Monday, December 5, 2011

Caring For Depression

Techniques that helped me: 

• Perhaps the biggest solace was realizing and accepting that this horrible feeling is only temporary and is the result of the disease, and that reality is not as bad as I perceive it to be. It stopped me from trying to resist it, which was vain and enervating, and helped me accept it. When the fog would come over me and torment my mind, I learned to "lay low" and "wait out the storm" by not trying to resist it. It is still difficult but takes less energy that vainly trying to break free from it.
• One thing that unfailingly makes me feel good when I feel hopeless and worthless, is reminding myself that other people felt the same way or even worse, thereby making it OK for me to feel this way. Like Abraham Lincoln, despite having severe depression he went on to do great things. It validates my feeling, and makes me feel like I'm not alone.
• The other solace is being able to relate to somebody else who was going through the same thing. It put things in perspective.
• Writing about my feelings (blogging and journaling), listening to validating music (I listened to Korn a lot), reading a validating book (like a memoir)
• Also, “coming out” was a great relief. It was hard to tell others, but telling friends took a huge burden off my shoulders of keeping it a secret. Letting others know about my illness makes me feel like I am breaking down the silence around it and that something good has come out of my experience. Sharing with others that you have a mental illness is difficult at first because you are vulnerable and stigmatized, but I noticed that, as a rule, when I share something personal others tend to share something about themselves. Also, it’s surprising how many people want you to share your experiences because they themselves are depressed. They are hoping that somebody will help them but are just too afraid to say reach out.
• Meditation. I paid $375 (which was already a 50% student discount on the full $750 fee) to learn transcendental meditation. The technique is really simple and does not require much training; however, paying the money made me commit to it more. The technique involves sitting still for 20 minutes in the morning and at night and repeating a mantra in your head--it can be anything, like "one" or "ohm"--while not thinking about anything else, and if you catch your mind drifting, gently bring it back to the mantra. Meditation is extremely effective at easing anxiety and worry. However, it is really hard to get into the habit and takes a few tries before you can calm your mind down effectively.
• Books. I bought several self-help books and memoirs, which helped tremendously. Reading memoirs helped me feel less alone and understand that what I was experiencing was normal, and reading self-help helped me understand what I was going through better and feel like I had some control over my well being. The memoirs I read were: An Unquiet Mind, and Darkness Visible. Recently I also read Lincoln's Melancholy, and Unholy Ghost. I also bought The Feeling Good Handbook by David Burns, which has a lot of helpful information and exercises. My therapist also recommended me the Dialectical Behavior Therapy Skills Workbook to help manage my emotions.

Other suggestions for how to get the most from depression treatment: 

Monitor your mood. Monitoring your moods and behavior from time to time can help your doctor treat your depression before it becomes hard to control. Try to observe any patterns of mood swings each week and call your doctor if you aren’t feeling at the top of your game. 
Strengthen your social support. While you cannot control your depression diagnosis, there are some things you can control. You can seek or create a positive support system for yourself. Whether your social network stems from your spouse, family members, close friends, co-workers, religious organizations, or community groups, support is available. 
See a depression expert. Any doctor can prescribe depression medication, but a prescription alone isn't the best treatment. You should seek out an expert, like a psychiatrist or a psychologist. Your condition is, by definition, hard to treat. It's important to talk with a trained professional during your treatment. Although psychologists cannot prescribe medication, they are well-trained in psychotherapy. You can work with a psychologist while taking antidepressants prescribed by your regular doctor, or you can see a psychiatrist for both your depression medication and talk therapy. Try to find someone who has a lot of experience helping people with treatment-resistant depression. 
Develop good habits. Take your depression medicine at the same time every day. It's easier to remember if you do it along with another activity such as eating breakfast or getting into bed. Get a weekly pillbox, which will make it easy to see if you've missed a dose. Since people sometimes forget a dose now and then, make sure you know what to do if that happens. 
Don't ignore side effects. Side effects are one of the main reasons that people give up on medication. For instance, in a British study of just over 1,000 people with depression, 65% said they stopped taking their medicine at some point. Of this group, about 45% said side effects were the reason. The results were published in Current Medical Research and Opinion in 2003. If you have side effects, talk to your doctor. See if there's any way to minimize or eliminate them. However, keep in mind that side effects might be worse when you first start a medicine. Side effects often ease up over time. 
Maintain regular sleep habits. Talk to your doctor if you have difficulty falling asleep or maintaining sleep. There are new non-addictive medications available that can help resolve sleep problems. Also, cognitive behavioral therapy has been shown in recent clinical trials to be a helpful adjunct treatment for patients who have impaired sleep efficiency, or anxiety and fears about poor sleep.

Andrew Solomon's interview (author of The Noonday Demon):
from documentary DEPRESSION: Out of the Shadows

What advice would you give others?
  1. First piece of advice: Deal with it early. Don't wait until it escalates out of control. Like any illness, it's easier to treat before it becomes acute.
  2. Second piece of advice: Find the right therapist and psychopharmacologist. Sometimes that's one person and sometimes it's two people; seek the best. There a lot of bad treatments and too many incompetent shrinks, so if you're not getting better, try seeing someone else. It's exhausting and annoying shopping around, but as in all other areas of life, there are some people who are highly skilled and others who just aren't very good. There are also people who work well for one patient and aren't right for another.
  3. Third piece of advice: If you have a chronic condition, treat it in the long-term. Have the courage to stay on your meds, and don't be tricked into thinking that brave people get better on their own. If you had lung cancer, you wouldn't try to cure it by breathing carefully. Don't trivialize depression. Remember that it can be fatal: A large number of depressed people commit suicide.
  4. Fourth piece of advice: Don't keep it all a big secret. Depression is stressful and keeping secrets is stressful. But tell people selectively and carefully. Some people can deal with it and others can't. And get yourself a support structure. Love won't cure depression, but it will make it a whole lot easier to tolerate.

Treatment facts:
• Treatment works for 80% of patients.
• If left untreated, the average duration of a major depressive episode is six months.
• The average duration of an episode of six months. 20% of these episodes can last two years or more, with 50% of depressive episodes ending spontaneously.
• After the major depressive episode is over, 20% to 30% of patients have residual symptoms.

Alternative (to medication) treatments:
 – Lifestyle changes/adjusting daily schedule
    • Physical exercise
    • Diet/Nutritional therapy (incl. multivitamins and omega-3 oil)
    • Getting enough and consistent sleep
    • Change in job/location
 – Herbal remedies
    • 5-HTP
    • St. John’s Wort
    • SAM-e
 – Meditation
 – Writing/Journaling
 – Music
 – Making new friends/creating a support network
 – Volunteering
 – Yoga
 – Getting a pet/Pet therapy
 – Hobbies
    • Dancing
    • Drawing/Art therapy
    • Hiking in nature
    • Gardening

Here are some of the supplements for mood and health that helped me. I've used Omega 3 and multivitamins for a long time and they've helped my mood a lot. 5-HTP helped take the edge off of stress and anxiety.

5-HTP: Nature's Way
I also suggest you take 5-HTP for mood and appetite control. This is 50ml capsules. You should take them every 4 or 5 hours. Start with 100ml per day, and then increase to 200ml per day if you don't get side effects. These are very powerful, so you should be careful when taking them, make sure to space them out and monitor your mood.

Omega 3 Mood: Country Life
Currently it's $15.12 for 45 days (90 1g softgels, twice a day)
In a nutshell, why it's good:
The ideal ratio of Omega-6 to Omega-3 should be 1:1, but the typical American's ratio ranges greater than 20 to 1. This is because we consume much more Omega-6, which is a fat found in corn, soy, sunflower and other oils. Also, countries with high consumption of seafood (which contains Omega-3), like Japan, have much lower rates of depression than America. There are two types of important Omega-3 fat: EPA and DHA. Fish oils are the best source of these. The EPA helps support mood, among other benefits, because it educes inflammation. The best ratio of EPA:DHA is 7:1 (some say it's 3:2, but 7:1 works for me). To have any effect, take 2g of Omega-3 per day for a few weeks. If you don't experience any effect, up your dose to 3 or 4 g/day (but not more). 
This one is the cheapest ever: $6.67 for a month supply. The doses in Alive are effective for depression. This multivitamin also increases energy.

Note: According to the book "Chemistry for Joy", these are the effective doses for depression (much higher than the RDA). Alive comes close to these.

Mineral Amount/day
Calcium 750-1500mg
Magnesium 375-750mg
Chromium 200-300mcg
Copper 1-2mg
Zinc 7-30mg
Manganese 5mg


Vitamin
A (beta-carotene) 25000IU
C 200-500mg
D 800IU (20mcg)
E 400mg
B6 10-50mg
B12 20-100mcg
Folic Acid 400mcg
Selenium 200mcg

More information about depression:

DEPRESSION: Out of the Shadows + TAKE ONE STEP: Caring for Depression, with Jane Pauley

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