Depression: What It Is and What to Do about It (Part 2)

Depression: What It Is and What to Do about It (Part II)

This is the second of a two-part series on depression. In this issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods.

1.    Psychotherapy: Exploring one's beliefs and ways of thinking, and learning new ways of thinking and behaving, with the guidance of a professional.
2.    Self-help: Exploring one's beliefs and ways of thinking on one's own.
3.    Medication: Altering one's brain chemistry by taking antidepressant medication.

A physician may recommend medication when four conditions exist:

1.     The patient's depression is severe.
2.     The patient has suffered at least two previous depressive episodes.
3.     There is a family history of depression.
4.     The patient asks for medication only and refuses psychotherapy.

There are four types of antidepressant medication available today:

�    Tricyclic antidepressants (TCAs)
�    Monoamine oxidase inhibitors (MAOIs)
�    Selective serotonin reuptake inhibitors (SSRIs)
�    Structurally unrelated compounds

The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs.

Treatment without Medicine

One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing.
Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy.

Prevention of Depression

Depression can often be prevented. It is especially important to take preventive action if you are aware that you have predisposing factors such as those mentioned in the last newsletter.

1.    Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlearned and replaced with something healthier.
2.    Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes.
3.    Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions.
4.    Build your life around things you can control. Learn to recognize what you can control and what you can't. Avoid spending much effort on situations that won't pay off for you.
5.    Learn self-acceptance. Instead of rejecting the parts of yourself you don't like, learn to manage them more productively.
6.    Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts.
7.    Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life.
8.    Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning.
9.    Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won't behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship.
10.    Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you.
11.    Avoid isolation. Talk to others about what's going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective.


Signs That Professional Therapy Is Needed

1.    Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.
2.    When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.
3.    Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
4.    You have become so isolated that you have no one with whom to test reality. Seek someone out to share your thoughts and feelings with.
5.    Depressive symptoms have become severe.
Please call for an initial free consultation. 813-240-3237 We are here to help!

Depression: What It Is and What to Do about It (Part I)

This is the first of a two-part series on depression. In this issue, I will explore what depression is and what causes it. In the next issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.

Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or "the blues." It can have an impact on nearly every aspect of a person's life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it.

Depression Is Pervasive

When a person suffers from depression, it can affect every part of his or her life, including one's physical body, one's behavior, thought processes, mood, ability to relate to others, and general lifestyle.

Symptoms of Depression

People who are diagnosed with clinical depression have a combination of symptoms from the following list:

·    Feelings of hopelessness, even when there is reason to be hopeful

·    Fatigue or low energy

·    Much less interest or pleasure in most regular activities

·    Low self-esteem

·    Feeling worthless

·    Excessive or inappropriate guilt

·    Lessened ability to think or concentrate

·    Indecisiveness

·    Thinking distorted thoughts; having an unrealistic view of life

·    Weight loss or gain without dieting

·    Change in appetite

·    Change in sleeping patterns

·    Recurrent thoughts of death

·    Suicidal thoughts

·    A specific plan for committing suicide

·    A suicide attempt

·    Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person's family and social relationships, as well as work life, are impaired.

When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, substance abuse, general medical condition, or bereavement.

Grief, Sadness, and Depression

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

Depression and Socioeconomic Factors

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link; depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-20s. People born more recently are being diagnosed at a younger age.

Physical Causes

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse.

Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

Signs That Professional Treatment Is Needed

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional.

1.    Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.

2.    When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.

3.    Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.

4.    You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with.

5.    Depressive symptoms have become severe.

In my next newsletter, I will discuss the treatment and prevention of depression.

Why Am I So Anxious?

Why Am I So Anxious?

Fact: You Cannot Be Anxious and Relaxed At The Same Time! Therefore, the antidote to anxiety = relaxation...

Every human feels anxiety on occasion; it is a part of life. All of us know what it is like to feel worry, nervousness, fear, and concern. We feel nervous when we have to give a speech, go for a job interview, or walk into our boss's office for the annual performance appraisal. We know it's normal to feel a surge of fear when we unexpectedly see a photo of a snake or look down from the top of a tall building. Most of us manage these kinds of anxious feelings fairly well and are able to carry on with our lives without much difficulty. These feelings don't disrupt our lives.

But millions of people (an estimated 15% of the population) suffer from devastating and constant anxiety that severely affects their lives, sometimes resulting in living in highly restricted ways. These people experience panic attacks, phobias, extreme shyness, obsessive thoughts, and compulsive behaviors. The feeling of anxiety is a constant and dominating force that disrupts their lives. Some become prisoners in their own homes, unable to leave to work, drive, or visit the grocery store. For these people, anxiety is much more than just an occasional wave of apprehension.

Types of Anxiety Disorders

An anxiety disorder affects a person's behavior, thoughts, feelings, and physical sensations. The most common anxiety disorders include the following:

Social anxiety or social phobia is a fear of being around other people. People who suffer from this disorder always feel self-conscious around others. They have the feeling that everyone is watching them and staring at them, being critical in some way. Because the anxiety is so painful, they learn to stay away from social situations and avoid other people. Some eventually need to be alone at all times, in a room with the door closed. The feeling is pervasive and constant and even happens with people they know.

People who have social anxiety know that their thoughts and fears are not rational. They are aware that others are not actually judging or evaluating them at every moment. But this knowledge does not make the feelings disappear.

Panic disorder is a condition where a person has panic attacks without warning. According to the National Institutes of Mental Health, about 5% of the adult American population suffers from panic attacks. Some experts say that this number is actually higher, since many people experience panic attacks but never receive treatment.

Common symptoms of panic include:

·    Racing or pounding heart

·    Trembling

·    Sweaty palms

·    Feelings of terror

·    Chest pains or heaviness in the chest

·    Dizziness and lightheadedness

·    Fear of dying

·    Fear of going crazy

·    Fear of losing control

·    Feeling unable to catch one's breath

·    Tingling in the hands, feet, legs, or arms

A panic attack typically lasts several minutes and is extremely upsetting and frightening. In some cases, panic attacks last longer than a few minutes or strike several times in a short time period.

A panic attack is often followed by feelings of depression and helplessness. Most people who have experienced panic say that the greatest fear is that the panic attack will happen again.

Many times, the person who has a panic attack doesn't know what caused it. It seems to have come "out of the blue." At other times, people report that they were feeling extreme stress or had encountered difficult times and weren't surprised that they had a panic attack.

Generalized anxiety disorder is quite common, affecting an estimated 3 to 4% of the population. This disorder fills a person's life with worry, anxiety, and fear. People who have this disorder are always thinking and dwelling on the "what ifs" of every situation. It feels like there is no way out of the vicious cycle of anxiety and worry. The person often becomes depressed about life and their inability to stop worrying.

People who have generalized anxiety usually do not avoid situations, and they don't generally have panic attacks. They can become incapacitated by an inability to shut the mind off, and are overcome with feelings of worry, dread, fatigue, and a loss of interest in life. The person usually realizes these feelings are irrational, but the feelings are also very real. The person's mood can change from day to day, or even hour to hour. Feelings of anxiety and mood swings become a pattern that severely disrupts the quality of life.

People with generalized anxiety disorder often have physical symptoms including headaches, irritability, frustration, trembling, inability to concentrate, and sleep disturbances. They may also have symptoms of social phobia and panic disorder.

Other types of anxiety disorders include:

Phobia, fearing a specific object or situation.

Obsessive-compulsive disorder (OCD), a system of ritualized behaviors or obsessions that are driven by anxious thoughts.

Post-traumatic stress disorder (PTSD), severe anxiety that is triggered by memories of a past traumatic experience.

Agoraphobia, disabling fear that prevents one from leaving home or another safe place.

Treatment Options

Most people who suffer from anxiety disorders begin to feel better when they receive the proper treatment. It can be difficult to identify the correct treatment, however, because each person's anxiety is caused by a unique set of factors. It can be frustrating for the client when treatment is not immediately successful or takes longer than hoped for. Some clients feel better after a few weeks or months of treatment, while others may need a year or more. If a person has an anxiety disorder in combination with another disorder (such as alcoholism and depression), treatment is more complicated and takes longer.

While a treatment plan must be specifically designed for each individual, there are a number of standard approaches. Mental health professionals who specialize in treating anxiety most often use a combination of the following treatments. There is no single correct approach.

Cognitive Therapy

The client learns how to identify and change unproductive thought patterns by observing his or her feelings and learning to separate realistic from unrealistic thoughts.

Behavior Therapy

This treatment helps the client alter and control unwanted behavior. Systematic desensitization, a type of behavior therapy, is often used to help people with phobias and OCD. The client is exposed to anxiety-producing stimuli one small step at a time, gradually increasing his or her tolerance to situations that have produced disabling anxiety.

Relaxation Training

Many people with anxiety disorders benefit from self-hypnosis, guided visualization, and biofeedback. Relaxation training is often part of psychotherapy.

Medication

Antidepressant and antianxiety medications can help restore chemical imbalances that cause symptoms of anxiety. This is an effective treatment for many people, especially in combination with psychotherapy.

The treatment for an anxiety disorder depends on the severity and length of the problem. The client's willingness to actively participate in treatment is also an important factor. When a person with panic is motivated to try new behaviors and practice new skills and techniques, he or she can learn to change the way the brain responds to familiar thoughts and feelings that have previously caused anxiety.

How People Change

What Is Happiness?

If you are thinking about changing your life for the better, one way to start is by identifying your goals. You are probably hoping to find some version of happiness or emotional well-being. That might look like any combination of the following:

·    A sense of freedom

·    Self-esteem

·    Self-confidence

·    Happy to get up in the morning

·    Working toward goals

·    A sense of purpose in life

·    Satisfying relationships

What Is Unhappiness?

If you are thinking about changing your life, you may be experiencing some combination of the following elements:

·    Feeling sad, lethargic or depressed

·    Feeling afraid

·    Abusing or being addicted to alcohol or drugs

·    Feeling lonely

·    Anxiety

·    Problems with relationships

·    Not getting what you want in life; feeling frustrated in working toward goals

·    Not caring enough to have goals

How Will You Change?

When you decide to change your life, try the following ideas.

1.    Explore your feelings. Keep a journal, talk to a trusted friend, work with a professional counselor.

2.    Envision your future. Write in a journal, make a collage, do a guided visualization, talk to a friend or counselor, research the possibilities.

3.    Explore wishes and dreams. Keep a journal, talk to a trusted friend, work with a professional counselor.

4.    Be open to new ideas. Take a class, travel, say yes to things you may have avoided in the past.

5.    Look for kindred spirits. Avoid people who make you feel bad about yourself, seek out those who make you blossom, reach out to those with similar interests and dreams.

6.    Try something different. Deliberately buy new items, try different brands, shop at different stores, do the opposite of what you usually do, see different movies, read different kinds of books and magazines.

7.    Set goals and targets. Learn how to set useful goals, follow through, evaluate progress regularly, reward yourself for achievement.

8.    Take one step at a time. Divide your goals into tiny pieces and do one small new thing each day, starting now.

9.    Look for lessons. Remind yourself that experiences are not good or bad; they are simply lessons.

How to Overcome Your Resistance to Change

Have you ever noticed that when you think about changing your life, you feel resistant? Many people say that they not only feel resistant, but they actually do things to keep their lives familiar. They do things like start a diet and then eat a candy bar on the first day, or quit smoking and then sneak a puff.

There are some things you can do to make yourself less resistant. Here are six effective strategies:

1.    Eliminate clutter. Clutter can be viewed as a sign of uncertainty. Accumulating "stuff" might be stopping you from committing to an important thing. If you keep a lot of half-started projects around, it makes it difficult to zero in on the really important things.

2.    Start small. Thinking of your overall goal can be overwhelming. So manage your resistance by choosing one small part of it and attacking it today. Let's say your goal is to lose 20 pounds. That can certainly seem like an impossible thing to accomplish. It will seem more doable if you tell yourself, I'm going to lose five pounds by (date).

3.    Disprove your disempowering beliefs. In Reinventing Your Life, authors Young and Klosko suggest that you identify the beliefs that keep you from succeeding. They offer a way to dispute those beliefs by asking, "Is there really an evidence today that this belief is true?" They suggest making a list of the evidence.

4.    Remind yourself of all of your available options. You always have alternatives and the power to choose among them.

5.    Take responsibility for what you want. Look for signs that you are blaming

your situation on others or not admitting past mistakes. Acknowledge them and move on.

6.    Visualize the future. Author Barbara Sher suggests one way to do this: Write an imaginary press release about yourself. The date is today's date, two years in the future. The press release is announcing the most extraordinary event you can think of. It doesn't matter whether this event seems only vaguely possible to you. The important thing is that it is exciting to imagine.

When to Seek Professional Help

Sometimes it makes sense to find a professional counselor to work with as you work through the change process. Here are some ways to know when that would be appropriate:

1.    You've tried several things but you still have the problem.

2.    You want to find a solution sooner rather than later.

3.    You have thoughts of harming yourself or others.

4.    You have symptoms of depression, anxiety, or another disorder that are significantly interfering with your daily functioning and the quality of your life. For example, you have lost time from work, your relationships have been harmed, your health is suffering. These are signs that you may need the help of a trained, licensed professional.

Managing Perfectionism

Perfectionists aspire to be top achievers and do not allow themselves to make even a single mistake. They are always on the alert for imperfections and weaknesses in themselves and others. They tend to be rigid thinkers who are on the lookout for deviations from the rules or the norm.

Perfectionism is not the same as striving for excellence. People who pursue excellence in a healthy way take genuine pleasure in working to meet high standards. Perfectionists are motivated by self-doubt and fears of disapproval, ridicule, and rejection. The high producer has drive, while the perfectionist is driven.

Causes and Characteristics

Fear of failure and rejection. The perfectionist believes that she will be rejected or fail if she is not always perfect, so she becomes paralyzed and unable to produce or perform at all.

Fear of success. The perfectionist believes that if he is successful in what he undertakes, he will have to keep it up. This becomes a heavy burden-who wants to operate at such a high level all of the time?

Low self-esteem. A perfectionist's needs for love and approval tend to blind her to the needs and wishes of others. This makes it difficult or impossible to have healthy relationships with others.

Black-and-white thinking. Perfectionists see most experiences as either good or bad, perfect or imperfect. There is nothing in between. The perfectionist believes that the flawless product or superb performance must be produced every time. Perfectionists believe if it can't be done perfectly, it's not worth doing.

Extreme determination. Perfectionists are determined to overcome all obstacles to achieving success. This is also true of high achievers, but the perfectionist focuses only on the result of his efforts. He is unable to enjoy the process of producing the achievement. His relentless pursuit of the goal becomes his downfall because it often results in overwhelming anxiety, sabotaging his heroic efforts.

The Costs of Being a Perfectionist

Perfectionism always costs more than the benefits it might provide. It can result in being paralyzed with fear and becoming so rigid that a person is difficult to relate to. It can produce contradictory styles, from being highly productive to being completely nonproductive. Some examples of these costs include the following:

Low self-esteem. Just as low self-esteem is a cause of perfectionist behavior, it is also a result. Because a perfectionist never feels good enough about himself or his personal performance, he usually feels like a loser or a failure.

Gloominess. Since a perfectionist is convinced that it will be next to impossible to achieve most goals, she can easily develop a negative attitude.

Depression. Perfectionists often feel discouraged and depressed because they are driven to be perfect but know that it is impossible to reach the ideal.

Guilt. Perfectionists never think they handle things well. They often feel a sense of shame and guilt as a result.

Rigidity. Since perfectionists need to have everything meet an ideal, they tend to become inflexible and lack spontaneity.

Lack of motivation. A person who expects perfection may never try new behaviors or learn new skills because she thinks that she will never be able to do it well enough. At other times, she may begin the new behavior but give up early because she fears that she will never reach her goal.

Paralysis. Since most perfectionists have an intense fear of failure, they sometimes become immobilized and stagnant. Writers who suffer from writer's block are examples of the perfectionist's paralysis.

Obsessive behavior. When a person needs a certain order or structure in his life, he may become overly focused on details and rules.

Compulsive behavior. A perfectionist who feels like a failure or loser may medicate him- or herself with alcohol, drugs, food, shopping, sex, gambling, or other high-risk behaviors.

Eating disorders. Many studies have determined that perfectionism is a central issue for people who develop eating disorders.

The Perfectionist versus

The High Achiever

People produce many of their best achievements when they are striving to do their best. High achievers, like perfectionists, want to be better people and achieve great things. Unlike perfectionists, high achievers accept that making mistakes and risking failure are part of the achievement process-and part of being human.

Emotionally Healthy High Producers

You can be a high achiever without being a perfectionist. People who accomplish plenty and stay emotionally healthy tend to exhibit the following behaviors:

·    Set standards that are high but achievable.

·    Enjoy the process, not just the outcome.

·    Recover from disappointment quickly.

·    Are not disabled by anxiety and fear of failure.

·    View mistakes as opportunities for growth and learning.

·    React positively to constructive feedback.

Once you are aware of the ways by which you expect yourself to be perfect, you can start to change your behavior. In my next newsletter, I'll offer some tips to help you get started. Until then, begin the change process by thinking about which causes apply to you and writing down examples of these perfectionist behaviors as you observe them.