I originally posted this on Saturday, but I'm posting it again because I believe it's an important topic to discuss. My response to Kelly on Friday was about ways to try and deal with a depressive episode in the work environment. And my list of five recommendations was geared to trying to help her feel better as soon as possible in order to be productive at work.
However, Friday night when I was sleeping (I have many of my best ideas when I'm dreaming), I realized that in focusing on depression and work, I didn't discuss some of my other theories about the nature of depressive episodes. Thus, the reason for this post.
I believe that depressive episodes usually have some sort of triggering event. In my own history of more than 120 depressive episodes, this was always the case even when I wasn't aware of it. And the cause was usually stress.
So...what I recommend to everyone who is suddenly feeling worse and whose medication is no longer able to mask the symptoms is this:
1. Keep a mood chart (I've written about this many times and you can check my archive for my recommendations on how to do this). Try and figure out what is causing your current depression. Is it work-related stress? A relationship problem? A seasonal problem? A medical problem? etc.
2. If your medication has worked well in the past and suddenly isn't, what has changed? Have you added a different medication to the mix? Have you changed the dosage of what you're currently taking? Are you noticing symptoms that you haven't before? Or, do you just think that your medication is "pooping out," which does happen.
3. Is it a seasonal problem? No matter how well I'm feeling and how happy I am, I always have a problem in the fall. While I make it a point to spend more time outdoors and increase my level of exercise, for the past number of years I usually have to go back on Adderall, the one medication that works for me. And this year is no different. I'm on a very low dosage of Adderall, but without it, I can't wake up in the morning.
4. If you can determine the trigger(s), or even if you can't and need help to do it, it is undoubtedly a good idea to talk with a counselor or therapist. Or if you decide that the way you handle stress is a constant problem, then I would recommend yoga, meditation, gardening, deep breathing exercises, and/or playing a musical instrument (which for me makes a big difference).
5. Try not to panic. In past years, one of the biggest problems I faced when I could feel a depression on the horizon (and I could pinpoint it within three days) was that I panicked. I don't mean that in the sense of a panic attack (I've never experienced one). It was just that I'd undergone so many depressions and they had become so debilitating that I was terribly concerned whether I could survive another episode. I believe now that my anxiety about the advent of the depressive episodes undoubtedly heightened their impact.
These days I know that my depressions (and I hesitate to use the word because it's not truly a depression; it's just a lower level of energy) are caused solely by seasonal change. I'm sorry they occur, but they are easily treatable and may only last a few weeks or a few months.
I know that Adderall works for me, and I have no hesitation in taking it. Since I can tell when the depressions end, I can titrate off it quickly with no ill effect.
Also, I also know that Adderall does have certain behavioral side effects, which I try to monitor. My mood rises during the day. If I don't monitor my behavior, I tend to talk too much, but since I'm aware of it, I try hard to make sure I listen to others. Also, if I'm a bit too wound up, I take small breaks during the day, and play an instrument or breathe. I am too enthusiastic, which I also monitor (While I don't find this to be problematic, I have learned that others do). And that's about it.
Over the years I have eliminated all other behavioral problems, including spending too much money, trying to "save" people who are needy, and participating in too many activities.
So, I guess what I'm saying is that in my case, my wellness activities cannot prevent Seasonal Affective Disorder. And since bright lights and a dawn simulator don't work for me, nor do vitamins and alternative remedies, I take Adderall, knowing that it causes a low level of hypomania. But...even this isn't a problem because I try hard to monitor my behavior, and prevent behavioral patterns that have been problematic in the past.