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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

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Seasons Come & Seasons Go 29/09/2011

Some people are Summer people. Some people, spring people. Some are winter people. Some love autumn.

No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about). I am simply talking about peoples’ favourite times of year. Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool. Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on. Some love the colours of autumn and the beginnings of that lick of ice in the early evening. And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…

I never settled to a favourite time of year. I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next. I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time. Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance. I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind. Actually – wind bugs me more than temperature. But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight. Full of life. At least, I always used to think so.

My dog pays attention to the seasons too.

Unlike me, the dog has clear preferences for different times of the year. It took me a while to work this out, but its consistent. The dog is stubborn in winter. He moves slow. He needs more time. He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months. I think he’s arthritic. He gives me no trouble if I allow for the arthritis though. A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine. I just need to be patient.

Summer is usually the dog’s best time of year. He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead. Spring and Autumn are strange. Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing. In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts. He is unpredictable. I can not afford to let my guard down for more than a few moments at a time. My sleep gets poor – this starts the ball rolling. My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it. It at these times that I have frequently relapsed (almost without exception). I made it through autumn this year. So far I have struggled this far through the last few weeks. Another 3 – 4 should see me through the worst of it.

Until then, its keep on keeping on and stick to the programme. Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors. Light does funny things to my health in other areas too. It’s like the dog becomes delirious. Here is a time when I need my friends and family – my supports more than any other time of the year. I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu. Still, I’m determined to conquer that one too. I get there on time more often than not – just not as often as I should. Just now – when I least feel like it – discipline becomes oh so important.

I had my last review with my Psychiatrist this week. We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.

Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine” with the temporary medication adjustment will prove to be a good protective measure. I’ve had a good year. I’d hate to mess it up now. I’m hoping to get to at least a whole year without a relapse this year!

So roll on to the latter end of Spring. Because despite all of this, I really do love spring. There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.

Come Dog. Heel. Walk. Heel. Walk. Heel …

Food Glorious Food 25/09/2011

Filed under: Clinical Depression,Depression,Managing Depression,Physical health & wellbeing,self-management strategies — jillnottelten @ 5:54 pm
Tags: Clinical Depression, Depression, Diabetes mellitus, Eating, GP, Health, Mental Health, nutrition, Physical exercise, planning, Relapse prevention plan, Sedentary lifestyle, self-management

Fruit. Vegetables. Meat. Protein. Dairy. Iron. Carbohydrates. Breads. Cereals. Rice. Pasta. Vitamin E. Vitamin C. Vitamin D. Vitamin B. Fats. Sugar. Cholesterol.
Hormones. Blood Sugar levels. Chocolate. Shortbread…

How we eat makes a big difference to how we feel. It affects how much energy we have. It affects how efficiently our system processes what we do eat and how easily it will break down and prevent or minimise constipation. For some it can affect them at a more vital level – for those with diabetes it is even more important to monitor food intake, as for those with particular allergies.

Recent studies indicated that people with depression have a high (anything up to a one in two) risk of developing diabetes. That is an enormously scarily high statistic. You might ask, “Why? Why this on top of everything else?”

A large part of the answer is thought to be tied up in lifestyle issues. They actually think that for most people this is preventable! Risk factors for development of type 2 diabetes include lack of exercise and sedentary lifestyle (ie sitting around a lot and inactive), obesity especially if your weight distribution is more around your stomach than your hips and thighs, eating unhealthily is a major cause of type 2 diabetes – too much fat, too many simple carbohydrates and not enough fibre in particular; also high blood pressure, high cholesterol levels, high cortisol (stress hormone) levels, smoking, family history, gestational diabetes and aging (over age 45 becomes higher risk).

A lot of these risk factors overlap with issues that occur regularly in people with depression. It is common for people with depression to have little physical exercise and very sedentary lifestyles, poor diet and become overweight due to a combination of this and at times side effects of medications – and the lovely little belly that the medication leaves is usually a tummy rather than hips and thighs. Stress level hormone levels may be high due to anxiety levels; depression, like diabetes often has genetic links, many of the high levels can be secondary to diet and lack of exercise and statistics indicate that a high proportion of people with depression also smoke. Oh – and yes, we might say that we’re 39 for a while, but everybody ages.

The good news is that the majority of the factors identified as risks are preventable. They are also helpful ways to improve the prognosis of the course of our mental health.

Look for ways to become more active. Start small and build up a little at a time. Sooner or later you will feel like you are exercising. In the meantime, you will be stretching out those muscles and getting them ready for a challenge. One of the biggest weight loss programmes in the world was started by a woman who started out by walking around her clothesline.

Research what needs to go into a balanced diet. Plan what you will eat ahead of time and stick to it. I find this really hard, but it really is worth it. I have more energy when I do and it helps keep a lot of other things more balanced. Try cutting up your veggies when you get them and storing them ready to use – that way you don’t have as much to do to prepare food when you have to cook. Same with your meat and everything else. It takes longer to store – but half the time (at least for me) a large part of the battle in getting the energy together to get something healthy and wholesome to eat is in overcoming that ‘I don’t feel like all the preparation’ feeling. At worst keep a couple of pre-cooked healthy meals stored in the freezer for when you don’t feel like cooking.

Talk to your doctor about a Quit smoking programme. It is possible. People do it all the time.

See someone about some anxiety management strategies. If you already see a case worker, therapist or doctor ask them for advice about what to do or where to go. Look around for local programmes through community health resources. If you get stuck and are not sure where to start, check out the mindfulness and CBT pages on this site or post me a comment and let me know. If you’re in Australia, ask your GP to write you a referral under “Better Health” to see a psychologist or clinical psychologist.

Just to start off, this week I had a really simple meal of a piece of steak about the size of the palm of my hand. I had a couple of mushrooms that I chopped up and cooked with it in the pan. I then steamed in the microwave generous serves of broccoli, cauliflower, both green beans and yellow ones and some snow peas that I grew in my garden. It was filling, plain and simple.

Why not share something healthy that you cook/prepare or plan to cook/prepare after reading this in the comments. Maybe we can collect some recipes and ideas?

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I wanna be a … 18/09/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 8:29 pm
Tags: Alarm clock, Clinical Depression, Depression, exercise, Mental Health, nutrition, Relapse prevention plan, routine, self-management, sleep, waking, work

Jetson!

Are you old enough to know The Jetsons, I wonder? Most are, surely.

I’m not after the groovy little space-sedan.

I’m not even in it so much for the robot house keeper – although I would certainly NOT turn her away …

I want the bed that tips you out when you need to get up, stands you up and puts you on a conveyor belt to the shower and gets you started for the day.

I swear, that has got to be the hardest part of the day! I’m okay once I’m showered and dressed for the day – but until that point it is all up hill.

On work days I don’t trust myself with less than two alarm clocks. I’ve been known to turn alarm clocks off in my sleep. I figure that one will at least bring me out of deep sleep and the second can wake me if the first doesn’t. I don’t keep at least one near my bed. I make sure that I need to touch floor to turn it off. I also make sure it’s a really noxious sound so that I don’t just let it keep going.

One thing that I don’t do that a lot of people say works well for them is put out my clothes the night before. I have tried it a few times, but tend to finish up thinking that I don’t feel like wearing what I put out and finish up dithering over what I do want to wear. That said – it would probably work fine on work days if I kept it up – so I should try it again.

I also tend to waste a lot of time putting off getting to the shower (especially in winter) puttering around the house. Alas! This just makes me late.

Oh for an alarm clock that tipped the mattress 45 degrees and dumped me on the floor with a bang if I reached for a snooze button!

Drat the need for motivation, will power, decent routine & bedtimes, discipline in lights out and organisation in the morning.

But then again, if I have been eating well, doing exercise, working, and going to bed at a decent hour I am likely to have been refreshed by sleep and find it easier (note that the word here is “easier” and NOT necessarily “easy”) to wake and rise. Perhaps key to my struggle with rising in the mornings is my lack of discipline in other areas – most obviously in getting to bed at a decent hour reliably, but also exercising regularly. I would also have more energy if my diet included more fruit and vegetables.

So many things to fine tune.

I still envy George Jetson.

Attishoo! Attishoo! We All Fall Down 31/08/2011

What’s going on?

I’ve got a headache that I’ve had on and off for a few days now. I’m so tired so much of the time. I’m disorganised. My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…

Hang on. These things are all among my early warning signs. I’m off my game. Nothing serious yet – but now is the time to act. I’ve been going really well for ages. It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting. Yet this I do know. In the past relapse has often followed physical illness. The dog acts when he knows I’m not at my best. He takes advantage of weakness.

So what do I do now? Give in? Panic? Book an extra doctor’s appointment? Nope. Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well. In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months. My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.

Now is the time to restart the action plans. I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be). I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward. I think I’m okay if I get reorganised at this point.

So its back to setting alarms and keeping them for going to bed and lights out at night. I’ve been letting the sleep run thin.

I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there. And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).

I need to put away the things that are lying around and creating clutter.

I need to clean the house. When that goes to my list though it will read room by room and the floors will be separate. That way I can do it in parts and feel like I’m making headway when I cross things off on my list.

I need to set up a routine for maintaining my housework.

I need to set aside time for doing things that I like to do.

I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.

I need to set aside time for some meditation and prayer.

I need to make sure I leave work on time.

I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me

I also really need to put some effort into starting to exercise and to spending more time outdoors.

If I need help with anything, I can and will ask.

I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult. It may get easier. Who knows? My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now. Now the need is to just do it.

We all fall down. We all need to know the best way to get up again too. Take the time to be prepared. I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ . You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf if you want to check it out a bit more closely). There are a number of different systems people have. The most important thing is to be ready to be ready.

All I have is a cold. It does not have to become a relapse.

Right now though it’s approaching bed time. So rather than editing anything else. I’m going to post this and head for the sack. Good night.

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When the Mallee Bull’s Away … 24/08/2011

In recent years I have developed a fierce respect for my health. Not only my mental health – but my physical health. Whereas before I had little patience for the times when I was sick, there are times now when I fear it. When I am sick I just use more sick days at work – which raises more questions and more suspicion: “what is really going on?”. I feel disgusting. I break all of my carefully laid down routines and maintenance plans. I have to take more tablets. And all too often it drags on for too long thanks to poor immunity and a system that’s already struggling with every day and brings me – if not to relapse, then certainly to the brink.

When I am sick, the dog often thinks he is allowed to play.

It makes sense. There is less energy to be on top of my game with my thinking, so if I’m not ultra careful I do forget to reality test my thoughts. I get lazy and don’t practice mindfulness. My appetite is lacking, so unless there is someone else cooking for me and serving up nutritious food, I’m not eating well. I’m exhausted and sleeping all the time and not maintaining my routine. I’m too sick to exercise. My medication is going in – but that’s about the only maintenance activity that is actually happening – and if I have a gastro bug even that gets out of kilter.

Short term bugs aren’t so bad. A day or two and I get back on top of my game without too many problems. No, the one that I hate most of all is surprising to some people. The thing I dread most is the common cold. It drags on forever. It saps my energy. It robs me of the desire to prepare decent food, to look after the house, to keep much of a routine. Sound like anything else you know? I live in fear that the head cold will go to my chest and then I will finish up coughing for weeks on end which leads to fear of aggravation of an old back injury – and so my thoughts become dominated by dismal and negative themes and the black dog leaves his rightful position at heel and begins to circle again. Thus it is that I find that a cold, if I can’t get rid of it quickly can be a trigger for relapse.

So – what do I do? I stay rested. I eat well. I have my flu shots – which I know some find controversial – and that there are also people who are not convinced that this helps, but as a health worker I find that it has left me less vulnerable and in Australia health workers get them for free. I wash my hands regularly and use hand disinfectant. I dress to the climate. I’ve given up rain walks in cold weather. Some people use vitamins, but to be honest I couldn’t face taking any more pills and don’t want to spend the money and would rather just eat the vegetables. I try to avoid spending a lot of time with people who are sick. If you look back a couple of posts to ‘Beyond Medicine‘, you will find that these are the things that will keep you physically healthy as well as mentally healthy. If you want to keep the bugs at bay these are the things you go to. Some I have already mentioned, but lifestyle habits and strategies that reduce stress are also important. Support is important. Hope is important. Sunshine is important. Recognising the early warning signs and triggers of physical illness is important. Our mental health and physical health are inextricably linked.

If I get a cold, I do start taking cold and flu tablets early when I get symptoms of a cold – particularly at night, and I use airway clearing aromatherapy oil before I go to sleep so that I can breathe clearly. I also sleep propped up slightly. Usually these things stop the cold from getting to my chest. Usually.

This year has gone well so far. I’ve stayed mentally well enough while I’ve been sick that I’ve still been able to use my mindfulness and cognitive behavioural techniques to keep the dog in line, so he hasn’t really challenged – even when some of the other important stuff has fallen by the wayside. It’s still going to involve work to get the rest back in place, but hopefully not as much as usual. So just for the moment while I get a bit better…

Sit, Dog… Sit.

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