Friday, August 22, 2008

Best Advice on Depression (Part 1)

Josh left the following comment on my post, Bipolar II. Because I wrote the the post a few days ago, I was afraid he wouldn't get many responses, so I've decided to post his comment in the body of my blog. He brings up so many important issues that it's difficult to address them in one post. So, I'll write an overall response, and will focus more on the topic of depression next week.

"I came upon your blog earlier today and can say with confidence that I will continue to read regularly. It's been helpful to read the testimonies of others, and has also provided me with some helpful suggestions.

"I've suffered from depression for the last sixteen years or so - half of my life. It had been manageable by making healthy choices in life, but that has not been so the last 4-5 years. I've been spiraling downwards and am desperately trying to recover happiness and peace of mind.

"One year ago, I sought the advice of three different doctors, hoping to achieve a common diagnosis. One suggested bipolar disorder, the next was somewhat certain that the symptoms fit while the last was absolutely certain. All the while, I did not fear a diagnosis of that sort. Something was wrong and I wanted to get well.

"Since the initial diagnosis, I have made very little progress toward achieving greater mental happiness. I've tried many different anti-depressants along with a few mood stabilizers such as Lamictal, Depakote, Keppra and Zyprexa. Several medications were helpful for a very short span of time, but none have continued their effectiveness, which has left me extremely frustrated. What is more, I can barely remember who I was before things started to deteriorate so badly.

"As I mentioned earlier, I have suffered from depression for a long time. Terrible bouts were sometimes triggered by external factors, some of which were in my control (poor performance in school, relationship problems, etc.), but often they were not (passing of my father at a young age). Depression and melancholy were just facets of my life I had come to accept. Peaks were always followed by troughs, very much like an ocean wave. The last several years, however, the waves have come at a much more rapid pace. Daily or weekly mood swings have become typical.

"I don't know what to do anymore. There are no clear paths to choose from. I feel very much alone. There are plenty of people that care about me, but none that can help me. My wife does not understand what I feel on a daily basis, which has created a great rift between us. I have two young, wonderful little boys, from whom I shelter my problems as best I can, but I can't do so 100% of the time...especially during times like these when I'm in such a deep valley.

"I appreciate the approach of Susan and many of the contributors to this blog regarding mental illness. I've always enjoyed meditation, self-awareness, the beauty of our natural environment and many other healthy options as a way to achieve peace and happiness. Those measures have not been helpful to me for some time now, which is why I sought the help of medical professionals. I feel like if I can just raise my head above water long enough I can fight my way out of this because I now understand some of things I need to do to ensure happiness. I have not been able to overcome that initial hurdle, however.

"Any help or insight that anyone can offer is greatly appreciated."

Many thanks,
Josh
* * *
Dear Josh,
My heart goes out to you. I know how tough it is to have young children and suffer from depression. I can't imagine how difficult it is to have to deal with these episodes, and also to try and hold your marriage together at the same time.

As I've mentioned in the caveat to my blog, I am not a doctor nor do I have medical experience. However, I will be happy to offer advice based on my own experience, and I'm hoping my readers will as well.

None of the mood stabilizers or antidepressants worked for me. The only medication that has worked for a number of years (although I only take it when I'm in a depressive episode) is Adderall, which is a stimulant. Five years ago, a new psychiatrist prescribed it for me because i had been in a year-long depressive episode and my former psychiatrist had prescribed a ton of different medications--none of which worked.

With Adderall, my depression lifted within one day. I must tell you that I do not respond to medication like anyone else I've ever read about. At the time, I began taking Adderall, I was considered a medication-resistant rapid cycler. When you say that your moods are shifting daily, it's quite possible that you are currently rapid cycling.

What I've read in dozens of books about bipolar disorder (as well as books about depression) has never rung true for me. In my case, the rapid cycling (frequent mood changes) was actually caused by medication. I'm not sure about you. None of the mood stabilizers had any effect. For the first three years after my diagnosis, Zoloft worked during my depressive episodes. But then it pooped out, and has never worked again.

From my own experience, I believe that sometimes--in a deep and ongoing depression--the only immediate relief can be provided by medication. At least, that has been true for me. However, the other strategies I use work (for me) on a long-term basis.

While I haven't had great luck with therapists, I also believe it's critical to talk to someone who can help you. I believe it's important to know what triggered your first depressive episode, and what triggers them now, and find ways to resolve things.

I also believe that stress plays a huge roll in exacerbating this illness. So, it's terribly important to find ways of relieving stress. A few wellness activities that work for me are deep breathing, neural path therapy (a form of deep breathing), meditation (my own method), and playing music. I play the harmonica and recorder for stress reduction and as a kind of Zen breathing exercise. I sing for the same reason, and I play the Autoharp.

I also believe that exercise is critical. The last time I researched it, I found more than 80 studies that show that exercise is far more effective than anti-depressants for long-term healing from depression.

There are other people who read this blog who have "cured" themselves. Jazz from In Pieces is one. Marja from Roller Coaster has effectively managed her symptoms. Gianna from Beyond Meds is working with a Orthomolecular psychiatrist, whom she truly believes in. Annie from A Psycho-therapist with Bipolar is another good resource. And Duane from Discover and Recover provides a lot of information in his blog.

I guess if I were to prioritize things, I would do the following: 1. Find a therapist or counselor with whom you can talk about how you're feeling, and with whom you can resolve any immediate problems. 2. Whether or not the diagnosis is bipolar disorder or depression, the first priority should be to stabilize things and get the fog to lift. For me, medication can do that. 3. If you're feeling well enough, I would start an exercise program immediately, even if it's just walking--and I'd do it every day.

4. I'd also get involved in all the other activities you've done in the past to promote wellness. 5. I'd have a physical examination to make sure the depression isn't caused by something physical. Long-term depression can wreak havoc with your immune system. 6. Diet and nutrition are really important as well. Naturalgal provides information on this in her blog as does Duane in Discover and Recover. 7) If you check out my other blog, Bipolar Wellness Program, I provide some other ideas. 8) Marja has found wellness through medication and spirituality, and prayer is shown to be an effective "antidepressant." 9) Dr. Deb is a psychotherapist and often provides good information. She's got an interesting post about hope therapy in her blog right now.

10. In terms of developing a sense of community, writing a blog is great therapy. I see you've got a page for a blog, but haven't yet posted on it. Actually, your first post could be your letter to me. If you post it on your blog, I can note it here, and people will start visiting. I believe that developing relationships with other people who have been in your shoes is a great way to learn about other wellness activities, meet people who can relate to what you're going through, and lessen your feeling of isolation.

Finally, know that these episodes always end and there is hope at the end of the tunnel! Best of luck. I will spend next week writing about various aspects of depression with you in mind. I hope some of my ideas and thoughts are helpful!

Warmly,
Susan

21 comments:

Gianna said...

Hi Susan,
Nice job...and welcome Josh.

I wanted to point out I have very extensive info on diet and nutrition on my "About" page as well.

I have found changing my diet and lifestyle in numerous ways has allowed me to be almost free of meds, and soon I will be.

Best to you Josh.

Wellness Writer said...

Thanks Gianna.

P.J. said...

Great job, Susan. I like the list of 'things to do' - that's even helpful for me!!

Wellness Writer said...

Glad to hear it P.J. Thanks for your comment.

discoverandrecover said...

Josh,

If you think it might help to talk by email....there is a 'Contact' section on my blog.

My best to you,

Duane

daplantinga said...

I'll second the exercise recommendation. It clears my head every time - I also describe it (tongue in cheek) as a "reset of my brain". Recently I've added a cold shower to the end of the workout. I read some research that suggested it helps and I tried it. For me, it did.

I'll also mention something that works for me when I can manage to do it: Thinking of others more than I think of myself. Helping others helps me. If I "crawl inside my head" I'm sure to get depressed. If I'm occupied in service to others (my wife doesn't mind me practicing on her), I'm almost always better off.

Merelyme said...

wow...i am just so impressed with how you have reached out beyond your depression to help others along their journey. much applause to you. wonderful site you have here. i need to spend more time reading you.

Wellness Writer said...

Thanks Duane. On Josh's behalf, I appreciate your willingness to help!

Wellness Writer said...

Dear Dirk,
Hey, welcome back! Thanks for the advice for Josh. I'm a big one for exercise, and my newest sport is badminton. Staring next week I'm taking it at my local community college. I'm not sure I'll beat the Chinese gold medalist, but who knows?

And I agree about helping others. But few people think of it in terms of their spouse's and that's a great idea!

Susan

Wellness Writer said...

Merelyme,
Welcome back, and thank you!

Susan

naturalgal said...

Hi Josh and Susan,

Susan listed lots of good ideas. Josh I also had a young child and symptoms similar to yours.

Josh, one of the best pieces of advice I received, from a psychiatrist no less, was to gather up some my toddlers favorite toys and put them on a quilt, put a timer on twenty minutes and sit on the quilt with my child and play with her...letting nothing distract me...no phone, no chores...only focus on her.

I do really think that helped both she and I. I had terrible bouts of depression and mania and had a hard time focusing on her...even though I really loved her.

You can and will get better. Just keep searching. Many of us here are better...even cured!

Bumps Stump said...

Susan,

Your thoughtful answers to Josh and others are much appreciated.

After diet, nutrition, medications, lifestyle changes and so forth I may have missed some kind of reference to electro-shock therapy?

A bi-polar person I know, after trying nearly everything else, was advised to begin an electo-shock regimen. It has not helped. The valley of depression persists.

There is suspicion that some memory has been lost.

I am curious.

The treatment troubles me. It sounds like the (not too) selective destruction of brain cells.

In my mind that echoes the (not too) effective frontal lobotomies of years ago.

What is your understanding?

Many thanks.

Dixon

Wellness Writer said...

Dear Naturalgal,
Thanks for sharing your story with Josh and with us! It's very touching and such good advice!

Susan

Wellness Writer said...

Dear Dixon,
I've never had electroshock therapy although at least one of my readers whom I know of--has. Hopefully, she'll respond to you.

However, ECT was presented as a possibility to me during a year-long severe depression. A few psychiatrists I consulted with suggested it was the "only" way to pull someone out of a depression if medication didn't work.

However, the downsides for me were:
1) My insurance only paid a small portion of the total cost and my inability to work was having a huge financial impact on our lives at the time, and 2)It would only work on the depression I was currently experiencing. At the time, I was having at least four or five depressive episodes a year.

So, even though I could barely survive, I still felt that if it brought me out of that depression, but I would need to repeat the process again in a few months, it wouldn't be that helpful.

However, hopefully, others who have gone through it will respond to you.

Susan

marja said...

Dixon: Re electroshock therapy. I received a series of them way back in 1966. Although they were pretty crude at that time in history, and not nearly as safe as they are today, they brought me out of a lengthy stay in a sixties' style mental hospital. Yes, they worked for me, quite dramatically.

On the other hand, I have a friend who is receiving ongoing ect treatments. She has been in hospital many times with attempted suicides. And her severe depressions keep recurring. Meds don't help. The only thing that seems to help are the treatments. But now, though she is getting these weekly, they're often not helping.

I suspect though, that with the two day's hospital stay that is required each week for them, she has no opportunity to make a life for herself. Often the treatment days vary. She can't plan anything. Always uncertainty about when she'll be called in. If she only had a chance to truly live.

So: I believe ect's are useful when there is extreme danger of suicide, and meds have not proven helpful.

I think my friend's case is an exception. Don't know whether she has just lost the motivation to carry on living.

It's very sad.

marja said...

Josh: When you said, "I feel so alone." that really made a strong impression on me. That, I think, is one of the worst things about depression. The feeling that you're alone with the emptiness, isolated from the living world around you.
I know that feeling well. And that's probably the worst of it.

Do you have someone who you can talk to once in a while, someone who will listen and be compassionate? someone who has been there himself?

I facilitate a peer support group, and simply having a chance to share with others who know what you're going through is very helpful.

Mind you, though I have a couple of close friends who I can talk to when I'm in a truly deep valley, even that doesn't help. Thing is, our friends and family aren't in a position to be able to fix us. All they can do is listen. And if they'll do that, we have a lot to be grateful for. Eventually, it WILL help.

The patience we need to endure this illness is the toughest part of it. But if we can endure, I believe that - in the end - we will be better persons for it. When we come out of depression, we can appreciate life more than those for whom life is easier.

Josh, I believe that once you come out of this - and you WILL come out of this - you will end up a stronger person than you were before this all started.

Wellness Writer said...

Dear Marja,
It's great to have you back. Thanks so much for responding to Dixon and Josh. Your warmth and compassion are so evident.

Susan

Howard said...

Hey, Susan.

Just thought I'd let you know as well as our community who reads this that I had somewhat of a breakthrough in my depressive episodes.

I had been having regularly, and increasingly severe, depressive episodes ever since we moved back to NYC. Sure, there were major life changes that could have triggered them, but I was really "happy" on the surface about almost all the changes. Then I found a new doctor, and he increased in late July my depakote (I also take zyprexa). I was taking 750mg and upped it first to 1000, then 1250, and now it's at 1500. It has been about five or six weeks and I've not had a depressive morning, when previously I was going through two-week depressive cycles every two weeks. I feel fairly "normal" and hope this continues for a long time!

I suppose I was somewhat resistant to the concept of letting medication "heal" me - I have always been struck by Frankl's logotherapy and I wanted my faith in Jesus to be the driving force in the healing process. But I can attest that giving myself over to the healing hands of this doc have provided a real improvement in my life.

I am not trying to steer Josh or anybody in a certain direction. Just offering hope that things can change and improve.

Wellness Writer said...

Dear Howard,
Thanks so much for sharing your story. Yes, I think it's really important for people to know that medication can work as well as other healing methods.

We come to this illness from different paths. Our bodies are so different. And what works for us is different as well.

Recovery--no matter how it occurs--is what everyone is seeking. To me, success is measured by the elimination of symptoms, and our feeling of well-being.

I didn't realize you were depressed. But I'm so glad you're feeling better.

Susan

jipps76 said...

Wow. Thank you all for your support, advice and kind words. It means a gerat deal, especially during times like this.

I spoke to my psychiatrist yesterday and described the difficulties I have been experiencing lately. It's anyone's guess whether he'll be able to help, but he's a nice man who seems to be genuininely concerned about his patients. That, in itself, is comforting.

To offer more information about my ailments and current treatment, I am currently on Lamictal, Effexor and Zoloft. I have been on Effexor for two years at varying levels. It had been very helpful for a while, but it gradually lost its effectiveness. I've continued to take 150mg in case it still had a minor effect, nonetheless. Lamictal was added in February. I started with 25, then increased to 400mg eventually. Since it wasn't working all that well, it has since been reduced to 100mg. It will be eliminated as soon as possible, though I feel part of why I have been feeling so terrible lately is due to withdrawal. I'm going to take it slow. Zoloft was added only one month ago.

The Doc suggested replacing Lamictal with Depakote, sticking with the Zoloft and continuing eliminating Effexor. I've become ambivalent to medications since they have largely been ineffective. Instead, I am convinced that I need to take matters into my own hands. That's not to say I will shun them entirely. I will accept the doctor's recommendations for a while longer - at small doses since I feel I've been overmedicated in the past - but vigilance in my daily life will impact matters more, I believe. It's going to be very hard, though. I had hoped to be given an initial push by medications, but I cannot count on them any longer.

Another obstacle is obsessions of mine and, to a slightly lesser extent, compulsions. Cleanliness is a huge issue for me. It makes daily life rather difficult. If I am in the comfort of my own home, without any external influences, I am OK. It's difficult welcoming visitors or letting the outside world in, so to speak. The regimens I undertake are arduous.

I have no idea how I will deal with the obsessions and compulsions. It would be wonderful if everyone else would change, but that's not likely. First, I need to achieve greater happiness. Other difficulties will partially improve as a result.

Finding the time to exercise has alluded me in the past. Any free time I've had I would usually spend in relaxation because my days are typically so exhausting. I've been organizing my garage lately in an attempt to create a mini-gym. It still own't be the same as playing a sport, which I was always accustomed to doing, but I'll have to force myself. Anyone live in NJ? I haven't played hoops or challenged anyone 1 on 1 in ages.

I've rambled on quite a bit, for that I apologize. I'll leave all of you with a few questions that I've struggled to find the answers to. Maybe someone will have some suggestions that will push me in the right direction. I felt better today than I did when I initially wrote, and I need to carry this sliver of momentum forward, as I cannnot afford to sink any lower.

-I'm not a morning person, and am inclined to exercise at night when my boys fall asleep. Yet, as a person who has difficulty falling/staying asleep, doing so before bedtime is not a wise decision. How do I balance one against the other?

-I know some of the things I need to do to become healthier. How do I remind myself of these things in the midst of a hectic day?

Once again, thank you all so much for your willingness to respond to my concerns. It warms my heart knowing that others care so much about the health of a stranger. Hopefully I can return the favor in some way. Finding this forum has been uplifting. The initial response by Susan meant a great deal. Subsequent posts by Gianna, Marja et al has overwhelmed me.

Many, many thanks.
Josh

Wellness Writer said...

Dear Josh,
I'm posting your comment and my response in Sunday's post, although I usually don't post on weekends. I wish you the best of luck on your journey!

Susan