That said – in the first exercise Sending Thoughts Away on Clouds   (http://www.allaboutdepression.com/relax/mindfulness/mm31QT.html ) I found the clouds a great way to dismiss unwanted or intrusive thoughts – the idea being that where a thought that was a distraction from the scene or your breathing came into your consciousness, you were to send it away on a cloud.  I could picture this as though just blowing the thought away.  Sending Thoughts Away on Leaves  (http://www.allaboutdepression.com/relax/mindfulness/mm41QT.html ) didn’t feel as natural, although it kind of worked.  In this guided image I was taken to a clear forest stream to enjoy it.

The final image was quite different in what it did with distracting thoughts.  In this the idea was to be Sorting Into Boxes (http://www.allaboutdepression.com/relax/mindfulness/mm51QT.html ) thoughts that intruded, the boxes being one for thoughts, one for emotions and one for sensations eg aches and itches.  This was more bizarre to start with and I found myself distracted by the boxes – but after a while I settled down and just focused on my breathing again and that helped.  For a while however, I think I was almost inventing itches and filing the thought ‘this is stupid’ over and over again.  Once I went back to breathing and visualisation the boxes became background scenery – a bit like a picnic basket when you’re not actually eating.  I can imagine this being helpful though if you were being flooded by intruding thoughts and feelings – you could just label them without processing them and put them to the side by the rules of the exercise without it being an intrusion on what you’re supposed to be doing – which is staying in the moment, just breathing and picturing a scene.

MY TOP 3

My favourite three out of these audio tracks in no particular order would have to be:

Increasing Awareness

Relaxing Phrases

Progressive Muscle Relaxation

Why not take the time to try a few?  What were your favourites?

 

Watching Wellth 16/10/2011

The journey’s oft’ rough as one travels the road

with one’s mood apt to upset the cart;

And if climbing back on aft’ one spill weren’t enough –

Alas – staying on top is an art!

For most of us who have passed though one episode of depression – or other forms of mental illness and come out the other side, a common concern draws us.  We don’t want to go back there.

Some have a harder battle ahead of them than others.  Some have different forms of depression; different forms of anxiety; different forms of mental illness that are more or less responsive to the things that we do to treat them.  Some are more vigilant than others – often this makes a big difference … and sometimes life’s not fair.  Some do all the ‘wrong’ things and yet never have another episode – but that’s unusual.

What’s usual is hard work with a need to use a range of strategies to stay well.  Things like good sleep, exercise, a nutritious diet, keeping up social support networks and getting out of the house, exposure to sunlight and fresh air, use of medications and talking therapies are just some examples of these.

But how do we know that we’re winning?  What can we do at the times when we’re worried about how our mood is going to try to prevent it from tipping over the edge into something we can’t manage?  How do we know if that new medication is doing anything to change anything at all?

One of the things that is helpful to do at times is to track your mood.  How do you do this?  You use a mood diary.  Ever done it?

The purpose of a mood diary is essentially to get a profile of what pattern your mood is following on a day-to-day basis.  At their most basic level, a mood diary will ask you to rate your mood on a numerical or incremental scale every day while you keep it.  Some will additionally ask you to record other information such as your anxiety levels, your irritability levels, how much sleep you had the night before, significant events and triggers throughout the day and/or the medication that you took.  The good thing about doing some of these other things is that they provide a much fuller picture of what is going on.

If you don’t already know what they are – this process can help you to work out what your early warning signs are as well as your triggers.  If you know your triggers and early warning signs, this can help you to monitor them. For that reason, I recommend choosing a mood diary that records significant events in the day.  I would also recommend one that includes the amount of sleep that you had the night before as this tends to be pretty universal and fairly influential.

Talk to someone close and ask for their help if you have trouble working out if you were irritable or if they noticed anything in particular that seemed to set you off if you are having trouble identifying these kinds of things – but the object of the exercise is to make observations about yourself – so do what you can on your own as well.

However, asking someone close to you whom you trust to help monitor your mood and to help you get to know your warning signs and triggers is a good strategy.  They sometimes see things that you are not in the right place to see or notice when you’re not well because your self-awareness can get a bit skewed.  They also see the ways that you differ from the way that you would normally be – so they can measure you against you and not somebody else.  Yes, it might be their perception – but it will still be your behaviour and actions and the things that you say and the responses and facial expressions that they are used to that are part of you.  Choose someone who you trust and talk with them and let them tell you about what they noticed changing last time and as you have been working through your recovery.

Do I use a mood diary and self monitoring systems all of the time?

Not on a daily basis.  When I am well I keep regular tabs on how I am going by talking about it with a good friend and checking over my early warning signs and triggers list regularly to ensure that my awareness of them is good and that I am alert to high risk periods.  I use what is called a WRAP – a Wellness Recovery Action Plan where I have identified what I am like when well, what my triggers are, what things are hints that I’m not as good as I could be, my early warning signs and so on …. I go through this regularly.  Some people do monitor their mood daily and find that it works well for them.  People with things like rapid cycling Bipolar disorder often find that they need to until it slows down and is brought under control.  At first I needed to chart my mood a lot more than I do now.

When I am in a high risk period I watch things more closely and have recently resolved to keep a mood diary through high risk periods because I still find myself at sea sometimes and feeling like I’m losing my grip.  I am particularly vigilant about my warning signs and triggers as well as their corresponding action plans during periods of high risk.  I have to be.  Recently I let things go at home and let the dishes and the housework pile up around me – a sign that things are getting away from me and didn’t act and it triggered me (it becomes a cycle).  I couldn’t face getting up to look at the house.  I didn’t want to go into the kitchen to prepare a decent meal because it was a mess and I didn’t feel up to cleaning it up – so of course my nutrition level went down, my budget blew out and thus the cycle continued.  In the end it took a cleaning weekend to put me back on track, followed by a week of very early nights and a lot  of discipline.  It’s too easy.  So I have decided that I need to do something to catch myself more quickly before it gets away from me.  Not simply cleaning, just lots of little things.  This time of year I need to be very careful about relapse prevention.  It sounds minor when I talk about dishes – but when it snowballs, I just keep sleeping and if I sleep through work or go in late consistently and am still going around in circles while I’m at work and don’t have energy or concentration to work – I could lose my job.

I’ve attached today some links to some self monitoring resources and different mood diary sites.  I know there’s a lot, but different things suit different people and I think these are important tools.  Most mood diaries have room for the full spectrum of mood disorders – both mania and depression.

Warning signs and triggers are important.  Monitoring your mood is tedious sometimes – but there are times when it is necessary.

General

http://breeze.blackdoginstitute.org.au/keepingwell/

Mood Diaries

http://www.bipolar.com.au/common/pdf/mood-diary.pdf

http://www.blackdoginstitute.org.au/docs/MoodChartforDepressionandhowtomonitoryourprogress.pdf

http://www.blackdoginstitute.org.au/docs/DailyRatingScale.pdf
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiary

http://www.moodscope.com/ for those who like online resources

https://www.moodtracker.com/ another online resource

http://itunes.apple.com/au/app/moody-me-mood-diary-tracker/id411567371?mt=8 for those who like apps

Mood Monitoring & Relapse Prevention Programmes

http://www.cci.health.wa.gov.au/docs/KYB-3-Self%20Monitoring.pdf

http://www.idamaecampbell.org/files/40263519.pdf (WRAP personal workbook)

Early Warning Signs

http://www.health.qld.gov.au/rbwh/docs/early_warming_signs.pdf

http://www.blackdoginstitute.org.au/docs/20.WellbeingPlanforBipolarDisorder.pdf (can be used for depression too)

Healthy Lifestyle

https://www.mindbodylife.com.au/Downloads/index.cfm

 

 

 

Just One Moment … 14/10/2011

The alarm clock rings.

Perhaps.

I drool.  I roll.

The dog opens an eyelid.

I haven’t moved yet.

The dog opens another.

I am snoring lightly.

His head lifts.

Tilts.

He listens.

I am breathing.

Not that he cares.

The dog rises on his haunches – quietly – all the while waiting for me to stir.

The song changes on the clock radio.

The dog waits.

But I don’t move …

… and slowly, slowly he rises to his legs and creeps out of the room.

The black dog roams free in the house.

And I sleep on.

Eventually, much later I wake.

I look at the clock.

%##@@

And then I see the empty patch on the floor …

and I know that something worse seems to be afoot.  I haven’t just slept through an alarm this morning.

The dog is at large in the house.

I fall back on the bed and close my eyes in dread.

What awaits me?

How awful will this become?

Can I face it again?

I pull the covers up over my head and try to snuggle back down to sleep.

It’s not really happening.

But I can’t do that anymore.

I’m not the same person that I was last time I found myself like this.

Bloody Dog!

Now I have to go and clean up this mess.

The mess.  Can I face the mess?

Sooner or later I have to.  I’m really just putting it off lying here in dread and imagining.

He’s only been loose a little while.  How bad can it be?

Bad.  It’s been bad quickly before.

Come on.  This is getting us nowhere – time to move.

So eventually.  Eventually.  Eventually – I do.

I was right.

He’s been everywhere.

But unlike before, I can catch him and rein him in reasonably quickly.

Sure, this leaves me tired.  But not defeated.

There are muddy prints where the dog has been – but all they are are the traces of his lies upon my consciousness.  I can clean those.

Tonight the dog is back on his leash.

Tonight is evidence of what gains I have made with the help of my psychologist in learning to be conscious of my thoughts, emotions, my actions and how my body is responding to situations and to be deliberate in how I respond to this.  Tonight I remember how these things used to crush me.  How encouragement was drowned out by self-derision.

Today my dog got off the lead.  Today I caught him again.

Yes, it made a mess of my morning.

Yes, it upset me.

But today, I could hear encouragement when it was offered by someone supportive.

Today Mindfulness skills allowed me to feel and experience the emotions of the moment and yet use the CBT strategies that I have learned to right my perspective and reorient my day so that I could finish it feeling like I had accomplished something useful.

Today, the dog has finished his day at heel.

 

Depression? … No, it’s not just … (sigh) … Forget it … 12/10/2011

If there are around 7 billion people in the world, then I reckon that there are about 7 billion ways to explain depression.   Seriously.  Everyone is so different.  Just when you think you’ve nailed a way to explain what it is and how it affects you, you come across someone for whom that explanation just doesn’t cut it.  Now, I know that it’s not necessary to tell everyone what is going on.  It is not everyone’s business and not everyone even wants to know.  But sometimes it’s necessary – and necessary that they have an understanding of what depression actually is rather than just what they assume it to be.  If someone is going to support you, live with you, take your sickness certificates seriously when they start piling up or you relapse in the work place – they need to understand more than just what they see at surface level.

So how do you get there?

How do you explain that you have this black dog that is constantly with you, even when under your command and at heel?

How do you help someone get past the idea that you could just put mind over matter if you wanted to?

How do you convince your boss that you’re not being lazy? Or taking sickies?

How do you convince your grandfather who is not very aware of mental health issues that you are not a hypochondriac?

Do you find yourself getting into arguments over these things?  Being left feeling guilty and doubting yourself because of the things that people say?  Feeling frustrated and defeated because they just don’t understand? Or just feeling out of your depth explaining the nature of depression, it’s causes, what perpetuates it and what helps to treat it and to support your recovery? You are not alone. Do you struggle to understand these things yourself?

The first step in becoming more confident explaining what is happening to you to someone else is to become more confident in your own understanding. Write down what you know.  Organise your ideas under headings like

My Diagnosis (there are different types of depression):

Definition of diagnosis and Symptoms:

Body chemistry:

Thoughts (ie what it does to them, not necessarily yours although you may include a couple of less risky examples):

Behaviour (ie what people do because of depression):

Effects on function and everyday life:

Treatments that people use (ie medication and therapies):

Treatments I use: How well my treatments are working (and if you are thinking of trying any others some time):

Things recommended to help recovery:

Things that I do/am doing:

Things that are recommended for carers/supporters/workplaces who are supporting people who have depression:

Resources that I have found that might be handy to give people:

How did you go?  Where are the gaps?

The next step is to dig around and fill in some of the gaps in your own mind.  Make a list of the questions that you still have.  You don’t necessarily need to have them all answered before you talk to someone about your depression – but they are there for you to follow up on for your own benefit.  Sometimes you can also make a joint venture out of finding the missing information with the person you plan to talk to if they are someone who you trust.  If anyone would like me to work through a series on these or to post any heading in particular I’d be happy to include something like this in future entries.  Please put any suggestions or requests in the comments section for this post.

When you have thought through these things for yourself and written them down – if you come to a time when you need to pull your thoughts together for an explanation it is so much easier to do. The next thing to think about is this.  What type of person or question are you dealing with?

People like your grandparents and some parents have been brought up in a generation where sickness is seen in form of a disease or medical issue – so with them, I would start by explaining to them the aspect of depression caused by biological factors and that it’s an episodic illness.  Perhaps I would give them some information to read, or would talk to them and describe what happens – maybe draw a diagram of a synapse and show them how my neurotransmitters are out of balance.  Then I would tell them the symptoms that causes and how they affect everything else.  Then I would go back to my drawing and show them how my medication works and talk to them about why I need to keep on taking it.  If they were interested and wanted to know more about my treatment, I might also explain that I go to a psychologist to learn techniques to overcome other symptoms too because they have become fairly stubborn and I get lost in them at times – but that I don’t expect that this will be like the medication, and it’s not like lying on a couch talking.  It’s about learning specific skills and having time limited therapy that has been show in the research to be very effective in strengthening recovery and preventing relapse.  I might then tell them about my goals and what I’ve been working on and how things are going.  Lastly I would talk to them about what kinds of things experts say that family and friends do that help.  If they wanted something to look at for more information, I would try for something from a doctor or official health site, in large print if I could find it.

Your boss might need a medical kind of approach too.  With them I would also look for information for employers on one of the mental health support websites.  BeyondBlue has a good one (http://beyondblue.org.au/index.aspx?link_id=7.980&tmp=FileDownload&fid=1176 ).  It has another one about whether or not to disclose if you are considering the decision (http://beyondblue.org.au/index.aspx?link_id=7.980&http://www.beyondblue.org.au/index.aspx?link_id=6.1068&tmp=FileDownload&fid=356 ).  I would stick to workplace issues only and be clear about how your efforts are going in relation to getting or staying on top of your work.  Make sure that you are clear of your work place rights.  If you are in Australia, BeyondBlue spell them out more specifically or direct you to a source.  I’m not sure where international readers would need to go.  Mr Google would, I’m sure.

For siblings and friends – it probably depends upon how they relate.  Some will understand best if you describe it by its symptoms and numerous courses, some will need a scientific approach, others will need an explanation of the treatments that they see you taking and using as an entry point.  Usually family and close friends want to know what they can do and feel frustrated when they feel helpless.  It’s important to make sure to give them information about your symptoms, your treatment, what your doctor thinks is causing it and what they can do to support you.  Sit down with them and talk about what helps if they are involved in your life.  If they are not talkative people, gradually feed them things to read.

I’m not going to talk about young to school-aged children here because I want to talk to a friend who is a specialist in this area and do a special post specifically on this topic at another time.  However, for adult children my advice is similar to that which I have written for siblings.  Generally they want to feel that Mum or Dad is okay.  Yes, it’s strange and they start hovering as though they were the parents and can get overbearing at times.  Other times they may be so caught up in their own lives that they don’t even seem to notice.  In both cases, it’s important that you are ready to educate.  If you don’t have the energy for the conversation, young adults will respond to websites.  Sending them to http://www.beyondblue.org.au , http://www.blackdoginstitute.org.au and http://www.scottishrecoverynetwork.net will get them well oriented to Depression, treatments and some people’s experiences stories if they look around.  There are also great resources there for family and friends.  Then they can come back and talk to you about what they have learned.

Then of course there are your parents.  All the strategies in the world will not stop their concern at times.  This is part of their world.  For most people, when things are hard – all a parent wants to be able to do is make it better, easier somehow.  It’s the nature of the role and love that they have had no matter how old we get.  I am aware that there are people who are not lucky enough to have families who have cared for them like this – but on the whole, a parent’s response to any perception of threat to your wellbeing is a desire to protect you (remember, that one that’s been driving you nuts since you were at least as young as 14).  When talking to your parents about your depression remember this.  Once a parent – who has considered themselves a carer or a protector throughout your life when you have been unwell or threatened – accepts that you have depression and understands the nature of the illness, they will find it difficult to respond to as well.  It is good to have information designed for families and carers for them if they find watching you struggle hard.  Make sure that you spend time talking with them about what helps and what doesn’t.  Calmly.  Write it down first if you need to.  I share things to read with my family.  They don’t say much, but their education shows in the things that come up when we are talking about my health or my plans for the future.

My observation from working with people who find their parents “too interfering” is that often in by not telling them anything about what they are doing for their depression – is that a lot of the parent’s interference is related to ignorance; and that more, rather than less information about what is going on, better education for the parent and some help to reassure the parent that their son or daughter is making healthy choices goes a long way toward defusing the situation.  I know that this is not true in every case, but frequently it is.  And while some of the parents need to learn better adult boundaries, others are just desperate for the wellbeing of their son or daughter.  It may not be possible to put all of your parent’s concerns to rest.  This is not your job.  Nor is it your job to protect them from ‘finding out’ – because ten to one odds say that they have already noticed that you haven’t been yourself for a while and are already worrying in secret if bothering to hide it.  Explaining the true shape of the issue that you are dealing with and telling them how they can help rather than leaving them to shadow box with the ghosts they imagine is all that you can do.

Sometimes, unfortunately, like we might have been to start with – the people we care about or people we need to know may also remain in denial of depression in someone they know.  This is very hard.  Sometimes a family member might respond if they come to the doctor with you.  Other times it may be a case of letting your treatment and the efforts that you are putting in prove themselves over time.  It is hard to be motivated to do this with someone saying that you are being lazy or playing sick.  It doesn’t help the thoughts.  It can increase anxiety.  It is humiliating even to one’s self.  If the person won’t respond to your attempts to talk to them or to give them information, unfortunately it is difficult to make their choices for them.  However, the best way to deal with them is to prove them wrong.  The best way to prove them wrong is to prove that the treatment that you are undertaking and the effort that you are putting in is having an impact.  Even if it’s a partial impact that goes in fits and starts – change can be a catalyst for more change.  Perhaps seeing a change in you as you progress will convince them that there was something to that information that you tried to give them a few months ago…

 

Medication: Weight or Baggage? 09/10/2011

Ever want to hear a room full of doctors or mental  health workers stop talking?

Introduce debates that have been raised in recent years questioning the effectiveness or the place of medications in the treatment of mental illness.  Suggest that there might be evidence of options that would be more appropriate starting points for treatment.  Ask them whether they would be ready to choose to live with the side effects that may result from some of the anti-depressants that are out there.

Have I surprised you?

I am not anti-medication by any means.  I use medication.  Unfortunately, at present, a lot of it although I hope in time to be in a position to reduce this.  There are some people who are.  They say that Depression can and should be managed by using strategies such as those that I discuss in “Beyond Medicine” with use of lifestyle strategies with regularity and discipline as well as well evidenced ‘talk therapies’ that build skills and resilience like CBT and Mindfulness.  Some even think that medication makes depression worse.

There are now groups who go over research that comes out about treatments to see what standards people are using to measure ‘success’ of treatments against and how it really measures up with other treatments if judged by the same criteria (eg http://www.power2u.org/medication-optimization.html ).

My depression falls within the ‘major depression’ and severe spheres.  That is within the spectrum of severity where it is clear from research that anti-depressants have a measurable effect.  It can be proven that they make a difference.  Research is finding not much evidence to prove that medication makes a measurable difference as opposed to placebo or other forms of therapy for mild depression and little more so for moderate depression.  Now, that’s not saying that there are no cases where it doesn’t work and all cases where it won’t be worth a shot – or that you won’t underestimate how severe your own depression is.  I certainly did at first.  What it does say is that it is worth asking some serious questions and exploring a range of other treatments either before or instead of medications.

Consider the some of the side effects of antidepressants.

Short term side effects of SSRIs can include nervousness, anxiety, muscle tics, suppression of REM sleep (and then drowsiness), nausea, dizziness, diarrhea, gastrointestinal problems, different types of sexual dysfunction, emotional blunting and apathy.  With long-term use come risks of cognitive changes.  Now most short-term effects will pass as the body gets used to the medication, but still …

Tricyclic antidepressants have potential side effects that include blurred vision, dry mouth, constipation, bladder problems, sexual dysfunction, dizziness, drowsiness and increased heart rate among others – again some settling after a short time and others continuing.  Not everyone gets any or all side effects, but most experience some.

If you take MAOI anti-depressants, then you can’t eat certain types of food.  Potential side effects here include low blood pressure, constipation, vomiting,  headache, altered sleep, dry mouth, drowsiness, fainting, sexual dysfunction, weight gain and lower alcohol tolerance.

And people wonder why people stop taking medications!!?!  Do you want to take them?  How will they help you?  Sometimes trying the non-medication based therapies first does make a lot of sense.  While it seems easier to just take a tablet, how confident can you be that the tablet will make you feel better?  Mine do.  But remember, firstly, my Depression is severe and secondly, I also need to bolster it with management strategies that aren’t medication-based.  I need both.

Here’s the thing though.  What ever you do decide to do – make sure that you are fully informed.  Do your research.  Also – ask your doctor the hard questions like:

“Why this medication?”

“What are the side effects?  How long would I expect them to last?”

“Are there any risks associated with this medication?”

“Will I be able to keep working while I start taking it (if you are working) or will it affect my performance?  Should I take a few days off?”

“How will I know if the medication is starting to work?  How long should it take?”

“Are there any precautions that I should follow over the next few days/weeks?”

“What happens if this medication doesn’t work?”

If you do agree to try a medication, stick with it as advised.  The time frame your doctor gives you for how long it should take to work will be only an estimate.  Also, some medications are dangerous to stop unsupervised.  If you are trying a medication, consider it a joint experiment by yourself and your doctor.  You bring your expertise of your experience and the effect that the medication has upon you.  Your doctor brings medical training and independent observations.  Both are needed to make an informed decision about where to go with your medications.

If you are on long-term medication, you doctor and yourself share a partnership.  Again, you are the expert on yourself, your symptoms, experience and how the medication is (or isn’t) impacting your life.  Your doctor is the expert on the medical facts, observations and assessments as well as the medication itself.  In any partnership for decisions to work to their best advantage both people should be involved in the decision-making event – even if the right of decision is mostly with one person.  This means that both people’s expertise can be used.  Sure, ultimately, it’s your life and your right to agree or disagree with your doctor’s medical opinion – but when there’s medication involved and you want to change it or come off it, at least informing them is a smart thing to do.  They can then tell you if you need to know about any risks and you can ask them what you need to know to make sure that you are safe.  You can also make a judgement call about how much you think you can manage with your own strategies with a lower dose of medication in place and work to negotiate this with your doctor.

Ultimately, I think it comes down to the type of depression that you have.  Some don’t need medication.  For some the decision could go either way.  And there will always be some that need it.  However, the question about whether we do or don’t use medication is weightier than deciding whether we can tolerate side-effects or would rather carry a load of self management strategies that may seem burdensome when we feel so amotivated.

We all need the self-management strategies.  These have been proven to be effective in reduction of depression regardless of the level of severity.  Our decisions about medications need to be weighed carefully.  How much of the work are we expecting them to do?  They are a tool, not a workshop and not a finished project.  They are designed to equip us to work at life.  If they’re working, you’ll be able to take up the management strategies that are more lifestyle driven and see your mental health improve to wellness.  Sometimes with meds still in the background.  Yet for others, in time a mutual farewell to the partnerships with doctors and health workers gives way to a continuing lifestyle-driven means of managing wellness.

 

 
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