I'm Blue, Soooo Blue (Depression, part 3)

Remember, everyone gets depressed at some time, but not everyone gets depression. Depression comes in many forms. Yesterday we talked about degrees of reactions to change. The same occurs in all symptoms of depression. The sympoms tend to run on a continuum: eating too much to not eating at all, or somewhere inbetween.

The Diagnositic and Statiscitcal Manual (DSM-IV-TR), which is the "bible" of diagnostic symptoms for mental health professionals, lists the symptoms of depression. According to the different levels, intensities, and symptoms, there are over 200 different combinations for depression.

The symptoms of major depression can be divided into three categories:

1. 
   Disturbances of emotion and mood.
2. 
   Changes in the "housekeeping" functions of the brain - those that regulate sleep, appetite, energy and sexual function.
3. 
   Disturbances of thinking and concentration.

Some of the most common symptoms of clinical depression include:

• loss of interest or pleasure in ordinary pleasurable activities, including sex.
• chronically sad or empty mood.
• irritability or excessive crying.
• social withdrawal or isolation.
• changes in energy levels, fatigue, feeling slowed down, slowed movements.
• agitated actions (pacing, hand-wringing, etc.)
• sleep disturbances (insomnia, early morning waking, or sleeping too much).
• changes in eating habits (loss of appetite, significant weight loss or weight gain).
• difficulty with focus or concentration, impaired memory, difficulty in making decisions.
• feelings of guilt, worthlessness or helplessness.
• feelings of hopelessness and despair.
• increase in addictive behavior.
• thoughts and/or talk of death and suicide.
• suicide attempts.
• chronic aches and pains that don't respond to treatment.

If some of these seem to apply to you, then think about them in terms of these three words - number, duration and intensity.

1) Number. The symptoms of depression are "additive" - that is, the greater the number of symptoms you have, the more likely you are to be clinically depressed. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), five or more of these symptoms should be present for a person or someone close to that person to consider him or herself "clinically depressed."

2) Duration. The longer you have been down in the dumps, the more likely it is that you are clinically depressed. According to the DSM IV, the five or more symptoms must exist for at least two weeks for a diagnosis of major depression to be made.

3) Intensity. Many of us can feel emotional pain and still cope with our daily existence. Some experiences of depression are within the normal course of living. The pain of major depression can be so great, however, that its intensity (along with the number and duration of symptoms) can significantly impair one's ability to cope.

If you feel like you are clinically depressed, GREAT! You know what you can do, talk to your primary physician or make an appointment with a mental health professional (psychiatrist, counselor, psychologist) to get started on a treatment plan. You can also go to one of these sites to assess your level of depression and share this information with your physician or MHP:
Zung Self Rated Depression Scale
Mayo Clinic Depression Screening
Psych Central Depression Quiz

Keep in mind these are SCREENING tools only and NOT a substitution for a thorough examination by your physician and/or MHP.


Remember, there is HELP and there is HOPE!


Next up: Treatment options.

I'm Blue, Soooo Blue (Depression, part 2)

So what causes depression? There are many factors that lead to depession. Often, more than one, and usually a combination of many factors combine to lead to depression.

Simply put, when one of the following factors occurs, it changes our brain chemistry in some way. Of course, the factors themselves can vary in intensity; so a job change can vary from moving to a new cube, getting a new boss, being transferred to new department, being transferred to a new city, getting a demotion, getting fired, getting arrested for imbezzlement, etc. So when you say job change, that can mean many different things.

Add to that, the way we react to that change. For some people, getting a new boss is a huge deal, others, its no biggie. It doesnt meant the former person is weaker or inferior than the latter, it just means that the person reacted differently.

So, a job change occurs and our brain chemistry changes somewhat depending upon the type of change and our reaction to it. If multiple things happen our chemistry can change to the point where we are getting low in them which is a common cause of depression.

Let's look at some of these factors:

Genetics and biology.
Like other medical conditions, for example heart disease, cholesterol, and cancer, depression tends to run in families. People can be born with a certain predisposition to depression or have lower levels of chemical neurotransmitters to begin with.

Childhood trauma and other psychological factors.
As we discussed, changes in our psychology (reactions to trauma, personal loss, rejection) can also alter the biochemistry of the brain and nervous system - sometimes permanently. How we adjust to traumas, or how we are taught to adjust, can have a huge impact on the likelihood of develping clinical depression.

Environmental factors.
Poor nutrition, hormonal imbalances, toxins in the environment, brain injuries, stress, substance abuse, and can lead to depressive states. Good nutrition, decreasing stress, healthy lifestyles are keys to minimizing depressive symptoms. Alcohol depresses the nervous system, thus drinking too much, too often can lead to depressive states. Thus, moderation in drinking alcohol is essential.

Prescription medications
Many people do not realize that many common prescription drugs have side effects that can induce depression. These include cardiac drugs and hypertensives, sedatives, steroids, stimulants, antibiotics, antifungal drugs and analgesics.

Sociological factors.
Many changes in modern society, such as the breakdown of traditional communities (people don't stay in one spot for very long any more), the dissolution of extended families (with mobility in the world, often families are spread throughout the country or world), the widening gap between rich and poor, and our increased isolation due to technology (we text/email people instead of calling or visiting), may play a part in the rising rates of depression worldwide.

Spiritual crises.
People can suffer from an existential depression when life loses its meaning and purpose. Any significant transition, especially a change of roles in family or work, can trigger this crisis in meaning. Connection to a "Higher Power"has been shown to increase mood and levels of neurochemicals.

Next, we'll look at symptoms of clinical depression...

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Fight or Flight

A friend of mine, who is a medical professional, is in a dilemma. She discovered a practice that many of her coworkers were doing, with the blessing of some supervisors, was bordering on illegal. A misdemeanor, but still legally damaging to the medical licenses and certainly a potential liability for the company. None of it was done maliciously, there was just misunderstanding of how situations should be reported. Some people thought one way, others a different way. One way was correct, one was not.

My friend certainly didn't see herself as a whistle blower, she simply (or so she thought) brought the situation to the supervisor on duty. This supervisor was one who thought incorrectly about the policy. My friend suggested that the supervisors "get on the same page", so that practitioners, like herself, could be consistent in applying the practice and be in compliance with the law.

The situation my friend was discussing with the supervisor had many dimensions to it, so it ended up being a bigger deal than expected. However, something unexpected happened. My friend's supervisor had a sit down with her and told her she should "watch how you interact" with other people and you shouldn't "tell the supervisors they need to get their act together". Her supervisor went so far as to hint that if she were wanting to advance in the company, she would need the backing of said supervisors, they have great influence with the hiring manager, so she needs to be aware of "your impact on others".

She felt this to be a veiled threat...shape up, go along with us...if you don't behave, we will not promote you (or discourage your advancement)....even when potential illegal activity occurs.

So what to do? Fight the system? The practice she brought to light is being changed to comply with the law, so that's good. Does she have anything to apologize for? Should she confront her supervisor about the veiled threat. What she seems most concerned about is that her supervisor is generally very good and this seems out of character for her.

Does she "comply" and mold to their expectations in order to advance within the company or does she stand up and say this is wrong. In whistle blower situations this is what happens...the whistle blowers are told to keep quiet, don't make a stir, just go along with the wrong situation. Brave people who stand up to the corporations at times have saved lives and have actually saved the company money in potential lawsuits, yet, they are threatened with loss of job, loss of advancement, or worse.

There comes a point where you have to say, "this is wrong" and let the chips land where the may. Its wrong to implement this practice illegally, it is wrong to threaten someone with loss of advancement if he/she doesn't tone it down.

How do you respond?

Anxiety, Part 4

An anxiety disorder can greatly reduce your quality of life, but it is treatable and can be easily managed. Fully understanding this disorder is essential to your success. Research symptoms, medications, natural remedies etc.





Behavioral Therapies




Counseling, particularly a type of counseling called Cognitive Behavioral Therapy (CBT), has been shown in research to be quite effective at reducing the symptoms of anxiety and helping people live normal lives. Many people get to the point where they have no symptoms at all! Traditional talk-therapy is also a helpful treatment for many. Try one and if it does not work, try another.




For individuals with Post-Traumatic Stress Disorder (PTSD), a newer treatment called Eye Movement Desensitization and Reprocessing (EMDR) has been shown to be very effective in the treatment of trauma related issues. It does not work for everyone, but for some, just one session of EMDR has brought significant relief from symptoms. Check the EMDR website to find a trained and qualified therapist near you



Anxiety Medications




There are quite a number of medications used to treat anxiety disorder. The most popular of these being a class of medicines called Benzodiazepines. These include {{{Xanax, Valium, and AtivalValium, Atival and Xanax. While these medicines do bring some sort of relief, they are accompanied by side effects, some very serious. Side effects can occur because of the medicines ability to greatly affect activity of the brain.



Side effects usually include:

• Headaches


• Diarrhea


• Insomnia


• Irritability


• Loss of appetite


• Change in sex drive/performance


• Mood changes


• Allergic reactions


• Muscle cramps


• Tiredness


• Depression


• Confusion


• Difficulty speaking

Medicine Usage



Make note that not all medications work the same for every individual. Each individual is different and has different levels of tolerance. We all carry around batches of chemicals in our bodies (hormones, neurotransmitters, water, minerals, vitamins, etc). Each of us has different levels of the chemicals, mine are different than yours. Medications are also chemicals. So putting the same amount of chemical in me versus you may cause your chemicals to react to the medications differently than mine.



Anti-anxiety drugs should only be used short term. Long term use can lead to physical or psychological addiction. Whenever you want to quit taking these drugs discuss with your physician and work out a plan to gradually reduce the quantity you take. This should greatly decrease any withdrawal reaction.



Natural Anxiety Remedies



Many people do not care for prescription drugs or the side effects and opt for more natural solutions.



These sometimes include hypnotherapy, psychotherapy, yoga, meditation, exercise and herbal remedies. Always check with your medical doctor before trying any herbal remedies as these may interact with any other medications you are taking.





Next we'll take a look at depression......

Anxiety, Part 3

Some Anxiety Symptoms


Individuals that suffer from anxiety disorder usually exhibit several different symptoms. Some of them are listed below.

• Extreme Fear



• Shortness of breath



• Insomnia



• Irritability



• Feeling of lump in throat



• Muscle spasm/twitching



• Irregular heart beat



• Heart palpitations
  


• Fever/chills

Keep in mind, that there are more symptoms and different degrees of the symptoms. If you feel like you have some of these and are concerened, please see your medical physician or other health care provider or a licensed mental health professional in your area. Because some of these symptoms usually occur with other illnesses it is important to seek professional advice. A physician should be the one to diagnose if you have anxiety.

For an idea of where you are with your anxiety, you can take this online assessment (for educational purposes only). Share your results with your PCP or MH professional.


It is always best to rule out other medical conditions. Ruling these out sometimes bring some peace of mind and can go a long way in easing some of your anxiety related symptoms.




Finally, tomorrow we'll look at some treatment options


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Anxiety, Part 2

Types of Anxiety Disorders

1. Generalized Anxiety Disorder-Individuals that this affect are always anticipating something bad to happen. They have excessive worries about health, money and family etc.GAD occurs more often in women than in men.

2. Obsessive-Compulsive Disorder-This disorder is characterized by obsessive behavior and compulsions. Individuals perform rituals (such as hand washing) in hopes that obsessive thoughts would go away.

3. Panic Disorder- Individuals who are affected by this disorder experience feelings of terror that come on suddenly and often. They are often left in fear of certain situations and and are always in fear about the next panic attack.

4. Post-Traumatic Stress Disorder- This disorder usually develops after an individual experience some terrifying situation usually involving physical harm, death, or near death. The individual is left with bad memories about the ordeal that don't seem to go away.

5. Social Anxiety Disorder- With this disorder individuals experience extreme, severe or excessive self-awareness in public situations. This is the classic Stage Fright, but taken to an extreme degree and applied in almost all situations: grocery store, school, open areas. There is always a fear of being watched and scrutinized.

A lot of returning soldiers stationed in Iraqi and Afghanistan experience this as they were constantly on high alert over there. The open market was a dangerous area for them. They never knew who was an enemy coming up to shoot, stab, or blow them up. So now, back at home, the basketball gym, the mall, 4th of July parade can bring on this fear.

So now, you know a little of the types of disorders. Keep in mind that each of these disorders can range from having very mild levels to very extreme levels, and anywhere in-between.

Next week, we'll start looking at some symptoms.

High Anxiety

We've looked at weight and nutrition and diet for the past couple months. Let's look a little at well-being.

We'll start with anxiety. Put in a very simple term, anxiety is all about fear. When you have anxiety, at the root is a fear of something. A good example is the "butterflies in the stomach" most of us have gotten before we had to give a talk, or say our line in the school play, etc. What's another term for those "butterflies"? Stage FRIGHT. Meaning we are afraid, or have fear, of getting in front of others.

Let's look at anxiety in more depth over the next few days.

Understanding Anxiety

Anxiety is a protection mechanism that the body uses to alert us to trouble. It puts our body in what's called a "fight or flight mode" and alerts us so we can react. It is also a normal reaction to stress. If you've ever come across a rabbit in the yard you may see them tense up and watch you, to see what you will do. They are in a "fight or flight" mode. They are waiting to see if they need to defend themselves or they need to run like hell. We are the same. When we percieve trouble (in any form) our body does the same thing. We have fear and our body waits to see what we should do about it.

We cannot get rid of anxiety because this is how the human body is made to operate. Anxiety is designed to protect us and help us face challenges. When our body is constantly or too often in this fight or flight mode and as a result we start to experience psychological, physical or emotional stress this is called anxiety disorder.

Too much stress can also lead to weight problems since when we are stressed our body naturally stores fat, or minimally, stops burning fat, just in case we need to "run like hell", we have the energy from the fat to burn. Fortunately most "stress" does not result in our need to run like hell, but our body does not necessarily know that. If we experience constant stress, then our body continues to burn less fat, store more.

This we can control and minimize to the point where it does not disrupt our daily lifestyle. However the first step in controlling anxiety is to understand how it affects us.

Tomorrow, we will look at the different types of anxiety problems.

Healthy Lifestyle Balance on Vacation

Final Thoughts on Vacationing and remaining Healthy:

Take time to think about the problems in advance. For example, you normally walk every morning before work, but you plan to sleep in on vacation.

Write out the problem and list some possible solutions. Could you walk every afternoon to a scenic area (such as along the beach)?

Decide on your best solution and write it out.

Agree with yourself in advance that if you are able to carry out the plan, you will somehow reward yourself afterwards.

Be specific about the goal and the reward.

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Healthy Lifestyle Balance on Vacation

Prepare for old friends or relatives you haven’t seen in a while.
Decide how and when you will want to be assertive with them about eating and activity. Consider talking with them in advance.

Plan for pleasures after your vacation.
Coming back from a vacation is often a let-down. Try to get back to regular activities gradually and plan some extra pleasures to offset post-vacation blues. Consider allowing an easy day at home before getting back to work full-steam.

Healthy Lifestyle Balance on Vacation

Decide what you want to do about alcohol.

Alcohol may lower self-control. If you drink, are you aware of the calories involved?

Try to balance rest with activity.

Look for ways to be active that you enjoy.

Healthy Lifestyle Balance on Vacation

If you tend to be tense on vacation, ask why and what you can do about it.

a. Avoid extended periods when you are doing what others want and not what you want. Be assertive about what you want to do.

b. Plan daily times to relax. Try not to get overtired (e.g., by doing too much sightseeing in a short period of time).

c. Plan regular breaks while driving. Carry low-calorie snacks and take breaks to get out of the car and walk.
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